National Registry of Emergency Medical Technicians (NREMT) Paramedic Cognitive Exam — Questions and Answers

Question 1: A patient presents with symptomatic bradycardia at 38 bpm unresponsive to atropine. What is the next intervention?

Synchronized cardioversion at 50 J
Administer adenosine 6 mg IV
Initiate transcutaneous pacing (Correct answer)
Administer a second dose of atropine 1 mg IV

Correct answer: Initiate transcutaneous pacing

When atropine fails to treat symptomatic bradycardia, transcutaneous pacing is the next step while preparing for transvenous pacing.

Question 2: Which of the following is an example of a closed-ended question appropriate for radio communication?

'Describe the scene for me.'
'Is the patient conscious and breathing?' (Correct answer)
'Tell me more about the patient's condition.'
'What do you think is causing the chest pain?'

Correct answer: 'Is the patient conscious and breathing?'

Closed-ended questions that elicit a 'yes' or 'no' answer are preferred on radio to save time and reduce misunderstandings.

Question 3: Which component of the EMS communication system is responsible for receiving emergency calls from the public and dispatching resources?

Mobile data terminal (MDT)
Base station transceiver
Mobile relay station
Public Safety Answering Point (PSAP) (Correct answer)

Correct answer: Public Safety Answering Point (PSAP)

A PSAP (Public Safety Answering Point) is the facility that receives 9-1-1 calls and coordinates dispatch of EMS, fire, and police.

Question 4: You are treating an 80-year-old male with a history of a previous MI who is complaining of dizziness and weakness. His heart rate is 38/min, BP is 82/54 mmHg, and an EKG shows a third-degree AV block. Atropine has been administered with no change in his condition. What is the most appropriate next step?

Initiate transcutaneous pacing (TCP). (Correct answer)
Administer Amiodarone 150 mg IV.
Administer a fluid bolus of 500 mL normal saline.
Administer an additional dose of Atropine.

Correct answer: Initiate transcutaneous pacing (TCP).

This patient has symptomatic bradycardia (dizziness, weakness, hypotension) caused by a third-degree AV block. Atropine is often ineffective for high-degree blocks (Mobitz II or third-degree) because the block is typically below the level of the AV node where atropine acts. The next indicated step in the ACLS algorithm for unstable bradycardia unresponsive to atropine is to initiate transcutaneous pacing.

Question 5: In the management of suspected cardiac tamponade in a pulseless patient, which intervention is definitive?

Fluid resuscitation with 1-2 L NS
Needle decompression of the chest
Pericardiocentesis (Correct answer)
Administration of epinephrine 1 mg IV

Correct answer: Pericardiocentesis

Pericardiocentesis, the needle drainage of blood from the pericardial sac, is the definitive treatment for cardiac tamponade.

Question 6: According to current ACLS guidelines for shock-refractory ventricular fibrillation (VF), after the third shock and administration of epinephrine, which of the following is an appropriate next step?

Deliver a fourth shock at the maximum energy setting.
Administer a 50 mEq bolus of sodium bicarbonate.
Administer a 300 mg IV/IO bolus of amiodarone. (Correct answer)
Immediately begin a lidocaine infusion at 2 mg/min.

Correct answer: Administer a 300 mg IV/IO bolus of amiodarone.

For ventricular fibrillation or pulseless ventricular tachycardia that is unresponsive to initial shocks and vasopressor therapy, current ACLS guidelines recommend administering an antiarrhythmic. Either amiodarone (initial dose 300 mg IV/IO) or lidocaine may be considered. Sodium bicarbonate is only indicated in specific situations like known hyperkalemia or tricyclic antidepressant overdose, not routinely in cardiac arrest. A lidocaine infusion is typically preceded by a bolus.

Question 7: A supraglottic airway device (e.g., King LT) is inserted but you are unable to achieve adequate ventilation. What should you check FIRST?

Lung compliance
Cuff pressures and tube depth (Correct answer)
Chest x-ray
Tidal volume settings

Correct answer: Cuff pressures and tube depth

Inadequate ventilation with a supraglottic airway most commonly results from improper depth or insufficiently inflated cuffs.

Question 8: Which rhythm is most commonly seen immediately after successful defibrillation of ventricular fibrillation?

PEA or asystole (Correct answer)
Atrial fibrillation
Normal sinus rhythm
Supraventricular tachycardia

Correct answer: PEA or asystole

Post-defibrillation PEA or asystole is common and requires immediate resumption of CPR for 2 minutes.

Question 9: Which personal protective equipment is required at minimum for a call involving suspected tuberculosis (TB)?

Standard surgical mask
Full face shield only
N95 or higher respirator (Correct answer)
PAPR (powered air-purifying respirator)

Correct answer: N95 or higher respirator

An N95 respirator (or higher) is required for airborne precautions involving suspected or confirmed tuberculosis.

Question 10: Which zone at a hazmat MCI is also called the 'exclusion zone' and requires full PPE?

Warm zone
Cold zone
Hot zone (Correct answer)
Support zone

Correct answer: Hot zone

The hot zone (exclusion zone) is the area of direct contamination where only properly equipped hazmat personnel may enter.

Question 11: Which of the following frequencies is designated as the national EMS calling/simplex channel in the United States?

155.340 MHz (Correct answer)
154.025 MHz
460.025 MHz
155.280 MHz

Correct answer: 155.340 MHz

155.340 MHz (MED 9) is the national EMS simplex calling channel designated by the FCC for use across the US.

Question 12: During CPR, which finding on capnography most reliably indicates return of spontaneous circulation (ROSC)?

ETCO2 remains stable at 20 mmHg
ETCO2 drops below 10 mmHg
ETCO2 rises gradually to 35 mmHg
ETCO2 suddenly rises above 40 mmHg (Correct answer)

Correct answer: ETCO2 suddenly rises above 40 mmHg

A sudden abrupt rise in ETCO2 above 40 mmHg during CPR is a reliable indicator of ROSC due to restored cardiac output.

Question 13: Which medication used in RSI provides neuromuscular blockade with the LONGEST duration of action?

Vecuronium (Correct answer)
Etomidate
Rocuronium
Succinylcholine

Correct answer: Vecuronium

Vecuronium is a non-depolarizing agent with a duration of 25-40 minutes, longer than rocuronium (30-60 min) and much longer than succinylcholine (8-12 min).

Question 14: Which pediatric anatomical difference is MOST important to consider when managing a child's airway after blunt head trauma?

The trachea is longer and more rigid than in adults
Children have smaller tonsils that rarely obstruct the airway
Children's airways are less susceptible to swelling
The occiput is proportionally larger, causing passive neck flexion when supine (Correct answer)

Correct answer: The occiput is proportionally larger, causing passive neck flexion when supine

A child's large occiput causes the head to flex forward when supine, potentially obstructing the airway; a padding roll under the shoulders maintains a neutral position.

Question 15: Which practice helps prevent radio frequency interference during a multi-agency incident?

Each agency disables its repeater to reduce signal overlap
A dedicated interoperability channel is assigned and all agencies switch to it (Correct answer)
All agencies default to their own primary frequency
Agencies alternate transmission windows every 30 seconds

Correct answer: A dedicated interoperability channel is assigned and all agencies switch to it

Assigning a designated interoperability (interop) channel allows multiple agencies to coordinate on a single, agreed-upon frequency.

Question 16: A patient with blunt abdominal trauma has Kehr's sign (left shoulder pain). Which organ injury does this suggest?

Liver laceration
Splenic rupture (Correct answer)
Left kidney contusion
Pancreatic injury

Correct answer: Splenic rupture

Kehr's sign is referred pain to the left shoulder caused by diaphragmatic irritation from blood pooling under the left hemidiaphragm due to splenic rupture.

Question 17: A 4-year-old child is in respiratory distress. The appropriately-sized ETT is selected using the formula. Which formula is correct for uncuffed tubes?

Age + 3
(Age + 16) / 4
(Age / 2) + 4
(Age / 4) + 4 (Correct answer)

Correct answer: (Age / 4) + 4

The Broselow tape or the formula (Age/4) + 4 estimates uncuffed ETT internal diameter in millimeters for pediatric patients.

Question 18: You are dispatched to a farm where a 45-year-old male is found confused and vomiting. His coworkers state he was spraying pesticides without protective gear. The patient has pinpoint pupils, is profusely sweating and salivating, and is incontinent of urine. These findings are most characteristic of which toxidrome?

Sedative-Hypnotic
Sympathomimetic
Cholinergic (Correct answer)
Anticholinergic

Correct answer: Cholinergic

This patient's signs and symptoms are classic for a cholinergic crisis, most likely caused by organophosphate poisoning from the pesticides. The mnemonic SLUDGEM (Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis, Miosis) or DUMBELS (Diaphoresis/Diarrhea, Urination, Miosis, Bradycardia/Bronchospasm, Emesis, Lacrimation, Salivation) describes the effects of excessive acetylcholine stimulation, which is the mechanism of organophosphate toxicity.

Question 19: A 60-year-old dialysis patient presents with peaked T waves, a HR of 38 bpm, and a wide QRS complex. After calcium gluconate, what is the next appropriate intervention?

Kayexalate (sodium polystyrene)
Sodium bicarbonate 50 mEq IV (Correct answer)
Albuterol nebulizer
Furosemide 40 mg IV

Correct answer: Sodium bicarbonate 50 mEq IV

Sodium bicarbonate temporarily shifts potassium into cells by alkalizing the blood, providing a rapid but temporary reduction in serum potassium.

Question 20: A patient presents with confusion, seizures, and a history of recent excessive water intake after a marathon. Serum sodium is 118 mEq/L. What condition does this represent?

Hyponatremia (dilutional) (Correct answer)
Hypernatremia
Syndrome of inappropriate ADH (SIADH)
Heat stroke

Correct answer: Hyponatremia (dilutional)

Excessive free water intake causing severe dilutional hyponatremia (sodium <120 mEq/L) leads to cerebral edema, manifesting as confusion and seizures.

Question 21: Which of the following is a primary indication for performing a needle cricothyrotomy in the prehospital setting?

A patient with a suspected C-spine injury who requires intubation.
An apneic patient with a foreign body airway obstruction that cannot be visualized.
A 'can't intubate, can't ventilate' situation with massive maxillofacial trauma. (Correct answer)
A patient in severe respiratory distress from an asthma exacerbation.

Correct answer: A 'can't intubate, can't ventilate' situation with massive maxillofacial trauma.

A cricothyrotomy is an invasive, rescue airway procedure indicated only when all other methods of securing an airway have failed or are impossible. [22] A 'can't intubate, can't ventilate' scenario, such as one caused by massive facial trauma that prevents bag-mask ventilation or intubation, is a primary indication. [8, 22]

Question 22: Which parameter determines whether a trauma patient meets physiological criteria for trauma center activation?

Involvement of a pedestrian
Age > 55 with any injury
Mechanism involving a rollover MVC
SBP < 90 mmHg or GCS < 14 (Correct answer)

Correct answer: SBP < 90 mmHg or GCS < 14

Physiological trauma triage criteria include SBP <90 mmHg or GCS <14, indicating hemodynamic or neurological compromise requiring highest-level trauma care.

Question 23: What is the correct initial dose and route of epinephrine for an adult patient experiencing anaphylaxis with respiratory compromise and hypotension?

1 mg (1:10,000) IV push
0.3 to 0.5 mg (1:1,000) intramuscular (IM) injection (Correct answer)
0.1 mg (1:1,000) subcutaneous injection
1 mg (1:1,000) intramuscular (IM) injection

Correct answer: 0.3 to 0.5 mg (1:1,000) intramuscular (IM) injection

The standard first-line treatment for an adult with anaphylaxis is epinephrine 0.3 to 0.5 mg of the 1:1,000 concentration administered via the intramuscular route, typically into the anterolateral thigh. This route provides rapid absorption. The IV route is typically reserved for patients in or near cardiac arrest or with profound hypotension unresponsive to initial IM injections and fluid resuscitation.

Question 24: A patient extricated from a cold-water drowning is pulseless. The correct action is:

Administer epinephrine only and observe for 10 minutes
Defibrillate immediately regardless of rhythm without warming first
Withhold resuscitation as cold-water drowning is universally fatal
Begin CPR and transport; do not pronounce death until the patient is warm (Correct answer)

Correct answer: Begin CPR and transport; do not pronounce death until the patient is warm

'Not dead until warm and dead' — hypothermia can mimic death; aggressive rewarming during CPR is indicated before terminating resuscitation.

Question 25: You administer flumazenil to a benzodiazepine overdose patient. Which complication must you most closely monitor for?

Precipitation of opioid withdrawal
Ventricular fibrillation
Seizures in a chronic benzodiazepine user (Correct answer)
Hypertensive crisis

Correct answer: Seizures in a chronic benzodiazepine user

Flumazenil can precipitate acute benzodiazepine withdrawal causing refractory seizures, especially dangerous in patients with chronic use or polysubstance ingestion.

Question 26: Which beta-blocker is cardioselective and primarily blocks beta-1 receptors at therapeutic doses?

Labetalol
Propranolol
Metoprolol (Correct answer)
Carvedilol

Correct answer: Metoprolol

Metoprolol is a cardioselective beta-1 blocker, reducing cardiac output and heart rate with less bronchospasm risk than nonselective agents.

Question 27: A patient in cardiac arrest is receiving high-quality CPR. The ETCO2 remains below 10 mmHg despite two rescuers alternating compressions. What does this most likely indicate?

ROSC has occurred
The patient has severe COPD
Hyperventilation by the rescuer
Inadequate compression depth or rate (Correct answer)

Correct answer: Inadequate compression depth or rate

Persistently low ETCO2 during CPR despite proper technique suggests poor cardiac output from inadequate compression depth or rate.

Question 28: When should a chemical spill be handled when a rescue effort is required?

Do not deal with the spill
After the rescue
At the same time as the rescue
Before the rescue (Correct answer)

Correct answer: Before the rescue

In situations involving a chemical spill and a rescue, the chemical hazard must be addressed and controlled *before* rescuers enter the hot zone to perform the rescue. This ensures the safety of both the rescuers and the patient, preventing further contamination or injury. Rescuer safety is paramount, and mitigating environmental hazards is a critical first step in any hazardous materials incident.

Question 29: A 72-year-old female presents with syncope, severe lightheadedness, and bradycardia at 38 bpm. She is pale and diaphoretic with a BP of 80/50. The ECG shows complete heart block. What is the first-line treatment?

Transcutaneous pacing (Correct answer)
Adenosine 6 mg rapid IV push
Atropine 0.5 mg IV
Amiodarone 300 mg IV

Correct answer: Transcutaneous pacing

Transcutaneous pacing is the first-line treatment for symptomatic third-degree (complete) heart block because atropine is often ineffective at this level of block.

Question 30: A patient in ventricular fibrillation receives a 200J biphasic shock. The rhythm converts to pulseless electrical activity (PEA). What is the most appropriate next step?

Increase shock energy to 360J
Administer amiodarone 300mg IV
Resume high-quality CPR and search for reversible causes (Correct answer)
Deliver another shock immediately

Correct answer: Resume high-quality CPR and search for reversible causes

PEA requires CPR and treatment of reversible causes (Hs and Ts); defibrillation is not indicated for PEA.

Question 31: A 62-year-old male presents with substernal chest pain. A 12-lead EKG reveals ST-segment elevation of 3 mm in leads II, III, and aVF. Which coronary artery is most likely occluded, and what is a primary prehospital treatment goal?

Left Anterior Descending (LAD); Administration of furosemide.
Posterior Descending Artery (PDA); Administration of sodium bicarbonate.
Right Coronary Artery (RCA); Rapid transport to a PCI-capable facility. (Correct answer)
Circumflex Artery; Initiation of therapeutic hypothermia.

Correct answer: Right Coronary Artery (RCA); Rapid transport to a PCI-capable facility.

ST elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction, which is most commonly caused by an occlusion of the Right Coronary Artery (RCA). The primary goal for a STEMI patient is rapid reperfusion, making immediate transport to a hospital with percutaneous coronary intervention (PCI) capabilities essential to minimize cardiac muscle damage.

Question 32: Which nerve is responsible for diaphragmatic innervation, and at what spinal level does it originate?

Accessory nerve, C1-C2
Vagus nerve, C10
Phrenic nerve, C3-C5 (Correct answer)
Intercostal nerve, T1-T6

Correct answer: Phrenic nerve, C3-C5

The phrenic nerve originates from C3, C4, and C5 and is the primary motor nerve driving diaphragm contraction for breathing.

Question 33: In the context of traumatic cardiac arrest, which reversible cause should be addressed first?

Hypothermia
Hypovolemia
Tension pneumothorax (Correct answer)
Hyperkalemia

Correct answer: Tension pneumothorax

Tension pneumothorax is the most rapidly correctable cause of traumatic cardiac arrest and should be immediately decompressed bilaterally during resuscitation.

Question 34: What makes croup distinctive?

Slow onset (Correct answer)
Child prefers to sit up
Drooling
Occasional stridor

Correct answer: Slow onset

Croup (laryngotracheobronchitis) is typically characterized by a slow, gradual onset, often starting with cold-like symptoms that progress over a few days to the classic barking cough, inspiratory stridor, and hoarseness. This distinguishes it from conditions like epiglottitis, which has a rapid onset and is associated with drooling and a preference to sit up.

Question 35: Which benefit of nasotracheal intubation is NOT thought to exist?

The tube cannot be bitten
The tube can be easily anchored
It is more comfortable for the patient
It is less traumatic for the patient (Correct answer)

Correct answer: It is less traumatic for the patient

Nasotracheal intubation is generally considered more traumatic for the patient than orotracheal intubation due to the potential for nasal bleeding, discomfort, and difficulty passing the tube through the nasal passages. While it offers advantages like easier tube anchoring and patient comfort once placed, the insertion process itself is often more invasive and carries higher risks of trauma.

Question 36: Which mechanism is associated with a Chance fracture of the lumbar spine?

Hyperextension from a rear-end collision
Direct blow to the spinous process
Lap belt restraint in a high-speed MVC (Correct answer)
Axial loading from a fall

Correct answer: Lap belt restraint in a high-speed MVC

A Chance fracture is a flexion-distraction injury associated with lap belt use during high-speed collisions, causing the vertebra to split horizontally.

Question 37: When assessing an unresponsive patient with a Left Ventricular Assist Device (LVAD), which finding is considered normal and should NOT be misinterpreted as a sign of poor perfusion or death?

A loud, continuous humming sound over the precordium. (Correct answer)
A blood pressure reading of 120/80 mmHg via automated cuff.
A heart rate of 0 on the cardiac monitor.
A palpable radial or carotid pulse.

Correct answer: A loud, continuous humming sound over the precordium.

LVADs are continuous-flow pumps, which often results in a non-pulsatile state. Therefore, palpable pulses and standard blood pressure readings may be absent even with adequate circulation. A continuous humming or whirring sound is the normal operating sound of the LVAD motor and is a key indicator that the device is functioning.

Question 38: Which of the following is the CORRECT tidal volume to deliver when ventilating an adult with a BVM?

300-400 mL over 0.5 seconds
800-1000 mL over 2 seconds
1000-1200 mL over 3 seconds
500-600 mL over 1 second (Correct answer)

Correct answer: 500-600 mL over 1 second

Adult BVM ventilation should deliver 500-600 mL (enough to produce visible chest rise) over approximately 1 second to minimize gastric inflation.

Question 39: Which of the following is NOT a sign of adequate ventilation during BVM use?

EtCO2 waveform present
Visible chest rise and fall
SpO2 improving toward normal
Audible gurgling over the epigastrium (Correct answer)

Correct answer: Audible gurgling over the epigastrium

Gurgling over the epigastrium indicates air is entering the stomach, not the lungs — this signals improper ventilation and risk of aspiration.

Question 40: Which acid-base pattern is most characteristic of salicylate (aspirin) poisoning in adults?

Metabolic alkalosis followed by respiratory acidosis
Respiratory alkalosis followed by metabolic acidosis (Correct answer)
Pure metabolic acidosis from the onset
Pure respiratory alkalosis throughout the course

Correct answer: Respiratory alkalosis followed by metabolic acidosis

Salicylates directly stimulate the respiratory center causing initial respiratory alkalosis, then impair oxidative phosphorylation producing high anion gap metabolic acidosis.

Question 41: A tension pneumothorax is BEST decompressed in the prehospital setting by:

Immediate chest tube placement at the 5th ICS
Applying a three-sided occlusive dressing
Positive pressure ventilation with high FiO2
Needle thoracostomy at the 2nd intercostal space, midclavicular line (Correct answer)

Correct answer: Needle thoracostomy at the 2nd intercostal space, midclavicular line

Needle thoracostomy (needle decompression) at the 2nd ICS midclavicular line is the standard prehospital treatment for tension pneumothorax.

Question 42: A laryngeal mask airway (LMA) provides which level of airway protection?

Infraglottic protection similar to ETT
Full protection only when cuff is inflated
Supraglottic airway — no aspiration protection (Correct answer)
Complete protection against aspiration

Correct answer: Supraglottic airway — no aspiration protection

The LMA sits above the glottis (supraglottic) and does not provide protection against aspiration of gastric contents.

Question 43: A motorcyclist struck a guardrail at high speed and has an open femur fracture with visible bone. Hemorrhage is controlled. The next priority is:

Wrap with a pressure bandage and avoid splinting
Immediate surgical referral only; no prehospital splinting
Reduce and splint the fracture in the field
Traction splint application to reduce blood loss and pain (Correct answer)

Correct answer: Traction splint application to reduce blood loss and pain

A traction splint reduces femur fracture displacement, decreasing internal blood loss (up to 1–2 liters) and pain before transport.

Question 44: How should the tubing of an esophageal obturator airway be held?

Like an apple
Like a pencil (Correct answer)
Like a fork
Like an axe

Correct answer: Like a pencil

When inserting an esophageal obturator airway (EOA) or similar supraglottic airway devices, the tubing or device should be held like a pencil. This grip allows for precise control, gentle manipulation, and accurate placement, minimizing the risk of trauma to the patient's airway structures during insertion. Proper technique is crucial for patient safety.

Question 45: During cardiac arrest resuscitation, epinephrine 1mg IV/IO should be administered every:

3–5 minutes (Correct answer)
Once only per resuscitation
2 minutes
5–10 minutes

Correct answer: 3–5 minutes

The AHA recommends epinephrine 1mg IV/IO every 3–5 minutes during cardiac arrest.

Question 46: You arrive at a single-vehicle MVC where the car has struck a utility pole. Live power lines are draped across the hood of the car, and the single occupant appears unresponsive. What is the most appropriate initial action?

Immediately begin triage to determine the extent of the patient's injuries.
Use rubber-handled rescue tools to break the window and access the patient.
Park the ambulance next to the vehicle to create a physical barrier from traffic.
Establish a danger zone, deny entry, and request immediate assistance from the power company. (Correct answer)

Correct answer: Establish a danger zone, deny entry, and request immediate assistance from the power company.

The primary principle of all EMS operations is scene safety. Approaching a vehicle in contact with live power lines poses an extreme risk of electrocution to responders. The correct initial action is to secure the scene by establishing a danger zone, prevent others from entering, and wait for the utility company to confirm the power is off before any patient contact is made.

Question 47: You are treating a patient with narrow-complex tachycardia at 180 bpm who is hemodynamically stable. Vagal maneuvers have failed. What is the next appropriate intervention?

Verapamil 5 mg IV slow push
Adenosine 6 mg rapid IV push followed by saline flush (Correct answer)
Synchronized cardioversion at 50J
Amiodarone 150 mg IV over 10 minutes

Correct answer: Adenosine 6 mg rapid IV push followed by saline flush

Adenosine is the first-line pharmacologic treatment for stable narrow-complex SVT after failed vagal maneuvers, as it temporarily blocks the AV node to terminate reentrant rhythms.

Question 48: When using hydraulic rescue tools ('Jaws of Life') near a hybrid or electric vehicle, the paramedic should advise rescuers to:

Avoid cutting orange-jacketed cables and disable the 12V accessory battery instead (Correct answer)
Submerge the battery module in water before cutting
Cut the orange high-voltage cables first to disable the system
Ignore hybrid components as they pose no additional risk

Correct answer: Avoid cutting orange-jacketed cables and disable the 12V accessory battery instead

Orange cables carry high-voltage DC current; the 12V accessory battery should be cut to depower safety systems without touching HV components.

Question 49: What kind of medication should be given to a youngster who is having seizures?

Epinephrine
Diazepam (Correct answer)
Neurontin
Dopamine

Correct answer: Diazepam

For acute seizures in the prehospital setting, benzodiazepines like diazepam (or lorazepam, midazolam) are the first-line medications. They act quickly to depress the central nervous system and stop seizure activity. Dopamine and epinephrine are used for cardiac support, and Neurontin is an anticonvulsant for long-term management, not acute seizure termination.

Question 50: You are evaluating a patient who has recently suffered a stroke to see if advanced therapy will be beneficial. What must you identify as the crucial element?

Is the patient experiencing receptive aphasia?
When did the patient's symptoms begin? (Correct answer)
All of the above.
Is the patient experiencing dysarthria?

Correct answer: When did the patient's symptoms begin?

For stroke patients, the most crucial element to identify for potential advanced therapies (like thrombolytics) is the exact time of symptom onset, often referred to as 'time last known well.' These therapies are highly time-sensitive and are only effective if administered within a narrow therapeutic window, typically within 3-4.5 hours of symptom onset. The presence of specific symptoms is important, but the timing is the critical determinant for treatment eligibility.

Question 51: What is the recommended target systolic BP for permissive hypotension in an adult trauma patient with suspected internal hemorrhage and NO traumatic brain injury?

60–70 mmHg
80–90 mmHg (Correct answer)
100–110 mmHg
120 mmHg or higher

Correct answer: 80–90 mmHg

Permissive hypotension targets a systolic BP of 80–90 mmHg to maintain perfusion while minimizing clot disruption in hemorrhaging patients without TBI.

Question 52: A patient is intubated and has equal bilateral breath sounds, but SpO2 remains at 84%. Waveform capnography shows a normal square waveform at 38 mmHg. What is the most likely cause?

Right mainstem intubation
Ventilation-perfusion mismatch (Correct answer)
Esophageal intubation
Equipment malfunction of the pulse oximeter

Correct answer: Ventilation-perfusion mismatch

Confirmed tube placement with normal ETCO2 and equal breath sounds rules out malposition; persistent low SpO2 with good ventilation suggests V/Q mismatch (e.g., pulmonary embolism, ARDS).

Question 53: When assessing a patient's respiratory rate, you count 8 breaths per minute in an adult. This finding is best described as:

Apnea
Tachypnea
Eupnea
Bradypnea (Correct answer)

Correct answer: Bradypnea

Bradypnea is an abnormally slow respiratory rate, defined as fewer than 12 breaths per minute in adults.

Question 54: A 45-year-old male presents with profound weakness, hypotension, hyponatremia, hyperkalemia, and hyperpigmentation of the skin. He reports he stopped taking his steroid medication. What is the diagnosis?

Cushing's syndrome
Hypothyroid storm
Pheochromocytoma
Addisonian crisis (adrenal crisis) (Correct answer)

Correct answer: Addisonian crisis (adrenal crisis)

Adrenal crisis presents with hypotension, electrolyte disturbances (hyponatremia, hyperkalemia), weakness, and skin hyperpigmentation, often precipitated by abrupt steroid discontinuation.

Question 55: Which resource list item is NOT regarded as a requirement?

Confined-space accidents
Transportation accidents
High-rise fire accidents (Correct answer)
High-angle accidents

Correct answer: High-rise fire accidents

While high-rise fires are significant emergencies, the question asks about 'resource list items' that are *not* regarded as a *requirement* in the context of specialized rescue teams. High-angle, confined-space, and transportation accidents often require highly specialized rescue teams and equipment that are distinct from standard fire suppression. High-rise fire response often falls under general fire department operations, although it can involve elements of high-angle rescue, it's not typically categorized as a standalone 'rescue resource requirement' in the same way as the others, which demand specific, dedicated rescue capabilities.

Question 56: A 5-year-old is found with altered mental status and blood glucose of 38 mg/dL. You establish IV access. What is the appropriate dextrose dose?

D10W 5 mL/kg IV
D50W 1 mL/kg IV
D25W 1 mL/kg IV
D25W 2 mL/kg IV (0.5 g/kg) (Correct answer)

Correct answer: D25W 2 mL/kg IV (0.5 g/kg)

For pediatric hypoglycemia, D25W at 2 mL/kg (0.5 g/kg) is the standard dose; D50 is avoided due to osmotic injury risk.

Question 57: In a patient with a suspected pelvic fracture and hemodynamic instability, what is the most appropriate prehospital intervention?

Apply a pelvic binder at the level of the iliac crests
Log roll to assess posterior pelvis
Avoid any movement of the pelvis
Apply a pelvic binder at the level of the greater trochanters (Correct answer)

Correct answer: Apply a pelvic binder at the level of the greater trochanters

A circumferential pelvic binder should be applied at the level of the greater trochanters to reduce pelvic volume and tamponade venous bleeding.

Question 58: A paramedic administers an IV medication too rapidly and the patient develops phlebitis. This is an example of which adverse drug effect?

Cumulative toxicity
Local tissue irritation (Correct answer)
Allergic reaction
Idiosyncratic reaction

Correct answer: Local tissue irritation

Phlebitis from rapid IV administration is a local tissue irritation caused by the drug's chemical properties or infusion rate.

Question 59: Which of the following is NOT something that can be evaluated while the patient is still trapped?

Vital signs
Extent of wounds (Correct answer)
Patient responsiveness
Airway constriction

Correct answer: Extent of wounds

While a patient is still trapped, paramedics can typically assess immediate life threats like airway constriction, patient responsiveness (level of consciousness), and vital signs (pulse, breathing). However, a full and detailed assessment of the *extent* of all wounds, especially internal or hidden injuries, is often difficult or impossible until the patient is disentangled and fully accessible. This comprehensive evaluation usually occurs once the patient is freed.

Question 60: Which of the following is the correct energy setting for synchronized cardioversion of stable atrial flutter?

360J monophasic
150–200J biphasic
50–100J biphasic (Correct answer)
200J biphasic

Correct answer: 50–100J biphasic

Atrial flutter typically responds to low-energy synchronized cardioversion starting at 50–100J biphasic.

Question 61: What does a colorimetric CO2 detector turning YELLOW indicate after endotracheal intubation?

Esophageal intubation confirmed
Tracheal intubation confirmed (Correct answer)
Device malfunction
Low EtCO2

Correct answer: Tracheal intubation confirmed

Yellow color on a colorimetric detector indicates the presence of CO2, confirming tracheal (not esophageal) placement.

Question 62: What is the PRIMARY hazard when performing rescue operations near downed electrical lines?

Step potential voltage traveling through the ground (Correct answer)
Direct contact with the wire only
Fire ignition from sparks
Electromagnetic interference with medical equipment

Correct answer: Step potential voltage traveling through the ground

Step potential (ground gradient) allows current to flow through a rescuer's body if their feet are at different voltages on energized ground.

Question 63: A 60-year-old male with CHF presents with severe dyspnea, pink frothy sputum, SpO2 of 86%, bilateral crackles, and hypertension at 200/110 mmHg. What is the best prehospital treatment?

Furosemide 40 mg IV and oxygen via NRB
Morphine 2-4 mg IV for anxiolysis
Normal saline 500 mL IV bolus to maintain preload
CPAP and nitroglycerin per protocol (Correct answer)

Correct answer: CPAP and nitroglycerin per protocol

CPAP improves oxygenation and reduces preload, while nitroglycerin reduces afterload and preload; both are evidence-based prehospital treatments for acute pulmonary edema with hypertension.

Question 64: A paramedic is managing a mechanically ventilated patient following intubation. The high-pressure alarm on the ventilator sounds. After confirming the patient is not biting the tube and there are no kinks in the circuit, which of the following is the most appropriate next step?

Administer a sedative to the patient.
Increase the high-pressure alarm limit.
Immediately extubate the patient.
Suction the endotracheal tube. (Correct answer)

Correct answer: Suction the endotracheal tube.

Common causes of a high peak airway pressure alarm include obstructions. [29] After ruling out external issues like a kinked tube or the patient biting it, an internal obstruction such as a mucus plug is a likely cause. [29] Suctioning the endotracheal tube is the appropriate intervention to clear such a blockage and resolve the high pressure.

Question 65: A 34-year-old male presents with a single stab wound to the right side of his chest. He is anxious, with a respiratory rate of 36, a heart rate of 130, and a BP of 88/60. You note absent breath sounds on the right and jugular vein distention. What is the most appropriate and immediate intervention?

Application of an occlusive dressing over the chest wound.
Immediate endotracheal intubation and positive pressure ventilation.
Rapid fluid bolus of 1 liter of normal saline.
Needle decompression of the right chest. (Correct answer)

Correct answer: Needle decompression of the right chest.

The patient is exhibiting clear signs of a tension pneumothorax: unilateral absent breath sounds, tachycardia, hypotension (obstructive shock), and jugular vein distention. The definitive prehospital treatment is to immediately decompress the pleural space by performing a needle thoracostomy to convert the tension pneumothorax into a simple pneumothorax and relieve the pressure on the heart and great vessels.

Question 66: The Incident Command System (ICS) principle of 'span of control' recommends one supervisor manage how many personnel?

3 to 7 (Correct answer)
10 to 15
2 to 4
8 to 12

Correct answer: 3 to 7

Optimal ICS span of control is 3–7 subordinates per supervisor, with 5 being ideal, to maintain effective oversight.

Question 67: During a 12-lead ECG acquisition in a patient with chest pain, you note new ST elevation in V1–V4. This pattern is most consistent with an occlusion of which vessel?

Left circumflex artery
Right coronary artery
Left anterior descending artery (Correct answer)
Posterior descending artery

Correct answer: Left anterior descending artery

Anterior STEMI (ST elevation in V1–V4) indicates occlusion of the left anterior descending (LAD) artery.

Question 68: Kehr's sign (left shoulder pain in a supine trauma patient) suggests injury to which structure?

Left kidney
Spleen with diaphragmatic irritation (Correct answer)
Left lung and pleura
Cardiac tamponade

Correct answer: Spleen with diaphragmatic irritation

Kehr's sign is referred left shoulder pain caused by blood irritating the diaphragm, classically associated with splenic laceration.

Question 69: A 40-year-old female presents with sudden dyspnea, pleuritic chest pain, and tachycardia after a long flight. Her SpO2 is 91% and she has a swollen left calf. What is the most likely diagnosis?

Spontaneous pneumothorax
Pleural effusion
Acute myocardial infarction
Pulmonary embolism (Correct answer)

Correct answer: Pulmonary embolism

Pulmonary embolism is strongly suspected given the triad of dyspnea, pleuritic chest pain, and tachycardia combined with DVT risk factors (immobility, unilateral leg swelling).

Question 70: A 65-year-old male has a blood glucose of 820 mg/dL, Kussmaul respirations, and fruity breath odor. He is alert but confused. Which condition does this presentation represent?

Hyperglycemic hyperosmolar nonketotic coma
Addisonian crisis
Hyperosmolar hyperglycemic state (HHS)
Diabetic ketoacidosis (DKA) (Correct answer)

Correct answer: Diabetic ketoacidosis (DKA)

Kussmaul respirations (deep, labored breathing) and fruity breath (ketones) combined with marked hyperglycemia indicate DKA, typically seen in Type 1 diabetics.

Question 71: During a vehicle rescue, which technique refers to the controlled removal of the roof to provide full patient access?

Dash roll
Third-door conversion
A-post displacement
Total roof removal (Correct answer)

Correct answer: Total roof removal

Total roof removal involves cutting all roof posts and removing the entire roof to provide unobstructed access for spinal precautions and patient extrication.

Question 72: Which of the following ECG findings is most consistent with hyperkalemia?

Delta waves with shortened PR interval
ST segment depression
Peaked T waves and widened QRS (Correct answer)
Prolonged QT interval

Correct answer: Peaked T waves and widened QRS

Hyperkalemia classically produces tall, peaked T waves progressing to widened QRS complexes and eventually a sine-wave pattern.

Question 73: You are tasked with establishing a landing zone (LZ) for a medical helicopter for a nighttime patient transport. Which of the following actions is most appropriate for ensuring a safe operation?

Select a site with no more than a 15-degree slope to ensure the aircraft remains stable.
Park the ambulance at the edge of the LZ with its headlights and strobes on, aimed at the touchdown point.
Mark the four corners of a 100 ft x 100 ft area with weighted cones or emergency lights. (Correct answer)
Use handheld road flares to clearly illuminate the center of the landing zone for the pilot.

Correct answer: Mark the four corners of a 100 ft x 100 ft area with weighted cones or emergency lights.

A safe helicopter landing zone should be a minimum of 100 ft by 100 ft, on firm ground with a slope of less than 10 degrees, and clear of overhead obstructions. At night, the corners should be marked with lights. Pointing vehicle headlights or strobes at the aircraft can blind the pilot, and flares create a fire hazard and can be drawn into the rotors.

Question 74: When calculating pediatric drug doses in the field, the MOST reliable method is to:

Estimate weight based on the child's apparent age
Use a length-based resuscitation tape (e.g., Broselow tape) (Correct answer)
Use the formula: weight (kg) = age × 4
Ask the caregiver for the child's last recorded weight

Correct answer: Use a length-based resuscitation tape (e.g., Broselow tape)

The Broselow tape provides weight-based dosing and equipment sizing directly correlated to the child's measured length, minimizing dosing errors.

Question 75: What is the recommended IV dose of epinephrine during cardiac arrest in an adult patient?

1 mg every 3-5 minutes (Correct answer)
0.5 mg every 3-5 minutes
2 mg every 3-5 minutes
1 mg every 1-2 minutes

Correct answer: 1 mg every 3-5 minutes

The standard ACLS dose of epinephrine in adult cardiac arrest is 1 mg IV/IO every 3-5 minutes.

Question 76: What is the correct compression-to-ventilation ratio for two-rescuer adult CPR with an advanced airway in place?

15:2 with pauses for ventilation
30:2 with pauses for ventilation
Continuous compressions at 100-120/min with 1 breath every 10 seconds
Continuous compressions at 100-120/min with 1 breath every 6 seconds (Correct answer)

Correct answer: Continuous compressions at 100-120/min with 1 breath every 6 seconds

Once an advanced airway is secured, CPR transitions to continuous chest compressions with asynchronous ventilations at a rate of one breath every 6 seconds.

Question 77: A patient has a femur fracture with an estimated blood loss of 1,500 mL. Which class of hemorrhage is this?

Class IV
Class II
Class I
Class III (Correct answer)

Correct answer: Class III

Class III hemorrhage involves 1,501–2,000 mL blood loss (30–40% of blood volume), causing marked tachycardia, tachypnea, and altered mental status.

Question 78: A 52-year-old male with a history of CHF presents with severe dyspnea, pink frothy sputum, and crackles bilaterally to the apices. SpO2 is 82%. What is the MOST appropriate initial intervention?

Nitroglycerin 0.4 mg SL
Furosemide 40 mg IV bolus
CPAP or BiPAP application (Correct answer)
Endotracheal intubation

Correct answer: CPAP or BiPAP application

CPAP/BiPAP reduces the work of breathing, improves oxygenation, and decreases preload in acute pulmonary edema, often preventing the need for intubation.

Question 79: You respond to a call where a 35-year-old male took 30 acetaminophen tablets 2 hours ago. He is currently asymptomatic. Which intervention is MOST appropriate?

Sodium bicarbonate infusion
Induce vomiting immediately
Activated charcoal if airway is intact and no contraindications (Correct answer)
Begin N-acetylcysteine in the field

Correct answer: Activated charcoal if airway is intact and no contraindications

Activated charcoal administered within 1-2 hours of ingestion can reduce acetaminophen absorption significantly if the airway is protected.

Question 80: A patient has a pulseless rhythm that appears as a rapid, completely disorganized waveform on the monitor. What is the immediate treatment?

Administer amiodarone 300 mg IV push
Begin CPR and administer epinephrine 1 mg IV
Initiate transcutaneous pacing
Deliver unsynchronized defibrillation immediately (Correct answer)

Correct answer: Deliver unsynchronized defibrillation immediately

Ventricular fibrillation is treated with immediate unsynchronized defibrillation, as there is no organized rhythm to synchronize with.

Question 81: Which section of the pharynx is the topmost?

Oropharynx
Laryngopharynx
Hypopharynx
Nasopharynx (Correct answer)

Correct answer: Nasopharynx

The pharynx is divided into three sections: the nasopharynx, oropharynx, and laryngopharynx (or hypopharynx). The nasopharynx is the topmost section, located posterior to the nasal cavity and superior to the soft palate. It serves as a passageway for air and connects to the middle ear via the Eustachian tubes.

National Registry of Emergency Medical Technicians (NREMT) Paramedic Cognitive Exam

The NREMT Paramedic Cognitive Exam assesses the knowledge and skills required to provide advanced prehospital emergency medical care as a Paramedic.

Questions

120 min

Time Limit

70%

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