EMT Refresher CE Exam Prep – Real Practice Questions, Answers & Detailed
Rationales (Updated 2026) | Patient Assessment & Vital Signs, Airway Management
& Oxygen Therapy, CPR & AED Procedures, Trauma & Medical Emergencies, Shock
Management, Cardiac & Respiratory Care, EMS Operations & Patient Transport,
NREMT Refresher Review & Continuing Education Scenarios
Question 1: Which of the following is the MOST appropriate initial action when
managing a patient with suspected tension pneumothorax?
A. Administer high-flow oxygen via non-rebreather mask
B. Perform needle decompression at the 2nd intercostal space, midclavicular line
C. Apply a chest seal to the affected side
D. Position the patient in Trendelenburg position
CORRECT ANSWER: B. Perform needle decompression at the 2nd intercostal
space, midclavicular line
Rationale: Tension pneumothorax is a life-threatening emergency requiring immediate
needle decompression to relieve intrathoracic pressure. The recommended site is the
2nd intercostal space at the midclavicular line on the affected side. While oxygen
administration is important, it does not address the underlying pathophysiology. Chest
seals are for open pneumothorax, and Trendelenburg positioning is contraindicated as it
may worsen respiratory compromise.
Question 2: A 68-year-old male presents with sudden onset of crushing substernal
chest pain, diaphoresis, and nausea. His vital signs are BP 90/60, P 110, R 24.
Which medication should an EMT administer FIRST if protocols allow?
A. Nitroglycerin
B. Aspirin
C. Morphine
D. Oxygen
CORRECT ANSWER: B. Aspirin
Rationale: In suspected acute coronary syndrome, aspirin (162-324 mg chewed) is
administered first to inhibit platelet aggregation and reduce mortality. Oxygen should be
given if SpO2 is below 94%, but aspirin has greater evidence for improving outcomes in
ACS. Nitroglycerin may be given for persistent pain after aspirin, provided systolic BP is
adequate. Morphine is typically an ALS intervention.
Question 3: During assessment of a trauma patient, you note paradoxical chest
wall movement. This finding is MOST indicative of:
A. Hemothorax
B. Flail chest
C. Cardiac tamponade
D. Pulmonary contusion
CORRECT ANSWER: B. Flail chest
,Rationale: Paradoxical chest wall movement, where a segment of the chest moves
inward during inspiration and outward during expiration, is the hallmark sign of flail
chest, resulting from fractures of two or more consecutive ribs in at least two places.
This creates an unstable chest wall segment. Hemothorax presents with diminished
breath sounds and shock; cardiac tamponade with Beck's triad; pulmonary contusion
with hypoxia and crackles.
Question 4: Which of the following BEST describes the purpose of the SAMPLE
history in patient assessment?
A. To determine the mechanism of injury
B. To gather essential patient history relevant to the current complaint
C. To assess neurological function
D. To calculate transport priority
CORRECT ANSWER: B. To gather essential patient history relevant to the current
complaint
Rationale: SAMPLE is a mnemonic for Signs/Symptoms, Allergies, Medications, Past
medical history, Last oral intake, and Events leading to the incident. It is used during the
focused history to obtain critical information that guides treatment and handoff
communication. Mechanism of injury is assessed separately; neurological function
uses AVPU or GCS; transport priority is determined by assessment findings.
Question 5: An EMT is treating a patient with anaphylaxis. After administering
epinephrine via auto-injector, the patient's symptoms begin to improve. What is the
NEXT most appropriate action?
A. Administer a second dose of epinephrine immediately
B. Transport the patient without delay
C. Reassure the patient and monitor vital signs every 15 minutes
D. Administer diphenhydramine orally
CORRECT ANSWER: B. Transport the patient without delay
Rationale: Even if symptoms improve after epinephrine administration, patients with
anaphylaxis require immediate transport to a hospital due to the risk of biphasic
reaction. Monitoring should occur en route. A second epinephrine dose is only indicated
if symptoms worsen or recur. Diphenhydramine is an adjunct, not a priority, and oral
administration is inappropriate in a potentially unstable airway patient.
Question 6: Which of the following is a contraindication to administering
nitroglycerin to a patient with chest pain?
A. History of hypertension
B. Systolic blood pressure less than 90 mmHg
C. Age greater than 75 years
D. Patient reports headache after previous dose
,CORRECT ANSWER: B. Systolic blood pressure less than 90 mmHg
Rationale: Nitroglycerin is a potent vasodilator that can cause significant hypotension.
It is contraindicated if systolic BP is below 90 mmHg or if the patient has taken
phosphodiesterase inhibitors (e.g., sildenafil) within 24-48 hours. Hypertension is not a
contraindication; age alone does not preclude use; headache is a common side effect,
not a contraindication.
Question 7: A patient with a suspected stroke presents with right-sided facial
droop, arm drift, and slurred speech. The symptoms began 90 minutes ago. What is
the EMT's MOST critical action?
A. Administer aspirin
B. Determine the exact time symptoms were last known normal
C. Perform a detailed neurological exam
D. Apply oxygen at 15 L/min via non-rebreather
CORRECT ANSWER: B. Determine the exact time symptoms were last known
normal
Rationale: Time of symptom onset is critical for determining eligibility for thrombolytic
therapy in ischemic stroke. The "last known normal" time guides hospital decision-
making for interventions within the 3-4.5 hour window. While oxygen may be given if
hypoxic, and aspirin may be considered later, establishing onset time takes priority. A
detailed exam can be performed en route.
Question 8: Which of the following findings is MOST suggestive of hypoglycemia in
a diabetic patient?
A. Kussmaul respirations and fruity breath odor
B. Confusion, diaphoresis, and tachycardia
C. Bradycardia and hypotension
D. Unilateral weakness and aphasia
CORRECT ANSWER: B. Confusion, diaphoresis, and tachycardia
Rationale: Hypoglycemia typically presents with neuroglycopenic symptoms
(confusion, altered mental status) and autonomic symptoms (diaphoresis, tachycardia,
tremors). Kussmaul respirations and fruity breath indicate diabetic ketoacidosis
(hyperglycemia). Bradycardia/hypotension are not typical of hypoglycemia. Unilateral
deficits suggest stroke.
Question 9: When performing CPR on an adult patient, what is the recommended
compression-to-ventilation ratio for a single rescuer?
A. 15:2
B. 30:2
C. 5:1
D. 20:2
, CORRECT ANSWER: B. 30:2
Rationale: Current AHA guidelines recommend a 30:2 compression-to-ventilation ratio
for adult CPR performed by a single rescuer or multiple rescuers. This ratio maximizes
coronary perfusion pressure while providing adequate ventilation. The 15:2 ratio is used
for two-rescuer infant/child CPR. Ratios of 5:1 and 20:2 are outdated.
Question 10: A patient has suffered a chemical burn to the eye from an alkaline
substance. What is the MOST appropriate initial prehospital management?
A. Cover both eyes with sterile dressings
B. Irrigate the eye continuously with copious amounts of water
C. Apply a neutralizing agent to the affected eye
D. Administer topical anesthetic drops
CORRECT ANSWER: B. Irrigate the eye continuously with copious amounts of water
Rationale: Immediate and continuous irrigation with water or saline is critical for
chemical eye burns to dilute and remove the offending agent. Alkaline substances
cause liquefactive necrosis and penetrate rapidly, making prompt irrigation essential.
Neutralizing agents can cause exothermic reactions and worsen injury. Covering both
eyes may be done after irrigation during transport. Topical anesthetics are not in the
EMT scope.
Question 11: Which of the following is the PRIMARY purpose of using a
nasopharyngeal airway (NPA)?
A. To provide positive pressure ventilation
B. To maintain a patent airway in a semi-conscious patient with an intact gag reflex
C. To suction secretions from the oropharynx
D. To protect the airway from aspiration
CORRECT ANSWER: B. To maintain a patent airway in a semi-conscious patient
with an intact gag reflex
Rationale: An NPA is tolerated better than an OPA in patients with a gag reflex because it
bypasses the tongue without stimulating the posterior pharynx. It helps maintain airway
patency in semi-conscious patients. NPAs do not provide positive pressure ventilation
(requires BVM), are not primarily for suctioning, and do not protect against aspiration
like a cuffed endotracheal tube.
Question 12: A 45-year-old female presents with sudden onset of severe headache
described as "the worst headache of my life," neck stiffness, and photophobia.
Which condition should the EMT suspect MOST strongly?
A. Migraine headache
B. Subarachnoid hemorrhage
C. Tension headache
D. Sinusitis
Rationales (Updated 2026) | Patient Assessment & Vital Signs, Airway Management
& Oxygen Therapy, CPR & AED Procedures, Trauma & Medical Emergencies, Shock
Management, Cardiac & Respiratory Care, EMS Operations & Patient Transport,
NREMT Refresher Review & Continuing Education Scenarios
Question 1: Which of the following is the MOST appropriate initial action when
managing a patient with suspected tension pneumothorax?
A. Administer high-flow oxygen via non-rebreather mask
B. Perform needle decompression at the 2nd intercostal space, midclavicular line
C. Apply a chest seal to the affected side
D. Position the patient in Trendelenburg position
CORRECT ANSWER: B. Perform needle decompression at the 2nd intercostal
space, midclavicular line
Rationale: Tension pneumothorax is a life-threatening emergency requiring immediate
needle decompression to relieve intrathoracic pressure. The recommended site is the
2nd intercostal space at the midclavicular line on the affected side. While oxygen
administration is important, it does not address the underlying pathophysiology. Chest
seals are for open pneumothorax, and Trendelenburg positioning is contraindicated as it
may worsen respiratory compromise.
Question 2: A 68-year-old male presents with sudden onset of crushing substernal
chest pain, diaphoresis, and nausea. His vital signs are BP 90/60, P 110, R 24.
Which medication should an EMT administer FIRST if protocols allow?
A. Nitroglycerin
B. Aspirin
C. Morphine
D. Oxygen
CORRECT ANSWER: B. Aspirin
Rationale: In suspected acute coronary syndrome, aspirin (162-324 mg chewed) is
administered first to inhibit platelet aggregation and reduce mortality. Oxygen should be
given if SpO2 is below 94%, but aspirin has greater evidence for improving outcomes in
ACS. Nitroglycerin may be given for persistent pain after aspirin, provided systolic BP is
adequate. Morphine is typically an ALS intervention.
Question 3: During assessment of a trauma patient, you note paradoxical chest
wall movement. This finding is MOST indicative of:
A. Hemothorax
B. Flail chest
C. Cardiac tamponade
D. Pulmonary contusion
CORRECT ANSWER: B. Flail chest
,Rationale: Paradoxical chest wall movement, where a segment of the chest moves
inward during inspiration and outward during expiration, is the hallmark sign of flail
chest, resulting from fractures of two or more consecutive ribs in at least two places.
This creates an unstable chest wall segment. Hemothorax presents with diminished
breath sounds and shock; cardiac tamponade with Beck's triad; pulmonary contusion
with hypoxia and crackles.
Question 4: Which of the following BEST describes the purpose of the SAMPLE
history in patient assessment?
A. To determine the mechanism of injury
B. To gather essential patient history relevant to the current complaint
C. To assess neurological function
D. To calculate transport priority
CORRECT ANSWER: B. To gather essential patient history relevant to the current
complaint
Rationale: SAMPLE is a mnemonic for Signs/Symptoms, Allergies, Medications, Past
medical history, Last oral intake, and Events leading to the incident. It is used during the
focused history to obtain critical information that guides treatment and handoff
communication. Mechanism of injury is assessed separately; neurological function
uses AVPU or GCS; transport priority is determined by assessment findings.
Question 5: An EMT is treating a patient with anaphylaxis. After administering
epinephrine via auto-injector, the patient's symptoms begin to improve. What is the
NEXT most appropriate action?
A. Administer a second dose of epinephrine immediately
B. Transport the patient without delay
C. Reassure the patient and monitor vital signs every 15 minutes
D. Administer diphenhydramine orally
CORRECT ANSWER: B. Transport the patient without delay
Rationale: Even if symptoms improve after epinephrine administration, patients with
anaphylaxis require immediate transport to a hospital due to the risk of biphasic
reaction. Monitoring should occur en route. A second epinephrine dose is only indicated
if symptoms worsen or recur. Diphenhydramine is an adjunct, not a priority, and oral
administration is inappropriate in a potentially unstable airway patient.
Question 6: Which of the following is a contraindication to administering
nitroglycerin to a patient with chest pain?
A. History of hypertension
B. Systolic blood pressure less than 90 mmHg
C. Age greater than 75 years
D. Patient reports headache after previous dose
,CORRECT ANSWER: B. Systolic blood pressure less than 90 mmHg
Rationale: Nitroglycerin is a potent vasodilator that can cause significant hypotension.
It is contraindicated if systolic BP is below 90 mmHg or if the patient has taken
phosphodiesterase inhibitors (e.g., sildenafil) within 24-48 hours. Hypertension is not a
contraindication; age alone does not preclude use; headache is a common side effect,
not a contraindication.
Question 7: A patient with a suspected stroke presents with right-sided facial
droop, arm drift, and slurred speech. The symptoms began 90 minutes ago. What is
the EMT's MOST critical action?
A. Administer aspirin
B. Determine the exact time symptoms were last known normal
C. Perform a detailed neurological exam
D. Apply oxygen at 15 L/min via non-rebreather
CORRECT ANSWER: B. Determine the exact time symptoms were last known
normal
Rationale: Time of symptom onset is critical for determining eligibility for thrombolytic
therapy in ischemic stroke. The "last known normal" time guides hospital decision-
making for interventions within the 3-4.5 hour window. While oxygen may be given if
hypoxic, and aspirin may be considered later, establishing onset time takes priority. A
detailed exam can be performed en route.
Question 8: Which of the following findings is MOST suggestive of hypoglycemia in
a diabetic patient?
A. Kussmaul respirations and fruity breath odor
B. Confusion, diaphoresis, and tachycardia
C. Bradycardia and hypotension
D. Unilateral weakness and aphasia
CORRECT ANSWER: B. Confusion, diaphoresis, and tachycardia
Rationale: Hypoglycemia typically presents with neuroglycopenic symptoms
(confusion, altered mental status) and autonomic symptoms (diaphoresis, tachycardia,
tremors). Kussmaul respirations and fruity breath indicate diabetic ketoacidosis
(hyperglycemia). Bradycardia/hypotension are not typical of hypoglycemia. Unilateral
deficits suggest stroke.
Question 9: When performing CPR on an adult patient, what is the recommended
compression-to-ventilation ratio for a single rescuer?
A. 15:2
B. 30:2
C. 5:1
D. 20:2
, CORRECT ANSWER: B. 30:2
Rationale: Current AHA guidelines recommend a 30:2 compression-to-ventilation ratio
for adult CPR performed by a single rescuer or multiple rescuers. This ratio maximizes
coronary perfusion pressure while providing adequate ventilation. The 15:2 ratio is used
for two-rescuer infant/child CPR. Ratios of 5:1 and 20:2 are outdated.
Question 10: A patient has suffered a chemical burn to the eye from an alkaline
substance. What is the MOST appropriate initial prehospital management?
A. Cover both eyes with sterile dressings
B. Irrigate the eye continuously with copious amounts of water
C. Apply a neutralizing agent to the affected eye
D. Administer topical anesthetic drops
CORRECT ANSWER: B. Irrigate the eye continuously with copious amounts of water
Rationale: Immediate and continuous irrigation with water or saline is critical for
chemical eye burns to dilute and remove the offending agent. Alkaline substances
cause liquefactive necrosis and penetrate rapidly, making prompt irrigation essential.
Neutralizing agents can cause exothermic reactions and worsen injury. Covering both
eyes may be done after irrigation during transport. Topical anesthetics are not in the
EMT scope.
Question 11: Which of the following is the PRIMARY purpose of using a
nasopharyngeal airway (NPA)?
A. To provide positive pressure ventilation
B. To maintain a patent airway in a semi-conscious patient with an intact gag reflex
C. To suction secretions from the oropharynx
D. To protect the airway from aspiration
CORRECT ANSWER: B. To maintain a patent airway in a semi-conscious patient
with an intact gag reflex
Rationale: An NPA is tolerated better than an OPA in patients with a gag reflex because it
bypasses the tongue without stimulating the posterior pharynx. It helps maintain airway
patency in semi-conscious patients. NPAs do not provide positive pressure ventilation
(requires BVM), are not primarily for suctioning, and do not protect against aspiration
like a cuffed endotracheal tube.
Question 12: A 45-year-old female presents with sudden onset of severe headache
described as "the worst headache of my life," neck stiffness, and photophobia.
Which condition should the EMT suspect MOST strongly?
A. Migraine headache
B. Subarachnoid hemorrhage
C. Tension headache
D. Sinusitis
