NREMT-EMR

Shock is caused by:

inadequate tissue perfusion. Shock (hypoperfusion) develops as a result of inadequate tissue perfusion and disrupts the body homeostasis. It is not typically caused by hyperactivity of an organ or systemic vasoconstriction.

You are caring for a 12-year-old who was injured at the neighborhood skate park. He was not wearing a helmet and is responsive to pain. You note snoring respirations and deformity to the left ankle. You should:

open the airway using a jaw-thrust maneuver.

Which of the following physiological responses helps protect the body from overheating:

peripheral vasodilation. Peripheral vasodilation helps the body dissipate body heat. Peripheral vasoconstriction helps the body conserve body heat. Shivering helps generate body heat. Syncope can result from overheating; it is not a protective mechanism.

You are considering administration of oral glucose to your diabetic patient. This drug is contraindicated when it:

poses a significant risk of harm. Medications are contraindicated when the risks outweigh the potential benefits. Oral glucose does not require a prescription. Some undesired effects (side effects) do not contraindicate use of a drug.

Your patient is a construction worker who fell from a residential rooftop. He is responsive to pain. Breaths are shallow and irregular. You should:

provide artificial ventilations with a bag-mask device and high flow oxygen.

Which of the following signs of hypoxia is more commonly found in pediatric patients?

seesaw respirations

You are dispatched for a possible CVA. Upon arrival, you determine the patient is responsive to painful stimuli. Which of the following should be assessed first for this patient?

Airway

Which of the following describes the purpose of administering aspirin to a suspected myocardial infarction patient?

Aspirin reduces platelet aggregation in the coronary arteries.

You are caring for a confused and restless 16-year-old female with blunt chest trauma following a single vehicle accident. She complains of dyspnea and orthopnea. You note a reduced tidal volume, cyanosis and tachycardia. Which of the following should be done first?

Begin positive pressure ventilations. The patient has inadequate ventilations. Positive pressure ventilations should be initiated before other assessments are performed.

Your patient is unresponsive following blunt trauma to the head. Which of the following is the EMT's first priority for an unresponsive patient?

Determine if CPR is indicated Unresponsive patients should be assessed using the CAB sequence. Circulation is assessed first in order to begin CPR as quickly as possible if needed.

While attempting to restrain a combative patient, your partner was bitten on the arm. Which of the following is true of bite wounds?

Human bites pose a high risk of infection. Human bites can be highly infectious. Vaccines do not prevent the risk of infection from a bite wound. Human saliva does not contain anticoagulant enzymes.

Which of the following medications is intended to decrease myocardial workload and increase myocardial blood flow?

Nitroglycerin Nitroglycerin is a vasodilator, so it can increase blood flow to the heart and reduce systemic vascular resistance. Activated charcoal is an adsorbent, aspirin is an anti-platelet aggregate, and epinephrine is a sympathomimetic.

You are caring for an unresponsive diabetic patient with deep, rapid respirations. The patient's blood glucose is 480 mg/dL. What is the most likely cause of this patient's hyperventilations?

This patient is likely hyperventilating due to severe acidosis. This patient is presenting with signs of DKA and Kussmaul ventilations. The hyperventilations are most likely due to severe acidosis. Hyperventilations will likely reduce CO2 levels. Hyperventilations cannot rapidly lower blood glucose levels.

Treatment should begin at a mass casualty incident:

after triage has been completed.

Your patient has severe bleeding to her forearm. If direct pressure does not control the bleeding, you should immediately:

apply a tourniquet. A tourniquet should be applied if bleeding from an extremity is not controlled by direct pressure. Application of a tourniquet should not be delayed to apply arterial pressure or for transport. Blood-soaked dressings should be covered, NOT removed.

While assessing an unresponsive patient, you discover a penetrating wound to the anterior chest. You should first:

apply an occlusive dressing. Penetrating chest wounds should be covered with an occlusive dressing before applying a trauma dressing. This should be done before performing continuing the assessment of assessing vitals.

A nonrebreather mask should be administered to patients who:

are breathing adequately with signs of hypoxia. A nonrebreather mask is indicated for spontaneously breathing patients with adequate ventilations and signs of hypoxia. Patients with inadequate, slow, or shallow ventilations should be ventilated.

An elderly patient reportedly collapsed on a golf course almost 10 minutes ago. You assess her level of consciousness and determine she is unresponsive. Which of the following should you do first:

assess pulse and begin CPR if needed

Nerve agents and choking agents are examples of:

chemical agents.

You are called for a 6-month-old infant with respiratory distress. Which of the following is true about patients in this age group?

infants are obligate nose breathers.

How should you open the airway of an unresponsive patient with an unknown mechanism of injury?

jaw-thrust maneuver

Which of the following conditions would most likely cause hypovolemic shock?

laceration of the liver. The liver is a solid organ and can bleed profusely when injured. Laceration of the liver would likely lead to hypovolemic shock. A spinal cord injury would most likely lead to distributive shock due to vasodilation. Insulin shock is not a common cause of hypovolemia (DKA is). Appendicitis is more likely to lead to septic shock.

The hypoxic respiratory drive works by monitoring:

oxygen levels.

You are called for a 40-year-old female with a severe headache. She is 32 weeks pregnant. The patient history reveals she also has nausea, blurred vision and sudden edema in her face and hands. Her blood pressure is 156/96. The patient is most likely experiencing:

preeclampsia. The patient has many of the classic signs and symptoms of preeclampsia. Eclampsia includes seizure activity. The signs and symptoms of an absence seizure and spontaneous abortion are very different than those presented in this question.

A patient with an isolated concussion injury will likely:

progressively improve over time Concussion patients typically improve over time, they do NOT typically get worse. A head injury patient that loses consciousness for long periods or requires an extended hospital stay likely has injuries beyond a concussion.

Carbon monoxide exposure is dangerous because it:

reduces delivery of oxygen.

A 30-year-old male was stabbed in the abdomen during an assault. The knife is impaled in his the right lower abdominal quadrant. It is important to:

stabilize the knife in place.

Which of the following findings indicates partial obstruction of the upper airway?

stridor. Stridor occurs in the upper airway. Rales, rhonchi and wheezes occur in the lower airway.

The rapid extrication technique should be used at a motor vehicle accident when:

the patient has life-threatening injuries.

Your pediatric patient has spontaneous respirations. This means the patient is breathing:

without assistance. Spontaneous breaths are unassisted breaths taken by the patient. Spontaneous breaths may occur at any rate or tidal volume and with or without difficulty.

Your patient has a partial thickness burn to his anterior chest. It is about the size of the palm of his hand. What is the approximate total body surface area of the burn?

1%

When there are signs and symptoms that your patient is hypoxic, you should:

Administer oxygen at 15 lpm via nonrebreather mask.

An oropharyngeal airway is indicated for which of the following patients?

a 44-year-old unconscious patient. OPAs are for unresponsive patients without a gag reflex. Three of the four options refer to patients that are not unresponsive.

Your patient has partial-thickness burns over a large surface area. You should:

apply a dry, sterile burn sheet

You are dispatched to the local jail for a prisoner found unresponsive in her cell. Her airway is clear. Respirations are rapid and shallow. The pulse oximeter (SaO2) reads 90%. Your first action should be to:

begin positive pressure ventilations. This patient requires artificial ventilations based on inadequate ventilations, a low pulse oximeter, and a decreased LOC. This should take place before assessing the blood glucose, blood pressure, or patient transport.

Which of the following is the first priority at a hazardous material incident?

ensure your own safety.

A 16-year-old male is unconscious following an assault. When you insert an OPA, the patient begins gagging. You should:

remove the airway and prepare to suction as needed

You arrive at a residence for an ill person. A child opens the door and says his dad is locked in the bedroom with his gun. You should:

retreat to safety and request law enforcement

Epinephrine stimulates which of the following physiological effects?

tachycardia. Epinephrine stimulates the sympathetic nervous system. This causes tachycardia and peripheral vasoconstriction. It does not have a sedative affect.

When caring for a patient with a behavioral emergency, remember:

the behavior may be caused by a physiological condition.

You are transporting a pregnant patient from an urgent care center to a high-risk OB facility. The transferring physician tells you the patient may have an abruptio placenta. This means:

the placenta is prematurely separating from the uterine wall.

You are caring for a 3-year-old patient in cardiac arrest. What is the correct compression to ventilation ratio for two-person CPR on this patient?

15 compressions to 2 ventilations

When a pulse oximeter is available, how should oxygen be administered to a patient experiencing chest pain?

Administer oxygen to maintain a pulse oximeter reading of at least 94%.

You are caring for a six-year-old patient with respiratory distress. The pulse oximeter (Sa02) reads 93%. Your management of the patient should include:

Administer sufficient oxygen to maintain a pulse oximeter reading of at least 94% Oxygen is indicated for patients with signs or symptoms of hypoxia, including a pulse oximeter below 94%. EMTs should not withhold oxygen from a patient with a pulse oximeter below 94%. EMTs do not contact the patient€™s physician for medical direction, nor do they administer MDIs which are not prescribed to the patient.

You are treating a 35-year-old man who was stung by a bee. He is allergic to bees and has a prescribed epinephrine auto-injector. His breath sounds are clear and non-labored. His BP is 130/82. How should you manage this patient?

Assess the patient for signs of hypoxia, administer oxygen as needed, and transport.

Your 5-year-old patient is unresponsive. A carotid pulse is present at 40 beats per minute. Breaths are shallow at six per minute. You should immediately:

Begin chest compressions CPR, beginning with chest compressions, is indicated for unresponsive children with a pulse rate below 60.

You respond to a preschool facility for an ill child. Upon arrival, you find an unresponsive 8-month-old. The infant has a palpable pulse of 50 beats per minute. Your next action should be to:

CPR, beginning with chest compressions, is indicated for unresponsive children with a pulse rate below 60. This should be done before transport. The AED is not indicated for patients with a pulse.

Which of the following accurately describes supine hypotensive syndrome?

Compression of the inferior vena cava by the uterus. Supine hypotensive syndrome occurs when the weight of the fetus and uterus compresses the inferior vena cava. This reduces the return of blood to the heart, reducing cardiac output and blood pressure.

The primary assessment of an adult with chest pain includes:

Determine the transport priority. Determining the patient transport priority is a component of the primary assessment. Scene safety is determined during the scene size up. Determining specifics about the patients pain and reassessing vitals are done later in the assessment process.

Which of the following statements about distributive shock is correct?

Distributive shock is caused by widespread vasodilation. Distributive shock is caused by systemic vasodilation. Impaired cardiac function leads to cardiogenic shock. Severe bleeding leads to hypovolemic shock. Severe hypoglycemia leads to insulin shock.

Life-threatening bleeding should be found and treated during the:

Primary assessment.

Your patient was injured during an industrial accident. He has an abdominal laceration with internal organs protruding. You should apply:

a moist, sterile dressing.

Which of the following patients should be your highest transport priority?

a partial-thickness burn with respiratory compromise.

You are caring for a patient who was ejected during a single vehicle rollover. The patient responds incoherently to verbal commands. You should first:

assess the patient's airway.

You are the first ambulance on the scene of a motor vehicle accident. Your first action upon arrival should be to:

assess the scene for hazards.

To determine if CPR is indicated for an unresponsive patient less than one year of age, you should assess the:

brachial pulse.

In unresponsive patients over one year of age, you should palpate the:

carotid pulse

While working out at the gym, you witness someone collapse. The patient is apneic with a pulse. You begin performing mouth-to-mask ventilations. What percentage of oxygen is your patient receiving?

16% Exhaled air contains about 16% oxygen; consequently, a patient receiving mouth to mask ventilations without supplemental oxygen will receive about 16% oxygen. Atmospheric air contains 21% oxygen.

Which of the following is true during inhalation of a spontaneously breathing patient?

There is a drop in pressure within the thorax.

Which of the following interventions should be performed first for an unresponsive patient with a suspected spinal cord injury?

Jaw thrust maneuver. The head-tilt, chin-lift is contraindicated for patients with suspected spinal injury. Manual airway techniques, in this case the jaw thrust maneuver, should be performed before inserting a mechanical airway adjunct.

Which of the following is considered a normal capillary refill time for infants and children?

Less than 2 seconds

You are first on the scene of a motor vehicle collision involving multiple vehicles. Which of the following should you do first:

Request additional resources. Requesting additional resources is part of the scene size up. Rescuers should request additional resources as quickly as possible, before triage, extrication, or the primary assessment.

You are caring for a 22-year-old female who complains of respiratory distress after exercising. She is alert, speaking full sentences, and has a persistent cough. She is most likely experiencing:

Respiratory distress with adequate breathing. The patient is alert and speaking full sentences. These signs indicate the patient is breathing adequately. Respiratory paralysis and respiratory arrest are not possible because the patient is alert and speaking.

Which of the following is true regarding the Emergency Response Guide (ERG):

The ERG helps identify the evacuation distance for specific hazardous materials.

You are caring for a multi-system trauma patient with possible internal bleeding. Select the correct statement about the rapid scan for a multi-system trauma patient:

The rapid scan is used to identify life-threatening conditions. The rapid scan is part of the primary assessment and is meant to identify any lift-threatening conditions not already discovered. It is not used to identify low priority injuries, this should be done during the secondary assessment. Any patient with the potential for life threatening conditions, conscious or unconscious, should receive a rapid scan.

Shallow respirations and bradypnea will likely cause:

a decrease in minute volume. Shallow respirations and bradypnea can both contribute to a decrease in minute volume. Neither will improve visibility of chest rise, an increased pulse oximeter reading, or reduced carbon dioxide levels.

Your patient exhibits crepitus to the thorax, paradoxical motion and signs of hypoxia. You should suspect:

a flail chest.

An elderly female reportedly had a severe headache for the last 24 hours. She was recently found unconscious in bed. Her family reports she has a history of hypertension and transient ischemic attacks (TIAs). The patient's current condition is most likely due to:

a hemorrhagic stroke.

Your adult patient reportedly smoked an unknown substance and passed out. The patient has inadequate ventilations and your partner begins ventilating with the BVM. Which of the following is the best indicator your patient is being ventilated adequately?

adequate bilateral chest rise and fall during BVM ventilation. Adult R- 12-20

A 36-year-old female presents with a sudden onset of difficulty breathing. She is anxious, has intercostal retractions and nasal flaring. Her respiratory rate is 24 breaths per minute. You do not have a pulse oximeter. You should:

administer oxygen via nonrebreather mask at 15 lpm

You are dispatched to a neighborhood park on a warm day for an 8-year-old with difficulty breathing. You find the patient breathing adequately but with some accessory muscle use. You note expiratory wheezes and a persistent cough. You suspect the patient is experiencing:

an asthma attack. Dyspnea, accessory muscle use, wheezing, and a cough are signs common signs and symptoms of asthma. Pulmonary edema is not common in pediatric patients and would likely cause rales, not wheezes. The patient would not be breathing adequately with a severe airway obstruction. The signs and symptoms of heat exhaustion would not be primarily respiratory in nature.

Your 67-year-old patient recently began taking a new medication. He is complaining of a sudden onset of severe respiratory distress. He quickly becomes semi-conscious and unable to follow verbal commands. His pulse oximeter (SaO2) is 89%. You should:

assist ventilations with a BVM. The patient has respiratory distress with inadequate breathing. The patient requires positive pressure ventilations. CPAP and an OPA are not appropriate for a semi-conscious patient

During a hazardous materials incident, you should take standard precautions:

before making contact with the patient.

You are dispatched to a soccer game for a 12-year-old female with signs and symptoms of an allergic reaction. Upon arrival, the patient's mother hands you an epinephrine auto-injector. You should:

begin the primary assessment. A primary assessment must be conducted before determining if an epi-pen should be administered. EMTs receive medical direction from their medical director(s), not the patient€™s physician.

Which of the following signs of hypoxia is more common in pediatric patients?

bradycardia Bradycardia is a more common sign of hypoxia in pediatric patients. Anxiety, tachycardia, and restlessness are common signs of hypoxia in patients of all ages.

Which of the following provides oxygenated blood directly to the heart?

coronary arteries. The coronary arteries provide oxygenated blood to the heart. The carotid and cerebral arteries provide blood to the brain.

Your 6-year-old patient jumped from a swing and injured his right leg. You note deformity to the right leg above the ankle. The patient most likely has a fracture to the:

distal tibia. The radius and ulna are located in the arm, not the leg. A proximal fibula injury would be closer to the knee, not the ankle.

You are on the scene of a motor vehicle accident. The driver is trapped in a vehicle that is leaking an unknown fluid. When is it appropriate to enter the vehicle and begin patient care?

do not enter until trained rescuers determine the vehicle is safe to enter.

Coordinating efforts through a unified command system at a mass casualty incident will likely:

educe duplication of effort and freelancing

The most common weapon of mass destruction used by terrorists is

explosive weapons.

Continuous positive airway pressure (CPAP) can reduce respiratory distress by:

helping to keep the alveoli open. CPAP helps to keep the alveoli open. CPAP is a treatment for sleep apnea and can help avoid intubation. CPAP does not relieve FBAO.

Inadequate oxygen delivery to the body's tissues is called:

hypoxia

The foramen magnum:

is an opening at the base of the skull. The foramen magnum is a large opening at the base of the skull that allows the brain and spinal cord to connect. The atlas (C1) and axis (C2) allow for lateral movement of the head.

You and your partner are preparing to lift the stretcher into the ambulance with a 300-pount patient. To protect yourself from injury, you should:

keep your back straight and bend at the knees.

You are treating a patient with respiratory distress. He has a history of multiple myocardial infarctions. Lung sounds indicate pulmonary edema. You note the patient does NOT have any JVD or pedal edema. The patient is most likely experiencing:

left heart failure. Pulmonary edema indicates possible left heart failure. Pedal edema and JVD indicate possible right heart failure. The patients presentation is not consistent with angina or asthma.

You are dispatched for a homeless person found unresponsive. You find the patient prone on the sidewalk unresponsive to pain. You should first:

log roll the patient into a supine position.

You are ventilating a patient with a stoma. You note air is escaping from the mouth and nose with each breath. You should:

manually seal the mouth and nose.

You are treating an unresponsive patient with slow, shallow respirations and pinpoint pupils. Which of the following conditions is most likely?

narcotic overdose. Bradypnea, shallow respirations, and pinpoint pupils are common signs with a narcotic overdose. This combination is not typical with an MI, hyperglycemia, or an amphetamine overdose.

You are first on the scene of an overturned container truck. You note a placard, but do not recognize the ID number. There is fluid leaking from the vehicle. You should:

notify your dispatcher a hazardous materials team is needed

Which of the following adult patients is breathing adequately?

patient with respirations at 16 per minute and equal chest rise and fall.

Your 8-year-old patient has blunt chest trauma after being struck by a car. The patient is alert. His airway is clear, breathing is adequate, and pulses are present but weak at 110 beats per minute. Which of the following should you do next?

perform a rapid scan

Which of the following vessels carries deoxygenated blood?

pulmonary arteries. The pulmonary arteries are the only arteries which carry deoxygenated blood. The pulmonary veins are the only veins which carry oxygenated blood.

The left side of the heart receives oxygenated blood from the:

pulmonary veins. The left side of the heart receives oxygenated blood from the pulmonary veins. The right side of the heart receives deoxygenated blood from the venae cavae. Deoxygenated blood leaves the right heart through the pulmonary arteries.

You are conducting a primary assessment on an elderly fall victim who complains of hip pain. While assessing circulation, you should check:

pulses, external bleeding and skin condition Pulses, bleeding, and skin condition are three components of circulation that should be included in the primary assessment. Pulse oximetry, lower extremities, motor function, and sensation are not part of the circulatory component of the primary assessment.

You are caring for an apneic patient with a suspected overdose. You have loaded the patient into the ambulance and entered the patient compartment. You should first:

put on your seat belt.

A 19-year-old female is found unconscious in her apartment living room. While surveying the apartment, your partner yells from the patient's bedroom "she has an SVN machine in here". This suggests the patient has a history of:

respiratory problems. An SVN machine is used to nebulize bronchodilator medications. This indicates a probable history of respiratory problems.

You are called for a drowning victim at a family barbecue. Upon arrival, two family members approach you yelling, swearing, and demanding to know what took so long. One of the family members pushes you. You should:

retreat and request immediate assistance from law enforcement. Scene safety is the EMT first priority. This scene is not safe and rescuers should withdraw from the scene until it is.

While eating dinner, your partner suddenly grabs his throat and has a panicked look on his face. He is unable to speak, has a faint inspiratory stridor and cyanosis around the lips. You should:

stand behind him and administer abdominal thrusts.

Which of the following is the most frequent cause of airway obstruction?

the tongue.

Your patient has been exposed to a chemical that over-stimulates the parasympathetic nervous system. You would expect this patient to exhibit:

vomiting. The parasympathetic nervous system exerts control over digestive functions. Over stimulation can lead to vomiting. Dilated pupils, dry mouth, and hypertension are more likely caused by stimulation of the sympathetic nervous system.