NREMT Practice Test — Questions and Answers
Question 1: You are assessing the vital signs of a child at a public health center. Which of the following would be considered a normal set of vitals for a healthy nine-year-old child?
- Respirations 14 breaths per minute, pulse 60 beats per minute, BP 190/70 mmHg.
- Respirations 20 breaths per minute, heart rate 98 beats per minute, BP 106/78 mmHg. (Correct answer)
- Respirations 12 breaths per minute, pulse 135 beats per minute, BP 90/62 mmHg.
- Respirations 45 breaths per minute, pulse 58 beats per minute, BP 128/66 mmHg.
Correct answer: Respirations 20 breaths per minute, heart rate 98 beats per minute, BP 106/78 mmHg.
Normal vital signs for a healthy 9-year-old child typically include a respiratory rate of 18-30 breaths per minute, a heart rate of 70-110 beats per minute, and a blood pressure around 97-115/57-76 mmHg. Option B, with respirations at 20, heart rate at 98, and BP at 106/78, falls perfectly within these established normal ranges. The other options present values that are outside these healthy parameters for a child of this age.
Question 2: A patient who is unresponsive is discovered wet in a bath tub. She is apneic and has no pulse. What is the best course of action to take first?
- Before transporting the patient, start CPR and use an automatic external defibrillator (AED) to defibrillate the patient.
- Give two rescue breaths.
- Use an automatic external defibrillator to defibrillate the patient (AED).
- CPR should be started while the patient is being moved out of the area in preparation for defibrillation with an automatic external defibrillator (AED). (Correct answer)
Correct answer: CPR should be started while the patient is being moved out of the area in preparation for defibrillation with an automatic external defibrillator (AED).
For an unresponsive, apneic, and pulseless patient, immediate chest compressions are critical to maintain perfusion to vital organs. However, an AED cannot be safely used in a wet environment due to the risk of electrical shock. Therefore, the best course of action is to initiate CPR immediately while simultaneously moving the patient to a dry, safe area to prepare for prompt defibrillation with an AED, minimizing interruptions to life-saving compressions.
Question 3: If an ALS service is not available, which of the following is not a common rule for transporting a cardiac arrest patient?
- All cardiac arrest patients must be sent right away. (Correct answer)
- When an automatic external defibrillator (AED) displays three "no shock advised" notifications in a row.
- If the patient regains a pulse and went back to normal.
- If six to nine shocks have been delivered.
Correct answer: All cardiac arrest patients must be sent right away.
In cardiac arrest, if ALS is not available, immediate transport is generally not the primary rule. Instead, resuscitation efforts, including high-quality CPR and AED use, should continue on scene until specific criteria are met, such as return of spontaneous circulation (ROSC), three 'no shock advised' messages, or delivery of 6-9 shocks. Transporting a patient in active cardiac arrest without these interventions significantly reduces their chances of survival, as effective CPR and defibrillation are time-sensitive.
Question 4: In most cases, which of the following is not included in a patient care report?
- Chief complaint.
- Description of care provided.
- Immunization record. (Correct answer)
- Assessment findings.
Correct answer: Immunization record.
A patient care report (PCR) is a legal document that details the immediate medical care provided during an emergency. It focuses on the patient's chief complaint, assessment findings, and the interventions performed during the prehospital encounter. An immunization record, while part of a patient's overall medical history, is not typically included in a prehospital PCR, which is centered on the acute event.
Question 5: A six-year-old is unable to communicate. The carotid pulse is measured at 64 beats per minute and is judged to be normal. Breaths are shallow and come in at a pace of six per minute. Which of the following is the best course of action?
- Place the patient in the sideway position.
- Begin the assisted ventilation process. (Correct answer)
- Start CPR by performing chest compressions.
- Give high-flow oxygen using a nonrebreather mask.
Correct answer: Begin the assisted ventilation process.
A respiratory rate of six breaths per minute for a 6-year-old is severely inadequate and indicates respiratory failure, despite a normal pulse. This patient is not moving enough air to oxygenate their blood effectively. Therefore, the most critical and immediate intervention is to begin assisted ventilation (e.g., with a bag-valve mask) to ensure adequate oxygenation and ventilation, preventing further deterioration.
Question 6: The diastolic blood pressure is best described by which of the following statements?
- During the relaxation phase of the ventricles, residual pressure remains in the arteries. (Correct answer)
- During the contraction phase of the ventricles, there is pressure within the arteries.
- In response to a reduction of vascular tone, a compensatory mechanism is activated.
- None of these.
Correct answer: During the relaxation phase of the ventricles, residual pressure remains in the arteries.
Diastolic blood pressure represents the pressure remaining in the arteries when the heart's ventricles are relaxed and refilling with blood (diastole). It reflects the resistance in the peripheral blood vessels and the baseline pressure that maintains blood flow between heartbeats. This is distinct from systolic pressure, which measures the pressure during ventricular contraction.
Question 7: Snoring respirations are heard during the initial assessment of a semiconscious patient's airway. What are these breathing patterns indicating?
- The upper airway is clogged with fluid.
- The bronchial tubes are clogged.
- A partially obstructed airway. (Correct answer)
- Mucus or secretions in the larger airway.
Correct answer: A partially obstructed airway.
Snoring respirations are a classic indicator of a partial upper airway obstruction, often caused by the tongue or soft palate falling back and partially blocking the pharynx in a semiconscious or unconscious patient. The sound is produced by the vibration of these tissues as air struggles to pass through the narrowed airway. This finding necessitates immediate intervention to open and maintain a patent airway.
Question 8: During the inhalation phase of ventilation, which of the following occurs?
- The chest cavity is enlarged as the diaphragm contracts and the intercostal muscles relax.
- The diaphragm moves upward as it contracts, forcing the lungs to expand outward.
- The diaphragm relaxes, which causes the chest cavity to shrink.
- When the diaphragm and intercostal muscles tighten, the chest cavity expands. (Correct answer)
Correct answer: When the diaphragm and intercostal muscles tighten, the chest cavity expands.
During the inhalation phase of ventilation, both the diaphragm and the intercostal muscles contract. The diaphragm moves downward, and the intercostal muscles pull the rib cage upward and outward. This coordinated action increases the volume of the thoracic cavity, creating a negative pressure that draws air into the lungs from the atmosphere.
Question 9: A 30-year-old man has been injured after falling from a two-story ladder. He is conscious and guarding his right thigh while bleeding from a wound on his left forearm. What is the most appropriate next step after completing a scene size-up and creating an overall impression?
- Assess the airway of the patient and stabilize the C-spine. (Correct answer)
- Examine the right thigh.
- Place an oropharyngeal airway in place.
- Apply a tourniquet near the elbow to stop the bleeding.
Correct answer: Assess the airway of the patient and stabilize the C-spine.
After ensuring scene safety and forming a general impression, the primary assessment in trauma always begins with assessing the patient's airway and breathing, while simultaneously stabilizing the cervical spine, especially after a significant fall. While the forearm bleeding needs attention, maintaining a patent airway and protecting the spinal cord are immediate life threats that take precedence in the initial assessment sequence to ensure patient survival.
Question 10: A patient with a cardiac history is experiencing chest pain. Which of the following is not a common symptom or sign linked with cardiac insufficiency?
- Diaphoresis with no apparent cause.
- Back ache that radiates.
- Significant numbness or tingling on one side of the body. (Correct answer)
- An erratic heartbeat.
Correct answer: Significant numbness or tingling on one side of the body.
Significant numbness or tingling on one side of the body (unilateral paresthesia) is a neurological symptom, often associated with conditions like a stroke, nerve impingement, or other central nervous system issues. It is not a typical or common symptom of cardiac insufficiency or chest pain. Common cardiac symptoms include chest discomfort, radiating pain (e.g., to the arm, jaw, back), diaphoresis, and an erratic heartbeat.
Question 11: A patient's generalized motor seizure has now come to an end. The patient is most likely to be in which of the following states?
- Self-resolved lack of orientation to person, place and time. (Correct answer)
- Person, place, and time are all in focus.
- Unresponsiveness to painful stimuli.
- Anxiety and agitation.
Correct answer: Self-resolved lack of orientation to person, place and time.
Following a generalized motor seizure, patients typically enter a postictal state, which is characterized by a period of confusion, disorientation, and drowsiness. During this time, the patient may not be fully oriented to person, place, or time, and might experience temporary memory loss. This state usually resolves spontaneously as the brain recovers from the seizure activity.
Question 12: After swimming in a cold river, a 35-year-old man has developed hypothermia. Despite the fact that he emerged from the river in a matter of minutes, he seemed to be suffering from a loss of consciousness. Which of the following is the best course of action?
- Cover the patient with blankets and turn up the heat in the ambulance's patient compartment. (Correct answer)
- Increase circulation by massaging the extremities.
- Encourage the patient to move to increase his circulation and generate heat in his body.
- Place heating pads beneath the patient's arms and groin and serve him hot coffee or tea.
Correct answer: Cover the patient with blankets and turn up the heat in the ambulance's patient compartment.
For a hypothermic patient, especially one with altered consciousness, the immediate priority is to prevent further heat loss and initiate passive external rewarming. Covering the patient with dry blankets and increasing the ambient temperature in the ambulance are appropriate and safe initial steps. Aggressive rewarming techniques like massage or direct heat application can be dangerous and are generally avoided in the prehospital setting.
Question 13: In a patient with suspected cardiac chest discomfort, which of the following is a contraindication to nitroglycerin administration?
- The patient is experiencing chest pressure but no discomfort.
- The systolic blood pressure of the patient is less than 100 mmHg. (Correct answer)
- The patient has never used nitroglycerin before.
- Hypertension and atherosclerosis are both present in the patient's medical history.
Correct answer: The systolic blood pressure of the patient is less than 100 mmHg.
Nitroglycerin is a potent vasodilator that can significantly lower blood pressure. Administering it to a patient whose systolic blood pressure is already below 100 mmHg can lead to severe hypotension, potentially compromising perfusion to vital organs and causing shock. Therefore, a systolic blood pressure less than 100 mmHg is a critical contraindication to nitroglycerin administration.
Question 14: A complication of poor hand placement during chest compressions is which of the following?
- Fractured ribs (Correct answer)
- Kidney stones
- Fractured clavicles
- Gastric distension
Correct answer: Fractured ribs
Poor hand placement during chest compressions, such as pressing too high on the sternum or over the xiphoid process, significantly increases the risk of complications. Fractured ribs are a common complication, along with potential damage to internal organs like the liver or spleen. Proper hand placement on the lower half of the sternum is crucial for effective compressions and to minimize injury.
Question 15: Given the scenario, which of the following is a suitable intervention during triage of a mass-casualty incident?
- Splinting a patient with a wrist fracture.
- Opening the airway of an unconscious patient with a pulse. (Correct answer)
- CPR is performed on a patient who is unresponsive and has no pulse.
- Covering a patient who is mildly hypothermic.
Correct answer: Opening the airway of an unconscious patient with a pulse.
During mass-casualty incident triage, interventions are limited to those that can rapidly save lives or significantly improve a patient's triage category. Opening the airway of an unconscious patient with a pulse is a quick, simple, and life-saving intervention that can immediately improve oxygenation and potentially change their triage status. More time-consuming interventions like CPR on a pulseless patient or extensive splinting are typically deferred during initial triage to prioritize the greatest good for the greatest number.
NREMT Practice Test
You are assessing the vital signs of a child at a public health center.
Which of the following would be considered a normal set of vitals for a healthy nine-year-old child?