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Quiz Session - Attempts With Random Questions

NREMT EMT Exam Questions

Page 2 of 52

21.

Which of the following principles allows an emergency medical technician to treat and transport an adult patient who is intoxicated? 

  • Implied consent

  • Expressed consent

  • Informed consent

  • Advance directive

Correct answer: Implied consent

Implied consent is assumed if a patient is unconscious or otherwise incapable of making a rational, informed decision. Examples of this are patients who are intoxicated by drugs or alcohol, mentally impaired, or suffering from a condition that precludes making a rational, informed decision (e.g., head injury). Implied consent only applies when a serious medical condition exists (i.e., a threat to life or limb). Every effort should be made to obtain consent from an available relative prior to treatment, but lifesaving care should not be delayed while waiting for such consent.

Expressed consent is the verbal authorization for, or otherwise acknowledgment of, treatment and/or transport. For consent to be legitimate, there must also be informed consent.

Informed consent is given after the patient understands the risks, benefits, and alternatives to treatment/transport, as well as the consequences of the refusal of treatment.

An advance directive is a written document that specifies medical treatment for a competent patient if they become unable to make decisions. 

22.

Which of the following would an emergency medical technician (EMT) be required to report to the proper authorities if suspected or discovered during treatment and/or transport?

  • Suspected child abuse

  • Illegal drug use

  • Physical injury from a fall

  • Alcohol use by a teen

Correct answer: Suspected child abuse

Special reporting situations may include mass-casualty incidents, gunshot wounds, animal bites, specific infectious diseases, or suspected physical or sexual abuse. Local laws and protocols dictate which incidents require special reporting. Drug or alcohol use by adults is not a mandatory reporting event in which EMS must contact authorities.  

Signs of abuse vary in pediatric patients. Some signs and symptoms include injuries (e.g., bruises, burns) at varying stages of healing, injuries to the genitals/buttocks, unusual patterns of injury, femoral fractures without obvious trauma, inappropriate parental concerns, a lack of supervision, a delay in seeking care, suspicious circumstances, and a history that is inconsistent with the injury.

23.

Which of the following dysrhythmias is most likely to deteriorate into ventricular fibrillation?

  • Ventricular tachycardia

  • Atrial tachycardia

  • Asystole

  • Atrial fibrillation

Correct answer: Ventricular tachycardia

Ventricular tachycardia is a rapid heart rhythm, usually between 150 and 200 beats per minute. In this case, electrical activity begins in the ventricle, instead of the atrium. There is not sufficient time for the ventricle to fill with blood, leading to a subsequent drop in blood pressure. Patients may complain of weakness or lightheadedness or may be unresponsive. Some cases of ventricular tachycardia deteriorate into ventricular fibrillation.

Atrial tachycardia, atrial fibrillation, and asystole are not known to convert to ventricular fibrillation.

24.

A 62-year-old obese patient complains of abdominal pain. She is conscious and alert but anxious. Her skin is cool and clammy, her heart rate is fast, and she may be experiencing hypovolemic shock. 

Which of the following would be most appropriate in this case?

  • Lay the patient flat on her back (supine)

  • Lay the patient face down (prone)

  • Sit the patient upright (Fowler or semi-Fowler)

  • Lay the patient flat on her left side (left lateral recumbent)

Correct answer: Lay the patient flat on her back (supine)

It may be difficult to lay an obese patient supine. However, any patient with suspected or obvious shock should be placed in the supine position; patients who are hypotensive are also placed in the supine position.

Patients who have no suspected injury and complain of chest pain or respiratory distress may be placed in a position of comfort, either the Fowler or semi-Fowler position. Pregnant patients should be placed on their left side. It is not appropriate to place a patient in the prone position.

25.

Which of the following statements is true regarding nitroglycerin?

  • Nitroglycerin is a vasodilator.

  • Nitroglycerin is indicated for patients with any chest pain.

  • Nitroglycerin should not be used for patients who have taken erectile dysfunction medication within the previous week.

  • Nitroglycerin is contraindicated in patients with systolic blood pressure under 110 mmHg.

Correct answer: Nitroglycerin is a vasodilator.

Nitroglycerin is a vasodilator that is indicated for patients with cardiac chest pain. Medical direction must be obtained, and the "rights" of medication administration must be checked before assisting in the administration of this medication.

Nitroglycerin is contraindicated in patients who have a systolic blood pressure below 100 mmHg, patients with a head injury, patients who have taken erectile dysfunction medications within the previous 48 hours, and patients who have already taken their maximum dose (typically three doses).

Most patients are allowed to repeat doses (typically up to three) if the pain remains after five minutes. Blood pressure should be assessed before the administration of initial or repeated nitroglycerin.

Headaches are a common side effect.

26.

An adult patient is found pulseless and apneic. CPR was initiated by bystanders. Which of the following is appropriate during automated external defibrillator (AED) use?

  • Ensure no one is touching the patient during analysis and defibrillation

  • Get the patient away from any water, even small puddles

  • Remove the patient if found in the snow

  • Always place the pads in an anterior/posterior position

Correct answer: Ensure no one is touching the patient during analysis and defibrillation

No one should touch the patient during analysis and defibrillation. Touching the patient during analysis may alter the AED's ability to assess a cardiac rhythm appropriately. Touching the patient during defibrillation may cause the rescuer to be shocked by the AED. If a shock is advised, chest compressions should be resumed while the AED is charging.

Not all AEDs use the anterior/posterior position for pad placement. Studies have shown that the apex/sternal positions have better defibrillation success rates with biphasic shocks. 

An AED may be used if a patient is in a small puddle of water or in the snow; however, the patient’s chest should be dried as much as possible. It is not appropriate to use an AED if a patient is submerged in water.

27.

During a scene size-up, all of the following components should be addressed except which one?

  • Forming a general impression

  • Ensuring the safety of the scene

  • Determining the need for additional resources

  • Determining the mechanism of injury/nature of illness

Correct answer: Forming a general impression

A scene size-up includes ensuring scene safety, determining the mechanism of injury/nature of the illness, taking standard precautions, determining the number of patients, and considering the need for additional or specialized resources.

The scene size-up does not include forming a general impression; this is completed during the primary assessment.

28.

Which of the following is the largest bone in the body?

  • Femur

  • Pelvis

  • Skull

  • Clavicle

Correct answer: Femur

The femur, the upper portion of the lower extremity (thigh), is the longest, largest, and strongest bone in the body. During a motor vehicle crash, the knee may strike the dashboard and force the head of the femur into the pelvis. A fracture of the pelvis can result in life-threatening internal bleeding.

The pelvis is a ring of bones that supports the weight of the upper body. The two major bones in the pelvis are the coxal bones, each comprised of three smaller bones that fuse together: the ilium, ischium, and pubic bone.

The skull is made of two sets of bones, those of the face and those of the cranium (forehead and back of the head). The cranium consists of eight large flat bones, which are joined by fixed joints known as sutures.

The clavicle (collarbone) is a thin bone that bridges the top of the sternum to the shoulder socket at the end of the shoulder blade. It is the only bone in the shoulder that connects directly to the ribcage.

29.

Which of the following is an absolute contraindication to injectable epinephrine use in a life-threatening allergic situation?

  • No contraindications

  •  Angle-closure glaucoma

  •  Hypertension

  •  Pregnancy when maternal systolic blood pressure is over 130 mm Hg

Correct answer: No contraindications

There are no absolute contraindications to the use of injectable epinephrine in a life-threatening allergic situation. 

Some products include the following contraindications: hypersensitivity to sympathomimetic amines, narrow-angle glaucoma, non-anaphylactic shock, thyrotoxicosis, in obstetrics when maternal blood pressure is over 130/80 mm Hg, and hypertension and other cardiovascular disorders.

Injectable epinephrine may aggravate angina or induce cardiac arrhythmias. Caution is suggested, particularly for patients receiving drugs that sensitize the myocardium. Peripheral constriction and cardiac stimulation may occur, inducing pulmonary edema; and decreased urine output may develop in patients with renal compromise.

30.

Which of the following is generally not included in a patient care report?

  • EMS opinion of the incident

  • Subjective findings endorsed by the patient

  • Initial assessment

  • Patient demographics

Correct answer: EMS opinion of the incident

The following are generally included in a patient care report:

  • patient information and demographics
  • chief complaint
  • level of consciousness
  • vital signs
  • objective and subjective findings from assessments
  • treatment provided
  • times of incident reporting, EMS notification, EMS arrival on scene, EMS departure from scene, EMS arrival at receiving facility, and transfer of patient care

Patient care reports should be free of EMS opinion of the incident. Use objective data only.

31.

Which of the following statements is false regarding viral hepatitis?

  • Asymptomatic patients with hepatitis C cannot transmit the virus.

  • Jaundice and right upper quadrant pain often occur several weeks after infection.

  • Vaccines are available for hepatitis A and B.

  • Hepatitis can be caused by cytomegalovirus.

Correct answer: Asymptomatic patients with hepatitis C cannot transmit the virus.

Hepatitis is a general term referring to inflammation of the liver, and it may result from either infectious (viral, bacterial, fungal, and parasitic organisms) or noninfectious (alcohol, drugs, autoimmune diseases, and metabolic diseases) causes.

In the United States, the most common causes of viral hepatitis are hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). All three of these viruses can result in acute disease, causing nausea, abdominal pain, fatigue, malaise, and jaundice. HBV and HCV also produce chronic infection, which can lead to cirrhosis and cancer.

Infections with hepatitis viruses, especially HBV and HBC, have been associated with a variety of extrahepatic manifestations. Other, infrequent causes of viral hepatitis include adenovirus, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes simplex virus (HSV).

Early signs and symptoms include a loss of appetite, vomiting, fever, fatigue, sore throat, coughing, and muscle and joint pain. Jaundice and right upper quadrant pain can develop several weeks after exposure. Vaccines are available for HAV and HBV, and new treatments for HCV are nearly 100% effective.

32.

An unresponsive 40-year-old male is apneic and cyanotic. He has a weak carotid pulse of 48 beats per minute. Rescue breathing via a bag-valve mask with a reservoir and supplemental oxygen is initiated. 

What is the appropriate ventilation rate for this patient?

  • One breath every five seconds to mimic a normal respiration rate

  • One breath every other second until his heart rate improves

  • One breath every two seconds until the patient's color improves

  • One breath every 10 seconds to match his low cardiac output

Correct answer: One breath every five seconds to mimic a normal respiration rate

A patient in respiratory distress or failure requires artificial ventilation. A bag-valve mask is an adequate method of artificial ventilation and can deliver up to 100% oxygen flowing at 15 liters per minute and a reservoir bag. 

Ventilation should be given to an adult patient every five seconds and to a child patient every three seconds; these rates mimic a normal ventilation rate. Any rate below these values may not provide adequate oxygenation. Ventilation should cause the chest to rise and fall and avoid gastric distension. Gastric distension may lead to vomiting and subsequent aspiration.

Rapid ventilation should be avoided due to the risk of gastric distension.

33.

According to AHA guidelines, which of the following should be considered for adult patients with ischemic-type chest discomfort (unless an allergy or a contraindication exists)? 

Select the 2 answer options which are correct.

  • Aspirin 

  • Nitroglycerin 

  • Start oxygen at 4 L/min regardless of oxygen saturation

  • Placing an AED 

Unless allergies or contraindications exist, consider the following for adult patients with ischemic-type chest discomfort:

  • if oxygen saturation is below 90%, start oxygen at 4 L/min and titrate
  • give aspirin 162 to 325 mg
  • administer nitroglycerin

The routine administration of oxygen is not recommended unless the patient's oxygen saturation is below 90%. An AED should only be placed if a patient is pulseless.

34.

You are attending to a newborn who has a good cry, a pink body but blue extremities, and a heart rate of 120 bpm. The newborn is grimacing but not actively pulling away from stimuli. What is the most appropriate next step?

  • Continue to monitor and provide warmth, as the baby is likely experiencing normal transition.

  • Begin immediate ventilations with a bag-valve-mask.

  • Initiate chest compressions.

  • Administer supplemental oxygen via the blow-by technique.

Correct answer: Continue to monitor and provide warmth, as the baby is likely experiencing normal transition.

The described condition (a good cry, pink body, blue extremities, and a heart rate over 100 bpm) suggests that the baby is experiencing acrocyanosis, which is normal in the first few hours post-delivery. The baby is showing normal physiological adaptation to extra-uterine life.

Ventilation with a BVM is indicated if there is inadequate respiratory effort, significant central cyanosis, or a heart rate below 100 bpm, none of which apply here.

Chest compressions are indicated for a heart rate below 60 bpm despite adequate ventilation, which is not the case.

Supplemental oxygen is not immediately indicated for a baby with a normal heart rate, a good cry, and only peripheral cyanosis.

35.

A six-year-old patient is unresponsive. Their carotid pulse is 64 beats per minute. Respirations are shallow and at a rate of six breaths per minute. Which of the following is the most appropriate next step?

  • Begin assisted ventilation

  • Initiate CPR, beginning with chest compressions

  • Place the patient in the recovery position

  • Give high-flow oxygen via a non-rebreather mask

Correct answer: Begin assisted ventilation

Respiratory arrest is the most common cause of cardiac arrest in children. Initiating ventilation is the most important intervention in this scenario to prevent cardiac arrest. 

A patient who is not adequately breathing and has a palpable pulse should be provided assisted ventilation; the rate of ventilation for a child is one breath every three to five seconds (12-20 breaths per minute). 

Placing the patient in the recovery position in this scenario would not allow adequate airway management. 

CPR should be initiated on a child without a palpable pulse or a pulse below 60 beats per minute.

High-flow oxygen would not be appropriate for a patient who is not breathing adequately.

36.

Which of the following would be expected for a patient who experienced stimulation to their sympathetic nervous system?

  • Tachycardia

  • Bradypnea

  • Constricted pupils

  • Hypotension

Correct answer: Tachycardia

The sympathetic nervous system is responsible for the fight-or-flight response. Stimulation of this system will cause tachycardia, tachypnea, pupil dilation, and increased glucose metabolism. Epinephrine is a hormone involved in the control of the sympathetic nervous system. It is also a sympathomimetic medication (i.e., its use will cause the sympathetic nervous system to be stimulated). Epinephrine is often used in the setting of anaphylaxis.

Conversely, the parasympathetic nervous system generally slows the body. Bradycardia and bradypnea are often seen.

Hypotension is generally not seen with stimulation of the sympathetic nervous system.

37.

Which of the following are types of ionizing radiation that cause direct tissue damage?

  • Alpha particles 

  • Beta particles 

  • Gamma rays 

  • Microwaves

  • Radio waves 

Ionizing radiation can damage tissue and poses a risk to EMS providers. The types of ionizing radiation include alpha particles, beta particles, gamma rays, and X-rays. Microwaves and radio waves are types of non-ionizing radiation that do not cause direct tissue damage.

38.

Which of the following does not commonly happen during an asthma attack?

  • Narrowing pulse pressure

  • Agitation

  • Accessory muscle usage

  • Tachypnea

Correct answer: Narrowing pulse pressure

Asthma is a condition in which bronchioles are inflamed and swollen and produce excessive mucus. Common triggers for an asthma episode include upper respiratory infections, exercise, exposure to cold air or smoke, and emotional stress. Asthma is rare in children younger than one year of age. It is generally characterized by wheezing that can be heard without a stethoscope and respiratory distress. 

Patients may present with agitation, anxiety, restlessness, stridor, accessory muscle use, retractions, tachypnea, tachycardia, nasal flaring, seesaw breathing, head bobbing, and assuming a position of comfort (e.g., the tripod position). Cyanosis and/or respiratory arrest may develop quickly. Albuterol via a metered-dose inhaler may be administered based on local protocols.

Narrowing pulse pressure occurs in cardiac tamponade.

39.

Which of the following statements concerning an infant's or a child's airway is false?

  • The tongues of infants and children are proportionately smaller than those of adults.

  • The tracheae of infants and children are smaller than those of adults.

  • The respiration rates of infants and children are greater than those of adults.

  • The diaphragms of infants and children support breathing to a greater degree than those of adults.

Correct answer: The tongues of infants and children are proportionately smaller than those of adults.

The tongues of infants and children are proportionately larger and take up more space within the mouth than the tongues of adults.

The tracheae of infants and children are smaller than those of adults and are more easily obstructed by secretions, blood, or swelling. The respiration rates of infants and children are greater than those of adults. The diaphragms of infants and children are relied upon more heavily to breathe than those of adults, who use more chest muscles in comparison.

40.

If ALS is not available, which of the following is an appropriate method to alleviate gastric distension in a patient with a suspected spinal injury?

  • Roll the patient to one side and apply pressure to the upper abdomen

  • Apply pressure to the abdomen between chest compressions

  • Interrupt CPR long enough to suction the patient

  • Decrease ventilation (increasing hypoxia) for a few cycles while continuing the chest compression sequence to naturally relieve the distension

Correct answer: Roll the patient to one side and apply pressure to the upper abdomen

In gastric distension, air is forced into the stomach secondary to artificial ventilation. To prevent gastric distension, ensure the patient's airway is appropriately positioned and ventilate the patient at an appropriate rate and volume.

To alleviate gastric distension, recheck and reposition the head and watch for the rise and fall of the chest wall with ventilations. Also, ALS may be able to perform a nasogastric decompression. If neither of these measures is successful or available, roll the patient to one side and apply manual pressure over the patient's upper abdomen, with suctioning prepared for likely vomitus. If the patient remains supine during manual decompression, aspiration of vomitus is likely. If the patient has a suspected spinal injury, using the spinal motion restriction device to turn the patient to one side and gently pushing on the abdomen is recommended.

Suctioning will not alleviate gastric distension.

Decreasing ventilations will not alleviate gastric distension. It may prevent further distension but potentially exposes the patient to hypoxia.

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