EMT-I Emergency Medical Technician Intermediate Exam Prep – Practice
Questions, Answers & Detailed Rationales (Updated 2026) |
Advanced Airway Management, IV Therapy & Medication Administration,
Trauma & Medical Emergencies, Cardiac & Respiratory Care, Patient
Assessment (Primary & Secondary Survey), Shock Management,
Pharmacology for EMT-I, Pediatric & Geriatric Care, EMS Operations,
NREMT-Style Scenarios
Question 1: Which of the following is the MOST appropriate indication for
performing endotracheal intubation in the prehospital setting?
A. Patient with mild asthma exacerbation responding to albuterol
B. Patient with altered mental status and inability to protect their airway
C. Patient with isolated extremity fracture and stable vital signs
D. Patient with nausea and vomiting but intact gag reflex
CORRECT ANSWER: B. Patient with altered mental status and inability to protect
their airway
Rationale: Endotracheal intubation is indicated when a patient cannot maintain or
protect their airway, such as in cases of significantly altered mental status, loss of gag
reflex, or anticipated clinical deterioration. Mild asthma responding to treatment,
isolated fractures, or nausea with intact reflexes do not warrant advanced airway
management.
Question 2: When administering epinephrine via the endotracheal tube during
cardiac arrest, what is the recommended dosage adjustment compared to the
IV/IO route?
A. Use the same dose as IV/IO administration
B. Use half the IV/IO dose
C. Use 2 to 2.5 times the IV/IO dose
D. Endotracheal epinephrine is contraindicated in cardiac arrest
CORRECT ANSWER: C. Use 2 to 2.5 times the IV/IO dose
Rationale: When medications are administered via the endotracheal route, absorption
is less efficient than via IV or IO routes. Therefore, epinephrine doses should be
increased to 2 to 2.5 times the standard IV/IO dose (typically 2-2.5 mg instead of 1 mg)
to achieve comparable therapeutic effects.
Question 3: A 58-year-old male presents with chest pain, diaphoresis, and
shortness of breath. His ECG shows ST-segment elevation in leads II, III, and aVF.
Which coronary artery is MOST likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
,CORRECT ANSWER: C. Right coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is most commonly caused by occlusion of the right
coronary artery. The left anterior descending artery typically affects anterior leads (V1-
V4), while the circumflex affects lateral leads.
Question 4: Which of the following medications administered by an EMT-
Intermediate requires continuous cardiac monitoring during infusion?
A. Normal saline bolus
B. Dopamine infusion
C. Oral aspirin
D. Intramuscular epinephrine
CORRECT ANSWER: B. Dopamine infusion
Rationale: Dopamine is a vasoactive medication that affects heart rate, blood pressure,
and cardiac rhythm. Continuous cardiac monitoring is essential during dopamine
infusion to detect arrhythmias, tachycardia, or other adverse hemodynamic responses
promptly.
Question 5: During IV catheter insertion, you observe blood return in the flashback
chamber, but the catheter will not advance. What is the MOST likely cause?
A. The vein has rolled or collapsed
B. The catheter tip has penetrated through the posterior wall of the vein
C. The tourniquet is too tight
D. The patient is dehydrated
CORRECT ANSWER: B. The catheter tip has penetrated through the posterior wall of
the vein
Rationale: When blood return is observed but the catheter cannot be advanced, it
typically indicates that the needle has passed completely through the vein (posterior
wall puncture). The appropriate action is to withdraw the catheter slightly and attempt
to redirect, or select a new site.
Question 6: A patient with suspected anaphylaxis presents with stridor,
hypotension, and urticaria. After administering intramuscular epinephrine, which
intervention should be performed NEXT?
A. Administer diphenhydramine IV
B. Establish IV access and initiate fluid bolus
C. Apply high-flow oxygen via non-rebreather mask
D. Prepare for endotracheal intubation
CORRECT ANSWER: B. Establish IV access and initiate fluid bolus
,Rationale: After initial epinephrine administration in anaphylaxis, securing IV access
and administering isotonic fluid boluses (e.g., normal saline) is critical to address
distributive shock and hypotension. Oxygen and antihistamines are important but
secondary to hemodynamic support.
Question 7: Which of the following is a contraindication to the administration of
nitroglycerin in a patient with chest pain?
A. Systolic blood pressure of 110 mmHg
B. Recent use of sildenafil (Viagra) within the past 24 hours
C. History of coronary artery disease
D. Mild headache prior to administration
CORRECT ANSWER: B. Recent use of sildenafil (Viagra) within the past 24 hours
Rationale: Nitroglycerin is contraindicated in patients who have taken
phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil) within 24-48 hours due to the
risk of severe, life-threatening hypotension from synergistic vasodilation. A systolic BP
of 110 mmHg is generally acceptable for nitroglycerin administration.
Question 8: When assessing a trauma patient with suspected tension
pneumothorax, which finding is MOST specific?
A. Decreased breath sounds on the affected side
B. Tracheal deviation away from the affected side
C. Subcutaneous emphysema
D. Pain with deep inspiration
CORRECT ANSWER: B. Tracheal deviation away from the affected side
Rationale: While decreased breath sounds are common in pneumothorax, tracheal
deviation away from the affected side is a late but highly specific sign of tension
pneumothorax, indicating mediastinal shift due to increasing intrathoracic pressure.
This is a critical finding requiring immediate needle decompression.
Question 9: Which of the following IV solutions is considered isotonic and is MOST
appropriate for initial fluid resuscitation in hypovolemic shock?
A. 5% Dextrose in Water (D5W)
B. 0.45% Normal Saline (Half-Normal Saline)
C. Lactated Ringer's solution
D. 3% Normal Saline
CORRECT ANSWER: C. Lactated Ringer's solution
Rationale: Lactated Ringer's and 0.9% Normal Saline are isotonic crystalloids
appropriate for volume expansion in hypovolemic shock. D5W becomes hypotonic after
dextrose metabolism, half-normal saline is hypotonic, and 3% saline is hypertonic and
used for specific indications like severe hyponatremia.
, Question 10: A pediatric patient weighs 20 kg. What is the appropriate dose of
epinephrine (1:1,000) for anaphylaxis via the intramuscular route?
A. 0.1 mg
B. 0.2 mg
C. 0.3 mg
D. 0.5 mg
CORRECT ANSWER: B. 0.2 mg
Rationale: The recommended pediatric dose of epinephrine (1:1,000) for anaphylaxis is
0.01 mg/kg IM, with a maximum single dose of 0.5 mg. For a 20 kg child: 20 kg × 0.01
mg/kg = 0.2 mg. This dose may be repeated every 5-15 minutes as needed.
Question 11: Which cardiac rhythm is characterized by the absence of P waves,
irregularly irregular R-R intervals, and a ventricular rate typically between 100-150
bpm?
A. Sinus tachycardia
B. Atrial flutter
C. Atrial fibrillation
D. Ventricular tachycardia
CORRECT ANSWER: C. Atrial fibrillation
Rationale: Atrial fibrillation is identified by the absence of distinct P waves (replaced by
fibrillatory waves), an irregularly irregular ventricular rhythm, and variable heart rates.
Atrial flutter shows sawtooth flutter waves; sinus tachycardia has regular P waves;
ventricular tachycardia has wide QRS complexes without preceding P waves.
Question 12: During synchronized cardioversion for unstable atrial fibrillation, why
is synchronization critical?
A. To ensure the shock is delivered during the T wave
B. To avoid delivering the shock during the relative refractory period
C. To maximize the energy delivered to the myocardium
D. To reduce patient pain during the procedure
CORRECT ANSWER: B. To avoid delivering the shock during the relative refractory
period
Rationale: Synchronization ensures the electrical shock is delivered on the R wave,
avoiding the T wave (relative refractory period). Delivering a shock during the T wave can
induce ventricular fibrillation, a life-threatening complication. Synchronization does not
affect energy delivery or pain perception significantly.
Question 13: Which of the following is the MOST reliable indicator of adequate
ventilation when using a bag-valve-mask device?
Questions, Answers & Detailed Rationales (Updated 2026) |
Advanced Airway Management, IV Therapy & Medication Administration,
Trauma & Medical Emergencies, Cardiac & Respiratory Care, Patient
Assessment (Primary & Secondary Survey), Shock Management,
Pharmacology for EMT-I, Pediatric & Geriatric Care, EMS Operations,
NREMT-Style Scenarios
Question 1: Which of the following is the MOST appropriate indication for
performing endotracheal intubation in the prehospital setting?
A. Patient with mild asthma exacerbation responding to albuterol
B. Patient with altered mental status and inability to protect their airway
C. Patient with isolated extremity fracture and stable vital signs
D. Patient with nausea and vomiting but intact gag reflex
CORRECT ANSWER: B. Patient with altered mental status and inability to protect
their airway
Rationale: Endotracheal intubation is indicated when a patient cannot maintain or
protect their airway, such as in cases of significantly altered mental status, loss of gag
reflex, or anticipated clinical deterioration. Mild asthma responding to treatment,
isolated fractures, or nausea with intact reflexes do not warrant advanced airway
management.
Question 2: When administering epinephrine via the endotracheal tube during
cardiac arrest, what is the recommended dosage adjustment compared to the
IV/IO route?
A. Use the same dose as IV/IO administration
B. Use half the IV/IO dose
C. Use 2 to 2.5 times the IV/IO dose
D. Endotracheal epinephrine is contraindicated in cardiac arrest
CORRECT ANSWER: C. Use 2 to 2.5 times the IV/IO dose
Rationale: When medications are administered via the endotracheal route, absorption
is less efficient than via IV or IO routes. Therefore, epinephrine doses should be
increased to 2 to 2.5 times the standard IV/IO dose (typically 2-2.5 mg instead of 1 mg)
to achieve comparable therapeutic effects.
Question 3: A 58-year-old male presents with chest pain, diaphoresis, and
shortness of breath. His ECG shows ST-segment elevation in leads II, III, and aVF.
Which coronary artery is MOST likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
,CORRECT ANSWER: C. Right coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is most commonly caused by occlusion of the right
coronary artery. The left anterior descending artery typically affects anterior leads (V1-
V4), while the circumflex affects lateral leads.
Question 4: Which of the following medications administered by an EMT-
Intermediate requires continuous cardiac monitoring during infusion?
A. Normal saline bolus
B. Dopamine infusion
C. Oral aspirin
D. Intramuscular epinephrine
CORRECT ANSWER: B. Dopamine infusion
Rationale: Dopamine is a vasoactive medication that affects heart rate, blood pressure,
and cardiac rhythm. Continuous cardiac monitoring is essential during dopamine
infusion to detect arrhythmias, tachycardia, or other adverse hemodynamic responses
promptly.
Question 5: During IV catheter insertion, you observe blood return in the flashback
chamber, but the catheter will not advance. What is the MOST likely cause?
A. The vein has rolled or collapsed
B. The catheter tip has penetrated through the posterior wall of the vein
C. The tourniquet is too tight
D. The patient is dehydrated
CORRECT ANSWER: B. The catheter tip has penetrated through the posterior wall of
the vein
Rationale: When blood return is observed but the catheter cannot be advanced, it
typically indicates that the needle has passed completely through the vein (posterior
wall puncture). The appropriate action is to withdraw the catheter slightly and attempt
to redirect, or select a new site.
Question 6: A patient with suspected anaphylaxis presents with stridor,
hypotension, and urticaria. After administering intramuscular epinephrine, which
intervention should be performed NEXT?
A. Administer diphenhydramine IV
B. Establish IV access and initiate fluid bolus
C. Apply high-flow oxygen via non-rebreather mask
D. Prepare for endotracheal intubation
CORRECT ANSWER: B. Establish IV access and initiate fluid bolus
,Rationale: After initial epinephrine administration in anaphylaxis, securing IV access
and administering isotonic fluid boluses (e.g., normal saline) is critical to address
distributive shock and hypotension. Oxygen and antihistamines are important but
secondary to hemodynamic support.
Question 7: Which of the following is a contraindication to the administration of
nitroglycerin in a patient with chest pain?
A. Systolic blood pressure of 110 mmHg
B. Recent use of sildenafil (Viagra) within the past 24 hours
C. History of coronary artery disease
D. Mild headache prior to administration
CORRECT ANSWER: B. Recent use of sildenafil (Viagra) within the past 24 hours
Rationale: Nitroglycerin is contraindicated in patients who have taken
phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil) within 24-48 hours due to the
risk of severe, life-threatening hypotension from synergistic vasodilation. A systolic BP
of 110 mmHg is generally acceptable for nitroglycerin administration.
Question 8: When assessing a trauma patient with suspected tension
pneumothorax, which finding is MOST specific?
A. Decreased breath sounds on the affected side
B. Tracheal deviation away from the affected side
C. Subcutaneous emphysema
D. Pain with deep inspiration
CORRECT ANSWER: B. Tracheal deviation away from the affected side
Rationale: While decreased breath sounds are common in pneumothorax, tracheal
deviation away from the affected side is a late but highly specific sign of tension
pneumothorax, indicating mediastinal shift due to increasing intrathoracic pressure.
This is a critical finding requiring immediate needle decompression.
Question 9: Which of the following IV solutions is considered isotonic and is MOST
appropriate for initial fluid resuscitation in hypovolemic shock?
A. 5% Dextrose in Water (D5W)
B. 0.45% Normal Saline (Half-Normal Saline)
C. Lactated Ringer's solution
D. 3% Normal Saline
CORRECT ANSWER: C. Lactated Ringer's solution
Rationale: Lactated Ringer's and 0.9% Normal Saline are isotonic crystalloids
appropriate for volume expansion in hypovolemic shock. D5W becomes hypotonic after
dextrose metabolism, half-normal saline is hypotonic, and 3% saline is hypertonic and
used for specific indications like severe hyponatremia.
, Question 10: A pediatric patient weighs 20 kg. What is the appropriate dose of
epinephrine (1:1,000) for anaphylaxis via the intramuscular route?
A. 0.1 mg
B. 0.2 mg
C. 0.3 mg
D. 0.5 mg
CORRECT ANSWER: B. 0.2 mg
Rationale: The recommended pediatric dose of epinephrine (1:1,000) for anaphylaxis is
0.01 mg/kg IM, with a maximum single dose of 0.5 mg. For a 20 kg child: 20 kg × 0.01
mg/kg = 0.2 mg. This dose may be repeated every 5-15 minutes as needed.
Question 11: Which cardiac rhythm is characterized by the absence of P waves,
irregularly irregular R-R intervals, and a ventricular rate typically between 100-150
bpm?
A. Sinus tachycardia
B. Atrial flutter
C. Atrial fibrillation
D. Ventricular tachycardia
CORRECT ANSWER: C. Atrial fibrillation
Rationale: Atrial fibrillation is identified by the absence of distinct P waves (replaced by
fibrillatory waves), an irregularly irregular ventricular rhythm, and variable heart rates.
Atrial flutter shows sawtooth flutter waves; sinus tachycardia has regular P waves;
ventricular tachycardia has wide QRS complexes without preceding P waves.
Question 12: During synchronized cardioversion for unstable atrial fibrillation, why
is synchronization critical?
A. To ensure the shock is delivered during the T wave
B. To avoid delivering the shock during the relative refractory period
C. To maximize the energy delivered to the myocardium
D. To reduce patient pain during the procedure
CORRECT ANSWER: B. To avoid delivering the shock during the relative refractory
period
Rationale: Synchronization ensures the electrical shock is delivered on the R wave,
avoiding the T wave (relative refractory period). Delivering a shock during the T wave can
induce ventricular fibrillation, a life-threatening complication. Synchronization does not
affect energy delivery or pain perception significantly.
Question 13: Which of the following is the MOST reliable indicator of adequate
ventilation when using a bag-valve-mask device?
