NREMT Cognitive Exam (EMT) — Questions and Answers

Question 1: When performing a rapid trauma assessment on a patient with a significant mechanism of injury, the EMT should assess the patient's body in which order?

Head to toe in a systematic manner (Correct answer)
Vital signs before any physical examination
Extremities, then head, then trunk
Only areas where the patient reports pain

Correct answer: Head to toe in a systematic manner

A rapid trauma assessment proceeds head-to-toe to ensure a systematic evaluation and prevent missed injuries. Beginning at the head and working toward the feet reduces the risk of overlooking less obvious injuries.

Question 2: You are dispatched to a 75-year old female patient who is currently in cardiac arrest. After one shock via the AED she begins breathing at 15 breaths per minute, and has a strong carotid pulse; what is your next step?

Assist ventilations with a bag-valve mask
Continue to administer shocks via AED
Request a non-transport and leave the scene
Provide supplemental oxygen by NRB (Correct answer)

Correct answer: Provide supplemental oxygen by NRB

After a successful defibrillation where the patient regains a pulse and begins breathing spontaneously, the immediate next step is to provide supplemental oxygen. A non-rebreather mask (NRB) is appropriate for delivering high-flow oxygen to support the patient's recovery and ensure adequate oxygenation, while continuously monitoring their condition.

Question 3: What is the priority for a seizure patient?

Give them water.
Hold them down.
Ensure airway and protect from injury (Correct answer)
Put something in their mouth.

Correct answer: Ensure airway and protect from injury

Ensure airway safety, protect from injury, and provide oxygen if needed.

Question 4: What is the best way to transport a pregnant woman in her third trimester?

Flat on her back.
On her right side.
On her left side (Correct answer)
Upright seated.

Correct answer: On her left side

Place her on her left side to prevent compression of the vena cava.

Question 5: Which of the following patients encountered would the paramedic most likely benefit from critical incident stress management?

Death of an 30-year-old male who was intoxicated while driving.
Death of a 43-year-old female from an explosion.
Death of an 82-year-old female from a suicide.
Death of a 4-year-old male patient from a fall. (Correct answer)

Correct answer: Death of a 4-year-old male patient from a fall.

Critical Incident Stress Management (CISM) is most beneficial after incidents that are particularly emotionally taxing or outside the normal range of human experience for EMS providers. The death of a child, especially a young one, is often one of the most difficult and traumatic events. Such incidents can lead to significant psychological stress, making CISM a vital support mechanism.

Question 6: An AED is used to treat patients in:

Pulseless Electrical Activity
Asystole
Acute Myocardial Infarction
Ventricular Fibrillation (Correct answer)

Correct answer: Ventricular Fibrillation

An Automated External Defibrillator (AED) is designed to deliver an electrical shock to interrupt chaotic electrical activity in the heart. Ventricular Fibrillation (VFib) is a life-threatening arrhythmia where the heart's ventricles quiver ineffectively, preventing blood circulation. The AED's shock aims to reset the heart's electrical system, allowing a normal rhythm to resume.

Question 7: A large collection of blood under the skin is known as?

Abrasion
Bruise
Hematoma (Correct answer)
Contusion

Correct answer: Hematoma

A hematoma is a localized collection of blood outside of blood vessels, typically clotted, that forms within tissues or an organ after trauma. Unlike a contusion (bruise), which is a more superficial and diffuse collection of blood, a hematoma is usually larger and can often be felt as a distinct lump. It indicates a more significant rupture of blood vessels.

Question 8: En route to the hospital, you intubate the patient. During your assessment of tube placement, you hear wheezing in the upper lung fields. What is most likely causing this wheezing?

Inhalation injury to the upper airway
Inhalation injury to the lower airway (Correct answer)
Inhalation induced cardiac wheezing
Inhalation induced asthma attack

Correct answer: Inhalation injury to the lower airway

Wheezing is a high-pitched whistling sound, typically heard on exhalation, caused by narrowing or obstruction of the lower airways (bronchioles). In a patient who has been intubated after a traumatic event, new-onset wheezing in the upper lung fields suggests an issue within the smaller, lower airways, such as bronchospasm or edema resulting from an inhalation injury (e.g., smoke, chemicals).

Question 9: Your patient is a 52-year old male complaining of dull, achy chest pains. He is alert & oriented but upon assessment, you notice his skin is pale, cool and clammy. What is your next step?

Obtain SAMPLE History
Administer Supplemental Oxygen (Correct answer)
Apply an AED
Assist the patient with his wife’s nitroglycerin.

Correct answer: Administer Supplemental Oxygen

In any patient presenting with signs of cardiac compromise, especially with pale, cool, and clammy skin indicating poor perfusion, administering supplemental oxygen is a critical initial step. This addresses potential hypoxia and helps improve oxygen delivery to the heart muscle and other vital organs. Following the ABCs (Airway, Breathing, Circulation) is paramount before proceeding with other assessments or interventions.

Question 10: The single largest cause of death for Americans is/are:

Coronary heart disease. (Correct answer)
Traumatic injuries.
Cancer.
Chronic obstructive airway disease.

Correct answer: Coronary heart disease.

Coronary heart disease (CHD) is the leading cause of death for both men and women in the United States. It involves the narrowing or blockage of the coronary arteries, which supply blood to the heart, often due to atherosclerosis. This can lead to myocardial infarctions (heart attacks), angina, and other serious cardiac events, making it the most significant cause of mortality.

Question 11: Your 16 year old trauma patient has what appears to be a mid-shaft femur fracture. You notice that there is a laceration directly over the suspected fracture. Bleeding is controlled. What type of fracture would this be?

Open (Correct answer)
Greenstick
Closed
Comminuted

Correct answer: Open

An open fracture, also known as a compound fracture, occurs when the skin and soft tissues overlying the fractured bone are broken, exposing the bone to the external environment. The presence of a laceration directly over a suspected mid-shaft femur fracture indicates a breach in skin integrity communicating with the fracture site. This classification carries a higher risk of infection due to the open wound.

Question 12: Cardiac arrest in children is most often caused by:

Irregular rhythm.
Chest trauma.
Respiratory compromise. (Correct answer)
Hypovolemia.

Correct answer: Respiratory compromise.

In children, cardiac arrest is most commonly secondary to respiratory failure or shock, rather than a primary cardiac event. Their hearts are generally healthy, but prolonged hypoxia or inadequate ventilation leads to bradycardia, which then progresses to asystole. Addressing respiratory issues early is critical in pediatric resuscitation to prevent cardiac arrest.

Question 13: A patient in active labor reports feeling a strong urge to push and says the baby is coming. The EMT sees crowning. The proper technique for controlling the head delivery is:

Pull down on the baby's head to assist delivery
Apply gentle counterpressure to the baby's head to guide a slow, controlled delivery (Correct answer)
Tell the patient to push as hard as possible to speed delivery
Cover the vaginal opening with a sterile drape and transport immediately

Correct answer: Apply gentle counterpressure to the baby's head to guide a slow, controlled delivery

Gentle counterpressure to the crowning head guides a slow, controlled delivery, reducing the risk of rapid expulsion that can cause maternal lacerations and neonatal injury.

Question 14: Cardiac arrest in children is most often caused by:

Hypovolemia.
Chest trauma.
Irregular rhythm.
Respiratory compromise. (Correct answer)

Correct answer: Respiratory compromise.

In children, cardiac arrest is most frequently a secondary event caused by progressive respiratory compromise or shock that leads to hypoxia and acidosis. Unlike adults, where primary cardiac events are more common, children's hearts are generally healthy and fail due to prolonged lack of oxygen. Addressing respiratory issues early is critical in pediatric care.

Question 15: Upon delivery, the umbilical cord is wrapped around the baby's neck (nuchal cord). The EMT should:

Stop the delivery and transport immediately
Immediately cut the cord before delivering the body
Pull the baby's body quickly to snap the cord free
Attempt to loop the cord over the baby's head; if tight, clamp and cut before body delivery (Correct answer)

Correct answer: Attempt to loop the cord over the baby's head; if tight, clamp and cut before body delivery

A nuchal cord should be looped over the baby's head if loose enough. If the cord is too tight to loop, it should be double-clamped and cut before delivering the body to prevent cord avulsion.

Question 16: What is the priority during delivery in the field?

Deliver placenta first.
Apply firm pressure on the uterus.
Delay delivery.
Support head and ensure airway (Correct answer)

Correct answer: Support head and ensure airway

During a field delivery, once the baby's head emerges, the primary concern is to support it gently to prevent injury and ensure the baby's airway is clear. Gently guiding the head and suctioning the mouth and nose if necessary helps the baby take its first breaths. Establishing a clear airway is crucial for the baby's immediate transition to life outside the womb.

Question 17: On the right side of the heart, there is a three-flap valve called:

Tricuspid valve (Correct answer)
Mitral valve
Triluminar valve
Tri-valve

Correct answer: Tricuspid valve

The tricuspid valve is located on the right side of the heart, specifically between the right atrium and the right ventricle. It is named for its three cusps or flaps, which open and close to regulate the flow of deoxygenated blood from the right atrium into the right ventricle. This prevents backflow during ventricular contraction.

Question 18: When assessing a patient complaining of depression, which of the following would be most suggestive that the patient is at risk for suicide?

Hostility toward concerned family members
Recent diagnosis of hypertension
Previous attempt that was unsuccessful (Correct answer)
Packing away of cherished possessions

Correct answer: Previous attempt that was unsuccessful

A previous suicide attempt is the single most significant predictor of future suicide attempts and completed suicide. Individuals who have attempted suicide before are at a much higher risk, even if the previous attempt was unsuccessful. This history indicates a higher lethality of intent and a demonstrated capacity to act on suicidal thoughts.

Question 19: What is a sign of preeclampsia?

Increased appetite.
High blood pressure and swelling (Correct answer)
Low blood pressure.
Frequent urination.

Correct answer: High blood pressure and swelling

Preeclampsia is a serious pregnancy complication characterized by new-onset high blood pressure (hypertension) and often protein in the urine after 20 weeks of gestation. Other common signs include significant swelling (edema), especially in the face and hands, and severe headaches. If left untreated, it can progress to eclampsia, which involves seizures and is life-threatening for both mother and baby.

Question 20: Which statement about a patient’s right to refuse care is correct?

EMTs should leave immediately whenever a patient says that he or she will refuse care.
No one can authorize treatment or transport for any other individual, regardless of his or her age.
An adult patient who is of sound mind and understands the consequences can refuse treatment. (Correct answer)
A child who is old enough to understand danger is old enough to refuse care and transport.

Correct answer: An adult patient who is of sound mind and understands the consequences can refuse treatment.

Competent adults have the right to make informed decisions about their own healthcare, including refusing treatment or transport, as long as they are of sound mind and understand the potential consequences of their refusal. Minors generally cannot refuse care, and EMTs should not immediately leave but rather attempt to persuade and document the refusal thoroughly. This principle upholds patient autonomy.

Question 21: What is meconium?

Placental tissue.
First stool of the baby (Correct answer)
Umbilical cord blood.
Amniotic fluid.

Correct answer: First stool of the baby

Meconium is the baby’s first stool and can be a risk factor if aspirated at birth.

Question 22: When caring for a patient with an intellectual disability, the EMT should:

Skip the assessment since history cannot be obtained
Assume the patient cannot understand anything and speak only to caregivers
Speak directly to the patient using clear, simple language at an appropriate level, involve caregivers as supplemental resources (Correct answer)
Sedate the patient for easier management

Correct answer: Speak directly to the patient using clear, simple language at an appropriate level, involve caregivers as supplemental resources

Patients with intellectual disabilities have varying levels of understanding. The EMT should speak directly to the patient in simple, clear language, observe their responses, and use caregivers to supplement the history. Never assume no comprehension.

Question 23: As an EMT, you release information on a patient to the newspaper. The patient felt he has been slandered. Which specific area of the law may the patient sue under?

Constitutional
Federal
Tort (Correct answer)
Criminal

Correct answer: Tort

A tort is a civil wrong that causes harm or loss to another, leading to legal liability for the person who commits the act. Releasing confidential patient information to the newspaper, especially if it leads to defamation or a breach of privacy, falls under tort law. The patient could sue under this area for damages resulting from the unauthorized disclosure.

Question 24: Your patient is an 80-year-old man who has been experiencing shortness of breath. Which of the following conditions could your patient be experiencing?

Congestive heart failure
All of the above (Correct answer)
Cardiac compromise
A myocardial infarction

Correct answer: All of the above

Shortness of breath (dyspnea) in an 80-year-old patient is a non-specific symptom that can indicate several serious cardiac conditions. Cardiac compromise is a general term encompassing various heart issues, including a myocardial infarction (heart attack) and congestive heart failure. All these conditions can present with shortness of breath, making "All of the above" the most comprehensive and correct answer.

Question 25: The cardiovascular system, often known as the circulatory system, is made up of three basic components; which of the following is not one of these components?

Heart
Blood
Blood vessels
Myoglobin (Correct answer)

Correct answer: Myoglobin

The three primary components of the cardiovascular (circulatory) system are the heart (the pump), blood vessels (the conduits), and blood (the transport medium). Myoglobin is an oxygen-binding protein found within muscle tissue, particularly cardiac and skeletal muscle, but it is not considered a basic structural component of the cardiovascular system itself.

Question 26: What is the maximum amount of time that may pass while attempting an intubation?

1 minute
10 Minutes
30 Seconds (Correct answer)
10 Seconds

Correct answer: 30 Seconds

During an attempt at endotracheal intubation, it is critical to limit each attempt to a maximum of 30 seconds. Prolonged intubation attempts can lead to severe hypoxia and bradycardia, as the patient is not being ventilated during this time. If intubation is unsuccessful within 30 seconds, the rescuer must stop, ventilate the patient, and then reattempt if necessary.

Question 27: Which rewarming method is most appropriate for a moderate hypothermia patient in the prehospital setting?

Active external rewarming with chemical heat packs placed directly on bare skin
Passive external rewarming by removing wet clothing and covering with insulating blankets (Correct answer)
Immersing the patient in warm water at the scene
Active internal rewarming with warmed IV fluids administered rapidly in the field

Correct answer: Passive external rewarming by removing wet clothing and covering with insulating blankets

Passive external rewarming — removing wet clothing, protecting from wind and ground, and covering with blankets — is the appropriate prehospital method, preventing further heat loss while avoiding complications of aggressive rewarming.

Question 28: Paradoxical motion of the chest during exhalation is often caused by what type of injury?

Clavicle break
Pneumothorax
Flail Chest (Correct answer)
Hemopneumothorax

Correct answer: Flail Chest

Paradoxical motion of the chest, where a segment of the chest wall moves inward during inhalation and outward during exhalation, is a classic sign of a flail chest. This injury occurs when three or more adjacent ribs are fractured in two or more places, creating a free-floating segment that moves independently of the rest of the chest wall. This significantly impairs effective ventilation.

Question 29: Your 16 year old trauma patient has what appears to be a mid-shaft femur fracture. You notice that there is a laceration directly over the suspected fracture. Bleeding is controlled. What type of fracture would this be?

Greenstick
Closed
Open (Correct answer)
Comminuted

Correct answer: Open

An open fracture, also known as a compound fracture, is characterized by a break in the skin overlying the fractured bone, exposing the bone to the external environment. The presence of a laceration directly over the suspected femur fracture indicates that the bone may have pierced the skin or the skin was broken by the same force. This significantly increases the risk of infection compared to a closed fracture.

Question 30: What is the initial step in neonatal resuscitation?

Begin chest compressions.
Administer medications.
Intubate immediately.
Provide warmth and stimulate (Correct answer)

Correct answer: Provide warmth and stimulate

Provide warmth, clear the airway if needed, and stimulate breathing.

Question 31: What is the first thing you should do after receiving orders from the medical direction physician?

Repeat the orders exactly as you heard them. (Correct answer)
Question anything you did not understand.
Document the orders in your report.
Carry out the orders immediately.

Correct answer: Repeat the orders exactly as you heard them.

After receiving orders from medical direction, repeating them exactly as heard is a critical step in closed-loop communication. This practice ensures that the EMT correctly understood the physician's instructions and allows the physician to confirm the accuracy of the relayed orders. This minimizes miscommunication and helps prevent medical errors, ultimately enhancing patient safety.

Question 32: What is the primary concern when a patient in the third trimester lies flat on her back during transport?

Supine hypotension syndrome from aortocaval compression (Correct answer)
Back pain from uterine weight
Increased respiratory effort from diaphragm elevation
Aspiration risk from gastroesophageal reflux

Correct answer: Supine hypotension syndrome from aortocaval compression

The enlarged uterus in the third trimester can compress the aorta and inferior vena cava when supine, reducing cardiac output and causing maternal hypotension (supine hypotension syndrome).

Question 33: A right-sided brain stroke most commonly produces weakness on which side of the body?

Right side
Both sides equally
Left side (Correct answer)
Neither side

Correct answer: Left side

Because motor pathways cross, a right-brain stroke affects the left side of the body.

Question 34: Please answer the following question. As the head of the Quality Assurance Committee for your service, you review all patient care reports prior to passing them on to the medical director. On one trip sheet, you note the following narrative: Patient states that he cannot move his bowls and has had abdomenal pane for three weaks. Patient also states that he has had a fever and took too Tylenol tablets this morming, but then became naseated. What advice would you give the paramedic regarding this report?

Only document what you know how to spell.
Make up abbreviations for any words he is unsure of how to spell.
Get a dictionary and look up any questionable words when documenting. (Correct answer)
Have the EMT-B do all of the documenting.

Correct answer: Get a dictionary and look up any questionable words when documenting.

Accurate and professional documentation is paramount in EMS, as patient care reports are legal documents. Misspellings and grammatical errors can lead to misinterpretation of patient conditions, compromise legal defensibility, and reflect poorly on the provider's professionalism. Using a dictionary to look up questionable words ensures clarity, accuracy, and credibility in documentation.

Question 35: What is a sign of imminent delivery?

Minimal pain.
Mild, irregular contractions.
Crowning and urge to push (Correct answer)
High blood pressure only.

Correct answer: Crowning and urge to push

Crowning, which is the visible appearance of the baby's head at the vaginal opening, is a definitive sign that delivery is imminent and often irreversible. When combined with the mother's uncontrollable urge to push, these indicators signal that the baby is actively descending through the birth canal. This combination means the final stage of labor is underway, requiring immediate preparation for birth.

Question 36: Your patient is not responding to your loud verbal stimuli. You find the following medications: Glucophage and Lipitor. What is the likely cause of the patient’s problem?

High cholesterol
Diabetic reaction (Correct answer)
High blood pressure
Coronary Artery Disease

Correct answer: Diabetic reaction

The presence of Glucophage (metformin), a medication for Type 2 diabetes, strongly suggests the patient has a history of diabetes. An unresponsive state in a diabetic patient is most commonly caused by a severe diabetic reaction, either hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar). Therefore, a diabetic reaction is the most likely primary field diagnosis.

Question 37: What is the primary sign that distinguishes pneumothorax from pulmonary edema during physical assessment?

Respiratory rate above 20 breaths per minute
Unilateral absent or decreased breath sounds on the affected side (Correct answer)
SpO2 below 94%
Presence of cyanosis

Correct answer: Unilateral absent or decreased breath sounds on the affected side

Pneumothorax causes absence or decrease of breath sounds on the affected side due to lung collapse or air in the pleural space. Pulmonary edema produces bilateral crackles from fluid in alveoli.

Question 38: A patient with multiple complaints and an unclear presentation should be treated by the EMT as:

High priority using a 'treat the worst case scenario' approach (Correct answer)
Medium priority with routine transport
Based on which complaint the patient mentions first
Low priority until a definitive diagnosis is established

Correct answer: High priority using a 'treat the worst case scenario' approach

When the presentation is unclear, EMTs should assume the most serious possible cause and treat accordingly. This 'treat the worst' approach protects against underreacting to potentially critical conditions.

Question 39: Your patient is a 32-year-old male who was complaining of ... Your patient is a 32-year-old male who was complaining of a severe, crushing feeling in the center of his chest and shortness of breath that began while he was mowing his lawn 45 minutes prior to your arrival. He is now only responding to painful stimuli. Presently, his minute ventilation is still adequate, his pulse oximeter reads 95% on room air, and you find his skin to be pale, cool, and diaphoretic. What would be your initial action?

4-6 liters oxygen by nasal cannula.
12- 15 liters oxygen by nonrebreather. (Correct answer)
325 mg aspirin.
Sublingual nitroglycerin.

Correct answer: 12- 15 liters oxygen by nonrebreather.

This patient presents with classic signs of a severe cardiac event (crushing chest pain, shortness of breath, pale, cool, diaphoretic skin, altered mental status). Despite adequate minute ventilation and 95% SpO2, these symptoms indicate significant myocardial ischemia and potential hypoxemia at the cellular level. Administering high-flow oxygen via a nonrebreather mask (12-15 LPM) is the immediate priority to maximize oxygen delivery to the compromised heart tissue and improve cellular oxygenation.

Question 40: What is the mnemonic for determining level of consciousness?

ABC
AVPU (Correct answer)
SAMPLE
OPQRST

Correct answer: AVPU

AVPU is a widely recognized mnemonic used in emergency medical services to quickly assess a patient's level of consciousness. It stands for Alert, Verbal (responds to verbal stimuli), Pain (responds to painful stimuli), and Unresponsive. This rapid assessment helps determine the patient's neurological status and guides further evaluation and treatment.

Question 41: What condition is characterized by gasping, labored breathing, and strange vocalizations?

Obstructed Airway
Agonal Breaths (Correct answer)
Stridor
Wheezing

Correct answer: Agonal Breaths

Agonal breaths are an abnormal pattern of breathing characterized by gasping, labored, and often noisy respirations, sometimes accompanied by strange vocalizations. These breaths are a sign of severe brain anoxia and impending respiratory or cardiac arrest, and they are not effective for ventilation. They indicate a critical medical emergency requiring immediate intervention.

Question 42: Your patient is a 17 year old male found face down in a swimming pool. He is currently being held face up at the surface of the water. He is unconscious but breathing and has a pulse. What is the best course of action for this patient?

Jump into the pool and begin CPR
Remove the patient from the pool, immobilize, and transport.
Apply cervical and spinal immobilization while the patient is still in the pool (Correct answer)
Wait for a trained water rescue team

Correct answer: Apply cervical and spinal immobilization while the patient is still in the pool

A patient found unconscious and face down in a swimming pool must be treated as if they have a potential spinal injury due to the mechanism of injury. Therefore, the priority is to apply cervical and spinal immobilization while the patient is still in the water, before attempting any extrication. This prevents further injury during removal from the pool.

Question 43: A pregnant patient at 28 weeks gestation has been in a motor vehicle collision and appears hemodynamically stable. The EMT should:

Treat and release since vital signs are stable
Focus only on obvious injuries; the fetus is well protected by amniotic fluid
Position in left lateral recumbent to prevent supine hypotension, and transport to a facility with obstetric capabilities (Correct answer)
Transport supine on a backboard if spinal injury is suspected, and monitor for delayed signs of placental abruption

Correct answer: Position in left lateral recumbent to prevent supine hypotension, and transport to a facility with obstetric capabilities

Pregnant trauma patients should be positioned left lateral when possible to prevent aortocaval compression (supine hypotension). Obstetric capabilities at the receiving facility are important for fetal monitoring.

Question 44: The bleeding must be stopped in every traumatic incident where tissue damage has caused bleeding. What are the best ways to stop bleeding?

Direct pressure, digital pressure, elevation, tourniquet (Correct answer)
Tourniquet, elevation, pressure dressing, direct pressure
Direct pressure, pressure dressing, tourniquet
Direct pressure, elevation, tourniquet, digital pressure

Correct answer: Direct pressure, digital pressure, elevation, tourniquet

The most effective ways to stop external bleeding, in order of preference and effectiveness, are direct pressure, followed by elevation of the injured limb (if no fracture is suspected), and then the application of a tourniquet for severe, uncontrolled hemorrhage. Digital pressure can be used on specific pressure points but is often incorporated into direct pressure. This systematic approach ensures the most conservative yet effective methods are tried first.

Question 45: Which statement about the assessment of a patient with cardiac compromise is correct?

You should not ask patients about nitroglycerin or other drug use.
The purpose of the focused history is to determine whether to use the AED.
Patients usually describe cardiac pain as localized and moderately severe.
You cannot determine the degree of cardiac damage in the field. (Correct answer)

Correct answer: You cannot determine the degree of cardiac damage in the field.

As an EMT or paramedic in the field, you can assess signs and symptoms suggestive of cardiac compromise and initiate appropriate prehospital care. However, definitive diagnosis of the specific type or extent of cardiac damage, such as the size of an infarct or the specific coronary artery involved, requires advanced diagnostic tools like EKGs, cardiac enzymes, and imaging available only in a hospital setting.

Question 46: What is the first stage of labor?

Crowning.
Delivery of the placenta.
Dilation of the cervix (Correct answer)
Delivery of the baby.

Correct answer: Dilation of the cervix

The first stage of labor, known as the dilation stage, is characterized by the onset of regular contractions that cause progressive effacement (thinning) and dilation (opening) of the cervix. This stage is typically the longest and ends when the cervix is fully dilated to 10 centimeters, allowing the baby to pass through.

Question 47: An altered mental status patient is best initially evaluated using which scale?

Glasgow Birth Scale
Cincinnati Stroke Scale
Apgar score
AVPU scale (Correct answer)

Correct answer: AVPU scale

The AVPU scale (Alert, Verbal, Painful, Unresponsive) quickly grades level of responsiveness.

Question 48: An EMT arrives to find a woman who has just delivered in the back of a car. The baby is not crying, is limp, and has a heart rate of 70 bpm. The first intervention should be:

Begin chest compressions immediately
Dry and stimulate the baby while opening the airway (Correct answer)
Administer blow-by oxygen at 6 L/min
Place the baby in a warm blanket and transport rapidly

Correct answer: Dry and stimulate the baby while opening the airway

The initial steps for a newly born infant in distress are: dry, warm, stimulate, and open the airway. Stimulation alone may be sufficient to initiate spontaneous respirations. A heart rate of 70 is low but not below the threshold for immediate compressions.

Question 49: What is the best treatment for a suspected fracture of the talus bone?

Apply a traction splint, heat, and elevate the leg
Splint the foot, apply heat, and elevate
Apply a traction splint, ice, and elevate the arm
Splint the ankle, apply ice, and elevate (Correct answer)

Correct answer: Splint the ankle, apply ice, and elevate

The talus bone is located in the ankle. The standard treatment for a suspected fracture or significant injury to an extremity involves immobilizing the injured area with a splint to prevent movement and further damage. Applying ice helps reduce swelling and pain, while elevation also aids in minimizing swelling by promoting venous return. Traction splints are specifically used for mid-shaft femur fractures, not ankle injuries.

Question 50: Please answer the following question. You are in charge of devising an ambulance deployment plan for the EMS system within your community. Your goal is to minimize response times while simultaneously using all of the EMS resources in an efficient and cost effective manner. As such, which of the following information would be most valuable in formulating a plan?

Socioeconomic status of neighborhoods
Time and location of calls over last 5 years (Correct answer)
Location of previous ambulance collisions
Average age of the population

Correct answer: Time and location of calls over last 5 years

To devise an efficient ambulance deployment plan, analyzing historical call data is paramount. Understanding the time and location of calls over several years allows EMS systems to identify patterns and anticipate demand. This data-driven approach enables strategic placement of ambulances, minimizing response times and optimizing resource utilization in a cost-effective manner.

Question 51: At what flow rate should oxygen be set when using a non-rebreather mask (NRB) to ensure the reservoir bag remains adequately inflated?

10–15 liters per minute (Correct answer)
6–8 liters per minute
4–6 liters per minute
18–20 liters per minute

Correct answer: 10–15 liters per minute

A non-rebreather mask requires 10–15 liters per minute to keep the reservoir bag at least two-thirds full, delivering approximately 90–95% oxygen. Lower flow rates allow exhaled CO2 to re-enter the bag, reducing oxygen concentration.

Question 52: You are performing rescue breaths using an Ambu bag attached to 100% O2. After several breaths you notice the patients O2 saturation has dropped significantly. What should you do next?

Reposition the patient's head (Correct answer)
Increase the rate of respirations
Change the seal on the mask
Remove the oral airway from the patients mouth

Correct answer: Reposition the patient's head

When performing rescue breaths with a bag-mask device, a sudden drop in oxygen saturation often indicates an ineffective seal or, more commonly, an obstructed airway. Repositioning the patient's head using a head-tilt chin-lift or jaw-thrust maneuver is the most immediate and effective step to open the airway and ensure proper ventilation, allowing air to reach the lungs.

Question 53: Which of the following is a contraindication to using a nasopharyngeal airway (NPA)?

Suspected basilar skull fracture (Correct answer)
The patient is unconscious
SpO2 of 91%
Mild gag reflex present

Correct answer: Suspected basilar skull fracture

A suspected basilar skull fracture is a contraindication to NPA insertion because the NPA could pass through the fracture into the cranial vault, causing severe brain injury. A mild gag reflex actually suggests NPA over OPA.

Question 54: What is the structure that prevents food and liquid from entering the trachea during swallowing?

Epiglottis (Correct answer)
Larynx
Diaphragm
Cricoid Cartilage

Correct answer: Epiglottis

The epiglottis is a leaf-shaped flap of cartilage located at the base of the tongue. During swallowing, it folds down to cover the opening of the larynx (glottis), preventing food and liquid from entering the trachea and lungs. This protective mechanism ensures that ingested material goes into the esophagus, preventing aspiration.

Question 55: Which of the following is the most common and noticeable finding in a crush injury?

Pain (Correct answer)
Pulselessness
Paresthesia
Paralysis

Correct answer: Pain

Pain is the most common and immediate symptom reported by patients with crush injuries due to the direct tissue damage, nerve compression, and inflammation. While paresthesia, paralysis, or pulselessness can occur, they are typically later or more severe manifestations. Pain is almost universally present from the outset of a crush injury.

Question 56: You have called an air medical service to come pick up your accident victim from your scene. The helicopter contacts you when they are 5 minutes out. They ask for landing zone (LZ) information. Which of the following should be included in this safety brief?

Type of surface, road way, gravel or field
All of the above (Correct answer)
High tension power lines a quarter of a mile from the LZ
Over head obstructions

Correct answer: All of the above

A comprehensive landing zone (LZ) safety brief is essential for the safe operation of air medical services. This brief must include all potential hazards that could affect the helicopter's approach, landing, or departure. Overhead obstructions (like wires or trees), the type of surface (which affects dust or debris), and the presence of high-tension power lines are all critical pieces of information for the flight crew.

Question 57: The first step in artificial ventilation with a bagvalve-mask unit in patients with no suspected trauma is to:

Position the mask correctly on the face using both hands.
Insert an airway adjunct and select the correct mask size.
Place the patient’s head in a hyperextended, sniffing position. (Correct answer)
Have an assistant squeeze the bag until the patient’s chest rises.

Correct answer: Place the patient’s head in a hyperextended, sniffing position.

For patients with no suspected trauma, the head-tilt/chin-lift maneuver is the initial and most effective way to open the airway. This maneuver lifts the tongue off the posterior pharynx, which is the most common cause of airway obstruction in an unconscious patient. Once the airway is open, an airway adjunct can be inserted, and the mask positioned.

Question 58: At a motor vehicle crash, the EMT observes a downed power line touching one of the involved vehicles. The appropriate action is:

Ask the patient to exit the vehicle immediately
Stage at a safe distance, contact dispatch for utility company response, and do not allow anyone to approach the vehicle (Correct answer)
Attempt to move the power line with a wooden stick
Touch the vehicle to assess the patient through the window

Correct answer: Stage at a safe distance, contact dispatch for utility company response, and do not allow anyone to approach the vehicle

Downed power lines represent an electrocution and arc flash hazard. The vehicle is electrified and anyone touching it or the ground near it can be electrocuted. Stage safely and await utility company response.

Question 59: Paradoxical motion of the chest during exhalation is often caused by what type of injury?

Flail Chest (Correct answer)
Clavicle break
Pneumothorax
Hemopneumothorax

Correct answer: Flail Chest

Paradoxical motion is the hallmark sign of a flail chest, which occurs when three or more adjacent ribs are fractured in two or more places. This creates a segment of the chest wall that moves independently of the rest of the rib cage. During exhalation, the flail segment bulges out, opposite to the normal chest wall movement.

Question 60: While responding to a Hazardous Materials incident, the EMT should approach the scene from _________?

Up wind, Uphill, Up river (Correct answer)
Up wind, Uphill, down river
Down wind, Over a hill, Down river
Down wind, Down hill, Down river

Correct answer: Up wind, Uphill, Up river

When approaching a Hazardous Materials (HazMat) incident, the EMT should always approach from upwind, uphill, and upriver. This strategy minimizes exposure to hazardous substances by ensuring that airborne contaminants are blown away, liquid spills flow downhill and away, and waterborne contaminants are carried downstream, keeping responders safe from the immediate danger zone.

Question 61: Following a normal delivery, normal findings in a newborn at 1 minute include all of the following EXCEPT:

Central cyanosis with no respiratory effort (Correct answer)
Vigorous crying and active movement
Heart rate of 120 beats per minute
Pink trunk with blue hands and feet (acrocyanosis)

Correct answer: Central cyanosis with no respiratory effort

Central cyanosis (blueness of the trunk, lips, and face) with absent respiratory effort is abnormal in a newborn at 1 minute and requires immediate resuscitative intervention.

Question 62: Any penetrating missile traveling over 2,000 ft\/sec would be classified as?

Low velocity
High velocity (Correct answer)
Medium velocity
Decelerating

Correct answer: High velocity

Penetrating trauma is classified by the velocity of the missile. Any penetrating missile traveling over 2,000 ft/sec is categorized as high velocity. High-velocity projectiles cause extensive damage due to the large amount of kinetic energy transferred to the tissues, creating a significant temporary cavity and widespread tissue destruction beyond the direct path of the missile.

Question 63: You are transporting an elderly male patient in respiratory distress with a history of COPD...The patient has very shallow, rapid respirations with minimal chest wall motion and slight wheezing in the upper lung fields. Given this situation, what would you expect the arterial carbon dioxide levels to be?

Elevated (Correct answer)
Lowered
Not enough information to determine
Normal

Correct answer: Elevated

The patient's history of COPD, combined with shallow, rapid respirations and minimal chest wall motion, indicates ineffective ventilation. This impaired gas exchange means that carbon dioxide is not being adequately expelled from the lungs. Consequently, carbon dioxide will accumulate in the bloodstream, leading to elevated arterial carbon dioxide levels (hypercapnia).

Question 64: When managing an open fracture, you should do which of the following?

Provide mild manual traction to restore distal circulation.
Apply a pressure dressing to prevent blood loss.
Leave the wound exposed if there is no massive bleeding from the area.
Cover the exposed bone ends with a moist sterile dressing. (Correct answer)

Correct answer: Cover the exposed bone ends with a moist sterile dressing.

When managing an open fracture, the primary goal after controlling any severe bleeding is to protect the exposed bone ends from contamination and further injury. Covering the wound with a moist sterile dressing helps prevent infection by creating a barrier and keeps the exposed tissues viable. This step is crucial before immobilization and transport.

Question 65: Which condition is more common in elderly patients?

Cystic fibrosis.
Asthma.
Chickenpox.
Osteoporosis and heart disease (Correct answer)

Correct answer: Osteoporosis and heart disease

Elderly patients are more prone to conditions like osteoporosis and heart disease.

Question 66: Which of the following complaints is often used to describe chest pain resulting from a cardiac event?

A ton of bricks on my chest (Correct answer)
Sharp stabbing pain which can be located with one finger
A tickling feeling
Dull tooth ache, nagging discomfort

Correct answer: A ton of bricks on my chest

Chest pain resulting from a cardiac event, such as a myocardial infarction, is frequently described as a heavy, crushing, or squeezing sensation. Patients often use phrases like 'a ton of bricks on my chest' or 'an elephant sitting on my chest' to convey the intense pressure and discomfort. This diffuse, oppressive pain is a classic symptom of cardiac ischemia.

Question 67: What condition is characterized by a high pitched sound resulting from turbulent air flow in the upper airway? It may be inspiratory, expiratory or present on both inspiration and expiration.

Wheezing
Asthma
Respiratory Arrest
Stridor (Correct answer)

Correct answer: Stridor

Stridor is a high-pitched, harsh sound, typically heard on inspiration, that results from turbulent airflow through a narrowed upper airway. It indicates a significant obstruction in the larynx or trachea, which can be caused by foreign bodies, swelling, or anatomical abnormalities. Stridor is a serious sign requiring immediate assessment and intervention.

Question 68: In order to assist intubation, a paramedic may utilize Sellick's maneuver. In this procedure, which cartilage are you compressing?

Cricoid cartilage (Correct answer)
Aryepiglottic cartilage
Hyoid cartilage
Thyroid cartilage

Correct answer: Cricoid cartilage

Sellick's maneuver, also known as cricoid pressure, involves applying firm pressure to the cricoid cartilage. This maneuver is performed during intubation to compress the esophagus against the cervical vertebrae, aiming to prevent gastric regurgitation and aspiration into the lungs. It helps improve visualization of the vocal cords by displacing the larynx posteriorly.

Question 69: You are dispatched to a 75-year old female patient who is currently in cardiac arrest. After one shock via the AED she begins breathing at 15 breaths per minute, and has a strong carotid pulse; what is your next step?

Request a non-transport and leave the scene
Assist ventilations with a bag-valve mask
Provide supplemental oxygen by NRB (Correct answer)
Continue to administer shocks via AED

Correct answer: Provide supplemental oxygen by NRB

After a patient in cardiac arrest receives a shock from an AED and regains a pulse and spontaneous breathing, the immediate next step is to provide post-resuscitation care. This includes ensuring adequate oxygenation and ventilation. Providing supplemental oxygen via a non-rebreather mask (NRB) is appropriate to support their breathing and oxygen levels as they recover.

Question 70: What law provides protection from legal action to someone who provides help to an injured person?

EMT Registration
Good Samaritan law (Correct answer)
Duty to act
No law exists

Correct answer: Good Samaritan law

Good Samaritan laws are designed to protect individuals who voluntarily provide emergency medical assistance to an injured person from legal liability. These laws encourage bystanders to help in emergencies by ensuring they won't be sued for negligence, provided they act in good faith, without expectation of payment, and within their scope of training or knowledge.

Question 71: This practice of protecting yourself and your patient from the transfer of bodily fluids is known as what?

Universal Precautions
Being Safe
Wearing Gloves
Body Substance Isolation (Correct answer)

Correct answer: Body Substance Isolation

Body Substance Isolation (BSI) is a comprehensive infection control strategy that assumes all bodily fluids are potentially infectious. It involves using personal protective equipment (PPE) such as gloves, masks, eye protection, and gowns to create a barrier between the EMT and the patient's bodily substances. This practice protects both the patient and the provider from the transfer of pathogens.

NREMT Cognitive Exam (EMT)

This computer adaptive test (CAT) evaluates the cognitive knowledge and critical thinking skills required for entry-level Emergency Medical Technicians.

Questions

120 min

Time Limit

70%

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