COPR Primary Care Paramedic (PCP) Entry to Practice Examination — Questions and Answers

Question 1: A patient in third-degree (complete) heart block will show:

Absent P waves with irregular QRS
Consistent PR prolongation >0.20 seconds
Complete dissociation of P waves and QRS complexes (Correct answer)
Progressively lengthening PR interval then a dropped beat

Correct answer: Complete dissociation of P waves and QRS complexes

Third-degree AV block shows complete dissociation — P waves and QRS complexes march independently at different rates.

Question 2: Which of the following is a contraindication to inserting a nasopharyngeal airway?

Nasal congestion
Suspected basal skull fracture (Correct answer)
Dental prosthetics
Intact gag reflex

Correct answer: Suspected basal skull fracture

A suspected basal skull fracture contraindicates NPA insertion due to the risk of intracranial placement.

Question 3: Which of the following is a sign of a tension pneumothorax that distinguishes it from a simple pneumothorax?

Hemodynamic instability and tracheal deviation (Correct answer)
Subcutaneous emphysema
Absent breath sounds
Pleuritic chest pain

Correct answer: Hemodynamic instability and tracheal deviation

Tension pneumothorax causes hemodynamic compromise and tracheal deviation, unlike simple pneumothorax which does not.

Question 4: You are assessing a diabetic patient who is conscious, but extremely confused. You are unable to determine whether the condition is hypoglycemia or hyperglycemia. What do you do?

Administer oral glucose. (Correct answer)
Immediately transport the patient to the nearest medical facility.
Administer IV Dextrose.
Monitor the patient for changes.

Correct answer: Administer oral glucose.

Explanation: In a conscious diabetic patient with confusion and uncertain glycemic status, administering oral glucose is the appropriate initial intervention. This helps to raise blood sugar levels in cases of hypoglycemia and does not pose a risk if the patient's condition is hyperglycemia. It's a safe and effective way to manage potential hypoglycemia while further assessing the patient's condition.

Question 5: Which of the following is a contraindication to field delivery and requires immediate transport?

Multipara with contractions 2 minutes apart
Transverse (shoulder) presentation (Correct answer)
Crowning with active pushing
Intact amniotic sac at crowning

Correct answer: Transverse (shoulder) presentation

Transverse presentation (shoulder dystocia in the birth canal) cannot be delivered vaginally in the field and requires emergency obstetric intervention.

Question 6: Aspirin is contraindicated in which patient population?

Patients with hypertension
Adults over 65
Children under 16 with viral illness (Reye's syndrome risk) (Correct answer)
Patients with type 2 diabetes

Correct answer: Children under 16 with viral illness (Reye's syndrome risk)

Aspirin in children with viral illness is associated with Reye's syndrome, a potentially fatal liver and brain disease.

Question 7: The Pediatric Assessment Triangle (PAT) evaluates which three components?

Heart rate, blood pressure, respiratory rate
Airway, Breathing, Circulation
Appearance, Work of Breathing, Circulation to Skin (Correct answer)
AVPU, pupils, GCS

Correct answer: Appearance, Work of Breathing, Circulation to Skin

The PAT rapidly assesses Appearance (tone, interactiveness), Work of Breathing (effort, sounds), and Circulation to Skin (color, mottling).

Question 8: What flow rate should a nasal cannula have?

1-4 LPM
4-6 LPM
3-6 LPM
1-6 LPM (Correct answer)

Correct answer: 1-6 LPM

Explanation: Nasal cannula oxygen therapy typically delivers oxygen at a flow rate between 1 to 6 liters per minute (LPM). This range allows for adjusting the oxygen flow based on the patient's oxygenation needs and respiratory status.

Question 9: What is the primary side effect of nitroglycerin that the paramedic must monitor for?

Hypertension
Bradycardia
Hyperglycemia
Hypotension and headache (Correct answer)

Correct answer: Hypotension and headache

Nitroglycerin commonly causes hypotension and headache due to vasodilation.

Question 10: Which document outlines the responsibilities and authority of emergency responders during a declared disaster in the United States?

National EMS Scope of Practice Model
Health Insurance Portability and Accountability Act (HIPAA)
Emergency Medical Treatment and Labor Act (EMTALA)
National Incident Management System (NIMS) (Correct answer)

Correct answer: National Incident Management System (NIMS)

NIMS provides a consistent nationwide framework for emergency management, including roles and responsibilities during disasters.

Question 11: Which zone in a hazardous materials incident is where patient decontamination occurs?

Cold zone (support zone)
Warm zone (contamination reduction zone) (Correct answer)
Hot zone (exclusion zone)
Command zone

Correct answer: Warm zone (contamination reduction zone)

Decontamination takes place in the warm zone, which is the transition area between the contaminated hot zone and the clean cold zone.

Question 12: A trauma patient presents with absent breath sounds on the left, tracheal deviation to the right, and hypotension. You suspect:

Hemothorax
Flail chest
Cardiac tamponade
Tension pneumothorax (Correct answer)

Correct answer: Tension pneumothorax

Absent breath sounds, tracheal deviation away from the affected side, and hypotension are classic signs of tension pneumothorax.

Question 13: Which finding on a 12-lead ECG is most consistent with a posterior STEMI?

ST elevation in V1–V4
Tall R waves and ST depression in V1–V2 (Correct answer)
ST elevation in I and aVL
ST elevation in II, III, aVF

Correct answer: Tall R waves and ST depression in V1–V2

Posterior STEMI produces reciprocal changes in V1–V2: tall R waves (reciprocal Q), ST depression, and upright T waves (reciprocal inversion).

Question 14: What is the appropriate ventilation rate for an apneic adult with a pulse?

20–24 breaths/min
6–8 breaths/min
30 breaths/min
10–12 breaths/min (Correct answer)

Correct answer: 10–12 breaths/min

An apneic adult with a pulse should be ventilated at 10–12 breaths per minute.

Question 15: Which route of administration provides the fastest onset of drug action?

Intramuscular (IM)
Oral (PO)
Subcutaneous (SQ)
Intravenous (IV) (Correct answer)

Correct answer: Intravenous (IV)

Intravenous administration delivers the drug directly into the bloodstream, providing the fastest onset of action.

Question 16: Which of the following patients would need a rapid trauma assessment the most?

An elderly man who is conscious, but who is also complaining of severe chest pain.
A teenage boy who is unconscious, but who has no obvious injuries.
A young woman with a gunshot wound to the chest. (Correct answer)
A middle-aged man who has fallen from a height of five feet.

Correct answer: A young woman with a gunshot wound to the chest.

Explanation: A rapid trauma assessment is crucial for patients with traumatic injuries that could be life-threatening. In this scenario, the young woman with a gunshot wound to the chest is at the highest risk of severe injury and requires immediate assessment to identify and manage any life-threatening conditions.

Question 17: Where do you begin a detailed physical examination?

The patient's head. (Correct answer)
The patient's neck.
None of the above.
The patient's chest.

Correct answer: The patient's head.

Explanation: A detailed physical examination typically begins with the patient's head. This involves assessing the head for any signs of trauma, abnormalities, or specific complaints related to the head and face. Starting with the head allows for a systematic approach to evaluating the patient's overall condition and identifying any potential concerns that may require further assessment or intervention.

Question 18: What is the third step of conducting an initial assessment?

Determine the patient's level of consciousness.
Assess the patient's airway and breathing.
Assess the patient's circulation.
Identify the patient's chief complaints or any life-threatening conditions. (Correct answer)

Correct answer: Identify the patient's chief complaints or any life-threatening conditions.

Explanation: The third step of conducting an initial assessment is to identify the patient's chief complaints or any life-threatening conditions. This step helps prioritize care by focusing on addressing immediate threats to the patient's life or well-being. Once identified, appropriate interventions can be initiated to stabilize the patient's condition.

Question 19: A delta wave on an ECG is associated with which condition?

Hypertrophic cardiomyopathy
Brugada syndrome
Long QT syndrome
Wolff-Parkinson-White (WPW) syndrome (Correct answer)

Correct answer: Wolff-Parkinson-White (WPW) syndrome

A delta wave (slurred QRS upstroke) indicates ventricular pre-excitation via an accessory pathway, characteristic of WPW syndrome.

Question 20: During BVM ventilation, the mask should be held using which hand position?

E-C clamp technique (Correct answer)
Two fingers on the mask rim only
Palm seal across the face
One hand cupping the chin

Correct answer: E-C clamp technique

The E-C clamp technique uses the third, fourth, and fifth fingers to lift the jaw (E) while the thumb and index finger seal the mask (C).

Question 21: What is the adult dose of epinephrine 1:1000 for anaphylaxis?

3.0 mg IM
0.3–0.5 mg IM (Correct answer)
0.1 mg IM
1.0 mg IM

Correct answer: 0.3–0.5 mg IM

The adult dose for anaphylaxis is 0.3–0.5 mg of epinephrine 1:1000 injected IM into the anterolateral thigh.

Question 22: The primary goal of fluid resuscitation in a hemorrhagic shock patient in the prehospital setting is to:

Prevent hypothermia
Maintain perfusion while minimizing further hemorrhage dilution (Correct answer)
Restore normal blood pressure immediately
Replace all lost blood volume

Correct answer: Maintain perfusion while minimizing further hemorrhage dilution

Permissive hypotension is used in penetrating trauma: maintain minimal adequate perfusion without aggressively diluting clotting factors.

Question 23: Which of the following is NOT considered a part of the patient's Signs and Symptoms?

Behavioral issues
Environmental emergencies
The patient's last oral intake (Correct answer)
Obstetrical conditions

Correct answer: The patient's last oral intake

Explanation: The patient's last oral intake is not typically considered a part of the signs and symptoms. Signs and symptoms refer to observable or measurable indications of a patient's condition, such as vital signs, physical findings, complaints, and behaviors. Last oral intake, while important for certain assessments (e.g., assessing for dehydration), is more related to history-taking rather than immediate signs and symptoms.

Question 24: At what gestational age is a fetus generally considered viable outside the womb?

16–18 weeks
32–34 weeks
24–28 weeks (Correct answer)
20–22 weeks

Correct answer: 24–28 weeks

Viability is generally considered to begin at 24–28 weeks gestation with intensive neonatal care.

Question 25: Nitroglycerin is contraindicated when a patient has taken a PDE-5 inhibitor (e.g., sildenafil) within:

24–48 hours (Correct answer)
72 hours
1 hour
6 hours

Correct answer: 24–48 hours

Nitroglycerin combined with PDE-5 inhibitors taken within 24–48 hours can cause severe, refractory hypotension.

Question 26: Which of the following medications is used prehospital to prevent eclamptic seizures?

Diazepam
Phenytoin
Magnesium sulfate (Correct answer)
Lorazepam

Correct answer: Magnesium sulfate

Magnesium sulfate is the drug of choice for prophylaxis and treatment of eclamptic seizures.

Question 27: Placental abruption (abruptio placentae) classically presents with:

Excessive fetal movement
Green-tinged amniotic fluid
Painful, dark vaginal bleeding with a rigid uterus (Correct answer)
Painless, bright red vaginal bleeding

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

Placental abruption presents with painful uterine contractions, a rigid/board-like uterus, and dark vaginal bleeding from premature placental separation.

Question 28: In a patient with a traumatic brain injury, you should avoid:

Spinal precautions
IV access
Hypotension and hypoxia (Correct answer)
Supplemental oxygen

Correct answer: Hypotension and hypoxia

Hypotension (SBP <90) and hypoxia (SpO2 <90%) are the two most damaging secondary insults in traumatic brain injury.

Question 29: Post-partum hemorrhage is defined as blood loss exceeding:

1500 mL regardless of delivery method
Any visible bleeding after 1 hour post-delivery
250 mL after vaginal delivery
500 mL after vaginal delivery or 1000 mL after C-section (Correct answer)

Correct answer: 500 mL after vaginal delivery or 1000 mL after C-section

PPH is defined as >500 mL blood loss after vaginal delivery or >1000 mL after cesarean section.

Question 30: When transporting a pregnant patient at 28 weeks, what position minimizes aortocaval compression?

Sitting fully upright at 90°
Left lateral recumbent or supine tilted 15–30° left (Correct answer)
Supine with legs elevated
Right lateral recumbent

Correct answer: Left lateral recumbent or supine tilted 15–30° left

Left lateral tilt displaces the uterus off the IVC and aorta, improving venous return and cardiac output.

Question 31: What minimum personal protective equipment (PPE) is recommended for EMS providers when treating a patient with suspected tuberculosis?

Standard precautions only (gloves)
Surgical mask and gloves
Powered air-purifying respirator (PAPR)
N95 respirator, gloves, and eye protection (Correct answer)

Correct answer: N95 respirator, gloves, and eye protection

OSHA and CDC guidelines require at minimum an N95 respirator, gloves, and eye protection for airborne precautions such as suspected TB.

Question 32: You are assessing a stroke patient and are trying to determine if advanced therapy will be effective. What is the critical factor you need to determine?

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

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

Explanation: The critical factor to determine when assessing a stroke patient to decide if advanced therapy will be effective is when the patient's symptoms began. The time of symptom onset helps determine if the patient is within the window for receiving certain time-sensitive treatments, such as thrombolytic therapy or mechanical thrombectomy, which are most effective when administered promptly after the onset of symptoms.

Question 33: What is the recommended safe distance from a vehicle that may have a hybrid or electric battery fire during scene size-up?

25 feet
150 feet
100 feet (Correct answer)
50 feet

Correct answer: 100 feet

A minimum of 100 feet is recommended from hybrid/electric vehicle fires due to risk of battery reignition and toxic off-gassing.

Question 34: Which principle of the Incident Command System (ICS) limits the number of subordinates one supervisor can effectively manage?

Span of control (Correct answer)
Modular organization
Chain of command
Unity of command

Correct answer: Span of control

Span of control defines the recommended ratio of 3–7 subordinates per supervisor to maintain effective oversight.

Question 35: Which of the following is the MOST reliable method to confirm airway patency in an unresponsive patient?

Observing chest rise and feeling exhaled air
Chest auscultation alone
End-tidal CO2 waveform capnography (Correct answer)
SpO2 reading above 95%

Correct answer: End-tidal CO2 waveform capnography

End-tidal CO2 waveform capnography is the most reliable continuous method to confirm and monitor airway patency and ventilation.

Question 36: Febrile seizures in children are most commonly associated with:

Epilepsy
Prolonged high fever over 48 hours
Rapidly rising body temperature (Correct answer)
Meningitis

Correct answer: Rapidly rising body temperature

Simple febrile seizures are triggered by rapid temperature rises, not necessarily very high temperatures.

Question 37: A paramedic crew is involved in a motor vehicle accident while responding to a call. According to most protocols, what is the FIRST notification that must be made?

Report to the hospital for a wellness check
Notify the patient's family
File a report with the state EMS office within 24 hours
Notify dispatch and follow agency protocol for responder injuries (Correct answer)

Correct answer: Notify dispatch and follow agency protocol for responder injuries

Dispatch must be notified immediately so another unit can respond to the original call and agency protocols for responder injury can be activated.

Question 38: A patient with a GCS of 8 is considered to have:

Severe head injury (Correct answer)
No significant injury
Mild head injury
Moderate head injury

Correct answer: Severe head injury

A GCS of 8 or less indicates a severe head injury and typically warrants airway protection.

Question 39: Which finding is most concerning when assessing a patient's airway?

Occasional dry cough
Mild nasal congestion
Stridor at rest (Correct answer)
Clear nasal discharge

Correct answer: Stridor at rest

Stridor at rest indicates significant upper airway obstruction and is a critical finding requiring immediate intervention.

Question 40: Pulseless electrical activity (PEA) is defined as:

Ventricular tachycardia with a BP of 70 mmHg
Complete cardiac asystole
Ventricular fibrillation without a palpable pulse
Organized ECG activity without a palpable pulse (Correct answer)

Correct answer: Organized ECG activity without a palpable pulse

PEA is organized (or semi-organized) electrical activity on the monitor in the absence of a palpable pulse.

Question 41: Which of the following is the MOST reliable indicator of internal abdominal hemorrhage in trauma?

Nausea and vomiting
Abdominal distension with hemodynamic instability (Correct answer)
Bruising of the abdomen
Patient-reported abdominal pain

Correct answer: Abdominal distension with hemodynamic instability

Abdominal distension combined with hemodynamic instability strongly suggests significant internal hemorrhage requiring urgent surgical intervention.

Question 42: A paramedic crew arrives at a scene where a patient is in cardiac arrest inside a building with an active gas leak. What is the correct action?

Don an N95 mask and enter
Stage away and wait for the scene to be made safe (Correct answer)
Attempt CPR from the doorway
Enter immediately to begin CPR

Correct answer: Stage away and wait for the scene to be made safe

An active gas leak makes the scene unsafe; EMS must stage away until fire/hazmat teams secure the environment before any patient care.

Question 43: Signs of dehydration in a pediatric patient include all of the following EXCEPT:

Bounding peripheral pulses (Correct answer)
Dry mucous membranes
Sunken fontanelle in infants
Decreased urine output

Correct answer: Bounding peripheral pulses

Dehydration causes weak, not bounding, pulses due to reduced circulating volume.

Question 44: Eclampsia differs from severe pre-eclampsia by the addition of:

Peripheral edema
Visual disturbances
Grand mal seizures (Correct answer)
Higher blood pressure readings

Correct answer: Grand mal seizures

Eclampsia is pre-eclampsia with the addition of tonic-clonic (grand mal) seizures.

Question 45: A 3-year-old is unresponsive and not breathing. After opening the airway, there is no spontaneous breathing. Your next action is:

Give 2 rescue breaths and then check for a pulse (Correct answer)
Start an IV before ventilating
Begin chest compressions immediately
Apply an AED immediately

Correct answer: Give 2 rescue breaths and then check for a pulse

After opening the airway in a pulseless child, give 2 rescue breaths then assess for a pulse before beginning compressions.

Question 46: Paradoxical chest wall movement (a segment moving inward on inspiration) is characteristic of:

Hemothorax
Flail chest (Correct answer)
Pneumothorax
Cardiac tamponade

Correct answer: Flail chest

Flail chest occurs when multiple rib fractures create a free-floating segment that moves paradoxically with breathing.

Question 47: Atrial fibrillation on an ECG is characterized by:

Wide QRS complexes at a rate of 300 bpm
Regular P waves with constant PR interval
Regular RR intervals with saw-tooth baseline
Irregularly irregular RR intervals with fibrillatory baseline and no distinct P waves (Correct answer)

Correct answer: Irregularly irregular RR intervals with fibrillatory baseline and no distinct P waves

Atrial fibrillation shows an irregularly irregular ventricular response with fibrillatory (chaotic) baseline replacing distinct P waves.

Question 48: After a normal delivery, the umbilical cord should be clamped and cut:

After the baby takes its first breath and pulsations in the cord slow or stop (Correct answer)
After the placenta delivers
Immediately after the baby is delivered
Only if the newborn is not breathing

Correct answer: After the baby takes its first breath and pulsations in the cord slow or stop

Delayed cord clamping (after pulsations slow) is recommended to allow placental blood transfer to the newborn.

Question 49: Which of the following is the correct pediatric dose of naloxone for opioid reversal?

0.01 mg/kg IV/IM (Correct answer)
2.0 mg flat dose IV
1.0 mg/kg IV/IM
0.1 mg/kg IV/IM

Correct answer: 0.01 mg/kg IV/IM

The pediatric dose of naloxone is 0.01 mg/kg IV or IM, titrated to restore adequate respirations.

Question 50: What is the first step you should take when you start to size up a scene?

Determine the mechanism of injury.
Do a Body Substance Isolation (BSI). (Correct answer)
Find out how many patients you need to treat.
Determine the safety of the scene.

Correct answer: Do a Body Substance Isolation (BSI).

Explanation: While ensuring scene safety is critical, so is protecting oneself from potential exposure to infectious materials. Before engaging further, paramedics should prioritize their safety by donning appropriate personal protective equipment (PPE), such as gloves, goggles, and masks, to prevent contact with bodily fluids or other hazardous substances.

Question 51: Which reversible cause of PEA is indicated by distended neck veins, absent breath sounds, and tracheal deviation?

Tamponade
Tension pneumothorax (Correct answer)
Hypovolemia
Hypothermia

Correct answer: Tension pneumothorax

Tension pneumothorax causes PEA with distended neck veins, absent unilateral breath sounds, and tracheal deviation away from the affected side.

Question 52: Which of the following best describes a drug's 'half-life'?

Duration of the drug's therapeutic effect
Time from administration to onset of action
Time for the drug to reach peak concentration
Time for the body to eliminate 50% of the drug (Correct answer)

Correct answer: Time for the body to eliminate 50% of the drug

Half-life is the time required for the plasma concentration of a drug to decrease by 50%.

Question 53: What is the appropriate management for a suspected foreign body airway obstruction in a conscious infant?

Blind finger sweep and back blows only
5 back blows alternating with 5 chest thrusts (Correct answer)
Immediate BVM ventilation
5 abdominal thrusts (Heimlich)

Correct answer: 5 back blows alternating with 5 chest thrusts

Conscious infants with FBAO are treated with alternating 5 back blows and 5 chest thrusts, not abdominal thrusts.

Question 54: A patient you are treating has just lost consciousness. What is the first thing you should do?

Obtain the patient's vitals.
Do a physical exam.
Assess the patient's breathing.
Open the patient's airway. (Correct answer)

Correct answer: Open the patient's airway.

Explanation: When a patient loses consciousness, the first action should be to open the airway to ensure that the patient can breathe effectively. This involves techniques such as head tilt-chin lift or jaw thrust to position the airway correctly and allow for adequate airflow. Once the airway is open, assessing the patient's breathing can follow to determine if further interventions are necessary.

Question 55: What is the correct compression-to-ventilation ratio for two-rescuer infant CPR?

30:2
5:1
15:2 (Correct answer)
30:1

Correct answer: 15:2

Two-rescuer infant CPR uses a 15:2 ratio, allowing more frequent ventilations given the respiratory etiology of most pediatric arrests.

Question 56: The Apgar score is assessed at 1 and 5 minutes after birth. Which five criteria are evaluated?

Alertness, Pulse, Grimace, Amplitude, Respiration
Activity, Pressure, Grunting, Appearance, Reflex
Alertness, Perfusion, Grimace, Appearance, Rate
Activity, Pulse, Grimace, Appearance, Respiration (Correct answer)

Correct answer: Activity, Pulse, Grimace, Appearance, Respiration

APGAR: Activity (muscle tone), Pulse, Grimace (reflex irritability), Appearance (color), Respiration — scored 0–2 each.

Question 57: When transporting a critical patient, what should the paramedic do if the receiving hospital is on diversion?

Bypass the hospital without notification
Use clinical judgment and medical direction to determine the most appropriate destination (Correct answer)
Always honor the diversion and go to the next closest hospital
Wait on scene until diversion is lifted

Correct answer: Use clinical judgment and medical direction to determine the most appropriate destination

EMS providers should use clinical judgment in consultation with medical direction to select the most appropriate facility, which may override diversion for critical patients.

Question 58: Which of the following is the first step you should take in treating a medical patient?

Ask about the patient's pertinent medical history.
Determine the patient's signs and symptoms. (Correct answer)
Find out what medications the patient is taking.
Determine if the patient has any allergies.

Correct answer: Determine the patient's signs and symptoms.

Explanation: Identifying the patient's signs and symptoms is the initial step in assessing their condition. This information helps paramedics understand the nature and severity of the medical issue, guiding further treatment decisions and interventions.

Question 59: Albuterol (salbutamol) works primarily by:

Reducing airway inflammation
Blocking muscarinic receptors in the bronchi
Stimulating beta-2 receptors causing bronchodilation (Correct answer)
Inhibiting mast cell degranulation

Correct answer: Stimulating beta-2 receptors causing bronchodilation

Albuterol is a beta-2 adrenergic agonist that relaxes bronchial smooth muscle, producing bronchodilation.

Question 60: The adult dose of oral aspirin for a suspected acute MI is:

162–325 mg chewed (Correct answer)
81 mg
500 mg swallowed whole
650 mg crushed

Correct answer: 162–325 mg chewed

162–325 mg of aspirin, chewed (not swallowed whole), is given for suspected acute MI to inhibit platelet aggregation rapidly.

Question 61: Gurgling sounds during breathing indicate the need for:

Spinal immobilization
Immediate suctioning (Correct answer)
Oxygen via nasal cannula
Oropharyngeal airway insertion

Correct answer: Immediate suctioning

Gurgling indicates fluid (blood, vomitus, secretions) in the upper airway and requires immediate suctioning.

Question 62: The 4 H's and 4 T's of PEA/asystole include Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Tension pneumothorax, Tamponade, Toxins, and:

Thrombosis (pulmonary or coronary) (Correct answer)
Hypertension
Hypothyroidism
Tachycardia

Correct answer: Thrombosis (pulmonary or coronary)

The 4 T's are Tension pneumothorax, Tamponade, Toxins, and Thrombosis (pulmonary embolism or AMI).

Question 63: During a water rescue, a paramedic without specialized water rescue training should follow which principle?

Wait for police to authorize entry
Attempt a swimming rescue with a partner
Reach, throw, row, then go (Correct answer)
Go immediately to save the victim

Correct answer: Reach, throw, row, then go

The reach-throw-row-go sequence prioritizes rescuer safety, reserving in-water rescue only for trained specialists as a last resort.

Question 64: A sucking chest wound should be treated by:

Leaving open to allow air equalization
Packing the wound with gauze
Applying an occlusive dressing vented on one side (Correct answer)
Applying an occlusive dressing sealed on all four sides

Correct answer: Applying an occlusive dressing vented on one side

A vented (three-sided) occlusive dressing allows air to escape on exhalation, preventing tension pneumothorax.

Question 65: What is one thing you should NOT do when treating a patient with an acute abdomen?

Attempt to diagnose the cause of the problem. (Correct answer)
Monitor vital signs.
Administer oxygen.
Clear the patient's airway.

Correct answer: Attempt to diagnose the cause of the problem.

Explanation: One thing you should NOT do when treating a patient with an acute abdomen is to attempt to diagnose the cause of the problem. Diagnosing the cause of an acute abdomen requires medical expertise and diagnostic tests that are beyond the scope of practice for a paramedic. Instead, focus on managing the patient's symptoms, providing supportive care, and promptly transporting the patient to a medical facility for further evaluation and treatment by a physician.

Question 66: Which of the following best controls severe external hemorrhage from an extremity?

Ice pack application
Pressure dressing
Tourniquet applied proximal to the wound (Correct answer)
Elevation alone

Correct answer: Tourniquet applied proximal to the wound

A tourniquet applied proximal to a life-threatening extremity hemorrhage is the most effective method of hemorrhage control.

Question 67: Which START triage category is assigned to a patient who is not breathing even after the airway is repositioned?

Yellow (delayed)
Red (immediate)
Black (expectant/deceased) (Correct answer)
Green (minor)

Correct answer: Black (expectant/deceased)

In START triage, a patient who does not breathe after a simple airway maneuver is tagged Black (expectant/deceased) and no further resources are allocated.

Question 68: In a newborn resuscitation, if heart rate is below 60 bpm after adequate ventilation, you should:

Begin IV epinephrine immediately
Transport immediately without further intervention
Start chest compressions with a 3:1 compression-to-ventilation ratio (Correct answer)
Increase oxygen flow only

Correct answer: Start chest compressions with a 3:1 compression-to-ventilation ratio

If HR <60 bpm despite 30 seconds of effective PPV in a newborn, begin chest compressions with a 3:1 (compression:ventilation) ratio.

Question 69: Oral glucose (e.g., glucose paste) is indicated for a patient who is:

Hyperglycemic and diaphoretic
Unconscious with unknown blood glucose
Unconscious with confirmed hypoglycemia
Conscious with confirmed hypoglycemia and able to swallow (Correct answer)

Correct answer: Conscious with confirmed hypoglycemia and able to swallow

Oral glucose is only safe for conscious patients who can swallow and protect their airway to prevent aspiration.

Question 70: A child presents with sudden onset of barking cough, stridor, and mild respiratory distress without drooling or toxic appearance. The most appropriate prehospital action is:

Calm the child, keep with caregiver, cool mist if available, transport (Correct answer)
Immediate intubation
Tongue blade examination
High-flow oxygen via tight-fitting mask

Correct answer: Calm the child, keep with caregiver, cool mist if available, transport

Croup management focuses on minimizing agitation — keep the child calm with the caregiver and provide cool humidified oxygen if available.

Question 71: A 90-year-old woman is having an acute ischemic stroke. She is conscious. What should you do?

Administer oxygen and transport at once. (Correct answer)
Check the patient's vitals.
Obtain the patient's history.
Perform an exam.

Correct answer: Administer oxygen and transport at once.

Explanation: In the case of an acute ischemic stroke in a conscious patient, the priority is to administer oxygen and transport the patient to a hospital capable of managing stroke patients promptly. Oxygen therapy helps ensure adequate oxygenation, while prompt transportation is crucial to access timely medical interventions such as thrombolytic therapy, which can improve outcomes for stroke patients.

Question 72: A patient at 10 weeks gestation presents with unilateral pelvic pain, vaginal bleeding, and hypotension. You suspect:

Ruptured ectopic pregnancy (Correct answer)
Normal implantation bleeding
Placental abruption
Placenta previa

Correct answer: Ruptured ectopic pregnancy

A ruptured ectopic pregnancy causes severe unilateral pain, vaginal bleeding, and hemodynamic instability in early pregnancy.

Question 73: A patient has noisy, snoring respirations while lying supine. The most likely cause is:

Pneumothorax
Pulmonary edema
Bronchospasm
Tongue occluding the airway (Correct answer)

Correct answer: Tongue occluding the airway

Snoring respirations in a supine patient are classically caused by the relaxed tongue falling back and partially obstructing the airway.

Question 74: In a mass casualty incident using START triage, a patient who is breathing at 24 breaths per minute with a radial pulse and follows commands is tagged:

Black (expectant)
Red (immediate)
Yellow (delayed) (Correct answer)
Green (minor)

Correct answer: Yellow (delayed)

In START triage, a patient who breathes, has a radial pulse, and can follow commands but has a respiratory rate >20 is classified Yellow (delayed).

Question 75: After delivery of the baby's head, the paramedic should immediately:

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

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

After the head delivers, check for a nuchal cord (cord around the neck) and suction the mouth and nose if secretions are present.

Question 76: Which of the following is the correct joule setting for synchronized cardioversion of an unstable narrow-complex tachycardia?

200 J biphasic
1 J/kg
50–100 J biphasic (Correct answer)
360 J monophasic only

Correct answer: 50–100 J biphasic

Synchronized cardioversion for narrow-complex tachycardia begins at 50–100 J biphasic and is escalated as needed.

Question 77: The 'six rights' of medication administration include all of the following EXCEPT:

Right medication
Right dose
Right patient
Right color of packaging (Correct answer)

Correct answer: Right color of packaging

The six rights are: patient, medication, dose, route, time, and documentation — not packaging color.

Question 78: The energy used for defibrillation of ventricular fibrillation with a biphasic defibrillator is:

100 J
50 J
200 J (Correct answer)
360 J (monophasic equivalent)

Correct answer: 200 J

Biphasic defibrillation for VF/pulseless VT typically starts at 200 J (or manufacturer's recommendation).

Question 79: A prolapsed umbilical cord is managed prehospital by:

Pushing the cord back into the uterus
Clamping and cutting the cord immediately
Placing the patient in high Fowler's position
Elevating the presenting part off the cord and rapid transport (Correct answer)

Correct answer: Elevating the presenting part off the cord and rapid transport

Manually elevate the presenting fetal part to relieve cord compression, place the patient in knee-chest or Trendelenburg position, and transport rapidly.

Question 80: Which of the following signs most strongly suggests epiglottitis in a child?

Mild stridor with runny nose
Low-grade fever with croup-like cough
Barking cough, hoarse voice
Drooling, tripod positioning, toxic appearance (Correct answer)

Correct answer: Drooling, tripod positioning, toxic appearance

Epiglottitis presents with drooling, tripod positioning, muffled voice, and a toxic (very ill) appearance.

Question 81: Which is NOT part of the lower airway?

The trachea
The bronchi
The epiglottis (Correct answer)
The larynx

Correct answer: The epiglottis

Explanation: The epiglottis is a part of the upper airway, not the lower airway. It is a flap of cartilage that covers the entrance to the larynx during swallowing to prevent food or liquid from entering the airway. The lower airway includes structures such as the trachea, bronchi, and lungs, which are located below the level of the larynx.

Question 82: When arriving at a motor vehicle collision, what is the FIRST priority for EMS personnel?

Establish an IV line on the most critical patient
Ensure scene safety (Correct answer)
Triage all patients
Request additional resources

Correct answer: Ensure scene safety

Scene safety must be confirmed before patient contact to prevent responders from becoming additional casualties.

Question 83: Which class of hemorrhagic shock is characterized by 30–40% blood volume loss with confusion and decreased BP?

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

Correct answer: Class III

Class III hemorrhagic shock involves 30–40% blood volume loss (1500–2000 mL) with confusion, decreased BP, and decreased urine output.

Question 84: For a patient with a suspected spinal injury and altered mental status, spinal motion restriction should be:

Avoided to prevent agitation
Applied only if the patient complains of neck pain
Applied based on mechanism of injury and clinical findings (Correct answer)
Deferred until hospital

Correct answer: Applied based on mechanism of injury and clinical findings

Spinal motion restriction decisions are based on mechanism of injury, clinical signs, and patient assessment findings.

Question 85: What is the correct size selection method for a nasopharyngeal airway (NPA)?

Width of the patient's thumb
Length of the patient's index finger
Distance from the earlobe to the corner of the mouth
Distance from the tip of the nose to the earlobe (Correct answer)

Correct answer: Distance from the tip of the nose to the earlobe

Measure the NPA from the tip of the nose to the earlobe to select the correct size.

Question 86: Which oxygen delivery device provides the lowest concentration of supplemental oxygen?

Non-rebreather mask
Venturi mask at 28%
Simple face mask
Nasal cannula (Correct answer)

Correct answer: Nasal cannula

A nasal cannula delivers the lowest FiO2, typically 24–44% at 1–6 L/min.

Question 87: Every squad should contact dispatch a certain minimum number of times on every call. What is this number?

6 (Correct answer)
5
4
7

Correct answer: 6

Explanation: Contacting dispatch at least six times during a call is a standard protocol to ensure effective communication and coordination between the paramedics on-site and the dispatch center. These communications include initial dispatch, arrival at the scene, patient assessment updates, requesting additional resources if needed, departure from the scene, and arrival at the hospital.

Question 88: The Broselow tape is used in pediatric emergencies to:

Assess neurological function
Estimate weight-based drug dosing and equipment sizing (Correct answer)
Determine respiratory rate norms
Measure blood pressure in small children

Correct answer: Estimate weight-based drug dosing and equipment sizing

The Broselow tape uses a child's length to estimate weight and provides color-coded drug doses and equipment sizes.

Question 89: The preferred position for a conscious adult patient with a suspected airway obstruction is:

Position of comfort, usually sitting upright (Correct answer)
Supine
Trendelenburg
Left lateral recumbent

Correct answer: Position of comfort, usually sitting upright

Conscious patients with airway distress should be allowed to assume their position of comfort, typically upright, to optimize breathing.

Question 90: A patient with a suspected cervical spine injury needs airway management. Which technique is preferred?

Hyperextension of the neck
Jaw thrust maneuver (Correct answer)
Head-tilt chin-lift
Flexion of the neck

Correct answer: Jaw thrust maneuver

The jaw thrust maneuver opens the airway while maintaining spinal alignment in suspected cervical spine injuries.

Question 91: A 2-year-old has a respiratory rate of 30 breaths per minute. This is:

A sign of respiratory failure
Significant tachypnea
Bradypnea
Normal for this age (Correct answer)

Correct answer: Normal for this age

Normal respiratory rate for a 2-year-old is 24–40 breaths per minute, so 30 is within normal limits.

Question 92: What is the normal systolic blood pressure range for a 5-year-old?

100–120 mmHg
60–70 mmHg
120–140 mmHg
80–100 mmHg (Correct answer)

Correct answer: 80–100 mmHg

A rough estimate for normal systolic BP in children is 80 + (2 × age in years); for a 5-year-old that's approximately 90 mmHg.

Question 93: Which type of burn requires immediate fluid resuscitation and hospital transport?

Full-thickness burns >10% BSA (Correct answer)
Partial-thickness burns <10% BSA
Superficial (first-degree) burns
Sunburn without blistering

Correct answer: Full-thickness burns >10% BSA

Full-thickness burns covering more than 10% BSA require immediate IV fluid resuscitation and urgent hospital care.

Question 94: In the Unified Command structure of ICS, who sets the overall incident objectives?

The senior law enforcement officer
All participating agency commanders together (Correct answer)
Each agency commander independently
The EMS medical director

Correct answer: All participating agency commanders together

In Unified Command, representatives from all involved agencies collaborate to establish shared incident objectives.

Question 95: Which of the following is NOT a part of the upper airway?

The nasopharynx
The pharynx
The oropharynx
The carina (Correct answer)

Correct answer: The carina

Explanation: The carina is not part of the upper airway; it is the point at which the trachea divides into the right and left main bronchi in the lower respiratory system. The upper airway includes structures such as the nasopharynx, oropharynx, and pharynx, which are located above the carina in the respiratory tract.

Question 96: What is the correct order of priorities in the primary survey for trauma patients?

Airway, Breathing, Circulation, Disability, Exposure (Correct answer)
Breathing, Circulation, Airway, Disability, Exposure
Circulation, Airway, Breathing, Disability, Exposure
Disability, Airway, Breathing, Circulation, Exposure

Correct answer: Airway, Breathing, Circulation, Disability, Exposure

The primary survey follows the ABCDE sequence: Airway, Breathing, Circulation, Disability, Exposure.

Question 97: Which of the following is the preferred site for intraosseous (IO) access in a pediatric patient?

Proximal tibia, anteromedial surface (Correct answer)
Distal femur
Calcaneus (heel bone)
Iliac crest

Correct answer: Proximal tibia, anteromedial surface

The proximal tibia (anteromedial surface, 2 cm below the tibial tuberosity) is the primary IO site in pediatric patients.

Question 98: In the NIMS framework, which section chief is responsible for acquiring and tracking all operational resources?

Logistics Section Chief (Correct answer)
Planning Section Chief
Finance/Administration Section Chief
Operations Section Chief

Correct answer: Logistics Section Chief

The Logistics Section Chief is responsible for procuring, maintaining, and tracking all resources and personnel needed for incident operations.

Question 99: Pre-eclampsia is defined as hypertension after 20 weeks gestation with:

Hypoglycemia
Vaginal bleeding
Proteinuria and/or organ dysfunction (Correct answer)
Fever above 38°C

Correct answer: Proteinuria and/or organ dysfunction

Pre-eclampsia is BP ≥140/90 mmHg after 20 weeks gestation, accompanied by proteinuria or signs of end-organ damage.

Question 100: What are the most important things to notice when doing a rapid trauma assessment?

Pooling of blood around the patient's head, torso, or extremities.
Bruises or tears to the skin.
Abnormal angulations or holes in the patient's body.
All of the above. (Correct answer)

Correct answer: All of the above.

Explanation: : When conducting a rapid trauma assessment, it's crucial to notice all of the mentioned signs: pooling of blood around the patient's head, torso, or extremities; abnormal angulations or holes in the patient's body; and bruises or tears to the skin. These observations help identify potential life-threatening injuries or conditions that require immediate attention and intervention.

Question 101: Which term describes the process of identifying and ranking hazards at an emergency scene before committing resources?

Risk-benefit analysis
Situational awareness
Triage
Scene size-up (Correct answer)

Correct answer: Scene size-up

Scene size-up is the systematic evaluation of an emergency scene to identify hazards, determine resource needs, and plan the approach.

Question 102: The classic ECG finding in hyperkalemia is:

Peaked (tent-shaped) T waves and widened QRS (Correct answer)
ST elevation in all leads
Prolonged QT interval and U waves
Short PR interval and delta waves

Correct answer: Peaked (tent-shaped) T waves and widened QRS

Hyperkalemia progressively causes peaked T waves, PR prolongation, widened QRS, and can degrade to sine-wave pattern and cardiac arrest.

Question 103: Supine hypotensive syndrome in a pregnant patient is caused by:

Aortocaval compression by the gravid uterus (Correct answer)
Vasovagal response to pain
Hyperventilation syndrome
Dehydration from morning sickness

Correct answer: Aortocaval compression by the gravid uterus

The gravid uterus compresses the inferior vena cava and aorta when the patient is supine, reducing venous return and cardiac output.

Question 104: What is the final step you should take when performing an initial assessment?

Assess the patient's circulation.
Assess the patient's airway and breathing.
Determine the patient's level of consciousness.
Make the transport decision or identify which patient is a priority. (Correct answer)

Correct answer: Make the transport decision or identify which patient is a priority.

Explanation: The final step in performing an initial assessment is to make the transport decision or identify which patient is a priority for transport. This step involves considering the patient's condition, the severity of their injuries or illness, available resources, and the destination facility to determine the most appropriate course of action for patient care and transportation.

Question 105: The antidote for benzodiazepine overdose is:

Atropine
Flumazenil (Correct answer)
Naloxone
Physostigmine

Correct answer: Flumazenil

Flumazenil is a benzodiazepine receptor antagonist used to reverse benzodiazepine sedation.

Question 106: A neonate is born limp, not breathing, and blue. Your first action is:

Administer epinephrine
Intubate immediately
Stimulate and dry the infant, then reassess (Correct answer)
Chest compressions

Correct answer: Stimulate and dry the infant, then reassess

Warm, dry, and stimulate the newborn in the first 30 seconds while repositioning the airway before further intervention.

Question 107: Which of the following fractures is most likely to cause life-threatening hemorrhage?

Clavicle fracture
Ulna fracture
Distal radius fracture
Femur fracture (Correct answer)

Correct answer: Femur fracture

A femur fracture can result in 1–2 liters of blood loss into the thigh, causing life-threatening hemorrhage.

Question 108: Non-accidental trauma (NAT) in a pediatric patient should be suspected when:

Bruising is found over bony prominences
The child has a single femur fracture from a fall
The child is crying and fearful of the paramedic
Injuries are inconsistent with the reported mechanism or developmental stage (Correct answer)

Correct answer: Injuries are inconsistent with the reported mechanism or developmental stage

Injuries inconsistent with the history, developmental ability, or delayed presentation are key red flags for non-accidental trauma.

Question 109: Transcutaneous pacing is indicated when:

The patient has rapid atrial fibrillation
Atropine fails to resolve symptomatic bradycardia with hemodynamic compromise (Correct answer)
The patient has ventricular fibrillation
The patient has asymptomatic sinus bradycardia

Correct answer: Atropine fails to resolve symptomatic bradycardia with hemodynamic compromise

Transcutaneous pacing is used when drugs fail and the patient has symptomatic bradycardia with hemodynamic instability.

Question 110: What does a low SpO2 reading combined with normal skin color most likely indicate?

Carbon monoxide poisoning
Accurate reading — patient is fine
Probe malposition or poor perfusion artifact (Correct answer)
Hyperoxia

Correct answer: Probe malposition or poor perfusion artifact

Discordant SpO2 and clinical appearance often suggest probe malposition, poor perfusion, or sensor artifact rather than true hypoxia.

Question 111: What is the recommended tidal volume for BVM ventilation in an adult?

800–1000 mL
500–600 mL (Correct answer)
1200–1500 mL
200–400 mL

Correct answer: 500–600 mL

The recommended tidal volume for adult BVM ventilation is 500–600 mL, delivered over 1 second.

Question 112: What is the most appropriate initial management for a patient with an impaled object in the chest?

Stabilize the object in place and do not remove it (Correct answer)
Shorten the object and then remove
Apply direct pressure around the object and remove it
Remove the object immediately to relieve pressure

Correct answer: Stabilize the object in place and do not remove it

Impaled objects should be stabilized in place and never removed in the prehospital setting as they may be tamponading hemorrhage.

Question 113: An ectopic pregnancy most commonly implants in the:

Cervix
Ovary
Fallopian tube (ampulla) (Correct answer)
Peritoneal cavity

Correct answer: Fallopian tube (ampulla)

Approximately 95% of ectopic pregnancies occur in the fallopian tube, most commonly in the ampullary region.

Question 114: A paramedic is attending to a patient who is experiencing non-traumatic back pain. As the paramedic is going through SAMPLE with the patient, what question should be asked when the M is reached?

Do you have any mild pain?
Are you having a medical emergency?
Are you on any medications? (Correct answer)
Do you have a medical alert bracelet?

Correct answer: Are you on any medications?

Explanation: When the paramedic reaches the "M" in the SAMPLE acronym (Signs and Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading up to the incident), they should ask if the patient is on any medications. This information is crucial for understanding the patient's medical history, potential interactions with any medications administered, and informing further treatment decisions.

Question 115: Which of the following best describes sinus bradycardia on an ECG?

Rate <60 bpm, irregular rhythm, normal P waves and QRS
Wide QRS at rate of 40 bpm with no P waves
Rate >100 bpm, narrow QRS, no P waves
Rate <60 bpm, regular rhythm, normal P-QRS relationship (Correct answer)

Correct answer: Rate <60 bpm, regular rhythm, normal P-QRS relationship

Sinus bradycardia is a rate <60 bpm with a normal regular P-QRS-T pattern, originating from the sinoatrial node.

Question 116: What should you look for to determine if a scene is safe to enter?

Environmental problems, such as unstable terrain, heat, or lack of light.
Hazardous substances or dangers like downed electrical lines, broken glass, etc.
Traffic from civilians, law enforcement, or other rescue personnel.
All of the above. (Correct answer)

Correct answer: All of the above.

Explanation: When determining if a scene is safe to enter, you should consider all of the options listed. This includes assessing for environmental problems, hazardous substances or dangers, and traffic from civilians, law enforcement, or other rescue personnel. Ensuring scene safety is crucial to protect both the paramedic and the patient from potential hazards.

Question 117: A pregnant patient at 32 weeks is experiencing vaginal bleeding that is painless. This presentation is most consistent with:

Placenta previa (Correct answer)
Ectopic pregnancy
Uterine rupture
Placental abruption

Correct answer: Placenta previa

Painless vaginal bleeding in the third trimester is characteristic of placenta previa, where the placenta covers the cervical os.

Question 118: Atropine is used in prehospital care primarily to treat:

Tachycardia and hypertension
Symptomatic bradycardia (Correct answer)
Hypoglycemia
Ventricular fibrillation

Correct answer: Symptomatic bradycardia

Atropine is an anticholinergic agent that increases heart rate by blocking vagal tone, used for symptomatic bradycardia.

Question 119: What medication is the first-line pharmacological treatment for symptomatic sinus bradycardia?

Epinephrine 1 mg IV
Adenosine 6 mg IV
Amiodarone 300 mg IV
Atropine 0.5 mg IV (Correct answer)

Correct answer: Atropine 0.5 mg IV

Atropine 0.5 mg IV is the first pharmacological intervention for symptomatic bradycardia, increasing heart rate by blocking vagal tone.

Question 120: Croup (laryngotracheobronchitis) is most recognizable by:

Barking seal-like cough and stridor (Correct answer)
Wheezing throughout all lung fields
Silent chest and cyanosis
Drooling and toxic appearance

Correct answer: Barking seal-like cough and stridor

Croup causes characteristic barking cough and inspiratory stridor due to subglottic edema.

Question 121: During a normal delivery, which fetal part presents first?

Feet
Shoulder
Buttocks
Head (vertex presentation) (Correct answer)

Correct answer: Head (vertex presentation)

The vertex (head) presentation is normal, occurring in approximately 96% of deliveries.

Question 122: A patient is found in a structure fire with severe burns and singed facial hair. Which is the PRIORITY action before transport?

Apply dry sterile dressings to burns
Administer high-dose morphine for pain control
Secure a definitive airway due to risk of inhalation injury (Correct answer)
Initiate two large-bore IVs and run fluids wide open

Correct answer: Secure a definitive airway due to risk of inhalation injury

Singed facial hair and eyebrows indicate potential inhalation injury with rapid airway edema; early intubation is the priority before swelling occludes the airway.

Question 123: When using the power lift technique to move a stretcher, paramedics should:

Keep the back straight and lift with the legs (Correct answer)
Bend at the waist with knees straight
Let the stronger partner do most of the lifting
Twist the torso to redirect the load

Correct answer: Keep the back straight and lift with the legs

The power lift requires a straight back and lifting with the legs to protect the spine and reduce injury risk.

Question 124: When approaching a helicopter landing zone (LZ), EMS personnel should approach from which direction?

From the front or side as directed by the pilot (Correct answer)
From behind the tail rotor
Approach only after the rotor has stopped
From any direction at a crouching walk

Correct answer: From the front or side as directed by the pilot

Personnel must approach from the front or side as directed by the pilot or crew, never from the rear where the lethal tail rotor is located.

Question 125: The most common cause of cardiac arrest in children is:

Hypovolemic shock
Respiratory failure leading to hypoxic arrest (Correct answer)
Congenital heart defect rupture
Ventricular fibrillation

Correct answer: Respiratory failure leading to hypoxic arrest

Unlike adults, pediatric cardiac arrest most often results from respiratory failure progressing to hypoxic arrest.

Question 126: The first-line treatment for stable narrow-complex SVT is:

Synchronized cardioversion at 100 J
Defibrillation at 200 J
Valsalva maneuver or carotid sinus massage (Correct answer)
Amiodarone IV

Correct answer: Valsalva maneuver or carotid sinus massage

Vagal maneuvers (Valsalva, carotid sinus massage) are the first-line treatment for stable SVT to slow conduction through the AV node.

Question 127: Which of the following best describes compensated shock in a pediatric patient?

Hypotension and altered mental status
Bradycardia with normal skin color
Normal blood pressure with tachycardia and poor perfusion (Correct answer)
Hypertension with warm, flushed skin

Correct answer: Normal blood pressure with tachycardia and poor perfusion

Children compensate for shock by maintaining near-normal BP through tachycardia and vasoconstriction — hypotension is a late, ominous sign.

Question 128: A patient with an organophosphate poisoning would benefit most from which medication?

Activated charcoal
Atropine (Correct answer)
Naloxone
Epinephrine

Correct answer: Atropine

Atropine blocks excessive muscarinic stimulation caused by organophosphate inhibition of acetylcholinesterase.

Question 129: Which medication is a first-line treatment for anaphylaxis?

Albuterol nebulized
Methylprednisolone IV
Epinephrine 1:1000 IM (Correct answer)
Diphenhydramine (Benadryl)

Correct answer: Epinephrine 1:1000 IM

Epinephrine 1:1000 administered IM into the lateral thigh is the first-line treatment for anaphylaxis.

Question 130: When immobilizing a long bone fracture, the splint should immobilize:

Only the fracture site
The joint above and below the fracture site (Correct answer)
The entire limb from hip to toes
The joint above the fracture only

Correct answer: The joint above and below the fracture site

Splints must immobilize the joint above and below the fracture site to prevent movement and further injury.

Question 131: Ventricular fibrillation (VF) on an ECG appears as:

Completely chaotic, irregular waveforms with no identifiable QRS (Correct answer)
Saw-tooth flutter waves at 300 bpm
Regular narrow QRS complexes at 150 bpm
Wide-complex regular tachycardia at 180 bpm

Correct answer: Completely chaotic, irregular waveforms with no identifiable QRS

VF produces chaotic, disorganized electrical activity with no identifiable QRS complexes, P waves, or T waves.

Question 132: You must follow protocol when using the radio in your emergency vehicle. Which of the following is NOT required by this protocol?

Press the push-to-talk button and wait two seconds for the carrier frequency to establish the connection.
Hold the mike approximately two inches from your mouth.
Transmit all pertinent information about the patient to the hospital using coded language. (Correct answer)
Monitor the frequency for several seconds to be certain it is not currently in use.

Correct answer: Transmit all pertinent information about the patient to the hospital using coded language.

Explanation: While it's important to transmit pertinent information about the patient to the hospital, using coded language is not typically required. Instead, clear and concise communication using standard medical terminology and patient information is preferred to ensure accurate understanding and appropriate response from hospital staff.

Question 133: For a 10 kg child in cardiac arrest, what is the correct defibrillation dose?

2 J/kg (20 J) (Correct answer)
1 J/kg (10 J)
4 J/kg (40 J)
360 J

Correct answer: 2 J/kg (20 J)

Initial pediatric defibrillation is 2 J/kg; subsequent shocks are 4 J/kg.

Question 134: What is the purpose of a medical incident command post (MCI CP) during a mass casualty event?

To provide medical direction to hospital staff
To treat the most critical patients on-site
To coordinate triage, treatment, and transport of patients (Correct answer)
To communicate directly with insurance companies

Correct answer: To coordinate triage, treatment, and transport of patients

The medical incident command post coordinates all patient care activities — triage, treatment, and transport — to organize the EMS response.

Question 135: The Glasgow Coma Scale (GCS) assesses which three components?

Orientation, memory, calculation
Heart rate, blood pressure, respiratory rate
Eye opening, verbal response, motor response (Correct answer)
Pupils, reflexes, level of consciousness

Correct answer: Eye opening, verbal response, motor response

The GCS evaluates eye opening, verbal response, and motor response, with a maximum score of 15.

Question 136: What is the primary mechanism of action of nitroglycerin?

Venous and arterial dilation reducing cardiac workload (Correct answer)
Beta-adrenergic blockade
Blocking calcium channels in the SA node
Increasing cardiac contractility

Correct answer: Venous and arterial dilation reducing cardiac workload

Nitroglycerin causes venous and arterial smooth muscle relaxation, reducing preload and afterload to decrease cardiac workload.

Question 137: Which method of patient transfer is MOST appropriate for a patient with a suspected spinal injury found in a vehicle?

Direct ground lift
Extremity lift
Rapid extrication technique (Correct answer)
Firefighter's carry

Correct answer: Rapid extrication technique

Rapid extrication is used for patients with suspected spinal injury when the scene is unsafe or the patient is critical, maintaining spinal alignment throughout.

Question 138: What is the appropriate oxygen flow rate when using a non-rebreather mask?

10–15 L/min (Correct answer)
5–6 L/min
2–4 L/min
20–25 L/min

Correct answer: 10–15 L/min

A non-rebreather mask requires 10–15 L/min to keep the reservoir bag inflated and deliver ~90% oxygen.

Question 139: Activated charcoal is contraindicated in which of the following situations?

Caustic/corrosive substance ingestion (Correct answer)
Acetaminophen overdose
Aspirin overdose
Benzodiazepine overdose

Correct answer: Caustic/corrosive substance ingestion

Activated charcoal is contraindicated with caustic ingestions because it does not bind caustics and obscures endoscopy.

Question 140: Which sign most reliably indicates successful bag-valve-mask ventilation?

Skin color improvement
Cyanosis resolution
Rise and fall of the chest (Correct answer)
Gurgling sounds

Correct answer: Rise and fall of the chest

Visible chest rise and fall with each ventilation is the most direct confirmation of effective BVM ventilation.

Question 141: Which action is MOST important when documenting a patient care report (PCR) after an emergency call?

Document only the treatments that were successful
Include personal opinions about patient behavior
Omit sensitive information to protect patient privacy
Provide an accurate, objective, and timely account of assessment and care (Correct answer)

Correct answer: Provide an accurate, objective, and timely account of assessment and care

The PCR must be accurate, objective, and completed promptly to support continuity of care, quality assurance, and legal documentation.

Question 142: Which rhythm is characterized by a regular narrow-complex tachycardia at 150–250 bpm with no visible P waves?

Supraventricular tachycardia (SVT) (Correct answer)
Atrial flutter
Sinus tachycardia
Ventricular tachycardia

Correct answer: Supraventricular tachycardia (SVT)

SVT presents as a regular narrow-complex tachycardia at 150–250 bpm; P waves are often buried in the preceding T wave.

Question 143: A patient with chest pain has a 12-lead showing ST elevation in V1–V4. This indicates:

Posterior STEMI
Inferior STEMI
Lateral STEMI
Anterior STEMI (Correct answer)

Correct answer: Anterior STEMI

Leads V1–V4 are the anterior precordial leads; ST elevation here indicates an anterior STEMI, typically from LAD occlusion.

Question 144: What oxygen concentration can a Bag Valve Mask (BVM) supply?

90 percent
95 percent
80 percent
100 percent (Correct answer)

Correct answer: 100 percent

Explanation: A Bag Valve Mask (BVM) can supply 100 percent oxygen concentration when properly fitted and used with an oxygen reservoir. This makes it an essential device for delivering high-flow oxygen to patients experiencing respiratory distress or failure.

Question 145: When suctioning a patient's airway, the maximum recommended suction time per attempt is:

10 seconds (Correct answer)
30 seconds
5 seconds
20 seconds

Correct answer: 10 seconds

Limit suction to no more than 10 seconds per attempt to prevent hypoxia and vagal stimulation.

Question 146: Which airway adjunct is most appropriate for an unconscious adult patient with no gag reflex?

Bag-valve-mask only
Nasal cannula
Nasopharyngeal airway
Oropharyngeal airway (Correct answer)

Correct answer: Oropharyngeal airway

An oropharyngeal airway (OPA) is indicated for unconscious patients without a gag reflex to maintain airway patency.

Question 147: Which medication reverses opioid-induced respiratory depression?

Adenosine
Naloxone (Narcan) (Correct answer)
Atropine
Flumazenil

Correct answer: Naloxone (Narcan)

Naloxone is a competitive opioid antagonist that reverses respiratory depression, sedation, and analgesia caused by opioids.

Question 148: A patient has burns covering the entire anterior torso and both arms. Using the Rule of Nines, what percentage of BSA is burned?

45%
27%
36% (Correct answer)
18%

Correct answer: 36%

Anterior torso = 18%, each arm = 9% (×2 = 18%), totaling 36% BSA burned.

Question 149: When ventilating a pediatric patient with a BVM, you should use:

Maximum tidal volume to ensure oxygenation
The largest adult mask available
Rapid ventilations above 30/min
Only enough volume to produce visible chest rise (Correct answer)

Correct answer: Only enough volume to produce visible chest rise

Ventilate pediatric patients with only enough volume to produce visible chest rise to avoid barotrauma and gastric distension.

Question 150: You are assessing a patient who is breathing, but he or she is doing so very slowly. What is the proper term for this form of breathing?

Dyspnea
Bradynea (Correct answer)
Tachypnea
Apnea

Correct answer: Bradynea

Explanation: Bradynea refers to abnormally slow breathing. In this scenario, the patient is breathing slowly, indicating Bradynea. This term helps paramedics accurately describe the patient's respiratory status during assessment.

Question 151: On a 12-lead ECG, ST-segment elevation in leads II, III, and aVF suggests an infarction in which territory?

Lateral wall
Inferior wall (Correct answer)
Anterior wall
Posterior wall

Correct answer: Inferior wall

Leads II, III, and aVF are the inferior leads; ST elevation in these leads indicates an inferior STEMI, typically from RCA occlusion.

COPR Primary Care Paramedic (PCP) Entry to Practice Examination

The COPR PCP Entry to Practice Examination assesses the knowledge and clinical competencies required for safe, entry-level Primary Care Paramedic practice in Canada, based on the National Occupational Competency Profile (NOCP) for Paramedics.

200

Questions

240 min

Time Limit

70%

To Pass

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