PREHOSPITAL EMERGENCY CARE ELEVENTH EDITION
EXAM SCRIPT FINAL PAPER 2026 COMPLETE SOLVED
QUESTIONS PARAMEDIC ACADEMIC INSIGHT - 249
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Prehospital Emergency Care / Paramedicine
Description This comprehensive final exam assesses mastery of advanced prehospital
emergency care concepts as outlined in the Eleventh Edition. It covers
pathophysiology, pharmacology, advanced airway management, trauma, medical
emergencies, special populations, and operational EMS. Questions demand
integration of knowledge, clinical reasoning, and application of evidence-based
guidelines.
Expected Grade A+
Total Questions 249
Duration 3 hours
Learning Outcomes 1. Integrate pathophysiological principles to manage complex medical and trauma
emergencies.
2. Apply advanced pharmacological knowledge to select and administer
appropriate medications.
3. Demonstrate proficiency in advanced airway management and ventilation
strategies.
4. Analyze and interpret diagnostic data (e.g., capnography, ECG, ultrasound) to
guide treatment.
5. Evaluate operational and ethical considerations in prehospital care.
Accreditation Meets or exceeds standards for paramedic education programs accredited by the
Commission on Accreditation of Allied Health Education Programs (CAAHEP)
and compliant with the National EMS Scope of Practice Model.
Page 1
,1. A patient with suspected acute coronary syndrome presents with ST-segment
elevation in leads II, III, and aVF. Which of the following is the most appropriate
immediate prehospital intervention to reduce mortality?
A. Administration of sublingual nitroglycerin 0.4 mg every 5 minutes for up to 3 doses
B. Administration of aspirin 324 mg chewed, and transport to a percutaneous coronary
intervention (PCI)-capable hospital
C. Administration of oxygen via non-rebreather mask at 15 L/min regardless of oxygen
saturation
D. Administration of morphine sulfate 2-4 mg IV for pain relief
Answer: B. Administration of aspirin 324 mg chewed, and transport to a
percutaneous coronary intervention (PCI)-capable hospital
Aspirin reduces mortality in acute coronary syndrome by inhibiting platelet
aggregation. While nitroglycerin and morphine relieve symptoms, they do not reduce
mortality. Oxygen is only indicated if SpO2 < 90%. The priority is antiplatelet therapy
and rapid transport to a PCI center.
2. During a prolonged transport of a patient in cardiac arrest, the end-tidal carbon
dioxide (ETCO2) reading suddenly drops from 35 mmHg to 15 mmHg. What is the
most likely cause?
A. Return of spontaneous circulation (ROSC)
B. Displacement of the endotracheal tube
C. Administration of sodium bicarbonate
D. Effective chest compressions
Answer: B. Displacement of the endotracheal tube
A sudden drop in ETCO2 during cardiac arrest indicates a loss of cardiac output or
ventilation. Tube displacement is a common cause. ROSC typically causes a rapid
increase in ETCO2. Bicarbonate may transiently increase CO2 but not cause a drop.
Effective compressions increase ETCO2.
Page 2
,3. Which of the following findings is most consistent with a tension pneumothorax in
a spontaneously breathing patient?
A. Hyperresonance to percussion on the affected side with tracheal deviation toward the
same side
B. Dullness to percussion on the affected side with tracheal deviation toward the opposite
side
C. Hyperresonance to percussion on the affected side with tracheal deviation toward the
opposite side
D. Dullness to percussion on the affected side with tracheal deviation toward the same side
Answer: C. Hyperresonance to percussion on the affected side with tracheal
deviation toward the opposite side
Tension pneumothorax traps air in the pleural space, causing hyperresonance and
shifting the trachea away from the affected side due to pressure. Dullness suggests
hemothorax or consolidation. Deviation toward the same side is seen with atelectasis.
4. A patient with a history of severe anaphylaxis to bee stings is found unresponsive,
with generalized urticaria, stridor, and hypotension. After administering 0.3 mg of
epinephrine 1:1000 IM, what is the next most important intervention?
A. Administer diphenhydramine 50 mg IV
B. Administer methylprednisolone 125 mg IV
C. Repeat epinephrine IM every 5-15 minutes if needed, and initiate IV fluids
D. Administer albuterol via nebulizer
Answer: C. Repeat epinephrine IM every 5-15 minutes if needed, and initiate IV
fluids
Epinephrine is the first-line treatment for anaphylaxis. If no improvement, repeat doses
are indicated. IV fluids treat hypotension. Antihistamines and steroids are adjunctive
but do not reverse airway obstruction or hypotension acutely. Albuterol may help
wheezing but is not the next priority.
Page 3
, 5. In a patient with suspected opioid overdose, the paramedic administers naloxone
0.4 mg IV. The patient regains consciousness but becomes agitated and combative.
What is the most appropriate next action?
A. Administer a second dose of naloxone 2 mg IV
B. Administer midazolam 2 mg IV for sedation
C. Apply soft restraints and reassess in 5 minutes
D. Administer flumazenil 0.2 mg IV to reverse naloxone
Answer: B. Administer midazolam 2 mg IV for sedation
Naloxone can precipitate acute withdrawal and agitation. If the patient is a danger to
self or others, sedation with a benzodiazepine (e.g., midazolam) is indicated. Giving
more naloxone may worsen agitation. Restraints are a last resort. Flumazenil is
contraindicated in opioid overdose.
6. A patient with diabetic ketoacidosis has a serum potassium of 3.2 mEq/L. After
starting an insulin infusion, what complication is most likely to occur if potassium is
not replaced?
A. Hyperkalemia due to insulin shifting potassium into cells
B. Hypokalemia leading to cardiac dysrhythmias
C. Metabolic alkalosis from bicarbonate loss
D. Hypoglycemia from insulin overcorrection
Answer: B. Hypokalemia leading to cardiac dysrhythmias
Insulin drives potassium into cells, worsening hypokalemia. Severe hypokalemia can
cause life-threatening dysrhythmias. Potassium replacement is critical before and
during insulin therapy. Hyperkalemia is not a risk with low initial K+. Alkalosis is not a
primary concern. Hypoglycemia is managed with dextrose.
Page 4
EXAM SCRIPT FINAL PAPER 2026 COMPLETE SOLVED
QUESTIONS PARAMEDIC ACADEMIC INSIGHT - 249
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Prehospital Emergency Care / Paramedicine
Description This comprehensive final exam assesses mastery of advanced prehospital
emergency care concepts as outlined in the Eleventh Edition. It covers
pathophysiology, pharmacology, advanced airway management, trauma, medical
emergencies, special populations, and operational EMS. Questions demand
integration of knowledge, clinical reasoning, and application of evidence-based
guidelines.
Expected Grade A+
Total Questions 249
Duration 3 hours
Learning Outcomes 1. Integrate pathophysiological principles to manage complex medical and trauma
emergencies.
2. Apply advanced pharmacological knowledge to select and administer
appropriate medications.
3. Demonstrate proficiency in advanced airway management and ventilation
strategies.
4. Analyze and interpret diagnostic data (e.g., capnography, ECG, ultrasound) to
guide treatment.
5. Evaluate operational and ethical considerations in prehospital care.
Accreditation Meets or exceeds standards for paramedic education programs accredited by the
Commission on Accreditation of Allied Health Education Programs (CAAHEP)
and compliant with the National EMS Scope of Practice Model.
Page 1
,1. A patient with suspected acute coronary syndrome presents with ST-segment
elevation in leads II, III, and aVF. Which of the following is the most appropriate
immediate prehospital intervention to reduce mortality?
A. Administration of sublingual nitroglycerin 0.4 mg every 5 minutes for up to 3 doses
B. Administration of aspirin 324 mg chewed, and transport to a percutaneous coronary
intervention (PCI)-capable hospital
C. Administration of oxygen via non-rebreather mask at 15 L/min regardless of oxygen
saturation
D. Administration of morphine sulfate 2-4 mg IV for pain relief
Answer: B. Administration of aspirin 324 mg chewed, and transport to a
percutaneous coronary intervention (PCI)-capable hospital
Aspirin reduces mortality in acute coronary syndrome by inhibiting platelet
aggregation. While nitroglycerin and morphine relieve symptoms, they do not reduce
mortality. Oxygen is only indicated if SpO2 < 90%. The priority is antiplatelet therapy
and rapid transport to a PCI center.
2. During a prolonged transport of a patient in cardiac arrest, the end-tidal carbon
dioxide (ETCO2) reading suddenly drops from 35 mmHg to 15 mmHg. What is the
most likely cause?
A. Return of spontaneous circulation (ROSC)
B. Displacement of the endotracheal tube
C. Administration of sodium bicarbonate
D. Effective chest compressions
Answer: B. Displacement of the endotracheal tube
A sudden drop in ETCO2 during cardiac arrest indicates a loss of cardiac output or
ventilation. Tube displacement is a common cause. ROSC typically causes a rapid
increase in ETCO2. Bicarbonate may transiently increase CO2 but not cause a drop.
Effective compressions increase ETCO2.
Page 2
,3. Which of the following findings is most consistent with a tension pneumothorax in
a spontaneously breathing patient?
A. Hyperresonance to percussion on the affected side with tracheal deviation toward the
same side
B. Dullness to percussion on the affected side with tracheal deviation toward the opposite
side
C. Hyperresonance to percussion on the affected side with tracheal deviation toward the
opposite side
D. Dullness to percussion on the affected side with tracheal deviation toward the same side
Answer: C. Hyperresonance to percussion on the affected side with tracheal
deviation toward the opposite side
Tension pneumothorax traps air in the pleural space, causing hyperresonance and
shifting the trachea away from the affected side due to pressure. Dullness suggests
hemothorax or consolidation. Deviation toward the same side is seen with atelectasis.
4. A patient with a history of severe anaphylaxis to bee stings is found unresponsive,
with generalized urticaria, stridor, and hypotension. After administering 0.3 mg of
epinephrine 1:1000 IM, what is the next most important intervention?
A. Administer diphenhydramine 50 mg IV
B. Administer methylprednisolone 125 mg IV
C. Repeat epinephrine IM every 5-15 minutes if needed, and initiate IV fluids
D. Administer albuterol via nebulizer
Answer: C. Repeat epinephrine IM every 5-15 minutes if needed, and initiate IV
fluids
Epinephrine is the first-line treatment for anaphylaxis. If no improvement, repeat doses
are indicated. IV fluids treat hypotension. Antihistamines and steroids are adjunctive
but do not reverse airway obstruction or hypotension acutely. Albuterol may help
wheezing but is not the next priority.
Page 3
, 5. In a patient with suspected opioid overdose, the paramedic administers naloxone
0.4 mg IV. The patient regains consciousness but becomes agitated and combative.
What is the most appropriate next action?
A. Administer a second dose of naloxone 2 mg IV
B. Administer midazolam 2 mg IV for sedation
C. Apply soft restraints and reassess in 5 minutes
D. Administer flumazenil 0.2 mg IV to reverse naloxone
Answer: B. Administer midazolam 2 mg IV for sedation
Naloxone can precipitate acute withdrawal and agitation. If the patient is a danger to
self or others, sedation with a benzodiazepine (e.g., midazolam) is indicated. Giving
more naloxone may worsen agitation. Restraints are a last resort. Flumazenil is
contraindicated in opioid overdose.
6. A patient with diabetic ketoacidosis has a serum potassium of 3.2 mEq/L. After
starting an insulin infusion, what complication is most likely to occur if potassium is
not replaced?
A. Hyperkalemia due to insulin shifting potassium into cells
B. Hypokalemia leading to cardiac dysrhythmias
C. Metabolic alkalosis from bicarbonate loss
D. Hypoglycemia from insulin overcorrection
Answer: B. Hypokalemia leading to cardiac dysrhythmias
Insulin drives potassium into cells, worsening hypokalemia. Severe hypokalemia can
cause life-threatening dysrhythmias. Potassium replacement is critical before and
during insulin therapy. Hyperkalemia is not a risk with low initial K+. Alkalosis is not a
primary concern. Hypoglycemia is managed with dextrose.
Page 4
