Paramedics Exam Paramedic Exam EMT 4 — Questions and Answers
Question 1: A patient presents with altered mental status, flushed dry skin, and a temperature of 41.2°C (106.2°F) after working outdoors. What is the priority field treatment?
- Administer acetaminophen 1000 mg orally
- Begin rapid active cooling with cold packs to groin, axillae, and neck (Correct answer)
- Administer IV dextrose 50%
- Position the patient supine and apply oxygen
Correct answer: Begin rapid active cooling with cold packs to groin, axillae, and neck
Classic heatstroke with hot, dry skin requires immediate aggressive cooling targeting the body's major blood vessel clusters to lower the core temperature rapidly.
Question 2: What is the correct compression-to-ventilation ratio when two trained rescuers perform CPR on an adult patient WITHOUT an advanced airway in place?
- 15:2
- 30:2 (Correct answer)
- 15:1
- 30:1
Correct answer: 30:2
AHA guidelines specify a 30:2 compression-to-ventilation ratio for two-rescuer adult CPR without an advanced airway.
Question 3: Which of the following signs differentiates neurogenic shock from hypovolemic shock?
- Tachycardia and cold clammy skin
- Bradycardia and warm flushed skin below the level of injury (Correct answer)
- Hypotension and anxiety
- Tachypnea and mottled skin
Correct answer: Bradycardia and warm flushed skin below the level of injury
Neurogenic shock results from loss of sympathetic tone below the spinal cord injury, causing vasodilation (warm, flushed skin) and bradycardia — the opposite of hypovolemic shock.
Question 4: A patient is experiencing a tonic-clonic seizure lasting more than 5 minutes. After establishing IV access, which drug is the first-line treatment?
- Phenytoin 15–20 mg/kg IV
- Lorazepam 4 mg IV (Correct answer)
- Diazepam 5 mg IV
- Levetiracetam 1000 mg IV
Correct answer: Lorazepam 4 mg IV
Benzodiazepines such as lorazepam are first-line treatment for status epilepticus, providing rapid seizure termination by enhancing GABA activity.
Question 5: A 28-year-old male was found unresponsive after a heroin overdose. He is breathing 6 times per minute with pinpoint pupils. After naloxone administration, he becomes agitated and tries to leave. What is the concern?
- Naloxone caused a hypertensive emergency
- The heroin may outlast the naloxone, causing re-narcotization (Correct answer)
- The patient has developed opioid-induced pulmonary edema
- Naloxone caused a paradoxical reaction
Correct answer: The heroin may outlast the naloxone, causing re-narcotization
Naloxone has a shorter half-life (30–90 min) than most opioids, so patients can relapse into sedation and respiratory depression after the naloxone wears off.
Question 6: A patient presents with severe dyspnea, absent breath sounds on the right, and tracheal deviation to the left 30 minutes after a stab wound to the right chest. Vital signs: BP 70/40, HR 130. What is the immediate intervention?
- Apply a three-sided occlusive dressing
- Perform needle decompression on the right at the 2nd ICS, MCL (Correct answer)
- Initiate IV fluid resuscitation with 2L NS
- Perform emergency thoracotomy
Correct answer: Perform needle decompression on the right at the 2nd ICS, MCL
Signs of tension pneumothorax (absent breath sounds, tracheal deviation away, hemodynamic instability) following penetrating chest trauma require immediate needle decompression on the affected side.
Question 7: When administering adenosine for stable SVT, why must it be given as a rapid IV push followed immediately by a saline flush?
- To prevent tissue irritation at the injection site
- Because its half-life is less than 10 seconds and it must reach the heart quickly (Correct answer)
- To dilute the medication and reduce side effects
- Because adenosine is incompatible with IV tubing materials
Correct answer: Because its half-life is less than 10 seconds and it must reach the heart quickly
Adenosine's extremely short half-life (less than 10 seconds) requires rapid bolus injection with immediate flush to deliver the drug to the AV node before it is metabolized.
Paramedics Exam Paramedic Exam EMT 4
A patient presents with altered mental status, flushed dry skin, and a temperature of 41.2°C (106.2°F) after working outdoors.
What is the priority field treatment?