NREMT EMT Exam Questions

Correct answer: Reverses bronchospasm

Albuterol is a medication that is often used for dyspnea. Patients who have asthma, bronchitis, or chronic obstructive pulmonary disease will commonly have a beta-agonist (e.g., albuterol) prescribed as a rescue inhaler. Like most medications used for respiratory distress, albuterol works by dilating the bronchioles, reversing bronchospasm. It does not affect swelling, myocardial oxygen demand, or moisture in the lungs. Common side effects include tachycardia, nervousness, and muscle tremors. Coughing is possible after inhalation of the medication.

Some respiratory medications (e.g., beclomethasone, fluticasone, montelukast) work via an anti-inflammatory pathway, reducing swelling and slowing mucus production in the airways.

Correct answer: Presence of meconium

Meconium (fetal stool) may appear after the amniotic fluid is released ("water breaking"). If the amniotic fluid is greenish, meconium is likely present. Newborn distress is possible if the fetus aspirates meconium during delivery.

Correct answer: Perform the abdominal thrust maneuver

The abdominal thrust maneuver (Heimlich maneuver) is the appropriate way to clear a complete airway obstruction. This maneuver is performed by standing behind the patient, wrapping one's arms around the patient, making a fist with one hand and grasping the fist with the other hand, placing the thumb side of the fist against the patient's abdomen just above the umbilicus and below the xiphoid process, and pressing the fist into the abdomen in a quick inward and upward thrust.

If the choking adult patient loses consciousness, start CPR and perform chest compressions. Chest thrusts may be performed in lieu of abdominal thrusts for obese patients or those in later pregnancy. Never attempt blind finger sweeps or suctioning of a conscious patient.

Correct answer: Apply a cervical collar and provide spinal motion restriction on a long backboard prior to removing her from the pool

Patients who fall on their heads, as in diving accidents, will likely have head and/or spinal injuries. These patients require spinal motion restriction to prevent further spinal injury. Spinal motion restriction should include the use of a cervical collar and a long backboard. It is inappropriate to move a patient with a suspected spinal injury unless there is a potential for danger.

CPR should be initiated for any patient who does not have a palpable pulse, beginning with chest compressions.

Rescue breathing (assisted ventilation without chest compressions) is reserved for patients who have a pulse but are not breathing adequately.

Correct answer: Four

The GCS is an evaluation tool that can determine the level of consciousness. It evaluates eye-opening, verbal response, and motor response. A lower score suggests a more severe extent of brain injury. Survivability is not assessed with GCS but is assessed via the Revised Trauma Score.

Eye-opening scoring:

• spontaneous eye-opening = 4 points
• eye-opening in response to speech = 3 points
• eye-opening in response to pain stimuli = 2 points
• no eye-opening = 1 point

Verbal response scoring:

• responding with an oriented conversation = 5 points
• responding with a confused conversation = 4 points
• responding with inappropriate words = 3 points
• responding with incomprehensible sounds = 2 points
• not responding verbally = 1 point

Motor response scoring:

• following basic commands = 6 points
• responding locally to pain = 5 points
• withdrawing from painful stimuli = 4 points
• abnormal flexion (decorticate posturing) = 3 points
• abnormal extension (decerebrate posturing) = 2 points
• no motor response = 1 point

This patient gains a point for not opening his eyes to stimuli (both verbal and pain), a point for no verbal response to verbal stimuli, and 2 points for abnormal extension of his extremities (decerebrate posturing).

Correct answer: Relaxes peripheral arteries

Nitroglycerin is a vasodilator. However, "the actions of nitroglycerin on the determinants of myocardial oxygen consumption are complex: it does not directly alter contractility and reflexly increases heart rate; however, it predominantly decreases arterial resistance and venous tone, thus leading to an expected decrease in myocardial wall tension."

Nitroglycerin does not appreciably increase blood flow in sclerotic coronary arteries. It does not constrict peripheral arteries, increase smooth muscle contractions, or increase myocardial oxygen demand. Nitroglycerin relaxes peripheral arteries, reduces venous tone, and relieves the demands on cardiac muscle.

Simple Triage and Rapid Transport (START) is a system that helps rapidly sort patients by priority. The components of START are:

• breathing (respirations >30 or <10)
• circulation (strong pulse or capillary refill <2 seconds)
• mental status (follows commands)

The mnemonic RPM (respiration, pulse, mental status) can help EMS providers remember the components of START. 

Age or major injuries are not components of patient prioritizing in START triage. 

Correct answer: Bradypnea

Bradypnea is an ominous sign of impending respiratory arrest in a pediatric patient. Bradycardia also affects pediatric patients with impending cardiopulmonary arrest.

Red flags are respiratory rates below 20 breaths/minute for children younger than 6 years of age and below 12 breaths/minute for older children.

Strong central pulses are a good indication that a child is not hypotensive and their blood pressure is adequate. Tachycardia may be an early sign of hypoxia; it also accompanies fevers, anxiety, pain, and excitement. A capillary refill of greater than 2 seconds is an estimation of low end-organ perfusion but can be affected by environmental factors.

Automated external defibrillator (AED) use in cardiac arrest improves patient outcomes. The AHA recommendations on AED use include the following:

• Ensure adequate CPR is being performed while the AED is being powered up and placed.
• Limit any interruption of CPR to ≤10 seconds.
• Power on the AED and apply pads.
• Stop CPR briefly when the machine advises or push the analyze button (if present).
• If a shock is advised, clear the patient and deliver the shock; after the shock is delivered, immediately resume CPR.
• If no shock is advised, resume CPR and check the pulse when directed by the AED or after 5 cycles of CPR.
• CPR can be delivered while the AED is charging for a shock; ensure the patient is clear before delivering a shock.
• Gather information about the arrest event if possible.
• If cardiac arrest occurs during transport, stop the ambulance while analyzing and shocking the patient with an AED.

Correct answer: When it prevents assessment of the airway

A helmet should be removed if it covers the full face, inhibits assessment or management of the airway, prevents proper spinal immobilization, or allows for excessive head movement. Patients in cardiac arrest should have their helmets removed for BLS resuscitation.

A helmet should be left in place if there are no impending airway/breathing problems, if it does not interfere with airway/breathing assessment and management, and if spinal immobilization can be properly achieved. If removing a helmet could cause further injury, it should be left in place.

Correct answer: Step back and prepare to retreat, if necessary, while awaiting assistance from law enforcement

Personal safety is paramount on every call. This patient may hurt EMS personnel if given the opportunity. If there is a concern that a patient may physically assault any member of the EMS team, move away from the situation and contact law enforcement.

An alert, competent adult may refuse treatment. However, the risks, benefits, and alternatives to the treatment and its refusal must be explained to the patient prior to accepting a refusal. Any refusal of treatment/transport should be documented and signed by the patient, with a witness. However, in most states, patients who are impaired in any way (due to mental illness, a medical condition, or intoxication) cannot legally refuse treatment/transport. Leaving in this scenario may constitute abandonment.

Correct answer: Stridor

Wheezing, stridor, and coughing are commonly heard in patients with a mild/partial airway obstruction. A patient with partial airway obstruction should be monitored for adequate oxygenation and progression of the obstruction. Patients with a partial airway obstruction and poor air exchange may present with an ineffective cough, stridor, increased difficulty breathing, and cyanosis. If the obstruction is visible, use a gloved index finger to sweep the obstruction forward and remove it from the mouth. Suction may be used to assist with this procedure as well as to maintain a clear airway. If the obstruction is not visible and air exchanged is adequate, administer oxygen and rapidly transport.

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

Crackles are high-pitched (fine) or low-pitched (coarse) crackling or bubbling sounds heard on inspiration. They result from air trying to pass through fluid in the alveoli. These sounds are often indicative of pulmonary edema or congestive heart failure.

Correct answer: Peripheral cyanosis

Appearance is assessed during the Apgar scoring of an infant at 1 and 5 minutes after birth. If the newborn is entirely blue or pale, the score is 0. If the newborn has a pink body, but their hands and feet remain blue (peripheral cyanosis), the score is 1. If the entire newborn is pink, their score is 2.

Cardiac insufficiency, neonatal sepsis, and central pontine demyelination are not evaluated by Apgar scoring.

Correct answer: Abdominal breathing

Abdominal breathing is a normal finding in a pediatric patient. Their chest muscles are not well-developed, so pediatric patients will rely more on their diaphragm for breathing.

If oxygenation or ventilation is not adequate, a pediatric patient will increase their work of breathing. They may present with abnormal airway noises like grunting or wheezing, the use of accessory muscles, retractions (the drawing in of intercostal or substernal muscles), head bobbing, nasal flaring, tachypnea (relative to a normal rate for the patient), or the tripod position.

Correct answer: Sinoatrial node

The sinoatrial (SA) node is the origin of normal electrical impulses of a healthy heart. It is located in the upper part of the right atrium. The impulses travel across both atria, contracting them. The impulse then crosses a bridge of specialized tissue, the atrioventricular (AV) node. The impulse slows for about 1/10 to 2/10 of a second prior to spreading throughout the ventricles via the bundle of His, the right and left bundle branches, and the Purkinje fibers, contracting the ventricles.

Correct answer: Hypoglycemia

Hypoglycemia (low blood glucose) is often caused by normal insulin dosing with a change in routine (e.g., increased exercise, delayed or inadequately sized meal), increased insulin use, or the presence of an acute illness. The onset is typically rapid. Pale, cool, clammy skin; shallow breathing; hypotension; a rapid, weak pulse; and altered mental status are common. Oral glucose is the key treatment for suspected hypoglycemia. Contraindications to oral glucose use are unconsciousness and an inability to swallow.

Hyperglycemia (high blood glucose) has a more gradual onset than hypoglycemia. Intense thirst and hunger; increased urination (polyuria); abdominal pain; vomiting; a rapid, weak, thready pulse; restlessness with progression to coma; slurred speech; and an unsteady gait are typical. Sweet, fruity breath and rapid, deep (Kussmaul) respirations are possible in the setting of diabetic ketoacidosis.

There is no evidence of drug or alcohol intoxication in this patient. Since she is diabetic, hypoglycemia is more likely. 

Hepatitis B, C, and D can be transmitted through blood or sexual contact. 

Hepatitis A can be transmitted through the fecal-oral route. 

Correct answer: Request police assistance

Scene safety and patient safety are paramount. If a violent situation arises or seems possible, EMS should contact law enforcement for assistance. If possible, complete this request in a way that does not draw the attention of the violent individual. 

Confronting with arrest or ignoring the husband or asking the husband to leave the scene may further aggravate him, escalating the situation and increasing the likelihood of violence.

Correct answer: Transport the mother immediately while providing high-flow oxygen.

A footling breech (a foot presenting first) is a type of breech presentation that typically requires surgical intervention (cesarean section) for delivery. Immediate transport to a medical facility is crucial, and providing high-flow oxygen can help ensure the mother and baby remain as healthy as possible during transport.

Attempting to reposition the baby could cause harm to both the baby and the mother. Repositioning attempts are outside the scope of practice for EMTs.

Encouraging the mother to push could exacerbate the complications associated with a breech presentation and is not advisable without medical supervision.

Applying traction to the presenting part could lead to serious injury to the baby, such as limb dislocation or nerve damage, and is not an appropriate action for an EMT.

Correct answer: Anaphylaxis

Most allergic reactions remain localized. Anaphylaxis is a severe response with multi-system involvement. It can involve bronchospasms, wheezing, chest tightness, coughing, dyspnea, hypotension, anxiety, and gastrointestinal complaints. Intramuscular epinephrine is the primary treatment for anaphylaxis in the prehospital setting.

Asthma is an acute spasm of the bronchioles associated with excessive mucus production and swelling of the mucous lining of the respiratory passages. Asthma produces a characteristic wheeze that may be heard without a stethoscope. Respiratory distress often develops because asthmatics, after dealing with reactive airway disease for years, sometimes wait more than a day to call for EMS support.

Emphysema, a type of chronic obstructive pulmonary disease (COPD), involves a loss of elastic material within the alveolar air space. It is more common than chronic bronchitis, another form of COPD. Adventitious breath sounds (e.g., crackles, rhonchi, wheezing) may be heard on lung auscultation. Dyspnea, chronic coughing, chronic sputum, and long expiration phases are possible in patients with COPD, particularly with exacerbations.

Pneumonia is an infection of the lungs. Risk factors for pneumonia include institutional residency, recent hospitalization, chronic disease processes (e.g., renal failure), being immunocompromised, and a history of chronic obstructive pulmonary disease (COPD). Symptoms of pneumonia vary between cases, depending on the cause and severity of the illness, as well as the patient’s age and overall health. Fevers, tachycardia, hypotension (exertional), dyspnea, wheezing/crackles/rhonchi on lung auscultation, dehydration, chest pain, weight loss, and altered mental status are all possible in pneumonia cases.