Certified Paramedic Response (CPR) Examination — Questions and Answers

Question 1: A team member with less experience performs a skill incorrectly but the team leader does not correct them to avoid embarrassment. This is an example of which leadership failure?

Diffusion of responsibility
Prioritizing team morale over patient safety
Passive leadership / conflict avoidance (Correct answer)
Avoiding the authority gradient

Correct answer: Passive leadership / conflict avoidance

Passive leadership or conflict avoidance allows preventable errors to persist; team leaders must address errors directly even when uncomfortable.

Question 2: A patient with severe lithium toxicity presents with tremor, confusion, ataxia, and seizures. Which intervention is the highest priority?

Supportive care and urgent hemodialysis consultation (Correct answer)
IV sodium bicarbonate to alkalinize urine and enhance excretion
Flumazenil for concurrent sedation reversal
Activated charcoal to reduce GI absorption

Correct answer: Supportive care and urgent hemodialysis consultation

Hemodialysis is the definitive treatment for severe lithium toxicity as there is no specific antidote; activated charcoal does not bind lithium, and supportive care manages acute symptoms until dialysis can clear the drug.

Question 3: While assessing a patient, you note a wide-complex tachycardia on the monitor with a rate of 180 bpm and a regular rhythm. The patient is pulseless and apneic. What is the most appropriate immediate action?

Administer Amiodarone
Begin high-quality CPR and prepare for defibrillation (Correct answer)
Obtain a 12-lead ECG
Perform synchronized cardioversion

Correct answer: Begin high-quality CPR and prepare for defibrillation

This patient is in cardiac arrest. The rhythm described is pulseless Ventricular Tachycardia (pVT). According to ACLS guidelines, the immediate priority for a shockable rhythm like pVT is to start high-quality CPR and deliver a defibrillation shock as soon as possible.

Question 4: For needle decompression of a tension pneumothorax in an adult, the MOST current recommended site is:

2nd intercostal space, midclavicular line
4th or 5th intercostal space, anterior axillary line (Correct answer)
3rd intercostal space, midaxillary line
1st intercostal space, sternal border

Correct answer: 4th or 5th intercostal space, anterior axillary line

Current evidence supports the 4th/5th intercostal space at the anterior axillary line as more reliable than the 2nd ICS MCL due to chest wall thickness in many patients.

Question 5: What is the purpose of the SAMPLE history mnemonic in patient assessment?

Assess neurological function
Determine medication dosing
Gather systematic medical history (Signs/Symptoms, Allergies, Medications, Pertinent history, Last oral intake, Events) (Correct answer)
Evaluate trauma mechanism

Correct answer: Gather systematic medical history (Signs/Symptoms, Allergies, Medications, Pertinent history, Last oral intake, Events)

SAMPLE provides a systematic framework to collect essential medical history: Signs/Symptoms, Allergies, Medications, Pertinent history, Last oral intake, and Events leading to the emergency.

Question 6: In the Pediatric Assessment Triangle (PAT), which three components are evaluated?

Heart rate, Respiratory rate, Blood pressure
Mental status, Perfusion, Oxygen saturation
Airway, Breathing, Circulation
Appearance, Work of breathing, Circulation to skin (Correct answer)

Correct answer: Appearance, Work of breathing, Circulation to skin

The PAT evaluates Appearance (tone, interactivity, consolability, gaze, speech), Work of Breathing, and Circulation to skin.

Question 7: A SAMPLE history reveals a patient takes warfarin daily. How does this MOST directly impact your stabilization plan?

Give aspirin to counteract the anticoagulant effect
Administer vitamin K immediately
Avoid IV access to prevent bruising
Anticipate severe bleeding and prepare hemorrhage control measures (Correct answer)

Correct answer: Anticipate severe bleeding and prepare hemorrhage control measures

Warfarin impairs clotting, so patients are at high risk for uncontrolled hemorrhage requiring aggressive bleeding control.

Question 8: When calculating a pediatric drug dose using the Broselow tape, what does the color zone indicate?

The child's age group only
The correct IV fluid type for resuscitation
The child's severity of illness
The estimated weight range and corresponding drug doses/equipment sizes (Correct answer)

Correct answer: The estimated weight range and corresponding drug doses/equipment sizes

The Broselow tape color zones correspond to estimated weight ranges, with precalculated drug doses and equipment sizes for each zone.

Question 9: Which rhythm requires immediate unsynchronized defibrillation?

Atrial fibrillation with rapid ventricular response
Stable ventricular tachycardia with a pulse
Supraventricular tachycardia
Pulseless ventricular fibrillation (Correct answer)

Correct answer: Pulseless ventricular fibrillation

Pulseless ventricular fibrillation is a shockable rhythm requiring immediate unsynchronized defibrillation as it has no organized cardiac complex to synchronize to.

Question 10: A paramedic identifies a regular rhythm with a rate of 140 bpm, narrow QRS complexes, and a 'sawtooth' pattern of flutter waves instead of P waves. This rhythm is best identified as:

Junctional Tachycardia
Ventricular Fibrillation
Sinus Tachycardia
Atrial Flutter (Correct answer)

Correct answer: Atrial Flutter

Atrial Flutter is characterized by a rapid, regular atrial depolarization from a re-entry circuit, which creates a classic 'sawtooth' pattern of flutter waves on the ECG. The ventricular response can be regular or variable depending on how many flutter waves are conducted through the AV node.

Question 11: What is the purpose of a cervical collar?

To prevent bleeding
To immobilize the neck and prevent spinal injury (Correct answer)
To control pain
To monitor vital signs

Correct answer: To immobilize the neck and prevent spinal injury

A cervical collar is applied to patients with suspected neck or spinal trauma to restrict movement of the head and neck. This immobilization is crucial to prevent further damage to the spinal cord, which could lead to permanent neurological deficits or paralysis. By maintaining spinal alignment, the collar helps protect the delicate structures of the cervical spine during transport and assessment.

Question 12: In a patient requiring RSI (Rapid Sequence Intubation), what is the CORRECT sequence of medication administration?

Succinylcholine first, then etomidate
Concurrent administration of both agents simultaneously
Sedative/induction agent first, then neuromuscular blocking agent (Correct answer)
Neuromuscular blocking agent first, then sedative

Correct answer: Sedative/induction agent first, then neuromuscular blocking agent

In RSI, the induction/sedative agent is always given first to achieve unconsciousness before the neuromuscular blocking agent is administered.

Question 13: A King LT supraglottic airway is inserted, and you are unable to ventilate. What is the most likely cause?

The patient's glottis is in spasm
The tube was inserted into the trachea
The cuffs are overinflated
The tube was inserted too shallowly (Correct answer)

Correct answer: The tube was inserted too shallowly

Shallow insertion of the King LT positions the distal cuff above the glottis rather than in the esophagus, obstructing ventilation.

Question 14: A patient in cardiac arrest has an LMA in place. During CPR, you notice gastric contents in the LMA tube. You should:

Apply more cricoid pressure
Continue CPR and suction the LMA in place
Leave the LMA and increase ventilation rate
Remove the LMA and insert an ETT after pre-oxygenation (Correct answer)

Correct answer: Remove the LMA and insert an ETT after pre-oxygenation

Regurgitation through an LMA indicates inadequate airway protection; the LMA should be removed and a definitive airway (ETT) established.

Question 15: A 68 kg patient in hemorrhagic shock requires a fluid bolus. Following current US EMS guidelines for crystalloid resuscitation, what is the appropriate initial bolus volume?

1 liter administered as fast as possible
2 liters administered rapidly
No IV fluid; transport immediately without fluid resuscitation
250–500 mL titrated to clinical response (Correct answer)

Correct answer: 250–500 mL titrated to clinical response

Current guidelines favor small-volume resuscitation (250–500 mL) titrated to clinical response to avoid dilutional coagulopathy and worsening hemorrhage.

Question 16: During nebulized albuterol therapy, which of the following patient assessments BEST indicates a therapeutic response?

Improved breath sounds with decreased wheezing and increased air movement (Correct answer)
Heart rate decrease from 110 to 90 bpm
Respiratory rate increase from 18 to 24 breaths/min
Blood pressure increase from 90/60 to 110/70

Correct answer: Improved breath sounds with decreased wheezing and increased air movement

Therapeutic response to albuterol is confirmed by improved air entry, reduced wheezing on auscultation, and decreased work of breathing.

Question 17: Which clinical sign indicates a post-cardiac arrest patient is in cardiogenic shock and may benefit from mechanical circulatory support?

Persistent hypotension with cool extremities and oliguria despite vasopressors (Correct answer)
Bradycardia with fever
Hypertension with diaphoresis
Isolated tachycardia with normal blood pressure

Correct answer: Persistent hypotension with cool extremities and oliguria despite vasopressors

Refractory cardiogenic shock characterized by low output signs despite maximum medical therapy may require IABP or other mechanical circulatory support.

Question 18: In high-performance CPR teams, how is the rhythm check typically coordinated to minimize hands-off time?

Compressions stop immediately when the rhythm check is called
Rhythm checks are avoided to maximize continuous compressions
The team leader announces a rhythm check countdown so all hands clear simultaneously (Correct answer)
The AED operator stops compressions unilaterally when ready

Correct answer: The team leader announces a rhythm check countdown so all hands clear simultaneously

A coordinated countdown allows the compressor to finish a cycle and all team members to clear simultaneously, minimizing the no-flow interval.

Question 19: Which statement about atropine use in asystole is MOST accurate per current AHA guidelines?

Atropine 1 mg every 3–5 min is first-line for asystole
Atropine has been removed from the asystole/PEA algorithm (Correct answer)
Atropine 0.5 mg is used to increase heart rate in asystole
Atropine reverses asystole by blocking vagal tone

Correct answer: Atropine has been removed from the asystole/PEA algorithm

Current AHA guidelines removed atropine from the cardiac arrest algorithm because evidence showed no benefit in asystole or PEA.

Question 20: Which of the following is a primary, potentially reversible cause of traumatic cardiac arrest that a paramedic should immediately address with a specific procedural intervention in the field?

Massive intracranial hemorrhage
Aortic transection
Severe abdominal evisceration
Tension pneumothorax (Correct answer)

Correct answer: Tension pneumothorax

In traumatic cardiac arrest (TCA), the focus is on treating reversible causes, often remembered by mnemonics like HOTT (Hypovolemia, Oxygenation, Tension pneumothorax, Tamponade). A tension pneumothorax is a life-threatening condition that can be rapidly treated in the prehospital setting by performing a needle decompression (thoracostomy), potentially restoring circulation. The other conditions listed are not directly reversible with a specific paramedic procedure in the field.

Question 21: During RSI, after administering succinylcholine you notice the patient develops masseter rigidity. This is most concerning for:

Succinylcholine apnea
Anaphylaxis to succinylcholine
Laryngospasm
Malignant hyperthermia (Correct answer)

Correct answer: Malignant hyperthermia

Masseter muscle rigidity following succinylcholine is an early sign of malignant hyperthermia, a life-threatening hypermetabolic crisis.

Question 22: What is the recommended dose of vasopressin that may be used as an alternative to the first or second dose of epinephrine in cardiac arrest?

20 units IV/IO
80 units IV/IO
40 units IV/IO (Correct answer)
60 units IV/IO

Correct answer: 40 units IV/IO

Vasopressin 40 units IV/IO may replace the first or second dose of epinephrine in cardiac arrest per older AHA guidelines.

Question 23: Which of the following BEST describes a tension pneumothorax presentation requiring immediate needle decompression?

Bilateral breath sounds, hypotension, tachycardia
Absent breath sounds bilaterally with normal blood pressure
Absent breath sounds on one side, tracheal deviation, hypotension, distended neck veins (Correct answer)
Crackles on auscultation with SpO2 of 94%

Correct answer: Absent breath sounds on one side, tracheal deviation, hypotension, distended neck veins

Tension pneumothorax classically presents with absent unilateral breath sounds, tracheal deviation away from the affected side, hypotension, and JVD.

Question 24: A patient is found unresponsive with gurgling respirations. After opening the airway, suctioning should last NO longer than:

30 seconds per attempt
60 seconds per attempt
5 seconds per attempt
10–15 seconds per attempt (Correct answer)

Correct answer: 10–15 seconds per attempt

Oropharyngeal suctioning should not exceed 10–15 seconds per attempt to avoid prolonged hypoxia and vagal stimulation.

Question 25: During a surgical cricothyrotomy, after incising the cricothyroid membrane, the tracheal hook is used to:

Retract the inferior edge of the thyroid cartilage to stabilize the trachea (Correct answer)
Dilate the incision horizontally
Inflate the ETT cuff through the incision
Puncture the membrane initially

Correct answer: Retract the inferior edge of the thyroid cartilage to stabilize the trachea

The tracheal hook retracts the inferior edge of the thyroid cartilage upward to stabilize the airway and hold the incision open for tube insertion.

Question 26: A patient in refractory VF has received 3 shocks and 300 mg amiodarone. What is the correct supplemental dose of amiodarone?

100 mg IV
150 mg IV (Correct answer)
300 mg IV
75 mg IV

Correct answer: 150 mg IV

After an initial 300 mg amiodarone dose, a single supplemental dose of 150 mg IV/IO may be given for refractory VF/pVT.

Question 27: A patient is rescued from a house fire and is in cardiac arrest with suspected cyanide toxicity. After standard ACLS, what antidote should be administered?

Sodium thiosulfate 12.5g IV alone
Flumazenil 0.2mg IV
Atropine 1mg IV
Hydroxocobalamin 5g IV (Correct answer)

Correct answer: Hydroxocobalamin 5g IV

Hydroxocobalamin (Cyanokit) 5g IV is the preferred cyanide antidote in smoke inhalation victims as it does not cause methemoglobinemia.

Question 28: Which of the following BEST indicates adequate perfusion is being restored during resuscitation?

Improved mental status and urine output (Correct answer)
Decreasing respiratory rate only
Increasing heart rate
Rising blood pressure while mental status declines

Correct answer: Improved mental status and urine output

Improved mentation and urine output (0.5–1 mL/kg/hr) are reliable indicators that organ perfusion is being restored.

Question 29: How should a paramedic manage a choking patient?

By using the Heimlich maneuver or abdominal thrusts (Correct answer)
By providing a sedative
By waiting for the patient to recover
By offering water

Correct answer: By using the Heimlich maneuver or abdominal thrusts

When a patient is choking, their airway is obstructed, preventing oxygen from reaching the lungs. The Heimlich maneuver, or abdominal thrusts, is the standard and most effective technique to dislodge the foreign object causing the obstruction. This maneuver creates an artificial cough by rapidly increasing pressure in the abdomen and chest, expelling the object and restoring the patient's ability to breathe.

Question 30: Which finding on a pulse oximeter waveform indicates a reliable SpO2 reading?

Flat plethysmographic waveform
Consistent pulsatile waveform matching heart rate (Correct answer)
Irregular, erratic waveform
High perfusion index regardless of waveform shape

Correct answer: Consistent pulsatile waveform matching heart rate

A consistent pulsatile plethysmographic waveform that correlates with the patient's heart rate indicates reliable pulse oximetry signal quality.

Question 31: A 28-year-old is found in cardiac arrest with suspected opioid overdose. Bystanders are performing chest compressions. According to AHA guidelines, what is the correct priority of interventions for this patient?

Withhold naloxone as it is ineffective once cardiac arrest has occurred.
Prioritize high-quality CPR with ventilations and use an AED; administer naloxone without interrupting these core resuscitation efforts. (Correct answer)
Administer naloxone immediately via the intranasal route, then begin ventilations.
Apply the AED and deliver a shock before any other intervention.

Correct answer: Prioritize high-quality CPR with ventilations and use an AED; administer naloxone without interrupting these core resuscitation efforts.

For a patient in cardiac arrest from a suspected opioid overdose, the cornerstone of treatment is high-quality CPR and ventilation to manage the severe hypoxia. While naloxone administration is recommended for suspected opioid overdose, it should not delay or interrupt fundamental BLS and ALS interventions like CPR and defibrillation. The priority is to address the arrest with standard, proven therapies while considering naloxone as a concurrent but secondary action.

Question 32: Which of the following is the MOST appropriate first-line intervention for massive extremity hemorrhage in the prehospital setting?

Apply direct pressure with a sterile dressing
Apply a pressure bandage and reassess
Apply a tourniquet proximal to the wound (Correct answer)
Elevate the extremity above the heart

Correct answer: Apply a tourniquet proximal to the wound

For massive extremity hemorrhage, a tourniquet applied proximal to the wound is the most effective and rapid intervention to control life-threatening bleeding.

Question 33: When performing a needle thoracostomy for tension pneumothorax, the traditional landmark on a male adult is:

2nd intercostal space, midclavicular line, above the 3rd rib (Correct answer)
2nd intercostal space, midaxillary line, above the 3rd rib
5th intercostal space, midclavicular line, above the 6th rib
4th intercostal space, anterior axillary line, below the 5th rib

Correct answer: 2nd intercostal space, midclavicular line, above the 3rd rib

The classic landmark is the 2nd ICS at the midclavicular line, inserting just above the 3rd rib to avoid the neurovascular bundle running below each rib.

Question 34: A 68-year-old male is in cardiac arrest with a persistent rhythm of Ventricular Fibrillation after three defibrillation attempts and a dose of epinephrine. According to the latest ACLS guidelines, which of the following is the most appropriate next pharmacological intervention?

Administer Amiodarone 300 mg IV/IO push. (Correct answer)
Administer Lidocaine 1.5 mg/kg IV/IO.
Administer an additional dose of Epinephrine 1 mg.
Administer Sodium Bicarbonate 1 mEq/kg.

Correct answer: Administer Amiodarone 300 mg IV/IO push.

For refractory Ventricular Fibrillation or pulseless Ventricular Tachycardia (VF/pVT) that is unresponsive to defibrillation and a vasopressor, the next line of treatment is an antiarrhythmic. Amiodarone, in an initial dose of 300 mg IV/IO, is the primary antiarrhythmic recommended in ACLS guidelines. While Lidocaine is an alternative, Amiodarone is generally preferred. Another dose of epinephrine would be administered later, and Sodium Bicarbonate is not routinely recommended.

Question 35: Which vital sign change is a late and ominous sign of decompensated shock in adults?

Hypotension (Correct answer)
Narrowing pulse pressure
Tachycardia
Cool, clammy skin

Correct answer: Hypotension

Hypotension is a late sign because compensatory mechanisms maintain blood pressure until approximately 30% blood volume is lost.

Question 36: The 'sniffing position' used to optimize laryngoscopic view in adults involves:

Head extension with neck slightly flexed on a folded blanket (Correct answer)
Neck fully extended with chin tucked
Neutral head position with jaw thrust
Lateral decubitus with head elevated 30 degrees

Correct answer: Head extension with neck slightly flexed on a folded blanket

The sniffing position aligns the oral, pharyngeal, and laryngeal axes by flexing the neck on the chest and extending the head at the atlanto-occipital joint.

Question 37: On an ECG, which lead configuration is best for identifying P wave morphology and diagnosing atrial rhythms?

Lead V6
Lead aVR
Lead II (Correct answer)
Lead V1

Correct answer: Lead II

Lead II is most commonly used to evaluate P wave morphology because it is oriented along the main atrial vector, producing the tallest and most upright P waves.

Question 38: Pulsus paradoxus greater than 10 mmHg during your assessment is a classic sign of:

Aortic stenosis
Pulmonary embolism
Cardiac tamponade (Correct answer)
Left ventricular failure

Correct answer: Cardiac tamponade

An exaggerated drop in systolic BP during inspiration (pulsus paradoxus >10 mmHg) is a hallmark of cardiac tamponade.

Question 39: A patient presents with miosis, bradycardia, bronchospasm, and excessive secretions after unknown substance ingestion. Which toxidrome does this represent?

Sympathomimetic
Sedative-hypnotic
Anticholinergic
Cholinergic (Correct answer)

Correct answer: Cholinergic

Cholinergic toxidrome (SLUDGE/DUMBELS) presents with miosis, bradycardia, bronchospasm, and excessive secretions, typically from organophosphate or carbamate exposure.

Question 40: A patient in cardiac arrest is found with a suspected pulmonary embolism as the cause. What is the recommended thrombolytic agent and dose for arrest-level PE?

Heparin 80 units/kg IV bolus
Tenecteplase 0.5mg/kg IV bolus
Alteplase 50mg IV bolus (Correct answer)
Streptokinase 250,000 units over 30 minutes

Correct answer: Alteplase 50mg IV bolus

Alteplase 50mg IV bolus is the recommended thrombolytic dose for cardiac arrest suspected to be caused by massive pulmonary embolism.

Question 41: Which antidote is used for acetaminophen (Tylenol) overdose to prevent hepatotoxicity?

Dimercaprol
Deferoxamine
Fomepizole
N-acetylcysteine (NAC) (Correct answer)

Correct answer: N-acetylcysteine (NAC)

N-acetylcysteine replenishes glutathione stores and detoxifies NAPQI, the hepatotoxic acetaminophen metabolite, preventing liver failure when administered within the treatment window.

Question 42: The Cincinnati Prehospital Stroke Scale assesses which three findings?

Pupils, speech, grip strength
Facial droop, arm drift, speech abnormality (Correct answer)
LOC, gaze deviation, limb weakness
Headache, vomiting, vision changes

Correct answer: Facial droop, arm drift, speech abnormality

The Cincinnati Prehospital Stroke Scale uses facial droop, arm drift, and abnormal speech to rapidly identify stroke.

Question 43: You are treating a patient in stable wide-complex tachycardia at 170 bpm. Which feature on the ECG most strongly supports ventricular tachycardia over SVT with aberrancy?

QRS width greater than 0.12 seconds
AV dissociation visible on the ECG (Correct answer)
Presence of left bundle branch block morphology
Rate greater than 150 bpm

Correct answer: AV dissociation visible on the ECG

AV dissociation (P waves marching independently through QRS complexes) is pathognomonic for ventricular tachycardia and cannot occur in SVT.

Question 44: A patient with suspected acute coronary syndrome has a blood pressure of 90/60 mmHg. Which medication should be WITHHELD?

12-lead ECG acquisition
Aspirin 324 mg chewed
Nitroglycerin 0.4 mg sublingual (Correct answer)
Oxygen if SpO2 <94%

Correct answer: Nitroglycerin 0.4 mg sublingual

Nitroglycerin is contraindicated in hypotensive ACS patients (SBP <90 mmHg) as further vasodilation can cause hemodynamic collapse.

Question 45: What is the purpose of administering oxygen in an emergency?

To enhance tissue oxygenation and organ function (Correct answer)
To calm the patient
To increase blood pressure
To reduce pain

Correct answer: To enhance tissue oxygenation and organ function

Administering supplemental oxygen in an emergency is vital because many medical and trauma conditions can lead to hypoxemia, a dangerously low level of oxygen in the blood. By increasing the oxygen concentration, paramedics can improve the oxygen supply to the patient's tissues and vital organs. This helps prevent cellular damage and supports overall physiological function, maintaining organ viability and patient stability.

Question 46: On an ECG, you observe a regular rhythm at 150 bpm with sawtooth flutter waves most visible in leads II, III, and aVF. What is the atrial rate most commonly associated with this rhythm?

250-300 bpm
200-250 bpm
350-400 bpm
300-350 bpm (Correct answer)

Correct answer: 300-350 bpm

Atrial flutter typically has an atrial rate of 300-350 bpm, commonly presenting with 2:1 conduction yielding a ventricular rate near 150 bpm.

Question 47: Which assessment correctly identifies a Class III hemorrhagic shock presentation?

Blood loss 750–1,500 mL, heart rate 100–120 bpm, and normal mentation
Blood loss 1,500–2,000 mL, heart rate >120 bpm, decreased pulse pressure, and altered mental status (Correct answer)
Blood loss >2,000 mL, blood pressure undetectable, and unconsciousness
Blood loss <750 mL, heart rate <100 bpm, and normal blood pressure

Correct answer: Blood loss 1,500–2,000 mL, heart rate >120 bpm, decreased pulse pressure, and altered mental status

Class III hemorrhage involves 30–40% blood volume loss (~1,500–2,000 mL), producing marked tachycardia, decreased pulse pressure, and confusion from cerebral hypoperfusion.

Question 48: What does it mean when a defibrillator displays 'CHECK ELECTRODES' during an attempted shock?

The device battery is critically low
Poor pad-to-skin contact or a disconnected lead is detected (Correct answer)
The energy level is set too high
The patient's rhythm has changed to a non-shockable rhythm

Correct answer: Poor pad-to-skin contact or a disconnected lead is detected

A 'CHECK ELECTRODES' message indicates the device detects high impedance due to poor contact, disconnection, or a faulty pad.

Question 49: What is the importance of obtaining a medical history from a patient?

To provide comfort
To identify underlying health conditions and treatment risks (Correct answer)
To speed up transportation
To administer medications

Correct answer: To identify underlying health conditions and treatment risks

Obtaining a medical history, often using the SAMPLE mnemonic, is crucial for paramedics. This information helps identify pre-existing conditions, allergies to medications, or current treatments that could impact the patient's current emergency or influence the paramedic's treatment choices. A thorough history ensures safer and more effective care by providing context for the patient's current condition.

Question 50: Which intervention is indicated if a patient's ETCO2 is consistently above 60 mmHg during BVM ventilation?

Switch immediately to 100% O2 without positive pressure
Administer sodium bicarbonate IV
Decrease ventilation rate to allow CO2 to normalize
Increase ventilation rate to eliminate excess CO2 (Correct answer)

Correct answer: Increase ventilation rate to eliminate excess CO2

ETCO2 above 60 mmHg indicates hypoventilation and CO2 retention; increasing ventilation rate will lower CO2 levels toward the normal range of 35-45 mmHg.

Question 51: A patient in cardiac arrest has ventricular fibrillation. After the first shock, CPR is resumed. When should the NEXT rhythm check occur?

After 1 minute of CPR
After 3 minutes of CPR
Immediately after the shock
After 2 minutes of CPR (5 cycles) (Correct answer)

Correct answer: After 2 minutes of CPR (5 cycles)

Per AHA ACLS protocol, CPR is performed for 2 minutes (approximately 5 cycles) before the next rhythm/pulse check after defibrillation.

Question 52: In pediatric resuscitation, which IV/IO fluid bolus volume is recommended for a child in hypovolemic shock?

40 mL/kg
10 mL/kg
20 mL/kg (Correct answer)
5 mL/kg

Correct answer: 20 mL/kg

Initial isotonic fluid bolus for pediatric hypovolemic shock is 20 mL/kg of normal saline or lactated Ringer's, repeated as needed.

Question 53: Which burn pattern is most consistent with non-accidental trauma (abuse) in a pediatric patient?

Irregular splash-pattern burn on the face and one arm
Symmetrical scald burns with a distinct tide line on bilateral lower extremities (Correct answer)
Flame burn with singed hair and inhalation injury
Chemical burn from household cleaner on the hands

Correct answer: Symmetrical scald burns with a distinct tide line on bilateral lower extremities

Forcible immersion scalds produce symmetrical, sharply demarcated burns with a tide line, inconsistent with accidental splash injuries, and are a hallmark of inflicted burns.

Question 54: Which of the following BEST describes the mechanism by which a tourniquet controls hemorrhage?

It reduces systemic blood pressure to decrease flow to the extremity
It causes vasoconstriction of peripheral arteries through pressure receptors
It compresses soft tissue and vessels against bone to occlude arterial blood flow (Correct answer)
It promotes local clot formation by activating platelets at the wound site

Correct answer: It compresses soft tissue and vessels against bone to occlude arterial blood flow

A tourniquet controls hemorrhage by physically compressing all soft tissue layers including vessels against the underlying bone, stopping distal arterial flow.

Question 55: Which combination of antidotes is used to treat severe organophosphate poisoning?

Physostigmine and pyridoxine
Naloxone and sodium bicarbonate
Pralidoxime (2-PAM) and atropine (Correct answer)
Flumazenil and calcium gluconate

Correct answer: Pralidoxime (2-PAM) and atropine

Atropine reverses muscarinic effects and pralidoxime (2-PAM) reactivates acetylcholinesterase before aging occurs, making them the dual treatment for organophosphate poisoning.

Question 56: Which of the following best describes torsades de pointes on ECG?

Polymorphic VT where QRS axis twists around the isoelectric line (Correct answer)
Irregular wide-complex rhythm with delta waves
Monomorphic wide-complex tachycardia at 200 bpm
Rapid regular narrow-complex tachycardia

Correct answer: Polymorphic VT where QRS axis twists around the isoelectric line

Torsades de pointes is a polymorphic ventricular tachycardia in which the QRS amplitude and axis appear to rotate or twist around the baseline.

Question 57: Which of the following BEST describes the concept of 'task fixation' as a team leadership hazard during resuscitation?

Repeating the same intervention more than twice
Delegating too many tasks simultaneously
Assigning the same task to multiple team members
Becoming so focused on one clinical task that the leader loses awareness of the overall resuscitation (Correct answer)

Correct answer: Becoming so focused on one clinical task that the leader loses awareness of the overall resuscitation

Task fixation ('tunnel vision') causes leaders to miss critical information or deteriorating conditions because they are absorbed in a single procedure.

Question 58: What is the first step in assessing an emergency patient?

To provide medications
To move the patient
To perform an initial assessment and prioritize treatment (Correct answer)
To transport the patient

Correct answer: To perform an initial assessment and prioritize treatment

The first step in assessing an emergency patient is to perform an initial assessment, often called the primary survey. This rapid evaluation focuses on identifying and addressing immediate life-threats to the patient's airway, breathing, and circulation (ABC). Prioritizing treatment based on these findings ensures that the most critical issues are addressed first, maximizing the patient's chances of survival.

Question 59: What is the purpose of the Glasgow Coma Scale?

To test muscle strength
To monitor oxygen levels
To evaluate the patient's level of consciousness (Correct answer)
To measure blood pressure

Correct answer: To evaluate the patient's level of consciousness

The Glasgow Coma Scale (GCS) is a standardized neurological assessment tool used by paramedics and other healthcare professionals. It evaluates a patient's level of consciousness by scoring their eye-opening, verbal response, and motor response. The GCS provides a quick, objective, and consistent way to track changes in a patient's neurological status, which is crucial for guiding treatment and predicting outcomes, especially in head injuries.

Question 60: During rapid sequence intubation (RSI), succinylcholine is contraindicated in which of the following patients?

A 30-year-old in anaphylactic shock
A 25-year-old with severe head injury
A 60-year-old with crush injury 72 hours prior (Correct answer)
A 40-year-old with active asthma exacerbation

Correct answer: A 60-year-old with crush injury 72 hours prior

Succinylcholine is contraindicated in crush injuries older than 24-48 hours due to upregulation of acetylcholine receptors causing life-threatening hyperkalemia.

Question 61: A patient with a suspected pelvic fracture and hemodynamic instability should be managed with:

Apply a pelvic binder at the level of the iliac crests
Apply a pelvic binder at the level of the greater trochanters (Correct answer)
Log-roll the patient to assess the posterior pelvis repeatedly
Avoid any movement and apply bilateral lower extremity traction splints

Correct answer: Apply a pelvic binder at the level of the greater trochanters

A pelvic binder applied at the level of the greater trochanters reduces pelvic ring volume and tamponades internal hemorrhage in unstable pelvic fractures.

Question 62: In the management of a patient with severe anaphylaxis, epinephrine should be administered via which route FIRST?

Intramuscular injection in the anterolateral thigh (Correct answer)
Subcutaneous injection in the deltoid
Intravenous bolus of 1 mg
Sublingual absorption

Correct answer: Intramuscular injection in the anterolateral thigh

Intramuscular epinephrine in the anterolateral thigh achieves faster and more reliable absorption than subcutaneous injection in anaphylaxis.

Question 63: Which of the following situations would MOST warrant transferring team leadership during an active resuscitation?

A more experienced paramedic arrives on scene (Correct answer)
The patient's rhythm converts to sinus rhythm
The team has been working for 10 minutes
The current leader needs to perform a specific procedure

Correct answer: A more experienced paramedic arrives on scene

Transferring leadership to a more experienced clinician is appropriate and should include a concise handoff of patient status and interventions already performed.

Question 64: During resuscitation of a lightning strike victim, which phenomenon explains why the cardiac arrest may be easier to reverse than other etiologies?

Lightning induces only atrial fibrillation, which self-terminates in most patients
The electromagnetic pulse from lightning depletes intracellular calcium, which is quickly replenished
Lightning causes a massive DC countershock that may spontaneously terminate within seconds, leaving a viable myocardium (Correct answer)
Lightning destroys the AV node, causing a predictable complete heart block that responds to pacing

Correct answer: Lightning causes a massive DC countershock that may spontaneously terminate within seconds, leaving a viable myocardium

Lightning delivers a massive direct current shock that often causes transient cardiac arrest with a viable myocardium, making these arrests highly salvageable with prompt CPR.

Question 65: An 8-year-old child in SVT is hemodynamically stable. Which is the FIRST intervention attempted?

Amiodarone 5 mg/kg IV
Adenosine 0.1 mg/kg IV
Vagal maneuvers such as ice water immersion of the face (Correct answer)
Synchronized cardioversion at 0.5 J/kg

Correct answer: Vagal maneuvers such as ice water immersion of the face

In a stable pediatric patient with SVT, vagal maneuvers are attempted first before adenosine or cardioversion.

Question 66: Which of the following is the MOST appropriate ventilation rate for a patient with ROSC (return of spontaneous circulation) who requires assisted ventilation?

20–24 breaths/min
6–8 breaths/min
10–12 breaths/min (Correct answer)
16–20 breaths/min

Correct answer: 10–12 breaths/min

Post-ROSC patients should be ventilated at 10–12 breaths/min to maintain normocapnia and avoid hypocapnia-induced cerebral vasoconstriction.

Question 67: A patient presents with confusion, fever of 104°F, diaphoresis, and muscle rigidity after starting a new antipsychotic. You suspect:

Neuroleptic malignant syndrome (Correct answer)
Thyroid storm
Malignant hyperthermia
Serotonin syndrome

Correct answer: Neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) is characterized by hyperthermia, rigidity, altered mental status, and autonomic instability following antipsychotic use.

Question 68: A patient with a known seizure disorder has been seizing for 8 minutes. After two doses of benzodiazepines, seizure activity continues. This is BEST described as:

Postictal state
Todd's paralysis
Pseudoseizure
Status epilepticus (Correct answer)

Correct answer: Status epilepticus

Status epilepticus is defined as continuous seizure activity lasting more than 5 minutes or two seizures without full recovery between them.

Question 69: A trauma patient has a systolic BP of 70 mmHg, heart rate of 130, and is unresponsive. Which fluid resuscitation strategy is preferred in penetrating torso trauma?

Normal saline at 1 L/hr maintenance
Permissive hypotension targeting SBP 80-90 mmHg (Correct answer)
No fluids until surgical hemorrhage control
2 L crystalloid bolus immediately

Correct answer: Permissive hypotension targeting SBP 80-90 mmHg

Permissive hypotension (targeting SBP 80-90 mmHg) is preferred in penetrating torso trauma to avoid diluting clotting factors while maintaining perfusion.

Question 70: What is the ETCO2 value that BEST indicates effective CPR compressions during cardiac arrest resuscitation?

< 10 mmHg
35–45 mmHg
> 20 mmHg (Correct answer)
10–15 mmHg

Correct answer: > 20 mmHg

An ETCO2 greater than 20 mmHg during CPR indicates adequate chest compressions generating sufficient cardiac output.

Question 71: When using a bag-valve-mask (BVM) on an adult, what tidal volume should each ventilation deliver?

200-300 mL
1200-1500 mL
800-1000 mL
500-600 mL (Correct answer)

Correct answer: 500-600 mL

Adult BVM ventilation should deliver approximately 500-600 mL tidal volume to produce visible chest rise without causing gastric inflation.

Question 72: How should a paramedic confirm mechanical capture during transcutaneous pacing?

Observe QRS complexes following each spike
Observe pacing spikes on the ECG
Confirm the patient is no longer symptomatic
Palpate a pulse corresponding to the paced rate (Correct answer)

Correct answer: Palpate a pulse corresponding to the paced rate

Mechanical capture must be confirmed by palpating a pulse at the paced rate, not just observing electrical activity on the monitor.

Question 73: A patient collapsed at a house fire presents with unconsciousness, severe lactic acidosis, and cardiovascular collapse from suspected cyanide poisoning. What is the preferred antidote?

N-acetylcysteine
Naloxone
Sodium thiosulfate alone
Hydroxocobalamin (Cyanokit) (Correct answer)

Correct answer: Hydroxocobalamin (Cyanokit)

Hydroxocobalamin directly binds cyanide to form nontoxic cyanocobalamin and is the preferred agent in fire victims because, unlike nitrites, it does not worsen concurrent carbon monoxide-induced hypoxia.

Question 74: A patient with stable supraventricular tachycardia at 180 bpm does not respond to vagal maneuvers or adenosine. What electrical therapy is appropriate?

Synchronized cardioversion at 360J
Transcutaneous pacing at 80 bpm
Synchronized cardioversion at 50-100J (Correct answer)
Unsynchronized defibrillation at 200J

Correct answer: Synchronized cardioversion at 50-100J

Stable SVT refractory to medications is treated with synchronized cardioversion starting at 50-100J.

Question 75: Which phrase BEST demonstrates closed-loop communication when a team leader orders 1 mg epinephrine IV?

'1 mg epinephrine IV — administering now. Epinephrine 1 mg given.' (Correct answer)
'Sure, I'll get on it.'
'Did you say epi or atropine?'
'Got it.'

Correct answer: '1 mg epinephrine IV — administering now. Epinephrine 1 mg given.'

Closed-loop communication requires repeating the order, confirming execution, and reporting completion — all three steps are demonstrated in this response.

Question 76: A patient in polymorphic VT (Torsades de Pointes) with a pulse becomes unstable. The MOST appropriate electrical therapy is:

Synchronized cardioversion at 100J
Transcutaneous pacing to overdrive suppress
Synchronized cardioversion at 360J
Unsynchronized defibrillation at 200J (Correct answer)

Correct answer: Unsynchronized defibrillation at 200J

Torsades de Pointes with an unstable pulse is treated with unsynchronized defibrillation because the irregular morphology makes synchronization unreliable.

Question 77: When a patient with an implanted cardioverter-defibrillator (ICD) requires external defibrillation, pads should be placed:

Directly over the ICD generator for best effect
Only in the anterior-lateral position
In any standard position without modification
At least 8 cm (3 inches) away from the ICD device (Correct answer)

Correct answer: At least 8 cm (3 inches) away from the ICD device

External pads should be placed at least 8 cm from an ICD generator to avoid damaging the device or reducing shock effectiveness.

Question 78: When applying defibrillator pads, the anterior-posterior electrode placement is preferred in which situation?

When performing synchronized cardioversion only
When the patient has a permanent pacemaker (Correct answer)
During pediatric defibrillation
When the patient is obese

Correct answer: When the patient has a permanent pacemaker

Anterior-posterior pad placement avoids delivering energy directly through a permanent pacemaker's leads and generator.

Question 79: A patient's ECG shows a QRS complex of 0.14 seconds with a right bundle branch block morphology and a rate of 180 bpm with no visible P waves. What rhythm should you suspect?

Supraventricular tachycardia with aberrancy
Torsades de pointes
Accelerated idioventricular rhythm
Ventricular tachycardia (Correct answer)

Correct answer: Ventricular tachycardia

A wide-complex tachycardia at 180 bpm without visible P waves is ventricular tachycardia until proven otherwise, even if RBBB morphology is present.

Question 80: What is an automated external defibrillator (AED) used for?

To cool the body down
To monitor heart rate
To administer pain relief
To deliver a shock and restore heart rhythm (Correct answer)

Correct answer: To deliver a shock and restore heart rhythm

An Automated External Defibrillator (AED) is a portable device used to treat sudden cardiac arrest caused by ventricular fibrillation or pulseless ventricular tachycardia. These conditions involve chaotic electrical activity in the heart, preventing it from effectively pumping blood. The AED analyzes the heart's rhythm and, if a shockable rhythm is detected, delivers an electrical shock to reset the heart's electrical activity, aiming to restore a normal, effective rhythm.

Question 81: Which of the following is a primary responsibility of the designated team leader during a complex resuscitation attempt?

Ensuring clear role assignments and monitoring overall team performance. (Correct answer)
Establishing IV/IO access as quickly as possible.
Performing all advanced airway procedures personally.
Performing continuous, high-quality chest compressions.

Correct answer: Ensuring clear role assignments and monitoring overall team performance.

The team leader's primary role is to maintain a 'big picture' view of the resuscitation. This includes assigning roles to team members, making treatment decisions, facilitating communication, and monitoring the quality of all interventions, rather than getting locked into a single task.

Question 82: During CPAP application, at what pressure setting should prehospital CPAP typically be initiated for acute pulmonary edema?

20-25 cm H2O
15-20 cm H2O
5-10 cm H2O (Correct answer)
1-2 cm H2O

Correct answer: 5-10 cm H2O

Prehospital CPAP for acute pulmonary edema is typically initiated at 5-10 cm H2O, which provides enough positive pressure to recruit alveoli without causing barotrauma.

Question 83: A patient's ECG shows 'saddle-back' or 'coved' ST elevation in V1-V2 with a right bundle branch block pattern in a patient who has had recurrent syncope. Which syndrome should be suspected?

Wellens syndrome
De Winter pattern
Kounis syndrome
Brugada syndrome (Correct answer)

Correct answer: Brugada syndrome

Brugada syndrome produces characteristic 'coved-type' ST elevation in V1-V2 with RBBB pattern and is associated with risk of ventricular fibrillation and sudden cardiac death.

Question 84: A patient is found in cardiac arrest with a narrow complex PEA rhythm. Which reversible cause should be treated FIRST in the field?

Pulmonary embolism
Hyperkalemia
Hypothermia
Tension pneumothorax (Correct answer)

Correct answer: Tension pneumothorax

Tension pneumothorax is a common, immediately treatable cause of PEA that can be rapidly reversed with needle decompression in the field.

Question 85: When performing two-thumb encircling chest compressions on a neonate, the sternum should be compressed to what depth?

One-half of the anterior-posterior chest diameter
One-third of the anterior-posterior chest diameter (Correct answer)
1-2 cm regardless of chest size
One-quarter of the anterior-posterior chest diameter

Correct answer: One-third of the anterior-posterior chest diameter

Neonatal chest compressions should compress the sternum approximately one-third of the anterior-posterior diameter of the chest.

Question 86: A patient's 12-lead ECG shows a normal sinus rhythm with ST elevation in aVR and diffuse ST depression in most other leads. What condition should you consider?

Right ventricular MI
Pericarditis
Anterior STEMI
Left main or proximal LAD occlusion (Correct answer)

Correct answer: Left main or proximal LAD occlusion

ST elevation in aVR with diffuse ST depression across multiple leads is a pattern strongly associated with left main coronary artery or proximal LAD occlusion, indicating high-risk ischemia.

Question 87: A paramedic is treating a 58-year-old male in cardiac arrest. After endotracheal intubation, waveform capnography shows a persistent, flat waveform with an ETCO2 value of 0 mmHg despite effective chest compressions. What is the MOST likely cause of this finding?

Esophageal intubation (Correct answer)
The endotracheal tube is correctly placed in the trachea
Return of spontaneous circulation (ROSC)
Severe bronchoconstriction

Correct answer: Esophageal intubation

A persistent, flat waveform on capnography with a value of 0 mmHg is the most reliable indicator of esophageal intubation. During cardiac arrest, even with effective CPR, some CO2 should be detected if the tube is in the trachea. The absence of CO2 indicates that the tube is in the esophagus, and no gas exchange is occurring.

Question 88: What is the role of the paramedic during trauma emergencies?

To monitor patients post-surgery
To provide initial stabilization and prepare for transport (Correct answer)
To prescribe painkillers
To perform surgeries

Correct answer: To provide initial stabilization and prepare for transport

During trauma emergencies, a paramedic's crucial role is to rapidly assess the patient, stabilize life-threatening injuries, and prepare them for safe transport to a definitive care facility. This involves controlling bleeding, ensuring an open airway, supporting breathing, and immobilizing potential spinal injuries. The goal is to prevent further injury and maintain the patient's condition during transit to the hospital.

Question 89: A patient in ventricular fibrillation receives a shock but immediately returns to VF. What is the recommended next step?

Administer lidocaine before the next shock
Resume CPR for 2 minutes then reassess rhythm (Correct answer)
Increase the defibrillation energy by 50 joules
Repeat the shock immediately at the same energy

Correct answer: Resume CPR for 2 minutes then reassess rhythm

After a failed shock, 2 minutes of high-quality CPR should resume to re-perfuse the myocardium before the next rhythm check.

Question 90: Which intraosseous (IO) insertion site is PREFERRED in adults when IV access cannot be obtained rapidly?

Distal femur
Distal tibia
Proximal humerus or proximal tibia (Correct answer)
Iliac crest

Correct answer: Proximal humerus or proximal tibia

The proximal humerus and proximal tibia are the preferred adult IO sites; the proximal humerus allows faster drug delivery due to higher flow rates.

Question 91: What is the IO dose of epinephrine in adult cardiac arrest?

0.5 mg of 1:1,000 solution
2 mg of 1:10,000 solution
1 mg of 1:10,000 solution (Correct answer)
1 mg of 1:1,000 solution

Correct answer: 1 mg of 1:10,000 solution

The standard epinephrine dose for adult cardiac arrest via IO route is 1 mg of 1:10,000 (0.1 mg/mL) solution every 3–5 minutes.

Question 92: During post-resuscitation care, which vasopressor is recommended to maintain a systolic BP ≥90 mmHg after ROSC?

Phenylephrine only
Epinephrine 1 mg boluses every 5 minutes
Norepinephrine or dopamine titrated to effect (Correct answer)
Vasopressin 20 units bolus repeated every 10 minutes

Correct answer: Norepinephrine or dopamine titrated to effect

Post-ROSC hypotension is treated with norepinephrine or dopamine titrated to maintain systolic BP ≥90 mmHg (or MAP ≥65 mmHg).

Question 93: Which of the following best describes the role of tranexamic acid (TXA) in trauma care?

It directly vasoconstricts injured vessels to reduce active bleeding
It replaces clotting factors lost in hemorrhagic shock
It inhibits fibrinolysis to prevent clot breakdown, reducing mortality when given within 3 hours of injury (Correct answer)
It is indicated only for penetrating trauma, not blunt injury

Correct answer: It inhibits fibrinolysis to prevent clot breakdown, reducing mortality when given within 3 hours of injury

TXA is an antifibrinolytic agent proven by the CRASH-2 trial to reduce mortality in traumatic hemorrhage when administered within 3 hours of injury.

Question 94: Which of the following correctly describes the function of a one-way flutter valve (e.g., Heimlich valve) used for chest decompression?

It allows air to exit the pleural space during exhalation and prevents re-entry (Correct answer)
It allows air to enter the chest during inspiration only
It regulates oxygen flow to the patient during transport
It prevents blood from entering the pleural space

Correct answer: It allows air to exit the pleural space during exhalation and prevents re-entry

A flutter valve allows trapped air to escape the pleural space during exhalation while its one-way design prevents atmospheric air from re-entering.

Question 95: Which statement about defibrillator pad placement is CORRECT?

Pads should overlap to maximize energy delivery
Gel pads and paddles can be used interchangeably on the same patient
Pads can be placed directly over nitroglycerin patches without concern
Medication patches under pads must be removed before defibrillation (Correct answer)

Correct answer: Medication patches under pads must be removed before defibrillation

Transdermal medication patches must be removed before pad placement to prevent arcing, burns, and interference with energy delivery.

Question 96: What is the primary cause of cardiac arrest in anaphylaxis, and how does it alter ACLS management?

Primary ventricular fibrillation; standard ACLS with defibrillation takes priority over epinephrine
Distributive shock and airway obstruction; epinephrine 1mg IV every 3-5 min plus aggressive fluid resuscitation (Correct answer)
Myocardial infarction; aspirin and fibrinolytics should be administered immediately
Vasospasm; nitroglycerin is added to the ACLS algorithm

Correct answer: Distributive shock and airway obstruction; epinephrine 1mg IV every 3-5 min plus aggressive fluid resuscitation

Anaphylactic arrest is driven by vasodilation and airway compromise, so IV epinephrine and high-volume fluid resuscitation are critical additions to standard ACLS.

Question 97: On a 12-lead ECG, ST elevation in leads II, III, and aVF with reciprocal depression in leads I and aVL suggests occlusion of which artery?

Right coronary artery (Correct answer)
Left anterior descending artery
Left main coronary artery
Left circumflex artery

Correct answer: Right coronary artery

Inferior STEMI (ST elevation in II, III, aVF) with reciprocal lateral changes is most commonly caused by right coronary artery occlusion.

Question 98: A patient with an implanted pacemaker goes into pulseless ventricular tachycardia. The paramedic should:

Only use transcutaneous pacing
Avoid defibrillation as it could damage the pacemaker
Defibrillate but place pads at least 8 cm away from the device (Correct answer)
Deliver a precordial thump and reassess

Correct answer: Defibrillate but place pads at least 8 cm away from the device

Defibrillation should not be withheld in pulseless VT; pads should be placed at least 8 cm from the pacemaker generator to avoid device damage while still delivering effective therapy.

Question 99: Which ECG change is the earliest and most sensitive indicator of acute myocardial ischemia before ST elevation develops?

Development of Q waves
ST segment depression in contiguous leads
PR segment depression
Hyperacute (peaked) T waves (Correct answer)

Correct answer: Hyperacute (peaked) T waves

Hyperacute T waves (tall, broad, symmetric) are often the earliest ECG change seen in acute coronary occlusion, appearing before ST elevation.

Question 100: During a cardiac arrest, ETCO2 rises from 10 mmHg to 35 mmHg without a change in CPR technique. This indicates:

Return of spontaneous circulation (Correct answer)
Tube displacement into the esophagus
Worsening cardiac output
Hyperventilation by the provider

Correct answer: Return of spontaneous circulation

A sudden rise in ETCO2 to near-normal levels (35-45 mmHg) during resuscitation is a reliable indicator of return of spontaneous circulation.

Question 101: A glucometer reads 'HI' for a diabetic patient in altered mental status. This indicates blood glucose is:

Exactly 500 mg/dL
Above the device's measurable range (>600 mg/dL) (Correct answer)
Between 200-300 mg/dL
Below 40 mg/dL

Correct answer: Above the device's measurable range (>600 mg/dL)

'HI' on a glucometer indicates the blood glucose exceeds the device's upper measurable limit, typically above 600 mg/dL, suggesting severe hyperglycemia.

Question 102: What is the primary intervention for a patient with a collapsed lung?

Administer oxygen
Provide pain relief
Decompress with a needle or chest tube (Correct answer)
Transport immediately

Correct answer: Decompress with a needle or chest tube

A collapsed lung (pneumothorax) occurs when air leaks into the space between the lung and chest wall, putting pressure on the lung and preventing it from expanding. Decompression with a needle (needle thoracostomy) or insertion of a chest tube is the primary intervention to release this trapped air, allowing the lung to re-expand and restore normal breathing. This immediate action is critical to prevent life-threatening respiratory distress and circulatory compromise.

Question 103: What type of medications are commonly carried by paramedics?

Blood thinners
Steroids
Antibiotics
Analgesics, epinephrine, nitroglycerin, and naloxone (Correct answer)

Correct answer: Analgesics, epinephrine, nitroglycerin, and naloxone

Paramedics carry a specific formulary of medications to address common emergencies. Analgesics manage pain, epinephrine treats severe allergic reactions (anaphylaxis) and cardiac arrest, nitroglycerin is used for chest pain related to cardiac ischemia, and naloxone reverses opioid overdose. These medications are crucial for immediate life-saving interventions and symptom management in the pre-hospital setting.

Question 104: Which of the following BEST describes the correct technique for applying a wound-packing agent to a junctional hemorrhage?

Pour the agent into the wound and apply light pressure for 30 seconds
Pack the agent tightly into the wound and apply firm direct pressure for 3 minutes (Correct answer)
Apply the agent to the wound surface only and cover with a dressing
Insert the agent and immediately apply a tourniquet above the site

Correct answer: Pack the agent tightly into the wound and apply firm direct pressure for 3 minutes

Wound packing requires tight packing of hemostatic agent into the wound followed by firm direct pressure for at least 3 minutes to activate clotting.

Question 105: Which serum biomarker measured at 48–72 hours after cardiac arrest has the highest specificity for poor neurological outcome?

Troponin I elevation
Lactate >4 mmol/L
BNP >500 pg/mL
Neuron-specific enolase (NSE) >60 µg/L (Correct answer)

Correct answer: Neuron-specific enolase (NSE) >60 µg/L

NSE levels >60 µg/L at 48–72 hours post-arrest have high specificity for poor neurological prognosis and are part of the multimodal neuroprognostication bundle.

Question 106: When preparing for electrical therapy, which of the following safety precautions is essential to prevent arcing and ensure effective energy delivery?

Using a smaller pad size for better skin contact.
Ensuring the patient's chest is clean and dry. (Correct answer)
Applying the pads over a transdermal medication patch.
Placing pads directly over an implanted pacemaker to capture it.

Correct answer: Ensuring the patient's chest is clean and dry.

Moisture (like sweat or water) on the chest can cause the electrical current to travel across the skin surface (arc) instead of through the heart, resulting in an ineffective shock and potential skin burns. Therefore, wiping the chest dry is a critical safety and efficacy step. Pads should not be placed over medication patches or implanted devices.

Question 107: What is the recommended initial adult IV dose of naloxone for suspected opioid overdose?

0.01 mg
0.1 mg
10 mg
0.4 to 2 mg (Correct answer)

Correct answer: 0.4 to 2 mg

The standard initial adult IV dose of naloxone ranges from 0.4 to 2 mg, titrated to restore adequate ventilation without precipitating full withdrawal in opioid-tolerant patients.

Question 108: Which of the following is the CORRECT position to place a patient in respiratory distress who is conscious and hemodynamically stable?

Supine with head of stretcher flat
Trendelenburg position
Left lateral recumbent position
High Fowler's position (sitting upright at 90 degrees) (Correct answer)

Correct answer: High Fowler's position (sitting upright at 90 degrees)

High Fowler's position maximizes diaphragmatic excursion and lung expansion, reducing the work of breathing in a conscious patient.

Question 109: ST elevation in leads V1-V4 with new right bundle branch block and hypotension in a STEMI patient should raise concern for which complication?

Pericarditis
Papillary muscle dysfunction
Left ventricular free wall rupture
Right ventricular MI (Correct answer)

Correct answer: Right ventricular MI

Anterior STEMI with new RBBB and hypotension can indicate right ventricular involvement, and right-sided leads (V4R) should be obtained to confirm RV MI.

Question 110: A post-arrest patient's end-tidal CO2 suddenly drops from 35 to 10 mmHg without a ventilator change. What does this most likely indicate?

Improvement in pulmonary perfusion
Hyperventilation by the ventilator
Esophageal intubation confirmed
Re-arrest or severe drop in cardiac output (Correct answer)

Correct answer: Re-arrest or severe drop in cardiac output

A sudden, dramatic fall in EtCO2 during the post-arrest period signals loss of cardiac output, indicating re-arrest or severe hemodynamic collapse.

Question 111: During a high-priority trauma transport, a patient's SpO2 drops from 98% to 82% with diminished breath sounds on the right. What is the MOST likely diagnosis?

Mucus plug causing right mainstem occlusion
Esophageal intubation
Pulmonary edema from fluid overload
Right-sided tension pneumothorax (Correct answer)

Correct answer: Right-sided tension pneumothorax

Unilateral diminished breath sounds with acute SpO2 decline in a trauma patient is tension pneumothorax until proven otherwise.

Question 112: What is the correct compression-to-ventilation ratio for a single rescuer performing CPR on an adult?

15:2
100:0 (continuous compressions)
30:2 (Correct answer)
5:1

Correct answer: 30:2

A single rescuer performing adult CPR uses a 30:2 ratio (30 compressions followed by 2 ventilations) to maximize perfusion time while providing oxygenation.

Question 113: What is the maximum recommended number of defibrillation attempts before initiating active rewarming in a hypothermic cardiac arrest patient with a core temperature below 30°C?

No limit — continue shocking every 2 minutes as per standard ACLS
1 shock
3 shocks (Correct answer)
6 shocks

Correct answer: 3 shocks

Current guidelines recommend up to 3 defibrillation attempts in severe hypothermia, then withholding further shocks until core temperature rises above 30°C.

Question 114: Which sign indicates increasing intracranial pressure (ICP) and impending cerebral herniation?

Unilateral fixed and dilated pupil with decreasing GCS and hypertension with bradycardia (Correct answer)
Bilateral mydriasis with tachycardia and hypotension
Nystagmus with preserved GCS and normal vital signs
Bilateral miosis with normal blood pressure and improving GCS

Correct answer: Unilateral fixed and dilated pupil with decreasing GCS and hypertension with bradycardia

A unilateral fixed dilated pupil (blown pupil) with decreasing GCS and Cushing's response (hypertension + bradycardia) indicates uncal herniation compressing CN III.

Question 115: Which ECG finding is most characteristic and specific for severe digoxin toxicity?

Delta waves with short PR interval
Right bundle branch block
Bidirectional ventricular tachycardia (Correct answer)
Prolonged QT interval

Correct answer: Bidirectional ventricular tachycardia

Bidirectional ventricular tachycardia, characterized by alternating QRS axis polarity beat-to-beat, is a highly specific ECG marker for severe digoxin toxicity and requires urgent treatment with digoxin-specific Fab fragments.

Question 116: A PEEP valve is attached to the BVM during ventilation of a patient with severe pulmonary edema. What does PEEP accomplish?

Increases inspiratory flow rate to improve oxygenation
Maintains positive airway pressure at end-expiration to recruit alveoli (Correct answer)
Prevents air trapping in asthmatic patients
Reduces the tidal volume delivered per breath

Correct answer: Maintains positive airway pressure at end-expiration to recruit alveoli

PEEP prevents alveolar collapse at end-expiration, recruits fluid-filled alveoli, and improves oxygenation in conditions like pulmonary edema and ARDS.

Question 117: Which intraosseous insertion site is preferred in adults when rapid IO access is needed?

Proximal tibia (Correct answer)
Proximal humerus
Distal tibia
Sternum

Correct answer: Proximal tibia

The proximal tibia is the preferred IO site in adults due to its accessibility, flat surface, and thick cortex that accommodates standard IO needles reliably.

Question 118: What is the first thing a paramedic must do when assessing a patient?

Monitor blood pressure
Administer pain relief
Check for life-threatening conditions (Correct answer)
Move the patient

Correct answer: Check for life-threatening conditions

When first assessing a patient, a paramedic's immediate priority is to rapidly identify and address any life-threatening conditions. This initial assessment, often called the primary survey, focuses on the patient's airway, breathing, circulation, and severe bleeding. Addressing these critical issues first is paramount to ensuring the patient's immediate survival and preventing irreversible harm.

Question 119: In submersion (drowning) arrest, when is it appropriate to withhold resuscitation in the field?

Only when a physician on scene orders termination of resuscitation
When ventricular fibrillation is absent on the initial rhythm check
Whenever submersion duration exceeds 20 minutes regardless of water temperature
When the victim has been submerged in warm water for more than 60 minutes and has obvious signs of death (Correct answer)

Correct answer: When the victim has been submerged in warm water for more than 60 minutes and has obvious signs of death

Resuscitation may be withheld in warm-water submersion with prolonged downtime and obvious signs of death, but cold-water submersions warrant full resuscitation attempts due to protective hypothermia.

Question 120: Which dysrhythmia is most commonly associated with hypothermic cardiac arrest at core temperatures below 30°C (86°F)?

Atrial fibrillation with complete heart block
Asystole
Ventricular fibrillation (Correct answer)
Pulseless electrical activity

Correct answer: Ventricular fibrillation

Ventricular fibrillation is the most common dysrhythmia in severe hypothermia and is the primary shockable rhythm encountered.

Question 121: The Sellick maneuver (cricoid pressure) is applied during RSI primarily to:

Improve laryngoscope view
Reduce the dose of sedative needed
Open the glottis wider
Prevent passive regurgitation of gastric contents (Correct answer)

Correct answer: Prevent passive regurgitation of gastric contents

Cricoid pressure compresses the esophagus against the vertebral body to reduce passive regurgitation and aspiration risk during intubation.

Question 122: A patient found in a confined space complains of headache and dizziness; co-workers are also symptomatic. You should FIRST:

Enter and begin patient care
Ensure scene safety and don appropriate PPE before entry (Correct answer)
Have bystanders remove the patients
Notify medical control before entering

Correct answer: Ensure scene safety and don appropriate PPE before entry

Scene safety is the first priority; a confined space with multiple symptomatic victims suggests toxic atmosphere requiring PPE before entry.

Question 123: A patient arrested after beta-blocker overdose fails to respond to standard ACLS and epinephrine. What high-dose rescue therapy should be considered?

Atropine 3mg IV followed by transcutaneous pacing
High-dose insulin euglycemic therapy (HIET) with insulin 1 unit/kg IV bolus (Correct answer)
Norepinephrine infusion at 0.5 mcg/kg/min
Calcium gluconate 3g IV over 5 minutes

Correct answer: High-dose insulin euglycemic therapy (HIET) with insulin 1 unit/kg IV bolus

High-dose insulin euglycemic therapy (HIET) improves myocardial carbohydrate metabolism and is a primary antidote for refractory beta-blocker and calcium channel blocker toxicity.

Question 124: Which communication failure is MOST likely to cause a drug administration error during resuscitation?

Speaking too loudly
Using medical terminology
Giving orders before the patient arrives
Failure to use closed-loop communication with dose confirmation (Correct answer)

Correct answer: Failure to use closed-loop communication with dose confirmation

Without closed-loop communication, verbal orders may be misheard, misunderstood, or ignored, leading to wrong drug or wrong dose errors.

Question 125: What is the maximum recommended depth of chest compressions for an adult patient?

1.5 inches
2 inches
1 inch
2.4 inches (Correct answer)

Correct answer: 2.4 inches

Current AHA guidelines recommend chest compressions of at least 2 inches but no more than 2.4 inches to optimize cardiac output and avoid injury.

Question 126: What is the maximum recommended rate of rewarming after targeted temperature management to minimize rebound cerebral injury?

2°C per hour
0.1°C per hour
1°C per hour
0.25°C per hour (Correct answer)

Correct answer: 0.25°C per hour

Controlled rewarming at no faster than 0.25°C per hour minimizes the risk of fever rebound, cerebral edema, and electrolyte shifts.

Question 127: You are treating a patient in hemorrhagic shock. After two large-bore IV lines fail, your NEXT best vascular access option is:

Femoral vein cutdown
Central venous catheter
Intraosseous access (Correct answer)
Subclavian line

Correct answer: Intraosseous access

Intraosseous (IO) access provides rapid, reliable vascular access when peripheral IV placement fails in critical patients.

Question 128: A scuba diver surfaces rapidly and develops cardiac arrest. Arterial gas embolism (AGE) is suspected. What position should be used during transport and resuscitation?

Semi-recumbent at 30 degrees to protect the airway
Supine (flat); avoid Trendelenburg or left lateral decubitus positioning (Correct answer)
Left lateral decubitus (Durant's maneuver) to trap bubbles in the right ventricle
Trendelenburg (head down) to force bubbles away from the cerebral circulation

Correct answer: Supine (flat); avoid Trendelenburg or left lateral decubitus positioning

Current guidelines recommend the supine position for AGE; head-down positions are no longer recommended as they may increase cerebral edema without improving bubble dynamics.

Question 129: A patient requires spinal motion restriction on a long backboard. After securing the torso, the head is immobilized:

Last, after torso and legs are secured (Correct answer)
Before securing the torso to prevent movement
Only if the patient is unconscious
Simultaneously with torso straps

Correct answer: Last, after torso and legs are secured

When applying a long backboard, the torso is secured first, then the legs, and finally the head, because securing the torso first prevents the patient from sliding and allows head blocks to hold securely.

Question 130: Which finding during auscultation of breath sounds BEST indicates right mainstem bronchus intubation?

Stridor heard bilaterally
Breath sounds present on the right, absent on the left (Correct answer)
Gurgling sounds over the epigastrium
Bilateral absent breath sounds

Correct answer: Breath sounds present on the right, absent on the left

Right mainstem intubation ventilates only the right lung, producing breath sounds on the right with absent sounds on the left.

Question 131: A 12-lead ECG reveals right axis deviation, tall R wave in V1, and deep S waves in V6. Which condition is most consistent with these findings?

Left bundle branch block
Left ventricular hypertrophy
Right ventricular hypertrophy (Correct answer)
Anterior hemiblock

Correct answer: Right ventricular hypertrophy

Right ventricular hypertrophy (RVH) classically presents with right axis deviation, dominant R wave in V1, and deep S waves in left precordial leads (V5-V6).

Question 132: Which size endotracheal tube is most appropriate for an average adult female?

5.0 mm uncuffed
7.0–7.5 mm cuffed (Correct answer)
8.5–9.0 mm cuffed
6.0 mm cuffed

Correct answer: 7.0–7.5 mm cuffed

Average adult females typically require a 7.0–7.5 mm internal diameter cuffed ETT, while adult males typically require 7.5–8.0 mm.

Question 133: During targeted temperature management (TTM), which physiological effect of cooling must be actively managed?

Hypertension
Bradypnea
Hyperthermia
Shivering (Correct answer)

Correct answer: Shivering

Shivering counteracts cooling efforts and must be suppressed with sedation, neuromuscular blockade, or magnesium sulfate.

Question 134: A patient presents with a GCS of 8 and is unresponsive to verbal stimuli. What is the MOST appropriate initial airway intervention?

Oropharyngeal airway with BVM ventilation
Nasopharyngeal airway insertion
Endotracheal intubation (Correct answer)
High-flow oxygen via non-rebreather mask

Correct answer: Endotracheal intubation

A GCS of 8 or below indicates the need for definitive airway management, and endotracheal intubation is the gold standard.

Question 135: A patient with known hyperkalemia is in cardiac arrest with a wide-complex rhythm. Which medication should be given first?

Regular insulin 10 units IV
Albuterol nebulization
Sodium bicarbonate 50 mEq IV
Calcium chloride 1g IV (Correct answer)

Correct answer: Calcium chloride 1g IV

Calcium chloride immediately stabilizes the cardiac membrane potential and is the fastest-acting treatment for hyperkalemic cardiac toxicity.

Certified Paramedic Response (CPR) Examination

The Certified Paramedic Response exam validates advanced pre-hospital emergency care competency, assessing clinical judgment and procedural skills across airway management, cardiology, trauma, and medical emergencies at the paramedic level.

135

Questions

150 min

Time Limit

70%

To Pass

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