NREMT Advanced Emergency Medical Technician (AEMT) Cognitive Exam — Questions and Answers

Question 1: When assessing pupils, the finding 'PERRL' indicates:

Pupils Equal, Round, and Reactive to Light (Correct answer)
Pupils Elevated, Round, and Reactive to Light
Pupils Equal, Round, and Restricted Laterally
Pupils Elevated, Rigid, and Reactive to Light

Correct answer: Pupils Equal, Round, and Reactive to Light

PERRL stands for Pupils Equal, Round, and Reactive to Light, which is the normal expected finding during neurological assessment.

Question 2: Patient that meet the STEMI inclusion criteria shall be transported to the closest Cardiac Intervention Center by air or ground as long as the delivery time is not more than _________ greater than transport to the nearest ED.

10 minutes
60 minutes
45 minutes (Correct answer)
15 minutes

Correct answer: 45 minutes

In the management of STEMI (ST-elevation myocardial infarction), timely reperfusion therapy is critical. Guidelines often specify a maximum allowable transport time to a specialized Cardiac Intervention Center (CIC) compared to the nearest emergency department (ED). A common threshold is 45 minutes, meaning if transport to a CIC would exceed the nearest ED by more than 45 minutes, alternative strategies like fibrinolytic therapy at the nearest ED should be considered.

Question 3: Which of the following is a sign of IV infiltration?

Increased flow rate
Blood return in the catheter hub
Patient reports warmth along the vein
Swelling, coolness, and pain at the insertion site (Correct answer)

Correct answer: Swelling, coolness, and pain at the insertion site

Infiltration occurs when fluid leaks into surrounding tissue, causing local swelling, coolness, and pain at the insertion site.

Question 4: The proximal tibia is a common IO site. It is located approximately:

At the midshaft of the tibia posteriorly
Over the fibular head laterally
2 cm distal to the tibial tuberosity on the anteromedial flat surface (Correct answer)
2 cm proximal to the lateral malleolus

Correct answer: 2 cm distal to the tibial tuberosity on the anteromedial flat surface

The proximal tibial IO site is approximately 2 cm distal to the tibial tuberosity on the flat anteromedial surface of the tibia.

Question 5: A child presents with a seal-bark cough, inspiratory stridor, and mild respiratory distress. This presentation is MOST consistent with:

Bronchiolitis
Croup (laryngotracheobronchitis) (Correct answer)
Asthma exacerbation
Epiglottitis

Correct answer: Croup (laryngotracheobronchitis)

Croup produces the classic seal-bark cough and inspiratory stridor due to viral subglottic inflammation, typically in children aged 6 months to 3 years.

Question 6: Medical direction in EMS serves which primary function?

Approving EMS personnel vacation requests
Determining billing codes for patient transports
Managing the ambulance fleet maintenance schedule
Providing physician oversight of the AEMT's scope of practice and clinical decision-making (Correct answer)

Correct answer: Providing physician oversight of the AEMT's scope of practice and clinical decision-making

Medical direction provides physician oversight that allows AEMTs to function as extensions of the medical director, defining their authorized scope of practice.

Question 7: What describes the action of the body on the drug?

Pharmacodynamics
Physiology
Microbiology
Pharmacokinetics (Correct answer)

Correct answer: Pharmacokinetics

Pharmacokinetics is the study of what the body does to the drug. It encompasses the processes of absorption, distribution, metabolism, and excretion (ADME), which collectively describe the movement of a drug through the body and how it is handled by various physiological systems. This field is crucial for understanding drug dosing, timing, and the overall fate of a drug once administered.

Question 8: Which of the following physiologic changes in the elderly increases the risk of drug toxicity?

Increased hepatic enzyme activity
Increased lean muscle mass
Enhanced gastric absorption of oral medications
Decreased renal clearance and reduced hepatic metabolism (Correct answer)

Correct answer: Decreased renal clearance and reduced hepatic metabolism

Aging reduces both kidney clearance and liver metabolism, causing drugs to accumulate to toxic levels more readily in elderly patients.

Question 9: In pediatric cardiac arrest, the MOST common initial rhythm is:

Complete heart block
Pulseless ventricular tachycardia
Ventricular fibrillation
Asystole or pulseless electrical activity (PEA) (Correct answer)

Correct answer: Asystole or pulseless electrical activity (PEA)

Unlike adults, pediatric cardiac arrest usually results from respiratory failure leading to asystole or PEA, not primary arrhythmia.

Question 10: Which Apgar component assesses the newborn's muscle tone?

Appearance (skin color)
Grimace (reflex irritability)
Respiration
Activity (muscle tone) (Correct answer)

Correct answer: Activity (muscle tone)

The 'A' in Apgar stands for Activity, which evaluates the newborn's muscle tone as absent (0), some flexion (1), or active motion (2).

Question 11: Which suction catheter is preferred for clearing thick secretions from the oropharynx of an adult patient?

French whistle-tip catheter
Bulb syringe
Nasogastric tube
Rigid (Yankauer) catheter (Correct answer)

Correct answer: Rigid (Yankauer) catheter

The rigid Yankauer catheter provides the greatest suction force and is designed to clear thick secretions and debris from the oropharynx.

Question 12: What is a long-term benefit of pain control for pediatric patients?

Increase the development of hypersensitized pain pathways
Increased long-term sequelae in children
There are no long-term benefits noted for pediatric patients
Decreased incidence of post-traumatic stress (Correct answer)

Correct answer: Decreased incidence of post-traumatic stress

Effective pain control in pediatric patients is crucial not only for immediate comfort but also for long-term psychological well-being. Uncontrolled or severe pain, especially during traumatic events, can be a significant stressor that contributes to the development of post-traumatic stress disorder (PTSD) in children. By adequately managing pain, healthcare providers can mitigate the psychological impact of injury or illness, thereby reducing the risk of long-term psychological sequelae like PTSD.

Question 13: You are administering a 20 mL/kg fluid bolus to a 70 kg adult in hemorrhagic shock. How many mL should you infuse?

700 mL
2,000 mL
1,000 mL
1,400 mL (Correct answer)

Correct answer: 1,400 mL

20 mL/kg × 70 kg = 1,400 mL; this is the standard initial fluid bolus for hypovolemic/hemorrhagic shock resuscitation.

Question 14: During a normal delivery, once the baby's head is delivered, you should immediately:

Check for a nuchal cord and suction the airway if needed (Correct answer)
Administer oxytocin to the mother
Clamp and cut the umbilical cord
Deliver the placenta before suctioning

Correct answer: Check for a nuchal cord and suction the airway if needed

After head delivery, check for a nuchal cord (cord around the neck) and suction the mouth and nose to clear the airway before full delivery.

Question 15: In a patient with suspected traumatic brain injury (TBI), which IV fluid is MOST appropriate?

Dextrose 5% in water (D5W)
Isotonic saline (0.9% NS) or LR, avoiding hypotonic solutions (Correct answer)
Hypotonic saline (0.45% NS)
Dextrose 10% in water

Correct answer: Isotonic saline (0.9% NS) or LR, avoiding hypotonic solutions

Hypotonic fluids lower plasma osmolality and worsen cerebral edema in TBI; isotonic crystalloids are used to maintain perfusion without increasing brain swelling.

Question 16: A patient develops redness, pain, and warmth tracking up the arm from the IV site. This is MOST consistent with:

Infiltration of IV fluid
Phlebitis or early cellulitis (Correct answer)
Allergic reaction to the tape
Hematoma formation

Correct answer: Phlebitis or early cellulitis

Red streaking with warmth and tenderness traveling proximally from an IV site indicates phlebitis (vein inflammation) or early cellulitis.

Question 17: Which IV fluid is classified as an isotonic crystalloid and is most commonly used for volume resuscitation in the prehospital setting?

0.45% Normal Saline (half-normal)
Dextrose 50% (D50W)
0.9% Normal Saline (NS) (Correct answer)
Albumin 5%

Correct answer: 0.9% Normal Saline (NS)

0.9% Normal Saline is an isotonic crystalloid that remains in the intravascular space and is the most widely used prehospital resuscitation fluid.

Question 18: Before infusing fluid through an IO needle, you should:

Obtain blood cultures from the IO hub
Attach a pressure bag set to 300 mmHg immediately
Flush with 10 mL of normal saline to confirm placement
Inject lidocaine slowly if the patient is conscious to reduce pain (Correct answer)

Correct answer: Inject lidocaine slowly if the patient is conscious to reduce pain

In conscious patients, IO infusion is painful; 2% preservative-free lidocaine injected slowly before fluids significantly reduces discomfort.

Question 19: Intraosseous (IO) access delivers medications and fluids to which anatomical structure?

The periosteal space around the bone
The subcutaneous fat layer adjacent to the bone
The cortical bone where nutrients diffuse slowly
The medullary cavity of the bone, which connects to the venous circulation (Correct answer)

Correct answer: The medullary cavity of the bone, which connects to the venous circulation

IO needles enter the medullary cavity, which contains a non-collapsible venous network that rapidly delivers fluids and drugs into central circulation.

Question 20: Which of the following routes have the highest bioavailability?

Oral
None of the above
SC
IV (Correct answer)
IM

Correct answer: IV

Intravenous (IV) administration provides the highest bioavailability because the drug is delivered directly into the bloodstream, bypassing any absorption barriers or first-pass metabolism. This ensures that 100% of the administered dose reaches the systemic circulation immediately. Other routes like oral, intramuscular (IM), and subcutaneous (SC) involve absorption steps that can reduce the amount of drug reaching the bloodstream.

Question 21: When ventilating an infant with a BVM, you should use a tidal volume of approximately:

6–8 mL/kg, just enough to produce visible chest rise (Correct answer)
20 mL/kg to ensure adequate oxygenation
Whatever volume fills the infant BVM bag
Fixed 500 mL adult volume

Correct answer: 6–8 mL/kg, just enough to produce visible chest rise

Infant ventilations should deliver 6–8 mL/kg — the key clinical indicator is visible chest rise, avoiding over-inflation.

Question 22: The transport decision made during the primary assessment is used to determine:

Which hospital-specific treatment protocols to follow
The definitive diagnosis of the patient's condition
Whether to activate the ALS intercept protocol
The priority and mode of patient transport (Correct answer)

Correct answer: The priority and mode of patient transport

The transport decision establishes whether the patient requires emergent priority transport or can be transported non-urgently to the appropriate facility.

Question 23: The Apgar score is assessed at which time intervals after birth?

At delivery and at 15 minutes
1 minute and 5 minutes after birth (Correct answer)
Immediately at birth and at 5 minutes
2 minutes and 10 minutes after birth

Correct answer: 1 minute and 5 minutes after birth

The Apgar score is formally assessed at 1 minute and 5 minutes after birth to evaluate the neonate's physiological status.

Question 24: What is the MOST important initial action when a prolapsed umbilical cord is identified?

Attempt to push the cord back into the uterus
Position the mother in knee-chest or Trendelenburg and keep the cord moist and warm (Correct answer)
Administer high-flow oxygen and transport without touching the cord
Clamp the cord to prevent blood flow

Correct answer: Position the mother in knee-chest or Trendelenburg and keep the cord moist and warm

Elevating the presenting part off the cord (knee-chest or Trendelenburg position) relieves cord compression while keeping the cord moist and warm prevents spasm.

Question 25: Which of the following would be considered a means to overcome pain management barriers?

Less medical oversight
Start an IV in children immediately
Offline protocols (Correct answer)
Training on medication administering

Correct answer: Offline protocols

Offline protocols, also known as standing orders, empower prehospital providers to administer certain medications or perform procedures without direct online medical control consultation. For pain management, having clear offline protocols allows AEMTs to initiate pain relief more quickly and efficiently, overcoming potential delays associated with contacting medical control for every patient. This streamlines care and reduces barriers to timely treatment.

Question 26: Which of the following correctly describes placenta previa?

The umbilical cord prolapses through the cervix before the baby
The placenta prematurely separates from the uterine wall, causing painful bleeding
The uterus ruptures along a previous scar
The placenta implants over or near the cervical os, causing painless bright-red vaginal bleeding (Correct answer)

Correct answer: The placenta implants over or near the cervical os, causing painless bright-red vaginal bleeding

Placenta previa involves abnormal low implantation of the placenta over the cervical opening, producing painless bright red third-trimester bleeding.

Question 27: What is a long-term benefit of pain control for pediatric patients?

Increase the development of hypersensitized pain pathways
There are no long-term benefits noted for pediatric patients
Decreased incidence of post-traumatic stress (Correct answer)
Increased long-term sequelae in children

Correct answer: Decreased incidence of post-traumatic stress

Question 28: When documenting a patient's refusal of care, which of the following is ESSENTIAL to include in the PCR?

Only the patient's name and that they refused
Documentation that the patient was informed of the risks of refusal, demonstrated decision-making capacity, and signed a refusal form (Correct answer)
The crew's opinion of the patient's decision
A note that the patient seemed unreasonable

Correct answer: Documentation that the patient was informed of the risks of refusal, demonstrated decision-making capacity, and signed a refusal form

A legally defensible refusal of care requires documenting patient capacity, information given about risks, the offer to return, and a signed refusal witnessed by a bystander or crew member.

Question 29: During reassessment, the AEMT notes the patient's mental status has changed from Alert to responding only to Verbal stimuli. This change most likely indicates:

A potential deterioration in the patient's condition (Correct answer)
Normal anxiety-related fluctuation in responsiveness
Improvement in the patient's hemodynamic status
Successful pain management reducing agitation

Correct answer: A potential deterioration in the patient's condition

A drop from Alert to Verbal on the AVPU scale represents a clinically significant decline in mental status indicating the patient's condition may be worsening.

Question 30: What is the criteria that a patient must meet for the Fibrinolytic Therapy Checklist for STEMI?

All of the above (Correct answer)
18 years or older
45 minutes
Sign and symptoms of STEMI

Correct answer: All of the above

The Fibrinolytic Therapy Checklist for STEMI includes specific inclusion criteria to ensure the therapy is appropriate and safe. These typically include the patient being 18 years or older, presenting with signs and symptoms consistent with STEMI, and being within a specific time window from symptom onset (often related to the 45-minute transport threshold for PCI). Therefore, all listed options are generally part of the inclusion criteria.

Question 31: The Pediatric Assessment Triangle (PAT) evaluates three components. Which of the following correctly lists them?

Pulse, temperature, glucose
Airway, breathing, circulation
Mental status, pupils, motor function
Appearance, work of breathing, circulation to the skin (Correct answer)

Correct answer: Appearance, work of breathing, circulation to the skin

The PAT provides a rapid across-the-room assessment using Appearance, Work of Breathing, and Circulation to the Skin to identify life threats.

Question 32: Which maneuver is appropriate for opening the airway of a trauma patient with suspected spinal injury?

Neck flexion
Hyperextension of the neck
Jaw-thrust without head tilt (Correct answer)
Head-tilt chin-lift

Correct answer: Jaw-thrust without head tilt

The jaw-thrust maneuver opens the airway by displacing the mandible anteriorly without moving the cervical spine.

Question 33: The primary assessment is designed primarily to identify:

The detailed mechanism of injury
The patient's complete medical history
Immediately life-threatening conditions (Correct answer)
The need for advanced diagnostic testing

Correct answer: Immediately life-threatening conditions

The primary assessment rapidly identifies and addresses life threats affecting airway, breathing, circulation, and disability.

Question 34: When assessing pain in a 3-year-old child who cannot verbalize, you should use:

Numeric Rating Scale (0–10)
Visual Analog Scale (VAS)
FLACC scale (Face, Legs, Activity, Cry, Consolability) (Correct answer)
Wong-Baker FACES scale only

Correct answer: FLACC scale (Face, Legs, Activity, Cry, Consolability)

The FLACC scale is validated for preverbal and non-verbal children up to 7 years old, using behavioral cues rather than self-report.

Question 35: A newborn is delivered and remains blue, limp, and apneic after 30 seconds of stimulation and warming. The NEXT step is:

Administer epinephrine IM
Begin chest compressions immediately
Clamp and cut the cord and defer to the hospital
Ventilate with a neonatal BVM at 40–60 breaths/min with 21% oxygen (Correct answer)

Correct answer: Ventilate with a neonatal BVM at 40–60 breaths/min with 21% oxygen

For an apneic newborn who does not respond to initial stimulation, positive pressure ventilation at 40–60 breaths/min with room air (21% O2) is the priority intervention.

Question 36: Which finding in a pregnant trauma patient is MOST concerning for significant internal hemorrhage?

Tachycardia exceeding 100 bpm with hypotension (Correct answer)
Blood pressure of 118/76 mmHg
Fetal movement reported by the mother
Mild nausea and vomiting

Correct answer: Tachycardia exceeding 100 bpm with hypotension

Tachycardia with hypotension in a pregnant trauma patient signals significant hemorrhage; compensatory mechanisms can mask shock until 30–40% of blood volume is lost.

Question 37: The Broselow tape is used in pediatric emergencies to:

Measure the child's height for documentation
Calculate the Pediatric Glasgow Coma Scale score
Assess pain level on a visual scale
Estimate body weight and guide drug dosing and equipment selection based on length (Correct answer)

Correct answer: Estimate body weight and guide drug dosing and equipment selection based on length

The Broselow tape uses a child's length to estimate weight and provide color-coded dosing and equipment size recommendations.

Question 38: Which of the following is a disadvantage of IM administration?

Can affect lab tests
B and C (Correct answer)
A and C
Larger volumes can be used
Painful

Correct answer: B and C

Intramuscular (IM) administration can be painful due to the injection into muscle tissue, especially with larger volumes or certain medications. Additionally, the muscle damage caused by the injection can elevate levels of muscle enzymes like creatine kinase (CK) in the blood, potentially affecting the interpretation of certain lab tests. Therefore, both pain and potential interference with lab tests are disadvantages of IM administration.

Question 39: Which set of vital signs would MOST concern an AEMT assessing an adult patient?

BP 142/90 mmHg, HR 80/min, RR 20/min, SpO2 95%
BP 132/84 mmHg, HR 88/min, RR 18/min, SpO2 96%
BP 90/60 mmHg, HR 124/min, RR 26/min, SpO2 91% (Correct answer)
BP 118/76 mmHg, HR 72/min, RR 16/min, SpO2 98%

Correct answer: BP 90/60 mmHg, HR 124/min, RR 26/min, SpO2 91%

Hypotension, tachycardia, tachypnea, and hypoxia together suggest a patient in decompensating shock requiring immediate aggressive intervention.

Question 40: In a field delivery, the umbilical cord should be clamped and cut:

Immediately at birth before stimulation
Only if the baby is cyanotic
Once the baby is breathing and crying; clamp at 2–3 cm and 5 cm from the navel (Correct answer)
After the placenta delivers

Correct answer: Once the baby is breathing and crying; clamp at 2–3 cm and 5 cm from the navel

After confirming the neonate is stable and breathing, clamp the cord at two points (2–3 cm and 5 cm from the navel) and cut between the clamps.

Question 41: A non-rebreather mask (NRB) at 15 L/min delivers approximately what percentage of oxygen?

60–70%
100%
40–50%
90–95% (Correct answer)

Correct answer: 90–95%

A properly fitted non-rebreather mask at 15 L/min delivers approximately 90–95% oxygen to the patient.

Question 42: You attempt IV access twice without success. Per most AEMT protocols, you should next:

Continue attempting peripheral IVs until you succeed
Administer medications IM instead of IV
Place a central line
Consider IO access or notify medical direction (Correct answer)

Correct answer: Consider IO access or notify medical direction

Most protocols limit peripheral IV attempts to two before escalating to IO access or contacting medical direction for guidance.

Question 43: During transport of an unstable priority patient, vital signs should be reassessed at minimum every:

10 minutes
15 minutes
5 minutes (Correct answer)
2 minutes

Correct answer: 5 minutes

Unstable or critical patients require vital sign reassessment every 5 minutes to detect trends and guide ongoing treatment decisions.

Question 44: What is the exclusion criteria that a patient must meet for the Fibrinolytic Therapy Checklist for STEMI?

Known bleeding disorder
All of the above (Correct answer)
Active internal bleeding within the last 21 days
Within 3 months of intracranial surgery, serious head trauma, or stroke

Correct answer: All of the above

Fibrinolytic therapy carries a significant risk of bleeding, so strict exclusion criteria are in place to prevent severe complications. Active internal bleeding, known bleeding disorders, and recent intracranial surgery, serious head trauma, or stroke are all major contraindications due to the high risk of intracranial hemorrhage or exacerbating existing bleeding. Therefore, all the listed items are critical exclusion criteria.

Question 45: Which of the following is an advantage of sublingual administration?

Rapid absorption
Avoid harsh GI environment
All of the above (Correct answer)
Convenient

Correct answer: All of the above

Sublingual administration offers several advantages, including rapid absorption because the drug diffuses directly into the systemic circulation through the highly vascularized oral mucosa, bypassing the liver's first-pass metabolism. This route also avoids the harsh acidic environment and enzymatic degradation of the gastrointestinal tract, preserving drug integrity. Furthermore, it is a convenient method for patients who may have difficulty swallowing.

Question 46: What is the entry of drugs into the plasma?

Distribution
Elimination
Metabolism
Absorption (Correct answer)

Correct answer: Absorption

Absorption is the process by which a drug moves from its site of administration into the systemic circulation, specifically into the plasma. This step is critical because it determines how much of the drug will actually reach its target tissues and exert its effects. Factors like the drug's formulation, route of administration, and physiological conditions can significantly influence the rate and extent of absorption.

Question 47: If a patient can not be delivered to a Cardiac Intervention Center within 45 minutes, a Fibrinolytic Therapy Checklist should be completed for STEMI and the patient should be transported to the nearest ED.

FALSE
TRUE (Correct answer)

Correct answer: TRUE

If a patient with STEMI cannot be transported to a Cardiac Intervention Center for primary percutaneous coronary intervention (PCI) within the recommended timeframe (e.g., 45 minutes greater than transport to the nearest ED), then fibrinolytic therapy becomes the preferred reperfusion strategy. In such cases, a Fibrinolytic Therapy Checklist is completed to assess eligibility and contraindications, and the patient is transported to the nearest ED for administration.

Question 48: Upon arriving at a scene with downed power lines across a vehicle, you should:

Stage at a safe distance, keep bystanders back, and wait for the utility company to de-energize the lines (Correct answer)
Approach immediately to assess victims and move them from the vehicle
Use metal tools to move the lines away from the vehicle
Drive over the lines to access the scene

Correct answer: Stage at a safe distance, keep bystanders back, and wait for the utility company to de-energize the lines

Downed power lines must be treated as energized until utility personnel confirm they are de-energized; approach creates lethal electrocution risk.

Question 49: At what rate should you deliver ventilations to an adult patient who is not breathing but has a pulse?

8–10 breaths/min
12–20 breaths/min
20–24 breaths/min
10–12 breaths/min (Correct answer)

Correct answer: 10–12 breaths/min

For an apneic adult with a pulse, AEMT protocols call for rescue breathing at 10–12 breaths per minute (one breath every 5–6 seconds).

Question 50: A patient is found unresponsive at the bottom of a staircase. Which mechanism of injury consideration is MOST important?

Checking for carbon monoxide exposure
Determining the patient's insurance status before transporting
Estimating the exact number of stairs the patient fell
Spinal precautions due to potential mechanism for cervical or thoracic injury (Correct answer)

Correct answer: Spinal precautions due to potential mechanism for cervical or thoracic injury

Falls down stairs represent a significant mechanism for spinal injury; cervical spine precautions should be implemented until injury is ruled out.

Question 51: Which of the following would be considered a contraindication to administering pain medication to a pediatric patient?

Pediatric trauma patients
Normal blood pressure
Glascow Coma Score (Correct answer)
Patients under the age of 10

Correct answer: Glascow Coma Score

The Glasgow Coma Scale (GCS) is a critical assessment tool used to evaluate a patient's level of consciousness. A low or declining GCS score indicates altered mental status, which is a significant contraindication for administering pain medications, especially opioids, to pediatric patients. Opioids can depress the central nervous system and respiratory drive, potentially worsening an already compromised neurological state and making it difficult to monitor changes in consciousness.

Question 52: The Pediatric Assessment Triangle (PAT) rapidly evaluates which three components?

Pulse quality, pupils, and peripheral perfusion
Heart rate, respiratory rate, and temperature
Appearance, work of breathing, and circulation to skin (Correct answer)
Airway, breathing, and disability

Correct answer: Appearance, work of breathing, and circulation to skin

The PAT assesses Appearance (tone, interactiveness, cry/speech), Work of Breathing (positioning, retractions, sounds), and Circulation to Skin (color, mottling) to identify life threats before touching the patient.

Question 53: The JUMP START triage system modifies START for pediatric patients primarily by:

Using heart rate instead of respiratory rate as the first assessment
Requiring capillary refill to be less than 1 second to be tagged green
Giving 5 rescue breaths before tagging a non-breathing child black, and adjusting respiratory rate thresholds (Correct answer)
Eliminating the use of mental status assessment

Correct answer: Giving 5 rescue breaths before tagging a non-breathing child black, and adjusting respiratory rate thresholds

JumpSTART gives 5 rescue breaths before tagging a non-breathing child black and uses age-adjusted respiratory rate thresholds, reflecting the respiratory origin of most pediatric arrests.

Question 54: The MOST common cause of postpartum hemorrhage is:

Retained placental fragments
Coagulation disorder
Cervical laceration
Uterine atony (failure of the uterus to contract) (Correct answer)

Correct answer: Uterine atony (failure of the uterus to contract)

Uterine atony, the failure of the uterus to contract after delivery, accounts for approximately 80% of postpartum hemorrhage cases.

Question 55: During a secondary assessment of a trauma patient, when examining the chest the AEMT should assess for all of the following EXCEPT:

Capillary refill time (Correct answer)
Paradoxical chest wall movement
Equal bilateral chest rise and fall
Jugular vein distension

Correct answer: Capillary refill time

Capillary refill is assessed in the extremities; chest assessment focuses on breathing mechanics, breath sounds, and signs of tension pneumothorax or hemothorax.

Question 56: Acute Coronary Syndrome (ACS) is defined as patients with angina, shortness of breath, chest, epigastric, arm, or jaw pain or discomfort and may be associated with diaphoresis, nausea, shortness of breath or difficulty breathing.

TRUE (Correct answer)
FALSE

Correct answer: TRUE

Acute Coronary Syndrome (ACS) is a broad term encompassing conditions caused by sudden, reduced blood flow to the heart. Its presentation is indeed characterized by symptoms like angina (chest pain), shortness of breath, and referred pain to the epigastrium, arms, or jaw. These symptoms are often accompanied by diaphoresis (sweating), nausea, and difficulty breathing, making the given definition accurate.

Question 57: Which component of the SAMPLE history is represented by the letter 'M'?

Medical allergies
Mechanism of injury
Medications currently taken (Correct answer)
Mental health history

Correct answer: Medications currently taken

The 'M' in SAMPLE stands for Medications, including all prescription, over-the-counter, and herbal supplements the patient currently takes.

Question 58: You are ordered to administer 250 mg of a drug dissolved in 100 mL NS over 30 minutes using a 60 gtt/mL microdrip set. What is the drip rate?

150 gtt/min
100 gtt/min
200 gtt/min (Correct answer)
250 gtt/min

Correct answer: 200 gtt/min

(100 mL × 60 gtt/mL) / 30 min = 200 gtt/min.

Question 59: Which of the following route is NOT a means to administer fentanyl?

Intravenous
Intramuscular (Correct answer)
Transmucosal
Intranasal

Correct answer: Intramuscular

Fentanyl is a potent opioid commonly administered in pre-hospital settings for rapid pain management. While it can be given via intravenous (IV), intranasal (IN), and transmucosal (e.g., buccal, sublingual) routes for quick absorption and effectiveness, intramuscular (IM) administration is generally not a preferred or common route for fentanyl. IM absorption can be slower and less predictable compared to other routes, making it less ideal for rapid pain control with this specific medication.

Question 60: What describes the action of a drug on the body?

Microbiology
Physiology
Pharmacokinetics
Pharmacodynamics (Correct answer)

Correct answer: Pharmacodynamics

Pharmacodynamics is the study of what the drug does to the body. It focuses on the biochemical and physiological effects of drugs and their mechanisms of action, including how drugs interact with receptors, enzymes, or other targets to produce their therapeutic or adverse effects. Understanding pharmacodynamics is essential for predicting a drug's efficacy and potential side effects.

Question 61: A patient with a suspected tension pneumothorax shows tracheal deviation, absent breath sounds on the left, and JVD. Your immediate airway action is:

Insert an NPA and ventilate faster
Maintain airway patency while your partner prepares for needle decompression (Correct answer)
Increase oxygen flow on the NRB mask
Perform cricothyrotomy

Correct answer: Maintain airway patency while your partner prepares for needle decompression

Tension pneumothorax requires needle decompression; your role is to maintain the airway while preparing for or performing that intervention.

Question 62: The START triage system classifies patients into four categories. Which color tag indicates immediate life-threatening injuries that are survivable with rapid intervention?

Yellow (Delayed)
Black (Expectant/Deceased)
Red (Immediate) (Correct answer)
Green (Minor)

Correct answer: Red (Immediate)

Red tags in START triage identify patients with critical but survivable injuries who require immediate treatment to prevent death.

Question 63: Which of the following is considered a barrier to pain management in the prehospital environment?

Ability to assess pain
High pain score
Immediate transport
Difficult vascular access (Correct answer)

Correct answer: Difficult vascular access

Difficult vascular access is a significant barrier to effective pain management in the prehospital setting, especially when intravenous (IV) medications are the preferred route for rapid relief. If an AEMT cannot establish an IV line quickly, it delays or prevents the administration of rapid-acting analgesics, prolonging the patient's discomfort. Other options like high pain scores are reasons *for* pain management, not barriers.

Question 64: A geriatric patient taking warfarin falls and strikes his head. Even if he appears normal on exam, you should:

Apply ice and discharge on scene
Reassure him and recommend he see his PCP tomorrow
Withhold the warfarin history from hospital staff
Transport with high suspicion for intracranial hemorrhage, given anticoagulation increases bleed risk (Correct answer)

Correct answer: Transport with high suspicion for intracranial hemorrhage, given anticoagulation increases bleed risk

Anticoagulant therapy dramatically increases the risk of intracranial hemorrhage after even minor head trauma; transport and imaging are essential.

Question 65: The mnemonic AVPU is used to rapidly assess which patient parameter?

Level of consciousness (Correct answer)
Airway patency
Peripheral circulation
Pupillary response

Correct answer: Level of consciousness

AVPU (Alert, Verbal, Painful, Unresponsive) is a quick tool to classify the patient's level of consciousness.

Question 66: When forming a general impression upon approaching a patient, the AEMT evaluates all of the following EXCEPT:

Blood glucose level (Correct answer)
Appearance and body position
Chief complaint
Level of consciousness

Correct answer: Blood glucose level

Blood glucose is measured during the secondary assessment; the general impression relies on immediate visual and verbal observations.

Question 67: What does the 'D' in SAMPLE history stand for?

Drug allergies
Disability assessment
Duration of symptoms (Correct answer)
Diagnosis

Correct answer: Duration of symptoms

In the SAMPLE history mnemonic, 'D' stands for the Duration of the patient's current signs and symptoms.

Question 68: Which of the following is the CORRECT order of the AEMT's scene size-up?

Number of patients → BSI → scene safety → mechanism
Mechanism of injury → scene safety → BSI → patient count
Scene safety → BSI/standard precautions → mechanism/nature of illness → number of patients → additional resources (Correct answer)
BSI precautions → mechanism of injury/nature of illness → scene safety → number of patients

Correct answer: Scene safety → BSI/standard precautions → mechanism/nature of illness → number of patients → additional resources

Scene size-up begins with ensuring safety first, then donning BSI precautions, assessing MOI/NOI, counting patients, and calling for additional resources as needed.

Question 69: Which of the following is an absolute contraindication to IO placement at a specific site?

Patient weight over 100 kg
Bilateral IV access already established
A fracture in the bone at the intended site (Correct answer)
Patient under 6 years of age

Correct answer: A fracture in the bone at the intended site

A fracture at the intended IO site is an absolute contraindication because fluid would extravasate into surrounding tissue through the fracture.

Question 70: Elder abuse should be suspected when:

An elderly patient refuses treatment
The patient has multiple bruises all on the shins and has a normal mental status
There are inconsistencies between the reported mechanism of injury and the pattern of injuries, combined with caregiver evasiveness (Correct answer)
The patient requires assistance with ADLs and lives in a nursing facility

Correct answer: There are inconsistencies between the reported mechanism of injury and the pattern of injuries, combined with caregiver evasiveness

Inconsistent histories, unexplained or patterned injuries, and caregiver defensiveness are red flags for elder abuse that must be documented and reported.

Question 71: During the primary assessment of circulation, the AEMT should check for all of the following EXCEPT:

Presence of major external bleeding
Presence of a radial or carotid pulse
Blood pressure via sphygmomanometer (Correct answer)
Skin color, temperature, and moisture

Correct answer: Blood pressure via sphygmomanometer

Blood pressure measurement is part of the secondary assessment; the primary assessment uses rapid, equipment-minimal checks for pulse, major bleeding, and skin signs.

Question 72: For a responsive, stable medical patient during transport, how frequently should vital signs be reassessed?

Every 5 minutes
Every 10 minutes
Every 20 minutes
Every 15 minutes (Correct answer)

Correct answer: Every 15 minutes

Standard protocol requires vital signs to be reassessed every 15 minutes for stable medical patients during transport.

Question 73: Which of the following is a sign of adequate ventilation in an adult patient receiving BVM ventilations?

Increasing abdominal distension
Decreasing pulse oximetry readings
EtCO2 of 35–45 mmHg (Correct answer)
SpO2 of 88% with rising trend

Correct answer: EtCO2 of 35–45 mmHg

An end-tidal CO2 of 35–45 mmHg indicates effective alveolar ventilation and proper CO2 clearance.

Question 74: When using a bag-valve-mask with two rescuers, the second rescuer's role is to:

Provide chest compressions during CPR only
Monitor SpO2 and EtCO2 only
Hold cervical spine stabilization only
Squeeze the bag while the first rescuer maintains a two-handed mask seal (Correct answer)

Correct answer: Squeeze the bag while the first rescuer maintains a two-handed mask seal

Two-rescuer BVM technique has one provider maintain a two-handed E-C clamp seal while the second squeezes the bag, improving mask seal and ventilation volume.

Question 75: Which airway adjunct is inserted through the mouth and used to keep the tongue from obstructing the airway in an unconscious patient?

Nasopharyngeal airway
Supraglottic airway
Oropharyngeal airway (Correct answer)
Endotracheal tube

Correct answer: Oropharyngeal airway

An oropharyngeal airway (OPA) is inserted through the mouth to prevent the tongue from blocking the airway in unconscious, non-responsive patients.

Question 76: The Glasgow Coma Scale (GCS) score consists of three components. What are they?

Pupils, pain response, posture
Eye opening, verbal response, motor response (Correct answer)
Orientation, memory, concentration
Respirations, blood pressure, pulse

Correct answer: Eye opening, verbal response, motor response

The GCS assesses Eye opening (1–4), Verbal response (1–5), and Motor response (1–6), with a maximum score of 15.

Question 77: Which of the following is considered an immediate benefit of pain control and additionally provides a calming effect?

Doing a patient assessment quickly
Administering the pain medication immediately
Patient’s vital signs remain the same
Improvement in the patient’s respiratory effort (Correct answer)

Correct answer: Improvement in the patient’s respiratory effort

Effective pain control, especially with appropriate analgesics, can lead to a calming effect and reduce the physiological stress response associated with pain. This can result in improved respiratory effort, as the patient may be less anxious, able to breathe more deeply, and experience less splinting due to pain. While immediate administration is good, and vital signs might change, improved respiratory effort is a direct physiological benefit and calming effect.

Question 78: A GCS score of 8 or less generally indicates:

The patient is oriented and communicating normally
A normal finding in sleeping elderly patients
Severe brain dysfunction requiring airway management consideration (Correct answer)
Mild confusion requiring oxygen only

Correct answer: Severe brain dysfunction requiring airway management consideration

A GCS of 8 or less signals severe brain injury or dysfunction and is a traditional threshold for considering advanced airway intervention.

Question 79: What is criteria on a EKG strip for a STEMI?

Posterior MI: ST depression greater than 1 mm in V1 and V2 with an R/S ratio of greater than equal to one and a narrow QRS complex.
New Left Bundle Branch Block: If a previous EKG showed a narrow QRS complex and the current EKG shows a wide QRS complex.
All of the above (Correct answer)
ST elevation greater than 1 mm in two or more contiguous leads and a QRS complex that is narrower than 0.12 seconds.

Correct answer: All of the above

The criteria for diagnosing a STEMI on an EKG are multifaceted and include several key indicators. Significant ST elevation (typically >1mm in two or more contiguous leads) is a primary sign. Posterior MIs have specific EKG findings like ST depression in V1-V2. A new Left Bundle Branch Block (LBBB) can also obscure typical STEMI findings and is considered a STEMI equivalent in the appropriate clinical context, making 'All of the above' the correct answer.

Question 80: Abruptio placentae is characterized by:

Painful dark vaginal bleeding with a rigid, board-like uterus (Correct answer)
Fetal foot presenting at the vaginal opening
Severe vomiting in the first trimester
Painless vaginal bleeding in the third trimester

Correct answer: Painful dark vaginal bleeding with a rigid, board-like uterus

Abruptio placentae causes painful, dark vaginal bleeding with uterine rigidity because the placenta separates from the uterine wall, trapping blood.

Question 81: Which of the following is considered an immediate benefit of pain control and additionally provides a calming effect?

Patient’s vital signs remain the same
Administering the pain medication immediately
Doing a patient assessment quickly
Improvement in the patient’s respiratory effort (Correct answer)

Correct answer: Improvement in the patient’s respiratory effort

Effective pain control, particularly with certain analgesics, can lead to a calming effect and reduce the physiological stress response. This often translates to an improvement in the patient's respiratory effort, as pain and anxiety can cause shallow, rapid breathing. Alleviating pain can help normalize breathing patterns, which is an immediate and beneficial physiological response.

Question 82: In the SAMPLE history mnemonic, the letter 'A' stands for:

Assessment findings
Activity prior to onset
Allergies (Correct answer)
Associated symptoms

Correct answer: Allergies

The 'A' in SAMPLE stands for Allergies, particularly to medications, foods, or environmental agents relevant to treatment.

Question 83: A pregnant patient at 32 weeks gestation is found unresponsive after a syncopal episode. You should position her:

Sitting upright at 90 degrees
Prone to protect the fetus
Supine with legs elevated 12 inches
Left lateral recumbent or with a wedge under her right hip to tilt the uterus left (Correct answer)

Correct answer: Left lateral recumbent or with a wedge under her right hip to tilt the uterus left

Positioning the pregnant patient with left lateral tilt relieves aortocaval compression by the gravid uterus, improving venous return and cardiac output.

Question 84: Which of the following best describes a hypertonic solution?

A solution with higher osmolality than plasma that draws fluid into the vascular space (Correct answer)
A solution with the same osmolality as plasma (approximately 285–295 mOsm/L)
A protein-containing colloid solution
A solution with lower osmolality than plasma that moves fluid into cells

Correct answer: A solution with higher osmolality than plasma that draws fluid into the vascular space

Hypertonic solutions have osmolality greater than plasma and draw water from interstitial and intracellular spaces into the vascular compartment.

Question 85: What percentage of patients in the pre-hospital environment complain of pain?

20% (Correct answer)
50%
100%
80%

Correct answer: 20%

Studies and clinical observations in the pre-hospital environment indicate that a significant, but not overwhelming, portion of patients complain of pain. While pain is a common complaint, 20% is often cited as a more accurate representation of patients actively seeking or requiring pain management interventions in the field, rather than a majority or all patients.

Question 86: Which tool is used in the field to rapidly estimate a pediatric patient's weight for medication dosing and equipment sizing?

APGAR score
Denver Developmental Screening Test
Pediatric Assessment Triangle
Broselow tape (Correct answer)

Correct answer: Broselow tape

The Broselow tape is a length-based, color-coded resuscitation tool that correlates patient length to estimated weight, guiding medication doses and equipment selection.

Question 87: An elderly patient with known COPD presents with worsening dyspnea and SpO2 of 82%. You should:

Give oxygen only if the patient asks for it
Withhold oxygen to avoid suppressing the hypoxic drive
Apply a non-rebreather mask at 15 L/min to achieve 100% saturation
Administer supplemental oxygen titrated to SpO2 of 88–92% and monitor closely (Correct answer)

Correct answer: Administer supplemental oxygen titrated to SpO2 of 88–92% and monitor closely

Current evidence supports titrating oxygen in COPD patients to SpO2 88–92% to correct hypoxia without excessive CO2 retention.

Question 88: HAZMAT scene operations for EMS personnel operating at the cold zone primarily involve:

Managing the incident command post
Entering the hot zone with full SCBA to rescue patients
Performing gross decontamination at the warm zone perimeter
Receiving decontaminated patients from the warm zone and providing medical care (Correct answer)

Correct answer: Receiving decontaminated patients from the warm zone and providing medical care

EMS personnel in the cold zone receive patients who have been decontaminated in the warm zone and provide definitive medical care safely away from the contamination.

Question 89: During a mass-casualty incident (MCI), which patient is assigned a BLACK tag under START triage?

Patients with apnea that persists after one attempt to open the airway (Correct answer)
Any patient who is unconscious
Patients with radial pulses present but weak
Patients with a respiratory rate above 30 breaths/min

Correct answer: Patients with apnea that persists after one attempt to open the airway

In START, a patient who remains apneic after one attempt to open the airway is tagged black (expectant/deceased) because resuscitation resources must be allocated to savable patients.

Question 90: A supraglottic airway device such as the King LT or LMA is best described as:

A catheter used for suctioning the lower airway
An advanced airway placed above the glottis to channel air into the trachea (Correct answer)
A device used only for conscious patients in respiratory distress
A definitive airway that passes through the vocal cords

Correct answer: An advanced airway placed above the glottis to channel air into the trachea

Supraglottic airways sit above the glottic opening and create a sealed channel that directs ventilations into the trachea without passing through the cords.

Question 91: The Incident Command System (ICS) principle of 'span of control' recommends that one supervisor oversee no more than:

3 subordinates
10 subordinates
15 subordinates
5–7 subordinates (Correct answer)

Correct answer: 5–7 subordinates

ICS recommends a span of control of 3–7 subordinates per supervisor, with 5 as the optimal number to maintain effective oversight.

Question 92: Which of the following route is NOT a means to administer fentanyl?

Intranasal
Intravenous
Intramuscular (Correct answer)
Transmucosal

Correct answer: Intramuscular

Question 93: When calculating a drip rate using a macro-drip IV set (10 gtt/mL), what is the drip rate for 1,000 mL to be infused over 60 minutes?

60 gtt/min
167 gtt/min (Correct answer)
10 gtt/min
100 gtt/min

Correct answer: 167 gtt/min

Drip rate = (Volume × drop factor) / time = (1,000 × 10) / 60 = 167 gtt/min.

Question 94: Which of the following BEST defines the AEMT's scope of practice?

Any skill the AEMT has personally practiced in the field
The specific assessment and intervention skills authorized by the state, local protocols, and medical director (Correct answer)
Whatever the receiving hospital requests
Any skill performed by a paramedic partner

Correct answer: The specific assessment and intervention skills authorized by the state, local protocols, and medical director

Scope of practice is defined by state law, local EMS protocols, and medical director authorization — not personal experience or hospital requests.

Question 95: The OPQRST mnemonic is used by the AEMT when assessing:

Circulatory and perfusion status
Airway patency and breath sounds
A patient's pain or chief complaint (Correct answer)
Mental status and orientation

Correct answer: A patient's pain or chief complaint

OPQRST (Onset, Provocation, Quality, Radiation, Severity, Time) systematically characterizes a patient's pain or presenting complaint.

Question 96: If a patient does not meet the criteria for fibrinolytic therapy, consultation should be done with the nearest Cardiac Intervention Center and the nearest ED to determine the most appropriate receiving facility.

TRUE (Correct answer)
FALSE

Correct answer: TRUE

When a STEMI patient does not meet the criteria for fibrinolytic therapy (due to contraindications or other factors), it necessitates a careful decision regarding the most appropriate receiving facility. Consultation with both the nearest Cardiac Intervention Center (for potential PCI if feasible) and the nearest Emergency Department (for supportive care and further assessment) is crucial to ensure the patient receives the best possible care pathway.

Question 97: Epiglottitis in a child is a life-threatening emergency. The classic presentation includes:

Sudden onset periorbital swelling
High fever, drooling, tripod positioning, and muffled voice with NO barking cough (Correct answer)
Wheezing and prolonged expiration
Barking cough, hoarse voice, and low fever

Correct answer: High fever, drooling, tripod positioning, and muffled voice with NO barking cough

Epiglottitis classically presents with high fever, drooling, the tripod position, muffled or hot-potato voice, and absent barking cough due to supraglottic (not subglottic) obstruction.

Question 98: Postpartum hemorrhage is defined as blood loss exceeding how much after vaginal delivery?

1,500 mL
500 mL (Correct answer)
250 mL
1,000 mL

Correct answer: 500 mL

Postpartum hemorrhage is traditionally defined as blood loss greater than 500 mL following a vaginal delivery.

Question 99: When should an AEMT perform a rapid full-body trauma assessment?

After completing transport and at the hospital
On all patients regardless of mechanism of injury
On patients with a significant mechanism of injury or altered mental status to identify life threats quickly (Correct answer)
Only when the patient requests a complete exam

Correct answer: On patients with a significant mechanism of injury or altered mental status to identify life threats quickly

A rapid trauma assessment is performed on patients with significant MOI or altered mental status to rapidly identify and treat life-threatening injuries before transport.

Question 100: During scene size-up, what is the FIRST action an AEMT should take upon arriving at an emergency scene?

Establish the mechanism of injury
Ensure scene safety (Correct answer)
Request additional resources
Determine the number of patients

Correct answer: Ensure scene safety

Scene safety is always the first priority so the AEMT and crew are not harmed before patient care begins.

Question 101: Lactated Ringer's (LR) solution differs from 0.9% NS in that LR:

Contains dextrose for energy support
Is contraindicated in trauma patients
Is hypertonic and pulls fluid into the vascular space
Contains potassium, calcium, and lactate, more closely mimicking plasma electrolytes (Correct answer)

Correct answer: Contains potassium, calcium, and lactate, more closely mimicking plasma electrolytes

Lactated Ringer's contains electrolytes (Na⁺, K⁺, Ca²⁺, Cl⁻, lactate) that more closely approximate plasma composition compared to normal saline.

Question 102: The preferred IV site for most adult emergency patients is:

Femoral vein
Antecubital fossa vein (Correct answer)
Dorsal foot vein
External jugular vein

Correct answer: Antecubital fossa vein

The antecubital fossa provides large, easily accessible veins and allows rapid fluid delivery, making it the preferred site in emergencies.

Question 103: Which of the following would be considered a means to overcome pain management barriers?

Less medical oversight
Training on medication administering
Start an IV in children immediately
Offline protocols (Correct answer)

Correct answer: Offline protocols

Offline protocols empower AEMTs to administer pain medications based on pre-approved guidelines without needing direct medical control contact for every case. This streamlines care, reduces delays, and allows for more timely pain relief in the field. Such protocols enhance the efficiency and effectiveness of prehospital pain management by providing clear, standing orders.

Question 104: The nasopharyngeal airway (NPA) is preferred over the OPA in a patient who:

Is completely unresponsive with no gag reflex
Requires ventilation via BVM
Is semi-conscious and has an intact gag reflex (Correct answer)
Has bleeding from the nares

Correct answer: Is semi-conscious and has an intact gag reflex

The NPA is tolerated by semi-conscious patients with an intact gag reflex because it passes through the nasal passage rather than triggering the gag reflex.

Question 105: Which of the following would be considered a contraindication to administering pain medication to a pediatric patient?

Patients under the age of 10
Normal blood pressure
Pediatric trauma patients
Glascow Coma Score (Correct answer)

Correct answer: Glascow Coma Score

Question 106: A patient is intubated and has bilateral breath sounds but high resistance when squeezing the BVM. The MOST likely cause is:

The tube is too short
Right mainstem intubation
Esophageal intubation
Bronchospasm or tension pneumothorax (Correct answer)

Correct answer: Bronchospasm or tension pneumothorax

High ventilation resistance with bilateral breath sounds suggests bronchospasm, severe asthma, or a tension pneumothorax compressing the airways.

Question 107: Which of the following is a disadvantage of using oral drugs

Low bioavailability
Overdose overcome by antidotes
First pass effect
A and B (Correct answer)

Correct answer: A and B

Oral drugs are subject to the "first-pass effect," where a significant portion of the drug is metabolized by the liver before reaching systemic circulation, reducing its effectiveness. This hepatic metabolism often leads to low bioavailability, meaning only a small fraction of the administered dose reaches the bloodstream intact. Therefore, both the first-pass effect and low bioavailability are significant disadvantages of oral drug administration.

Question 108: Which finding in an infant is a late sign of decompensated shock?

Hypotension (Correct answer)
Tachycardia
Irritability
Mottled skin and cool extremities

Correct answer: Hypotension

Infants maintain blood pressure through compensatory mechanisms for a long time; hypotension is a late and ominous sign indicating decompensated shock.

Question 109: A febrile 18-month-old is brought in for a generalized tonic-clonic seizure lasting 2 minutes that stopped spontaneously. The MOST likely diagnosis is:

Hypoglycemia
Status epilepticus
Meningitis
Simple febrile seizure (Correct answer)

Correct answer: Simple febrile seizure

A simple febrile seizure is a generalized seizure lasting less than 15 minutes in a child aged 6 months to 5 years associated with fever, with no underlying neurologic cause.

Question 110: Which component of the AEMT's primary assessment is evaluated using the mnemonic AVPU?

Pulse quality
Ventilation rate
Level of consciousness/responsiveness (Correct answer)
Airway patency

Correct answer: Level of consciousness/responsiveness

AVPU (Alert, Verbal, Painful, Unresponsive) is a rapid tool for assessing a patient's level of consciousness during the primary survey.

Question 111: A neonate has an Apgar score of 4 at one minute. The MOST appropriate action is:

Administer epinephrine immediately
Transport without further assessment
Begin positive pressure ventilation (PPV) and stimulation (Correct answer)
Reassess at 5 minutes without intervention

Correct answer: Begin positive pressure ventilation (PPV) and stimulation

An Apgar score of 4–6 indicates a depressed neonate requiring assisted ventilation and continued stimulation to improve oxygenation.

Question 112: The Glasgow Coma Scale (GCS) evaluates which three components to assess neurological status?

Orientation, memory, and judgment
Pupils, reflexes, and sensation
Airway, breathing, and circulation
Eye opening, verbal response, and motor response (Correct answer)

Correct answer: Eye opening, verbal response, and motor response

The GCS scores eye opening (1–4), verbal response (1–5), and motor response (1–6) for a composite score ranging from 3 to 15.

Question 113: The primary purpose of the OPQRST mnemonic during patient assessment is to:

Obtain a past medical history
Assess neurological function
Document vital signs in order
Characterize the patient's chief complaint in detail, especially pain (Correct answer)

Correct answer: Characterize the patient's chief complaint in detail, especially pain

OPQRST (Onset, Provocation, Quality, Radiation, Severity, Time) is used to thoroughly characterize a patient's pain or presenting complaint.

Question 114: When transferring patient care to hospital staff, the AEMT should provide:

The patient's insurance card and nothing else
Written PCR only, without verbal communication
A verbal report including history, assessment findings, interventions, and patient response to treatment (Correct answer)
Only the patient's name and chief complaint

Correct answer: A verbal report including history, assessment findings, interventions, and patient response to treatment

A complete verbal hand-off ensures continuity of care and includes the patient's history, physical findings, interventions performed, and clinical response.

Question 115: Flow-restricted, oxygen-powered ventilation devices (FROPVDs) are contraindicated in:

Patients who are obese
Patients with COPD exacerbation
Adults in respiratory arrest
Pediatric patients under 12 years old (Correct answer)

Correct answer: Pediatric patients under 12 years old

FROPVDs deliver high pressures that can cause barotrauma in pediatric patients whose small airways cannot safely handle the flow rates.

Question 116: A patient in anaphylaxis has an IV established. Which of the following is the FIRST-LINE medication to administer IV?

Methylprednisolone 125 mg IV
Albuterol nebulization
Epinephrine 1:1,000 IM (or diluted IV per protocol) (Correct answer)
Diphenhydramine (Benadryl) 50 mg IV

Correct answer: Epinephrine 1:1,000 IM (or diluted IV per protocol)

Epinephrine is the first-line treatment for anaphylaxis; while IM is standard, diluted IV epinephrine (1:10,000) may be used per protocol in severe cases.

Question 117: To assist with shoulder dystocia in the field, the McRoberts maneuver involves:

Pulling firmly on the baby's head to dislodge the shoulder
Applying suprapubic pressure while the mother is in knee-chest position
Hyperflexing the mother's thighs onto her abdomen to flatten the lumbar lordosis and widen the pelvis (Correct answer)
Rotating the baby 180 degrees inside the birth canal

Correct answer: Hyperflexing the mother's thighs onto her abdomen to flatten the lumbar lordosis and widen the pelvis

The McRoberts maneuver hyperflexes the mother's thighs to her abdomen, straightening the lumbosacral curve and effectively widening the pelvic inlet to free the impacted shoulder.

Question 118: Which sign is the BEST indicator of correct BVM placement and effective ventilation?

Epigastric gurgling
High airway resistance
Visible chest rise (Correct answer)
Muffled heart sounds

Correct answer: Visible chest rise

Visible bilateral chest rise is the primary clinical indicator that the bag-valve-mask is correctly positioned and ventilations are effective.

Question 119: Signs and symptoms of eclampsia include:

Fever, rigid abdomen, and septic shock
Hypertension, proteinuria, severe headache, and seizures (Correct answer)
Hypotension, bradycardia, and visual improvement
Painless vaginal bleeding with normal blood pressure

Correct answer: Hypertension, proteinuria, severe headache, and seizures

Eclampsia is characterized by hypertension, proteinuria, and the development of grand mal seizures in a pregnant or postpartum patient.

Question 120: A patient with a nasal fracture and suspected basilar skull fracture needs an airway adjunct. You should:

Apply only a non-rebreather mask
Avoid the nasopharyngeal route and use an OPA or supraglottic device instead (Correct answer)
Insert an NPA immediately because it is safer than an OPA
Attempt nasotracheal intubation

Correct answer: Avoid the nasopharyngeal route and use an OPA or supraglottic device instead

A basilar skull fracture is a contraindication for nasopharyngeal airways because the device could inadvertently enter the cranial vault.

Question 121: A pregnant patient is in active labor and you can see the baby's foot in the vaginal opening. This is called:

Breech presentation (Correct answer)
Prolapsed cord
Placenta previa
Abruptio placentae

Correct answer: Breech presentation

A breech presentation occurs when the baby's buttocks or feet are the presenting part instead of the head.

Question 122: After inserting a supraglottic airway in a cardiac arrest patient, you should confirm placement by:

Feeling air exhaled from the device after each compression
Auscultating breath sounds and checking waveform capnography (Correct answer)
Noting the patient's SpO2 rises above 99%
Observing cyanosis resolve immediately

Correct answer: Auscultating breath sounds and checking waveform capnography

Auscultating bilateral breath sounds and confirming waveform capnography are the standard methods for verifying supraglottic airway placement.

Question 123: An elderly patient presents with confusion, fever of 101.8°F, and urinary symptoms. You should suspect:

Myocardial infarction
Hyperthyroid storm
Ischemic stroke
Urinary tract infection (UTI) — a common cause of altered mental status in the elderly (Correct answer)

Correct answer: Urinary tract infection (UTI) — a common cause of altered mental status in the elderly

UTIs frequently cause acute confusional states in geriatric patients because the aging brain is more vulnerable to systemic infection and inflammation.

Question 124: Sellick's maneuver (cricoid pressure) is applied to:

Compress the cricoid ring posteriorly to occlude the esophagus and reduce aspiration risk (Correct answer)
Open the airway by lifting the thyroid cartilage
Relieve a complete foreign-body airway obstruction
Improve mask seal during BVM ventilation

Correct answer: Compress the cricoid ring posteriorly to occlude the esophagus and reduce aspiration risk

Cricoid pressure compresses the cricoid cartilage against the esophagus, reducing the risk of regurgitation and aspiration during ventilation.

Question 125: Shoulder dystocia occurs when:

The baby's anterior shoulder is impacted behind the maternal pubic symphysis after head delivery (Correct answer)
The baby presents in a transverse lie
The placenta delivers before the baby
The umbilical cord is wrapped around the neck

Correct answer: The baby's anterior shoulder is impacted behind the maternal pubic symphysis after head delivery

Shoulder dystocia is an obstetric emergency where the baby's anterior shoulder becomes caught behind the pubic symphysis after the head has been delivered.

Question 126: A patient with a GCS score of 8 or less typically requires:

Aggressive airway management and protection (Correct answer)
Moderate sedation and monitoring
Observation only with serial neuro checks
Standard transport without airway intervention

Correct answer: Aggressive airway management and protection

A GCS of 8 or less indicates severe neurological impairment and is the threshold at which airway protection, including advanced airway management, is strongly indicated.

Question 127: A patient is found unresponsive with absent breathing and no detectable pulse. After recognizing cardiac arrest, the AEMT's FIRST action should be:

Apply and analyze the AED immediately
Obtain a 12-lead ECG
Begin high-quality CPR (Correct answer)
Establish IV access for medication administration

Correct answer: Begin high-quality CPR

High-quality CPR must be initiated immediately upon recognition of cardiac arrest to maintain circulation until defibrillation can be performed.

Question 128: A 20-gauge IV catheter is inserted and the patient is to receive a fluid bolus. What does increasing the IV bag height accomplish?

It increases flow rate by increasing hydrostatic pressure (Correct answer)
It has no effect on flow rate
It decreases flow rate by reducing back pressure
It reduces the risk of air embolism

Correct answer: It increases flow rate by increasing hydrostatic pressure

Raising the IV bag increases hydrostatic pressure in the tubing, which increases the flow rate of the infusing fluid.

Question 129: When performing a focused exam on a patient with isolated extremity trauma, the AEMT should assess for all of the following EXCEPT:

Distal pulses
Skin color and capillary refill distal to injury
Pedal edema bilaterally (Correct answer)
Distal sensation and motor function

Correct answer: Pedal edema bilaterally

Pedal edema is a systemic finding associated with conditions like congestive heart failure, not acute localized extremity trauma; neurovascular status distal to the injury is the focus.

Question 130: A 7-year-old child (22 kg) needs defibrillation. What is the correct initial energy dose?

88 J (2 J/kg) (Correct answer)
200 J
360 J
50 J

Correct answer: 88 J (2 J/kg)

Pediatric defibrillation starts at 2 J/kg; for a 22 kg child that is 44 J, and subsequent shocks can be increased to 4 J/kg.

Question 131: Air embolism is a potentially fatal complication of IV therapy. To prevent it, you should:

Prime the IV tubing to remove all air before connecting to the catheter (Correct answer)
Flush the line with heparin solution
Hang the IV bag below the level of the heart
Use a 16-gauge or larger catheter

Correct answer: Prime the IV tubing to remove all air before connecting to the catheter

Priming (flushing air out of) the IV tubing before connecting it to the patient prevents air from entering the venous system.

Question 132: What percentage of patients in the pre-hospital environment complain of pain?

100%
50%
80%
20% (Correct answer)

Correct answer: 20%

While pain is a common complaint, studies and clinical observations in the pre-hospital environment indicate that a significant, but not overwhelming, percentage of patients present with pain. The figure of 20% represents a common estimate found in research regarding the prevalence of pain complaints among patients encountered by EMS. This highlights that while pain management is important, it's not a universal complaint across all calls.

Question 133: Which of the following is considered a barrier to pain management in the prehospital environment?

Difficult vascular access (Correct answer)
Immediate transport
Ability to assess pain
High pain score

Correct answer: Difficult vascular access

In the pre-hospital environment, several factors can hinder effective pain management. Difficult vascular access, particularly in pediatric patients or those with trauma, can delay or prevent the administration of intravenous pain medications, which are often the most effective route for rapid relief. Other options like ability to assess pain or high pain scores are reasons to manage pain, not barriers, and immediate transport doesn't inherently prevent pain management.

Question 134: You are ventilating an apneic adult at 12 breaths/min with a BVM. After 2 minutes, EtCO2 climbs to 55 mmHg. You should:

Increase rate slightly or improve tidal volume to enhance CO2 clearance (Correct answer)
Switch to a non-rebreather mask
Reduce rate to 6 breaths/min
Administer sodium bicarbonate IV

Correct answer: Increase rate slightly or improve tidal volume to enhance CO2 clearance

A rising EtCO2 above 45 mmHg indicates hypoventilation; increasing rate or tidal volume will improve CO2 elimination.

Question 135: The epinephrine dose for pediatric cardiac arrest is:

1 mg flat dose regardless of weight
0.1 mg/kg of 1:1,000 IV/IO
0.1 mg/kg of 1:10,000 IM
0.01 mg/kg of 1:10,000 IV/IO (Correct answer)

Correct answer: 0.01 mg/kg of 1:10,000 IV/IO

Pediatric epinephrine for cardiac arrest is 0.01 mg/kg of 1:10,000 solution IV/IO, repeated every 3–5 minutes.

NREMT Advanced Emergency Medical Technician (AEMT) Cognitive Exam

The NREMT AEMT cognitive exam certifies candidates to provide advanced pre-hospital emergency care, including IV therapy, advanced airway management, and medication administration beyond the EMT level. It covers clinical judgment, medical emergencies, trauma, airway management, and EMS operations.

135

Questions

135 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds