EMT Refresher CE Exam Prep – Real Practice Questions, Answers &
Detailed Rationales (Updated 2026) | Patient Assessment &
Trauma Care, Airway Management & Oxygen Therapy, Cardiac &
Respiratory Emergencies, CPR & AED Skills, Shock Management, Medical
Emergencies, Pharmacology Basics, EMS Operations, Pediatric &
Geriatric Care, NREMT Continuing Education Review
Question 1: During the primary assessment of an adult patient, you note the patient
is unresponsive with agonal respirations. What is your immediate next action?
A. Apply a non-rebreather mask at 15 L/min
B. Begin chest compressions immediately
C. Open the airway using the head-tilt/chin-lift maneuver
D. Check for a carotid pulse for no more than 10 seconds
CORRECT ANSWER: D. Check for a carotid pulse for no more than 10 seconds
Rationale: In an unresponsive patient with agonal respirations, the EMT must
immediately assess for a pulse to determine if the patient is in cardiac arrest. Agonal
gasps are not effective breathing and may occur in cardiac arrest. Checking the carotid
pulse for no more than 10 seconds is the critical next step before initiating CPR or
rescue breathing per current BLS guidelines.
Question 2: Which of the following is the most reliable indicator of adequate
ventilation when using a bag-valve-mask device on an adult patient?
A. Seeing chest rise with each ventilation
B. Hearing air escape around the mask seal
C. Feeling resistance when squeezing the bag
D. Noting a heart rate increase after ventilation
CORRECT ANSWER: A. Seeing chest rise with each ventilation
Rationale: Visible chest rise is the most direct and reliable clinical indicator that
ventilations are effectively delivering air into the patient's lungs. While other signs may
provide supportive information, chest rise confirms adequate tidal volume delivery and
proper airway positioning during bag-valve-mask ventilation.
Question 3: An EMT is preparing to administer aspirin to a patient with suspected
acute coronary syndrome. Which of the following is an absolute contraindication to
aspirin administration in this scenario?
A. Patient reports a history of gastric ulcers
B. Patient is currently taking warfarin
C. Patient has a known allergy to aspirin or NSAIDs
D. Patient is 78 years old
CORRECT ANSWER: C. Patient has a known allergy to aspirin or NSAIDs
,Rationale: A known allergy to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
is an absolute contraindication to aspirin administration due to the risk of severe
allergic reaction, including anaphylaxis. While history of gastric ulcers or anticoagulant
use requires caution and medical direction consultation, they are not absolute
contraindications in the prehospital setting for a single dose of aspirin in ACS.
Question 4: When assessing a pediatric patient with respiratory distress, which
finding is most concerning for impending respiratory failure?
A. Nasal flaring
B. Intercostal retractions
C. Head bobbing with respirations
D. Grunting on exhalation
CORRECT ANSWER: C. Head bobbing with respirations
Rationale: Head bobbing is a sign of severe respiratory distress in infants and young
children, indicating use of accessory muscles and significant work of breathing. It
suggests the child is tiring and may be approaching respiratory failure. While nasal
flaring, retractions, and grunting are signs of respiratory distress, head bobbing
represents a more critical level of compromise requiring immediate intervention.
Question 5: Which of the following best describes the mechanism of injury that
should raise the highest suspicion for cervical spine injury in a trauma patient?
A. Fall from standing height onto concrete
B. Motor vehicle collision with airbag deployment
C. Axial loading force to the top of the head
D. Lateral impact to the torso during a collision
CORRECT ANSWER: C. Axial loading force to the top of the head
Rationale: Axial loading forces, such as a direct blow to the top of the head or a fall
landing on the feet or buttocks, transmit force directly through the vertebral column and
carry the highest risk for cervical spine compression fractures or dislocations. While
other mechanisms can cause spinal injury, axial loading is particularly concerning for
unstable cervical spine injuries requiring immediate immobilization.
Question 6: An adult patient presents with sudden onset of severe, tearing chest
pain radiating to the back. Blood pressure is 190/110 mmHg in the right arm and
150/90 mmHg in the left arm. Which condition should the EMT suspect?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Tension pneumothorax
CORRECT ANSWER: C. Aortic dissection
,Rationale: The classic presentation of aortic dissection includes sudden, severe, tearing
or ripping chest pain that may radiate to the back, along with pulse or blood pressure
discrepancies between extremities due to involvement of branch arteries. This is a life-
threatening emergency requiring rapid transport. While MI and PE can cause chest pain,
the blood pressure discrepancy and pain quality are hallmark signs of dissection.
Question 7: During patient reassessment, you note that a trauma patient's radial
pulse is no longer palpable, but the carotid pulse remains strong. What is the most
appropriate interpretation of this finding?
A. The patient is developing compensated shock
B. The patient has progressed to decompensated shock
C. The patient's blood pressure has increased significantly
D. The patient is experiencing a vagal response
CORRECT ANSWER: B. The patient has progressed to decompensated shock
Rationale: Loss of peripheral pulses (radial) while central pulses (carotid) remain
palpable indicates worsening shock and decreased perfusion pressure. This represents
progression from compensated to decompensated shock, where the body can no
longer maintain adequate blood pressure to perfuse peripheral tissues. Immediate
intervention and rapid transport are critical.
Question 8: Which of the following is the correct sequence for managing a patient
with an impaled object in the cheek that is compromising the airway?
A. Stabilize the object, provide oxygen, transport immediately
B. Remove the object, control bleeding, then manage airway
C. Remove the object only if it obstructs the airway, then control bleeding
D. Apply direct pressure around the object and prepare for surgical airway
CORRECT ANSWER: C. Remove the object only if it obstructs the airway, then
control bleeding
Rationale: Impaled objects in the cheek may be removed if they interfere with airway
management or breathing, as the cheek has good vascularity and bleeding can typically
be controlled. Objects impaled elsewhere should generally be stabilized in place. If
removal is necessary for airway access, it should be done carefully with immediate
control of bleeding using direct pressure or packing.
Question 9: A patient with a history of diabetes is found confused, diaphoretic, and
tachycardic. Blood glucose reading is 48 mg/dL. After administering oral glucose,
the patient's mental status improves. What is the most appropriate next action?
A. Discharge the patient with instructions to eat a meal
B. Transport the patient for further evaluation despite improvement
C. Recheck blood glucose in 30 minutes and allow refusal if normal
D. Administer a second dose of oral glucose prophylactically
, CORRECT ANSWER: B. Transport the patient for further evaluation despite
improvement
Rationale: Even after successful treatment of hypoglycemia with improvement in
mental status, patients require transport for medical evaluation to determine the cause
of the hypoglycemic episode and prevent recurrence. Hypoglycemia can rebound, and
underlying causes such as medication errors, infection, or other medical conditions
need hospital assessment.
Question 10: Which of the following findings is most indicative of a tension
pneumothorax in a trauma patient?
A. Decreased breath sounds on the affected side with tracheal deviation away from the
injury
B. Bilateral wheezing with prolonged expiratory phase
C. Crackles at lung bases with frothy sputum
D. Stridor with inspiratory difficulty and hoarseness
CORRECT ANSWER: A. Decreased breath sounds on the affected side with tracheal
deviation away from the injury
Rationale: Tension pneumothorax is characterized by accumulation of air in the pleural
space under pressure, causing lung collapse, mediastinal shift, and tracheal deviation
away from the affected side. Decreased or absent breath sounds on the affected side,
combined with respiratory distress, hypotension, and tracheal deviation, are classic
signs requiring immediate needle decompression.
Question 11: When using an automated external defibrillator (AED) on an adult
patient in cardiac arrest, what is the correct action immediately after the AED
analyzes the rhythm and advises a shock?
A. Clear the patient and deliver the shock
B. Perform 2 minutes of CPR before shocking
C. Check for a pulse before delivering the shock
D. Administer epinephrine before shocking
CORRECT ANSWER: A. Clear the patient and deliver the shock
Rationale: When an AED advises a shock, the EMT must ensure no one is touching the
patient (clear the patient), then immediately deliver the shock as directed. After shock
delivery, CPR should be resumed immediately starting with chest compressions,
without checking for a pulse or rhythm, per current AHA BLS guidelines.
Question 12: A pediatric patient presents with a barking cough, inspiratory stridor,
and mild respiratory distress. Symptoms worsen at night. Which condition is most
consistent with this presentation?
A. Epiglottitis
B. Bronchiolitis
Detailed Rationales (Updated 2026) | Patient Assessment &
Trauma Care, Airway Management & Oxygen Therapy, Cardiac &
Respiratory Emergencies, CPR & AED Skills, Shock Management, Medical
Emergencies, Pharmacology Basics, EMS Operations, Pediatric &
Geriatric Care, NREMT Continuing Education Review
Question 1: During the primary assessment of an adult patient, you note the patient
is unresponsive with agonal respirations. What is your immediate next action?
A. Apply a non-rebreather mask at 15 L/min
B. Begin chest compressions immediately
C. Open the airway using the head-tilt/chin-lift maneuver
D. Check for a carotid pulse for no more than 10 seconds
CORRECT ANSWER: D. Check for a carotid pulse for no more than 10 seconds
Rationale: In an unresponsive patient with agonal respirations, the EMT must
immediately assess for a pulse to determine if the patient is in cardiac arrest. Agonal
gasps are not effective breathing and may occur in cardiac arrest. Checking the carotid
pulse for no more than 10 seconds is the critical next step before initiating CPR or
rescue breathing per current BLS guidelines.
Question 2: Which of the following is the most reliable indicator of adequate
ventilation when using a bag-valve-mask device on an adult patient?
A. Seeing chest rise with each ventilation
B. Hearing air escape around the mask seal
C. Feeling resistance when squeezing the bag
D. Noting a heart rate increase after ventilation
CORRECT ANSWER: A. Seeing chest rise with each ventilation
Rationale: Visible chest rise is the most direct and reliable clinical indicator that
ventilations are effectively delivering air into the patient's lungs. While other signs may
provide supportive information, chest rise confirms adequate tidal volume delivery and
proper airway positioning during bag-valve-mask ventilation.
Question 3: An EMT is preparing to administer aspirin to a patient with suspected
acute coronary syndrome. Which of the following is an absolute contraindication to
aspirin administration in this scenario?
A. Patient reports a history of gastric ulcers
B. Patient is currently taking warfarin
C. Patient has a known allergy to aspirin or NSAIDs
D. Patient is 78 years old
CORRECT ANSWER: C. Patient has a known allergy to aspirin or NSAIDs
,Rationale: A known allergy to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
is an absolute contraindication to aspirin administration due to the risk of severe
allergic reaction, including anaphylaxis. While history of gastric ulcers or anticoagulant
use requires caution and medical direction consultation, they are not absolute
contraindications in the prehospital setting for a single dose of aspirin in ACS.
Question 4: When assessing a pediatric patient with respiratory distress, which
finding is most concerning for impending respiratory failure?
A. Nasal flaring
B. Intercostal retractions
C. Head bobbing with respirations
D. Grunting on exhalation
CORRECT ANSWER: C. Head bobbing with respirations
Rationale: Head bobbing is a sign of severe respiratory distress in infants and young
children, indicating use of accessory muscles and significant work of breathing. It
suggests the child is tiring and may be approaching respiratory failure. While nasal
flaring, retractions, and grunting are signs of respiratory distress, head bobbing
represents a more critical level of compromise requiring immediate intervention.
Question 5: Which of the following best describes the mechanism of injury that
should raise the highest suspicion for cervical spine injury in a trauma patient?
A. Fall from standing height onto concrete
B. Motor vehicle collision with airbag deployment
C. Axial loading force to the top of the head
D. Lateral impact to the torso during a collision
CORRECT ANSWER: C. Axial loading force to the top of the head
Rationale: Axial loading forces, such as a direct blow to the top of the head or a fall
landing on the feet or buttocks, transmit force directly through the vertebral column and
carry the highest risk for cervical spine compression fractures or dislocations. While
other mechanisms can cause spinal injury, axial loading is particularly concerning for
unstable cervical spine injuries requiring immediate immobilization.
Question 6: An adult patient presents with sudden onset of severe, tearing chest
pain radiating to the back. Blood pressure is 190/110 mmHg in the right arm and
150/90 mmHg in the left arm. Which condition should the EMT suspect?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Tension pneumothorax
CORRECT ANSWER: C. Aortic dissection
,Rationale: The classic presentation of aortic dissection includes sudden, severe, tearing
or ripping chest pain that may radiate to the back, along with pulse or blood pressure
discrepancies between extremities due to involvement of branch arteries. This is a life-
threatening emergency requiring rapid transport. While MI and PE can cause chest pain,
the blood pressure discrepancy and pain quality are hallmark signs of dissection.
Question 7: During patient reassessment, you note that a trauma patient's radial
pulse is no longer palpable, but the carotid pulse remains strong. What is the most
appropriate interpretation of this finding?
A. The patient is developing compensated shock
B. The patient has progressed to decompensated shock
C. The patient's blood pressure has increased significantly
D. The patient is experiencing a vagal response
CORRECT ANSWER: B. The patient has progressed to decompensated shock
Rationale: Loss of peripheral pulses (radial) while central pulses (carotid) remain
palpable indicates worsening shock and decreased perfusion pressure. This represents
progression from compensated to decompensated shock, where the body can no
longer maintain adequate blood pressure to perfuse peripheral tissues. Immediate
intervention and rapid transport are critical.
Question 8: Which of the following is the correct sequence for managing a patient
with an impaled object in the cheek that is compromising the airway?
A. Stabilize the object, provide oxygen, transport immediately
B. Remove the object, control bleeding, then manage airway
C. Remove the object only if it obstructs the airway, then control bleeding
D. Apply direct pressure around the object and prepare for surgical airway
CORRECT ANSWER: C. Remove the object only if it obstructs the airway, then
control bleeding
Rationale: Impaled objects in the cheek may be removed if they interfere with airway
management or breathing, as the cheek has good vascularity and bleeding can typically
be controlled. Objects impaled elsewhere should generally be stabilized in place. If
removal is necessary for airway access, it should be done carefully with immediate
control of bleeding using direct pressure or packing.
Question 9: A patient with a history of diabetes is found confused, diaphoretic, and
tachycardic. Blood glucose reading is 48 mg/dL. After administering oral glucose,
the patient's mental status improves. What is the most appropriate next action?
A. Discharge the patient with instructions to eat a meal
B. Transport the patient for further evaluation despite improvement
C. Recheck blood glucose in 30 minutes and allow refusal if normal
D. Administer a second dose of oral glucose prophylactically
, CORRECT ANSWER: B. Transport the patient for further evaluation despite
improvement
Rationale: Even after successful treatment of hypoglycemia with improvement in
mental status, patients require transport for medical evaluation to determine the cause
of the hypoglycemic episode and prevent recurrence. Hypoglycemia can rebound, and
underlying causes such as medication errors, infection, or other medical conditions
need hospital assessment.
Question 10: Which of the following findings is most indicative of a tension
pneumothorax in a trauma patient?
A. Decreased breath sounds on the affected side with tracheal deviation away from the
injury
B. Bilateral wheezing with prolonged expiratory phase
C. Crackles at lung bases with frothy sputum
D. Stridor with inspiratory difficulty and hoarseness
CORRECT ANSWER: A. Decreased breath sounds on the affected side with tracheal
deviation away from the injury
Rationale: Tension pneumothorax is characterized by accumulation of air in the pleural
space under pressure, causing lung collapse, mediastinal shift, and tracheal deviation
away from the affected side. Decreased or absent breath sounds on the affected side,
combined with respiratory distress, hypotension, and tracheal deviation, are classic
signs requiring immediate needle decompression.
Question 11: When using an automated external defibrillator (AED) on an adult
patient in cardiac arrest, what is the correct action immediately after the AED
analyzes the rhythm and advises a shock?
A. Clear the patient and deliver the shock
B. Perform 2 minutes of CPR before shocking
C. Check for a pulse before delivering the shock
D. Administer epinephrine before shocking
CORRECT ANSWER: A. Clear the patient and deliver the shock
Rationale: When an AED advises a shock, the EMT must ensure no one is touching the
patient (clear the patient), then immediately deliver the shock as directed. After shock
delivery, CPR should be resumed immediately starting with chest compressions,
without checking for a pulse or rhythm, per current AHA BLS guidelines.
Question 12: A pediatric patient presents with a barking cough, inspiratory stridor,
and mild respiratory distress. Symptoms worsen at night. Which condition is most
consistent with this presentation?
A. Epiglottitis
B. Bronchiolitis
