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Quiz Session - Attempts With Random Questions

NREMT EMT Exam Questions

Page 6 of 52

101.

A 17-year-old male was struck on the side of the head. Police found him unconscious and called for EMS assistance. By the time they arrive, the patient has regained consciousness and states that he is fine. During the primary assessment, there is no obvious bleeding or airway compromise, and his breathing is fine. As EMS proceeds, he becomes obtunded and subsequently loses consciousness. What is the likely cause of this patient's sudden decline?

  • Epidural hematoma

  • Severe concussion

  • Hemorrhagic shock

  • Subarachnoid hemorrhage

Correct answer: Epidural hematoma

Intracranial hemorrhage is the accumulation of blood within the skull, increasing intracranial pressure (ICP). Bleeding can occur between the skull and the dura mater (epidural), between the dura mater and the brain (subdural), within the brain tissue (intracerebral), or in the subarachnoid space where the cerebrospinal fluid (CSF) circulates.

An epidural hematoma is nearly always the result of a temporal bone fracture from a blow to the side of the head. The middle meningeal artery will commonly bleed from this fracture and result in rapidly progressing symptoms. Patients commonly present with an immediate loss of consciousness followed by a brief period of consciousness (lucid interval) and later, lapse back to unconsciousness. ICP continues to increase, and the pupil on the affected side becomes fixed and dilated. Death is imminent if surgical interventions are not completed rapidly.

A concussion is a temporary interruption of the central nervous system function from blunt force trauma. A concussion commonly presents with a brief loss of consciousness and a gradually improving condition. Because this patient's condition is worsening, an epidural hematoma is more likely than a concussion.

Hypovolemic shock (due to hemorrhage) is unlikely to occur from a closed head injury. The cranial vault cannot contain a volume of blood large enough to cause hypovolemia. Bleeding into the brain (subdural or subarachnoid) can cause a loss of consciousness from direct damage to neurons or the mass effect of the blood pushing against the brain, with the potential for cerebral herniation.

A subarachnoid hemorrhage will cause bloody CSF and meningeal irritation (e.g., neck rigidity, headache). Trauma and ruptured aneurysms are common causes.

102.

A patient is bleeding from a leg wound. The blood is dark red and flowing steadily. Which of the following is the most likely source of bleeding?

  • Venous

  • Arterial

  • Capillary

  • Internal

Correct answer: Venous

Venous bleeding is dark red and flows steadily from a wound.

Arterial bleeding is bright red and often spurts in time with the patient’s pulse; the spurting makes arterial bleeding more difficult to control. Capillary bleeding is dark red and oozes steadily but slowly from wounds. Internal bleeding is any bleeding that occurs in a space inside the body.

103.

What techniques can an EMT can use to reduce the risk of being injured by lightning? 

Select the two correct answer options.

  • Get away from bodies of water

  • Avoid extreme high ground for shelter

  • Shelter under an isolated tree

  • Run whenever in the open 

To reduce the chance of being injured by lightning, squat low and make minimal contact with the ground. Avoid extreme high ground like rocky cliffs for shelter. Immediately get out of and away from ponds, lakes, and other bodies of water. If you must seek shelter in trees, find a bunch of trees that are uniform in size. 

Never shelter under an isolated tree and avoid staying in the open, especially in places where you are the tallest object. Running will not decrease the risk of lightning injury and may increase your risk of injury from tripping. 

104.

Which of the following signs is not commonly seen in a patient with a foreign body airway obstruction?

  • Vomiting 

  • Non-productive coughing

  • Stridor

  • Cyanosis

Correct answer: Vomiting

Wheezing and coughing are commonly heard in patients with mild airway obstruction. A patient with mild airway obstruction should be monitored for adequate oxygenation and progression of the obstruction. Patients with mild airway obstruction and poor air exchange may present with an ineffective cough, stridor, increased difficulty breathing, and cyanosis. Vomiting is not commonly seen with airway obstruction but rather with a gastrointestinal problem. 

A patient with poor air exchange should be treated as if they have severe airway obstruction. These patients will be unable to breathe, talk, or cough; cyanosis and extreme difficulty breathing are common. Opening the airway and performing abdominal thrusts are appropriate for severe airway obstruction. Do not attempt to remove a foreign body if it cannot be visualized.

105.

An 11-year-old female complains of a possible allergic reaction. Upon arrival, the patient's mother presents an epinephrine auto-injector. Which of the following is the most appropriate next step?

  • Begin the primary assessment

  • Administer the epinephrine auto-injector

  • Direct the mother to administer the epinephrine auto-injector

  • Contact the physician who prescribed the epinephrine auto-injector

Correct answer: Begin the primary assessment

At least a primary assessment must be conducted prior to performing any intervention, including the use of an epinephrine auto-injector. The general impression, formal assessment (e.g., vital signs, DCAP-BTLS), and the determination of the priority of the patient are all involved in the primary assessment. Administering treatment prior to evaluation is negligent.

In this scenario, there is no reason to contact a prescribing provider.

106.

Ventricular tachycardia (VTACH) is a rapid heart rhythm that is life-threatening and requires rapid intervention. Which of the following are signs/symptoms of VTACH? 

Select the 3 answer options which are correct.

  • Impalpable pulse

  • Unresponsiveness

  • Heart rate of 150-220 beats/min

  • High blood pressure

During ventricular tachycardia, the heart beats too fast, not allowing adequate time for the ventricles to fill with blood. This results in a loss of blood pressure and inadequate circulating blood volume. 

Signs and symptoms of ventricular tachycardia include a heart rate of 150-220 beats/min, lightheadedness or unresponsiveness, chest pain, and a weak or impalpable pulse. 

107.

A responsive adult patient complaining of shortness of breath could benefit from oxygen delivered via a non-rebreather mask, but they are unable to tolerate a mask on their face. What is the most appropriate next step?

  • Use a nasal cannula with supplemental oxygen flowing at six liters per minute

  • A simple oxygen mask at 15 liters per minute held 4 inches away from the patient's face.

  • Use a nasal cannula with supplemental oxygen flowing at 15 liters per minute

  • Avoid providing oxygen altogether

Correct answer: Use a nasal cannula with supplemental oxygen flowing at six liters per minute

A nasal cannula has limited use in the prehospital setting; a non-rebreather mask is preferred. However, if a patient is unable to tolerate a non-rebreather mask, a nasal cannula is a suitable alternative. The maximum flow rate for a nasal cannula is 6 liters per minute. It is inappropriate to avoid providing oxygen to a patient who may benefit from it. A simple oxygen mask held 4 inches away from the face would not be an effective oxygen delivery method for this patient.

There are no indications that this patient requires artificial ventilation (for inadequate breathing) or a nasopharyngeal airway (for an inability to maintain the airway spontaneously).

108.

Which of the following are types of pelvic fractures? 

Select the 3 answer options which are correct.

  • Straddle 

  • Vertical shear

  • Open-book

  • Mid-shaft

Pelvic fractures can be vertical shear, open-book, or straddle fractures based on the mechanism of injury and characteristics of the fracture. 

A mid-shaft fracture would involve a long bone such as a femur, not the pelvis. 

109.

A non-ambulatory, 150-kg patient requires transport from a fourth-floor apartment. The elevator is too narrow to accommodate this patient on a stretcher. Which of the following is the most appropriate next step?

  • Request lifting assistance from dispatch and stand by until their arrival

  • Transfer the patient to a stair chair and proceed to the elevator

  • Use a scoop stretcher to transport to the bottom floor and then onto a stretcher

  • Ask a family member on-scene to help lift the patient

Correct answer: Request lifting assistance from dispatch and stand by until their arrival

Lifting and moving bariatric patients can pose a challenge for EMS crews. If transport is required, plan early for extra help; additional providers and/or specialized equipment may be necessary. Do not risk dropping the patient or injuring a team member by lifting too much weight.

Using a stair chair may allow the patient to fit in the elevator but will not address the weight each member has to lift to transport the patient.

A scoop stretcher is not likely to fit in the elevator.

It would be inappropriate to ask a family member to assist in lifting the patient; this may injure the family member if they are not familiar with appropriate body mechanics.

110.

An adult male has ineffective spontaneous respirations. His ventilations are assisted with a bag-valve mask and supplemental oxygen. 

Which of the following is the most reliable indicator that ventilations are being delivered effectively?

  • Improved skin color

  • Diminished breath sounds

  • Respiratory rate

  • Pulse rate

Correct answer: Improved skin color 

The purpose of assisted ventilation is to improve oxygenation and ventilatory status. Patients in respiratory distress/failure are no longer able to maintain adequate oxygen levels for the body and are therefore in a hypoxic state. 

The most reliable indicator of effective assisted ventilation is the reversal of symptoms of hypoxia. Hypoxia causes bradypnea; tachypnea; an irregular rhythm; diminished, absent, or noisy auscultated breath sounds; a reduced flow of air from the nose or mouth; unequal or inadequate chest expansion; accessory muscle use; and shallow depth.

111.

Which of the following positions would not be beneficial when managing a patient's airway?

Select the three answer options which are correct.

  • Placing the patient in the recovery position

  • Placing the head in a chin-down position

  • Placing the head in a hyperflexed position

  • Placing the head in a sniffing position

Placing the head in the neutral, hyperflexion or chin-down position would make it more difficult to perform airway management, as these positions can actually occlude the airway. The recovery position is only used for patients who are breathing on their own, and airway management is not anticipated.

Place any patient who needs airway management supine in the sniffing position.

112.

A patient is involved in a motor vehicle crash. The patient, who is still trapped inside the car, is reported to be apneic. Once the scene is safe to enter, it is determined the patient is entrapped in the driver's seat by the dashboard. 

What is the appropriate next step?

  • Provide inline stabilization, open the airway, and begin ventilation if possible

  • Attempt an emergency move without a rescue team

  • Begin extrication with tools that bystanders have available. 

  • Wait for the rescue/extrication team to arrive before attempting any intervention 

Correct answer: Provide inline stabilization, open the airway, and begin ventilation if possible

A patient who is trapped in a vehicle should be assessed and treated like any other patient. As long as the scene is safe, a primary assessment should be completed. Since this patient is apneic, artificial ventilation is appropriate.

Never attempt extrication without proper training and equipment. Serious injury can occur to rescuers and patients if this step is not performed properly with the correct tools. 

Never withhold lifesaving treatment until extrication is available. It is not appropriate to attempt an emergency move without a rescue team, as this will likely cause increased injury to the patient.

113.

The most widely used water-rescue model consists of which components?

Select the two answer options which are correct.

  • Reach 

  • Throw 

  • Float 

  • Pull 

  • Push

The most widely used water-rescue model consists of reach, throw, row, go. 

REACH: The victim is located close to the shoreline, and rescuers can retrieve them by reaching with an outstretched arm or leg, a rescue pole or hook, an oar, a backboard, etc., without having to enter the water. 

THROW: The victim is too far away from the shoreline to be reached with a rigid object. Rescuers can throw ropes, rope bags, flotation rings or discs tied to a rope, a life vest tied to a rope, etc. to retrieve the victim without having to enter the water. 

ROW: The victim is too far away from the shoreline to be reached or to have a flotation device thrown to them. Rescuers must use a boat or an approved watercraft to access and retrieve the victim without having to enter the water. 

GO: Rescuers must physically enter the water and swim to the victim to retrieve them. This method may be used from the shoreline or from a boat, depending on the circumstances, and should only be attempted by trained rescuers. 

114.

Which of the following are endocrine glands? 

Select the 3 answer options which are correct.

  • Parathyroid glands

  • Pancreas

  • Adrenal glands

  • Gallbladder

Endocrine glands of the human body include:

  • adrenal glands
  • pancreas
  • thyroid gland
  • parathyroid glands
  • pituitary gland
  • testes and ovaries

The gallbladder is part of the digestive system.

115.

Which of the following may be signs of post-traumatic stress disorder (PTSD) in an EMT after responding to a mass-casualty event?

Select the 3 answer options which are correct.

  • Feelings of hopelessness, guilt, or low self-worth

  • Losing interest in activities

  • Changes in eating habits

  • Vivid memories of the incident

Signs of PTSD after an event may vary from person to person, but the most frequent ones include: 

  • intrusive memories, dreams, or flashbacks of a specific incident
  • refusing to talk about a traumatic event
  • changes in eating habits or appetite
  • losing interest in activities
  • avoiding places where a traumatic event occurred
  • feelings of hopelessness, guilt, or low self-worth

Talking about the event with other responders is normal and healthy, and it is encouraged as part of a critical incident stress debrief (CISD). It is also normal to think about the incident.

Having vivid memories of an incident is considered normal. However, vivid memories that become intrusive in daily thoughts or interfere with daily activities can be a sign of PTSD. 

116.

Which of the following statements is true regarding the pathophysiology of abruptio placentae?

  • Abruptio placentae may result in shock.

  • Pain is commonly mild or absent,

  • Abruptio placentae is the development of the placenta over the vaginal opening.

  • Abruptio placentae is the result of the uterus compressing the inferior vena cava.

Correct answer: Abruptio placentae may result in shock.

Abruptio placentae is the premature separation of the placenta from the uterine wall. The most common causes are hypertension and trauma. Severe pain is common; the degree of vaginal bleeding depends on the severity of the separation. If blood loss is severe, the patient may exhibit signs of shock (e.g., a weak, rapid pulse and pale, cool, diaphoretic skin).

Placenta previa is when the placenta covers the cervical opening. Patients may experience heavy vaginal bleeding, often without pain.

Supine hypotensive syndrome occurs when a pregnant patient lies supine and the uterus compresses the inferior vena cava. The blood returning to the heart is decreased, resulting in hypotension in the mother. Because of this risk, any patient in the third trimester of pregnancy should be positioned on her left side during transport.

117.

Which of the following are management principles for the treatment of a patient with an animal bite?

Select the 3 correct answer options.

  • Irrigate with sterile water to decontaminate the wound

  • Apply a dry, sterile dressing

  • Immobilize the area with a splint if needed

  • Allow the wound to bleed to flush bacteria

Emergency care of a patient with an animal bite should include bleeding control, gross decontamination by irrigating with sterile water before placing a dry sterile dressing over the wound, and splinting as necessary. Provide prompt transport to the ED after dressing the wounds.

Do not allow the wound to bleed; this would not flush bacteria out of the wound and could lead to shock.

118.

If a competent adult patient refuses EMS care and/or transport to the hospital, which of the following is appropriate?

  • Discuss the risks, benefits, and alternatives to refusal of care/transport and have the patient sign a written refusal

  • Discuss the risks, benefits, and alternatives to refusal of care/transport and document verbal confirmation from the patient

  • If you did not provide any treatment at the scene, no refusal form is necessary

  • If you do not provide any treatment or assessment at the scene, verbal confirmation is adequate for refusal

Correct answer: Discuss the risks, benefits, and alternatives to refusal of care/transport and have the patient sign a written refusal

Verbal confirmation is not enough for adequate documentation of a refusal. Have a witness sign the refusal if the patient is unwilling or unable to sign.

An adult patient must be conscious, alert, and able to make decisions in order to refuse treatment/transport. Ensure the patient has all pertinent information (e.g., assessment, treatment options, consequences of refusal) before accepting a refusal of treatment. A parent or guardian may refuse treatment/transport for a child in non-emergent cases. Refusal of treatment/transport should be documented and signed by the patient; a witness to the signature, such as a family member or police officer, is appropriate. Always obtain information and discuss all aspects with the patient before leaving the scene. 

A signed refusal is required if you have any patient contact, even if it is only an assessment of their mental status. 

119.

What is the most appropriate way to clean blood off a stretcher's metal rails and mattress?

  • Use a bleach-water solution to wipe the stretcher and mattress

  • Use an antibacterial soap and hot water to wipe the stretcher and mattress

  • Use an alcohol-water solution to wipe the stretcher and mattress

  • Consider it contaminated and request a new stretcher before returning to service

Correct answer: Use a bleach-water solution to wipe the stretcher and mattress

Cleaning is an essential part of the prevention and control of communicable diseases. The ambulance and equipment should be cleaned after each run and on a daily basis. Cleaning is generally done with a bleach and water solution at a 1:10 dilution. Do not use alcohol or aerosol spray. Cleaning should be done quickly but completely to return to service as soon as possible. Ideally, cleaning should be done at the hospital. If cleaning is done at the station, adequate ventilation is a must. Any medical waste should be placed in a red biohazard bag and disposed of at the hospital. Contaminated equipment is placed in a red bag for transport and cleaning at the station.

Since the metal rails and mattress are not porous, they are not considered contaminated and can be cleaned using the solution above.

120.

An 11-year-old patient complains of chest tightness and itchy, red skin. They have rapid, labored breathing and a rapid heart rate. Which of the following conditions is most likely?

  • Allergic reaction

  • Toxic ingestion 

  • Sepsis

  • Smoke inhalation

Correct answer: Allergic reaction

Chest tightness, tachycardia, rapid or labored breathing, and itchy, red skin are all common signs of an allergic reaction. Additional signs include sneezing, rhinorrhea, dyspnea, persistent coughing, hoarseness, wheezing/stridor, hypotension, flushing, cyanosis/pallor, tingling sensations, altered mental status, anxiety, gastrointestinal complaints, headaches, itchy/watery eyes, and dizziness.

Toxic ingestion is a possibility but would most likely include vomiting and other gastrointestinal symptoms.

Signs of sepsis include delayed capillary refill, flushed skin, and a fever. 

Signs of smoke inhalation include burns around the mouth, soot or ashes in the mouth, stridor, and wheezing lung sounds. 

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