NREMT EMT Exam Questions

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61.

Which of the following would have rights to otherwise confidential information without expressed patient consent?

  • A third-party billing representative

  • A close relative, such as a son or daughter

  • The patient's employer

  • The patient's legal spouse

Correct answer: A third-party billing representative

Any communication between patient and EMS personnel is considered privileged information, even the fact that the patient is under prehospital/hospital care. Additional information that is protected under HIPAA (protected health information, or PHI) includes patient history, assessment findings, and treatment provided. This information may only be disclosed for the purposes of treatment, payment (to third-party billing personnel), or operations, as well as when legally required (e.g., cases of suspected abuse, when subpoenaed).

Otherwise, proper authorization—typically documented permission from the patient—is required to disclose confidential information. Personal electronic devices, such as cell phones, should not be used to capture information.

62.

Which of the following can be used to identify hazardous materials in a transportation incident?

Select the three correct answer options.

  • Waybill

  • Emergency Response Guidebook

  • Shipping papers

  • ChemTrec

  • NFPA 704 system

  • Poison control

The conductor of a train carries the waybill, which can be used to identify the materials on board. The Emergency Response Guidebook (ERG) can be used in conjunction with the labels or placards on materials being transported to identify the items being carried. Shipping papers are required whenever hazardous materials are transported from one place to another. They identify the material being shipped and specify the weight and quantity of each part of the shipment.

ChemTrec may be contacted later, but it will not help identify the material initially. The NFPA 704 system is used to identify hazardous materials at fixed facilities, not transportation incidents. Poison control would guide the treatment of people exposed to a substance, but it would not be helpful until the substance has been identified.

63.

A 16-year-old patient was struck in the mouth by a thrown baseball, knocking an incisor out of its socket. Which of the following is not true about the proper management of a permanent tooth avulsion?

  • The tooth should be rinsed immediately with copious amounts of water

  • Reimplantation should occur within one hour after the incident

  • The tooth may be placed in sterile saline to be transported

  • The tooth may be placed in cold milk to be transported

Correct answer: The tooth should be rinsed immediately with copious amounts of water

Bleeding will occur when a tooth is violently displaced from its socket; therefore, direct pressure should be administered. Suctioning and/or removal of cracked or loose teeth may be required to maintain a patent airway. Handle any avulsed tooth by the crown, not the root. Place the tooth in a special tooth storage solution, if available, or in cold milk or sterile saline. Reimplantation is recommended from 20 minutes to one hour after the incident.

64.

Which findings characterize hypoglycemia?

Select the 3 answer options which are correct.

  • Rapid onset of symptoms

  • Altered mental status

  • Pale, cool, and moist skin

  • Bradycardia 

Signs and symptoms of hypoglycemia include:

  • rapid onset of symptoms
  • altered mental status
  • slow, shallow respirations when severe
  • rapid, weak pulse (tachycardia)
  • pale, cool, and moist skin

65.

What is the common presentation of a superficial partial-thickness burn?

  • Skin that is pink, moist, soft, and exquisitely tender when touched. It may or may not present with blisters

  • Skin that shows a mixture of red and blanched white, with thick-walled and ruptured blisters

  • Dry, leathery, dark brown skin

  • Skin with moderate erythema and pain at the site without blistering

Correct answer: Skin that is pink, moist, and soft and exquisitely tender when touched

As the understanding of thermal injury improves, classifications are changing, and focus has shifted to the depth of the burn as a measure of severity. This has led to more accurate descriptions, such as superficial, partial-thickness, and full-thickness. The patient in this scenario has a superficial partial-thickness burn.

A superficial (first-degree) burn involves only the epidermis, and it is most commonly seen as a sunburn. The patient will present with mild to moderate erythema and pain at the site without blistering.

Superficial partial-thickness and deep partial-thickness burns are the two types of second-degree burns. A superficial partial-thickness burn involves the epidermis and superficial (papillary) dermis, often resulting in thin-walled, fluid-filled blisters. These burns appear pink, moist, and soft and are exquisitely tender when touched by a gloved hand. Deep partial-thickness burns extend into the reticular dermis. The skin color is usually a mixture of red and blanched white, and the capillary refill is slow. Blisters are thick-walled and often ruptured.  

A full-thickness (third-degree) burn extends through the skin to the subcutaneous layer, muscle, bone, and/or internal organs. The affected area is dry, leathery, dark brown, or charred and may feel hard to the touch. Clotted blood vessels or subcutaneous tissue may be visible. If the nerve endings are destroyed, sensation may be lacking. A full-thickness burn is often surrounded by less severe burns that are painful.

66.

A 73-year-old patient is being transported to a hospital for chest pain. During transport, they suddenly become unconscious, pulseless, and apneic. 

Which of the following is the appropriate next step?

  • Initiate CPR, beginning with chest compressions, until the AED is ready to analyze

  • Analyze the patient’s rhythm via the AED and defibrillate while continuing transport

  • Provide assisted ventilation

  • Perform a 12-lead electrocardiogram

Correct answer: Initiate CPR, beginning with chest compressions, until the AED is ready to analyze

CPR should be initiated for any patient who does not have a palpable pulse. High-quality CPR and rapid defibrillation are important factors for survival. The vehicle should be stopped so that the AED can analyze the patient’s rhythm and defibrillate if indicated.

This patient will require assisted ventilation, as they are apneic; however, chest compressions are completed prior to ventilation in CPR.

A 12-lead electrocardiogram may provide information regarding this patient’s condition, but it will not promote survival.

67.

You are attending to a pregnant woman in active labor. Upon examination, you note a loop of umbilical cord protruding from the vagina. What is the immediate next step in the management of this condition?

  • Place the mother in a knee-chest position and cover the cord with a moist sterile dressing.

  • Gently push the cord back into the vagina.

  • Cut the cord and clamp both ends to prevent bleeding.

  • Encourage the mother to push harder to expedite delivery.

Correct answer: Place the mother in a knee-chest position and cover the cord with a moist sterile dressing.

Placing the mother in a knee-chest position helps relieve pressure on the cord, potentially improving blood flow to the fetus. Covering the cord with a moist sterile dressing prevents it from drying out and maintains its viability. If you notice that a pulse is not palpable in the cord, you may slip a gloved hand into the birth canal to relieve pressure off the cord until a pulse is felt. You may have to keep this position until arrival at the hospital.

Attempting to reinsert the cord can increase the risk of infection and potentially worsen cord compression.

Cutting the cord pre-hospital without the presence of immediate neonatal support and in an uncontrolled environment can lead to neonatal complications.

Encouraging the mother to push could increase compression on the umbilical cord, reducing blood flow to the fetus and potentially leading to fetal distress.

68.

An EMT is under noticeable stress; their mood has changed, and they fall asleep at work. Which of the following is a potential activity that could be exacerbating their response to stress?

  • Excessive alcohol use

  • Adequate exercise regimen

  • Discussing feelings

  • Spending time with family

Correct answer: Excessive alcohol use

Acceptable alcohol use is currently defined as 1-2 drinks per day (1 for women and 2 for men). Avoidance of alcohol may help manage stress. Some other strategies for managing stress include the following:

  • minimize/eliminate stressors as much as possible
  • change partners to avoid a negative/hostile personality
  • change work hours or environment
  • cut back on overtime
  • change attitude about a stressor
  • talk about feelings with trusted people
  • seek professional counseling, if needed
  • do not obsess over frustrating situations that are not able to be changed
  • adopt a relaxed, philosophical outlook
  • expand friends and social support systems and develop interests beyond emergency services
  • perform relaxation techniques (e.g., yoga, deep breathing, muscle relaxation, meditation)
  • perform regular physical exercise
  • limit intake of caffeine and tobacco

Proper nutrition, hydration, exercise, relaxation, and sleep are important to prepare for potentially stressful situations. Additionally, balancing work, family, and health can prevent future stressors and alleviate current stress.

69.

Which of the following is a contraindication to the use of an automated external defibrillator?

  • Responsiveness

  • Hypertension

  • Apnea

  • Active myocardial infarction

Correct answer: Responsiveness

An automated external defibrillator (AED) is indicated for a patient who is pulseless and unresponsive. An AED should not be used on a patient who is responsive or has a palpable pulse.

Blood pressure, apnea, and an active myocardial infarction have no bearing on whether an AED should be used.

70.

When should an oropharyngeal airway be used for a pediatric patient?

  • When the child is unconscious and unable to sustain an open airway spontaneously

  • When the child is conscious but unable to breathe

  • When the child is in respiratory distress and needs supplemental oxygen

  • When the child is unresponsive from ingesting a caustic substance

Correct answer: When the child is unconscious and unable to sustain an open airway spontaneously

Never attempt to insert an oropharyngeal (OP) airway in a conscious child. OP airways are used to maintain a patent airway in the event of respiratory insufficiency (failure) or obstruction (primarily from the tongue). Contraindications to OP airway placement include an intact gag reflex and the ingestion of a caustic or petroleum product.

A child in respiratory distress who needs supplemental oxygen may not require an oral airway unless an obstructed airway is suspected from the tongue and the patient meets the indications outlined above. A patient in respiratory distress may need assisted ventilation in addition to supplemental oxygen. Vesicular breath sounds are normal breath sounds.

71.

A patient has an impaled object in their right thigh. Which of the following is not appropriate for impaled object injuries in the extremities?

  • Apply ice to help reduce swelling

  • Stabilization of the object

  • Control of bleeding around the object

  • Assessment for an exit wound

Correct answer: Apply ice to help reduce swelling

It is not appropriate to apply ice to an impaled object. This may actually impair blood clotting and make the wound bleed. 

Penetrating injuries generally have obvious wounds and external bleeding. Pain at the site of the wound, nausea, and vomiting are common. If a penetrating (impaled) object is still in place, apply a stabilizing bandage around it to control external bleeding and minimize the movement of the object. Inspect the patient's back in cases of anterior penetrating injuries and the front to assess for exit wounds.

Removal of a penetrating object outside of a surgical setting may cause more injury to the area; therefore, in a prehospital setting, penetrating objects should remain in place unless a life-threatening condition (e.g., inability to manage the airway) exists.

72.

Which of the following statements regarding a non-rebreather mask is false?

  • It provides a lower concentration of oxygen.

  • It contains a reservoir bag that must be filled with oxygen prior to placement on the patient's face.

  • The recommended flow rate for a non-rebreather mask is 10-15 liters per minute.

  • Leaving the mask in place without flowing oxygen will cause the patient to rebreathe exhaled carbon dioxide.

Correct answer: It provides a lower concentration of oxygen.

A non-rebreather mask is used to provide up to 90% of a patient's oxygen when the reservoir bag is filled. The reservoir bag should be full before the mask is placed on the patient. The recommended flow of the mask is 10-15 liters per minute. If the mask is left in place while oxygen is not flowing, the patient will be exposed to rebreathing exhaled carbon dioxide.

A nasal cannula provides a lower concentration of oxygen (24%-44%). A typical flow for the nasal cannula is 1-6 liters per minute.

73.

Which of the following is the most appropriate initial intervention for a hypoxic patient with chronic obstructive pulmonary disease?

  • Place them in the Fowler position and apply oxygen via a non-rebreather mask

  • Place them in the recovery position and apply oxygen via a nasal cannula

  • Place them supine and provide respiration using a bag-valve mask

  • Place them in the semi-Fowler position and apply oxygen via a nasal cannula

Correct answer: Place them in the Fowler position and apply oxygen via a non-rebreather mask

Patients experiencing hypoxia should be given high-flow oxygen, preferably with a non-rebreather mask. A nasal cannula can be used if the patient does not need large volumes of oxygen or cannot tolerate a mask. 

Patients with respiratory complaints should be placed in a position of comfort unless they are hypotensive. This is typically a Fowler or semi-Fowler position.

There is no indication that this patient has inadequate breathing, only hypoxia. Assisted ventilation (e.g., from a bag-valve mask) is indicated for patients with respiratory distress or failure.

Many people will mention that giving a COPD patient oxygen will suppress their breathing, as they are accustomed to low oxygen and high carbon dioxide levels. However, this is unlikely to be triggered with an hour or so of high-flow oxygen; unless a long transport time is expected, it is unlikely to be an issue. Nevertheless, it is always best to be ready for any possibility. Have a bag-valve setup close at hand, just in case. Never withhold oxygen.

74.

Which of the following is a sign of increased pressure within the chest, secondary to a cardiac tamponade?

  • Jugular vein distension

  • Palpable carotid pulse

  • Hypertension

  • Expansion of the lungs

Correct answer: Jugular vein distention

Increased chest pressure may occur due to trauma, pneumothorax, hemothorax, or constrictive pericarditis and cardiac tamponade. Jugular vein distention, hypotension, and collapse of the lung may occur if chest pressure is increased.

A palpable carotid pulse is a normal finding. Hypertension is not a sign of increased chest pressure. Increased chest pressure leads to hypotension and the inability of the lungs to expand fully. 

75.

A motor vehicle crash occurs. Law enforcement confirms the scene is safe. Multiple trauma patients are noted. Which of the following is the most appropriate next step?

  • Request additional resources, establish an incident command, and begin primary triage

  • Request additional resources and begin secondary triage

  • Immediately begin primary triage

  • Establish to what hospital all patients will be transported

Correct answer: Request additional resources, establish an incident command, and begin primary triage

A mass-casualty incident (MCI) involves, or could potentially involve, three or more patients. Protocols will vary by MCI and location. Commonly, an MCI will increase the demand for equipment and personnel. The scene should not be left if patients remain without care. Upon arrival at an MCI, additional resources are requested, an incident command is established if not already done, and primary triage procedures are started. Patients are triaged by priority of care (immediate, delayed, minimal, and expectant). After primary triage, the following information should be conveyed to the medical branch director:

  • total number of patients
  • number of patients in each triage category
  • recommendations for extrication/movement of patients
  • resources needed to complete triage and begin the movement of patients

Secondary triage is the sorting of patients into categories for movement/transport.

Once law enforcement has declared a scene safe, it is acceptable to enter the scene and begin assessment/treatment. If a new potential danger arises, immediately leave the scene and contact appropriate authorities. The transportation officer will establish which hospital each patient will be transported to once triage has been completed and patients are moved into an established treatment area. 

76.

Which of the following is a late sign of respiratory distress for an adult patient?

  • Bradycardia

  • Tachypnea

  • Retractions

  • Vesicular breath sounds

Correct answer: Bradycardia

Early signs of respiratory distress for an adult patient may include the tripod position, tachypnea, and retractions.

As respiratory distress continues and the patient becomes tired from the effort of breathing, late signs include hypoxia, bradypnea, bradycardia, and an altered level of consciousness can occur. In severe respiratory distress, wheezing can be audible.

Vesicular breath sounds are normal breath sounds.

77.

Which of the following patients is most likely to suffer from hypothermia?

  • A 74-year-old male who is living in an unheated house in 38 °F (3.3 °C) weather

  • A 26-year-old female who is living in an unheated house in 38 °F (3.3 °C) weather

  • A 50-year-old female who is swimming actively in 72 °F (22.2 °C) water

  • A 10-year-old male who is swimming actively in 72 °F (22.2 °C) water

Correct answer: A 74-year-old male who is living in an unheated house in 38 °F (3.3 °C) weather

Risk factors for the increased likelihood of issues related to environmental exposure are poor physical condition, young or advanced age, poor nutrition/hydration, and very cold or hot conditions. However, hypothermia cases may occur between 30 °F (-1.1°C) and 50 °F (10.0°C), and hyperthermia cases may occur at temperatures above 80 °F (26.7°C) with humidity at 80%.

It is unlikely that a patient who has dressed appropriately and is actively moving will suffer from hypothermia.

It is extremely unlikely that resilient, healthy patients in water temperatures above 72 °F (22.2 °C) will suffer from hypothermia.

78.

An adult has a possible closed tibia/fibula fracture. Which of the following may help restore adequate blood supply to the foot?

  • Realignment of the limb

  • Securing the affected leg to the opposite leg

  • Replacing fracture fragments in their anatomic position

  • Restoration of blood supply to the foot is not possible in a closed fracture

Correct answer: Realignment of the limb

A fracture of the tibia or fibula may occur at any place between the knee and the ankle. Often, both bones are fractured at the same time. Open fractures are more common with the tibia, as this bone is just beneath the skin. 

Fractures should be stabilized with a padded rigid leg splint or air splint that extends from the foot to the upper thigh. Once splinted, secure the affected leg to the opposite leg to prevent further movement/injury. Gentle longitudinal traction should be used to help realign the limb. Realignment will frequently restore adequate blood supply to the foot. It is not necessary to replace fracture fragments in their anatomic position.

79.

A 28-year-old female was awakened by lower left quadrant abdominal pain. She endorses spotty vaginal bleeding. Her last menstrual period was three months ago; she assumed she was pregnant but has not taken a home test. Her vital signs are within normal limits. 

Which of the following is a concern?

  • Ectopic pregnancy

  • Normal pregnancy

  • Placenta previa

  • Preeclampsia

Correct answer: Ectopic pregnancy

An ectopic pregnancy is a pregnancy that occurs outside the uterus, most commonly in the fallopian tube. Risk factors include a history of pelvic inflammatory disease, tubal ligation, or previous ectopic pregnancies. Patients with ectopic pregnancy may suffer internal bleeding. A common symptom is sudden, severe unilateral lower abdominal pain. An ectopic pregnancy is a medical emergency and should be evaluated in a hospital setting.

A normal pregnancy is possible in this case but is not commonly associated with severe abdominal pain or vaginal bleeding. The patient should be evaluated for potential complications of pregnancy.

Placenta previa is the development of the placenta over the cervical opening. Heavy vaginal bleeding is common, but abdominal pain is rare.

Preeclampsia is a possible complication during pregnancy, typically affecting primigravida patients. It can develop after week 20 of gestation and is characterized by severe hypertension, headaches, visual abnormalities, edema, and anxiety. The condition can progress into eclampsia, which is defined by the onset of seizures due to hypertension.

80.

A 32-year-old male was involved in a construction accident. He is unconscious and has snoring respirations. The patient has an obvious wound on his left upper arm that is bleeding profusely with bright red, spurting blood. What is the EMT's most appropriate next step after ensuring scene safety and donning appropriate protective gear?

  • Apply a tourniquet to the left arm

  • Place an oral airway

  • Apply oxygen

  • Assist ventilations with a bag-mask device

Correct answer: Apply a tourniquet to the left arm

EMS providers should follow the XABC pathway for trauma patient assessment and management. 

  • X: control life-threatening bleeding
  • A: ensure an open airway  
  • B: ensure adequate breathing and oxygenation
  • C: circulation/treat for shock

The EMT should control the bleeding, open the airway, and ensure adequate breathing and oxygenation. Once those steps are complete, treat this patient for shock. Ensure stabilization of the C-spine throughout and prepare for rapid transport to a trauma center.