NREMT
Exam Practice
400+ Practice Qs & Ans
Exam Preparation
Main Features:
• Multiple-Choice Questions, Answers, and Rationales
• Extensive collection of Review questions and answers
• Helpful for identifying knowledge gaps
• Covers high-yield concepts
• Supports structured study and final revision
1
,1. Hypoglycemia and acute ischemic stroke can present similarly because:
A. both oxygen and glucose are needed for brain function.
B. the majority of stroke patients have a history of diabetes.
C. the most common cause of a stroke is hypoglycemia.
D. they are both caused by low levels of glucose in the blood.
Correct Answer: A. both oxygen and glucose are needed for brain function.
Reason: Although stroke and hypoglycemia are two distinctly different conditions,
their signs and symptoms are often similar. This is because the brain requires both
oxygen and glucose to function normally. An acute ischemic stroke is caused by a
lack of oxygen to a part of the brain due to a blocked cerebral artery, whereas
hypoglycemia (low blood glucose level) deprives the entire brain of glucose. In either
case, the patient presents with signs of impaired brain function (ie, slurred speech,
weakness, altered mental status). Both conditions may lead to permanent brain
damage or death if not treated promptly.
2. When dealing with an emotionally disturbed patient, you should be MOST concerned
with:
A. gathering all of the patient's medications.
B. safely transporting to the hospital.
C. whether the patient could harm you.
D. obtaining a complete medical history.
Correct Answer: C. whether the patient could harm you.
Reason: When managing any patient with an emotional or psychiatric crisis, your
primary concern is your own safety. Safely transporting the patient to the hospital is
your ultimate goal. If possible, you should attempt to obtain a medical history and
should take any of the patient's prescribed medications to the hospital. However,
this should not supercede your own safety or interfere with safely transporting the
patient.
3. You are at the scene where a man panicked while swimming in a small lake. Your
initial attempt to rescue him should include:
A. rowing a small raft to the victim.
B. reaching for the victim with a long stick.
C. throwing a rope to the victim.
D. swimming to the victim to rescue him.
Correct Answer: B. reaching for the victim with a long stick.
Reason: General rules to follow when attempting to rescue a patient from the water
include "reach, throw, row, and then go." In this case, you should attempt to reach
2
, the victim by having him grab hold of a large stick or similar object. If this is
unsuccessful, throw the victim a rope or flotation device (if available). If these are not
available, row to the patient in a small raft (if available). Going into the water to
retrieve the victim is a last resort. The rescuer must be a strong swimmer because
patients who are in danger of drowning are in a state of blind panic and will make
every attempt to keep themselves afloat, even if it means forcing the rescuer
underwater.
4. How should you classify a patient's nature of illness if he or she has a low blood
glucose level, bizarre behavior, and shallow breathing?
A. Behavioral emergency
B. Altered mental status
C. Respiratory emergency
D. Cardiac compromise
Correct Answer: B. Altered mental status
Reason: The nature of illness (NOI) is the medical equivalent to mechanism of injury
(MOI). Altered mental status should be the suspected NOI in any patient with any
fluctuation in level of consciousness, which can range from bizarre behavior to
complete unresponsiveness. Causes of an altered mental status include hypo- or
hyperglycemia, head trauma, stroke, behavioral crises, drug overdose, and shock,
among others.
5. A young female is unresponsive after overdosing on an unknown type of drug. Her
respirations are slow and shallow and her pulse is slow and weak. Which of the
following drugs is the LEAST likely cause of her condition?
A. Seconal
B. Heroin
C. Cocaine
D. Valium
Correct Answer: C. Cocaine
Reason: Of the drugs listed, cocaine would be the least likely cause of the patient's
condition. Cocaine is a central nervous system (CNS) stimulant; you would expect
her to be hypertensive, tachycardic, tachypneic, and perhaps even violent. Heroin,
Valium, and Seconal are all CNS depressants and could explain her condition. Heroin
is an illegal narcotic (opiate), Valium is a benzodiazepine sedative-hypnotic drug,
and Seconal is a barbiturate. Narcotics, benzodiazepines, and barbiturates are all
CNS depressants. When taken in excess, they cause a decreased level of
consciousness, respiratory depression, bradycardia, and hypotension.
6. Activated charcoal is contraindicated for a patient who is:
A. conscious and alert and has ingested a large amount of Motrin.
3
,B. emotionally upset and has ingested two bottles of aspirin.
C. agitated and claims to have ingested a bottle of Tylenol.
D. awake and alert and has swallowed a commercial drain cleaner.
Correct Answer: D. awake and alert and has swallowed a commercial drain cleaner.
Reason: Activated charcoal adsorbs (sticks to) many ingested substances,
preventing them from being absorbed into the body by the stomach or intestines. In
some cases, you may give activated charcoal to patients who have ingested certain
substances, if approved by medical control or local protocol. Activated charcoal is
contraindicated for patients who have ingested an acid or alkali (ie, drain cleaner) or
a petroleum product (ie, gasoline), who have a decreased level of consciousness and
cannot protect their own airway, or who are unable to swallow.
7. The MOST obvious way to reduce heat loss from radiation and convection is to:
A. move away from a cold object.
B. increase metabolism by shivering.
C. wear a thick wind-proof jacket.
D. move to a warmer environment.
Correct Answer: D. move to a warmer environment.
Reason: In a cold environment, the body has two ways of staying warm: generating
heat (thermogenesis) and reducing heat loss. Radiation is the transfer of heat by
radiant energy. The body can lose heat by radiation, such as when a person stands
in a cold room. Convection occurs when heat is transferred to circulating air, as
when cool air moves across the body's surface. A person standing in windy cold
weather, wearing lightweight clothing, is losing heat to the environment mostly by
convection. The quickest and most obvious way to decrease heat loss from radiation
and convection is to move out of the cold environment and seek shelter from wind.
Shivering increases the body's metabolism and is a mechanism for generating heat,
not reducing heat loss. Layers of clothing trap air and provide excellent insulation;
thus, layered clothing decreases heat loss better than a single, thick jacket.
Conduction is the direct transfer of heat from a part of the body to a colder object by
direct contact, as when a warm hand touches cold metal or ice. The most obvious
way to decrease heat loss by conduction is to remove your hand from the cold
object.
4
,8. A near-drowning is MOST accurately defined as:
A. complications within 24 hours following submersion in water.
B. immediate death due to prolonged submersion in water.
C. survival for at least 24 hours following submersion in water.
D. death greater than 24 hours following submersion in water.
Correct Answer: C. survival for at least 24 hours following submersion in water.
Reason: Collectively, drowning and near-drowning are referred to as submersion
injuries. Drowning is defined as death after submersion in a liquid medium, usually
water. In a drowning, death is either immediate or occurs within 24 hours following
submersion. Near-drowning is defined as survival, at least temporarily (24 hours),
after submersion. It should be noted, however, that complications such as
pneumonia and pulmonary edema can cause death greater than 24 hours following
submersion. For this reason, all patients with a submersion injury should be
transported to the hospital, even if they appear fine at the scene.
9. A young woman reports significant weight loss over the last month, persistent fever,
and night sweats. When you assess her, you note the presence of dark purple lesions
covering her trunk and upper extremities. You should suspect:
A. end-stage cancer.
B. HIV/AIDS.
C. tuberculosis.
D. rheumatic fever.
Correct Answer: B. HIV/AIDS.
Reason: Weight loss, fever, and night sweats could indicate tuberculosis or
HIV/AIDS; however, the dark purple lesions on the skin, which are called Kaposi's
sarcoma, are malignant skin tumors and are a classic finding in patients in the later
stages of AIDS.
10. A 48-year-old male became acutely hypoxic, experienced a seizure, and is now
postictal. The MOST effective way to prevent another seizure is to:
A. dim the lights in the back of the ambulance.
B. place him in the recovery position.
C. administer high-flow supplemental oxygen.
D. give him oral glucose if he can swallow.
Correct Answer: C. administer high-flow supplemental oxygen.
Reason: You should administer high-flow oxygen to all patients who are actively
seizing and to patients who experienced a seizure and are postictal. This is
especially true if the seizure was caused by hypoxia. Increasing the oxygen content
of the blood, which minimizes hypoxia, may prevent another seizure. The recovery
position is appropriate for uninjured patients with a decreased level of
5
, consciousness and adequate breathing; it will help maintain the airway and facilitate
drainage of secretions from the mouth, but will not prevent another seizure. Oral
glucose may prevent another seizure if hypoglycemia was the cause of the seizure.
You should dim the lights in the back of the ambulance to help prevent any seizure,
not just those that are caused by hypoxia.
11. Which of the following conditions would be the LEAST likely to be present in a
patient who was submerged in water?
A. Spinal injury
B. Gastric distention
C. Hyperglycemia
D. Laryngospasm
Correct Answer: C. Hyperglycemia
Reason: Many factors can contribute to or result from a submersion injury (eg,
drowning, near-drowning). It is not uncommon for a person to experience a spinal
injury after diving head first into shallow water, especially if he or she is under the
influence of alcohol. When a swimmer panics, he or she initially swallows large
amounts of water, resulting in gastric distention. Gastric distention can cause
aspiration if the patient regurgitates water during rescue breathing; protect the
airway! During the panic phase, the victim expends a tremendous amount of energy
(and glucose) from flailing around in the water, possibly resulting in hypoglycemia.
Inhaling even a small amount of fresh or salt water can severely irritate the larynx,
which sends the muscles of the larynx and vocal cords into spasm (laryngospasm),
resulting in airway blockage and hypoxia.
12. A 42-year-old male presents with fever, a severe headache, and a stiff neck. He is
conscious, but confused. His wife tells you that he does not have any medical
problems and does not take any medications. You should be MOST suspicious for:
A. acute stroke.
B. influenza.
C. meningitis.
D. tuberculosis. (
Correct Answer: C. meningitis.
Reason: Meningitis is an inflammation of the protective coverings of the brain and
spinal cord (meninges). Common signs and symptoms of meningitis include fever,
headache, neck stiffness (nuchal rigidity), and vomiting. An altered mental status is
common in severe cases. Meningococcal meningitis, caused by a bacterium, is the
most contagious and potentially fatal type of meningitis. The patient's signs and
symptoms are not consistent with acute stroke, tuberculosis (TB), or influenza (the
flu). Although fever is common with both TB and the flu, neither causes neck
6
, stiffness. Acute stroke may be associated with a headache, especially a hemorrhagic
stroke; however, stroke patients typically do not have a fever.
13. All of the following are signs of gastrointestinal bleeding, EXCEPT:
A. melena.
B. hematemesis.
C. tachycardia.
D. hemoptysis.
Correct Answer: D. hemoptysis.
Reason: Signs and symptoms of gastrointestinal (GI) bleeding include abdominal
pain; vomiting blood (hematemesis); the passage of dark, tarry stools (melena); and
bright red rectal bleeding (hematochezia). If blood loss is significant, the patient may
have signs of shock (eg, tachycardia, diaphoresis, tachypnea, hypotension).
Hemoptysis (coughing up blood) is a sign of a pulmonary injury, not GI bleeding.
14. A 24-year-old female presents with a rash to her left leg and swollen, painful knee
joints. She tells you that she and her friends returned from a hiking trip in the
mountains a week ago. She is conscious and alert with a blood pressure of 112/62 mm
Hg, a pulse of 84 beats/min, and respirations of 14 breaths/min. Her symptoms are
MOST likely the result of:
A. Rocky Mountain spotted fever.
B. tetanus.
C. Lyme disease.
D. a localized allergic reaction.
Correct Answer: C. Lyme disease.
Reason: The patient's symptoms and her history of a recent hiking trip are
consistent with Lyme disease, which was the result of a tick bite. Ticks can carry two
infectious diseases: Lyme disease and Rocky Mountain spotted fever. Both are
spread through the tick's saliva, which is injected into the skin when the tick
attaches itself. The first symptom of Lyme disease, a rash that may spread to several
parts of the body, begins about 3 days after the bite of an infected tick. The rash may
eventually resemble a target bull's-eye pattern in one third of patients. After a few
more days or weeks, painful swelling of the joints, particularly the knees, occurs. If
recognized and treated promptly with antibiotics, many patients recover completely.
Rocky Mountain spotted fever, which is not limited to the Rocky Mountains, occurs
within 7 to 10 days after being bitten by an infected tick. Its symptoms include
nausea, vomiting, headache, weakness, paralysis, and possibly cardiopulmonary
failure.
15. A 50-year-old woman who is conscious and alert complains of a severe migraine
headache. When caring for her, you should generally avoid:
7
,A. transporting her in a supine position.
B. shining a light into her pupils.
C. dimming the lights in the ambulance.
D. applying ice packs to her forehead.
Correct Answer: B. shining a light into her pupils.
Reason: Patients with migraine or cluster headaches typically have photophobia
(light sensitivity). Any type of bright light, especially if shone directly into the eyes,
will cause the patient with a headache unnecessary severe pain. Dimming the lights
in the ambulance and making the patient as comfortable as possible are the
treatments of choice for a patient with a headache. Some patients benefit from ice
packs applied to the forehead; just be sure to wrap the ice pack with roller gauze.
Oxygen also should be administered as needed. Typically, the patient will prefer to
lie supine or on the side
16. A patient who overdosed on heroin would be expected to present with:
A. tachycardia.
B. hyperpnea.
C. hypotension.
D. dilated pupils.
Correct Answer: C. hypotension.
Reason: Heroin is a Schedule I (illegal) narcotic that is typically injected. As with all
narcotics, legal or illegal, overdose causes depression of the central nervous system
(CNS), resulting in a decreased level of consciousness; bradycardia; hypotension;
and slow, shallow (reduced tidal volume) breathing. Hyperpnea (deep breathing)
would not be present in a patient who overdosed on a narcotic. In a narcotic
overdose, the pupils are typically constricted (miosis). Barbiturates, such as
phenobarbital, are also CNS depressants and cause the same symptoms seen with
narcotic overdose. The patient's pupils, however, are typically dilated (mydriasis),
not constricted.
17. When caring for any patient with a decreased level of consciousness, your primary
concern should be the:
A. potential for airway compromise.
B. patient's blood glucose level.
C. possibility of a spinal injury.
D. possibility of a drug overdose.
Correct Answer: A. potential for airway compromise.
Reason: Altered mental status could be caused by a high or low blood glucose level,
drug overdose, or head injury, among other causes. Furthermore, the possibility of a
spinal injury should be considered if the patient was injured. However, your primary
8
, concern should be the status of the patient's airway. Patients with a decreased level
of consciousness are at risk for aspiration if vomiting occurs. Unless spinal trauma
is present or the patient is breathing inadequately (eg, fast or slow rate, shallow
breathing [reduced tidal volume]), place him or her in the recovery position to
facilitate drainage if vomiting occurs. Remember this: no airway, no patient!
18. A 16-year-old, 125-pound male ingested a bottle of aspirin approximately 20
minutes ago. Medical control orders you to administer activated charcoal in a dose of 1
g/kg. How much activated charcoal should you administer?
A. 54 g
B. 60 g
C. 51 g
D. 57 g
Correct Answer: D. 57 g
Reason: First, you must determine the patient's weight in kilograms (kg). Either of
the following formulae can be used to convert pounds to kilograms: Formula 1:
weight (in pounds) ÷ 2.2 = weight in kg. Formula 2: weight (in pounds) ÷ 2 - 10% =
weight in kg. On the basis of the above formulae, a 125-pound patient weighs 57 kg.
Using formula 1, the equation is as follows: 125 (weight in pounds) ÷ 2.2 = 56.81 (57
[rounded to the nearest tenth]). Using formula 2, the equation is as follows: 125
(weight in pounds) ÷ 2 = 62.5 (63 [rounded to the nearest tenth] - 6.3 (10% of 63) =
56.7 (57 [rounded to the nearest tenth]). Since the drug order is for 1 g/kg, you
should administer 57 g of activated charcoal to your 125-pound patient.
19. Which of the following is the MOST significant finding in a patient with a severe
headache?
A. Pain in both legs
B. Chest discomfort
C. Unilateral weakness
D. Abdominal tenderness
Correct Answer: C. Unilateral weakness
Reason: Unilateral weakness (weakness on one side of the body) is a clinically
significant finding in a patient with a headache because it could indicate a stroke
(ischemic or hemorrhagic). Abdominal, chest, and leg pain are not common
complaints associated with a headache, although they should be noted and
investigated if they are present.
20. When caring for a patient with severe hypothermia who is in cardiac arrest, you
should:
A. perform rescue breathing only.
B. perform BLS and transport.
9
, C. avoid using the AED.
D. hyperventilate the patient.
Correct Answer: B. perform BLS and transport.
Reason: Patients with severe hypothermia (core body temperature < 86°F) who are in
cardiac arrest should be managed with basic life support (chest compressions and
ventilations), passive external rewarming (ie, removal of wet clothing, applying warm
blankets) and rapid transport to the hospital where they can be actively rewarmed.
Because cold muscle is a poor conductor of electricity, defibrillation, if indicated,
should be limited to 1 attempt until the patient's body temperature has been
increased. Cardiac arrest patients with severe hypothermia generally do not respond
to defibrillation. Hyperventilation should be avoided as this may increase
intrathoracic pressure and impair blood flow back to the heart.
21. You should not attempt to actively rewarm a patient with moderate or severe
hypothermia in the field because:
A. rewarming too quickly can cause a fatal cardiac dysrhythmia.
B. the risk of inadvertently inducing hyperthermia is too high.
C. it is painful for the patient and you cannot give analgesic drugs.
D. active rewarming has been shown to cause severe hypertension.
Correct Answer: A. rewarming too quickly can cause a fatal cardiac dysrhythmia.
Reason: When caring for a patient with hypothermia, your goal is to prevent further
heat loss; this involves removing wet clothing, applying warm blankets, and allowing
the patient's body temperature to rise gradually and naturally (passive rewarming). If
the patient is moderately or severely hypothermic, you should not try to rewarm him
or her actively (placing heat on or into the body). Rewarming too quickly may cause
a fatal cardiac dysrhythmia, such as ventricular fibrillation (V-Fib). Active rewarming
may also cause rewarming shock, a condition in which the blood vessels dilate when
heat is applied to the body, resulting in significant hypotension. For these reasons,
active rewarming should only be performed in the controlled setting of a hospital.
10
Exam Practice
400+ Practice Qs & Ans
Exam Preparation
Main Features:
• Multiple-Choice Questions, Answers, and Rationales
• Extensive collection of Review questions and answers
• Helpful for identifying knowledge gaps
• Covers high-yield concepts
• Supports structured study and final revision
1
,1. Hypoglycemia and acute ischemic stroke can present similarly because:
A. both oxygen and glucose are needed for brain function.
B. the majority of stroke patients have a history of diabetes.
C. the most common cause of a stroke is hypoglycemia.
D. they are both caused by low levels of glucose in the blood.
Correct Answer: A. both oxygen and glucose are needed for brain function.
Reason: Although stroke and hypoglycemia are two distinctly different conditions,
their signs and symptoms are often similar. This is because the brain requires both
oxygen and glucose to function normally. An acute ischemic stroke is caused by a
lack of oxygen to a part of the brain due to a blocked cerebral artery, whereas
hypoglycemia (low blood glucose level) deprives the entire brain of glucose. In either
case, the patient presents with signs of impaired brain function (ie, slurred speech,
weakness, altered mental status). Both conditions may lead to permanent brain
damage or death if not treated promptly.
2. When dealing with an emotionally disturbed patient, you should be MOST concerned
with:
A. gathering all of the patient's medications.
B. safely transporting to the hospital.
C. whether the patient could harm you.
D. obtaining a complete medical history.
Correct Answer: C. whether the patient could harm you.
Reason: When managing any patient with an emotional or psychiatric crisis, your
primary concern is your own safety. Safely transporting the patient to the hospital is
your ultimate goal. If possible, you should attempt to obtain a medical history and
should take any of the patient's prescribed medications to the hospital. However,
this should not supercede your own safety or interfere with safely transporting the
patient.
3. You are at the scene where a man panicked while swimming in a small lake. Your
initial attempt to rescue him should include:
A. rowing a small raft to the victim.
B. reaching for the victim with a long stick.
C. throwing a rope to the victim.
D. swimming to the victim to rescue him.
Correct Answer: B. reaching for the victim with a long stick.
Reason: General rules to follow when attempting to rescue a patient from the water
include "reach, throw, row, and then go." In this case, you should attempt to reach
2
, the victim by having him grab hold of a large stick or similar object. If this is
unsuccessful, throw the victim a rope or flotation device (if available). If these are not
available, row to the patient in a small raft (if available). Going into the water to
retrieve the victim is a last resort. The rescuer must be a strong swimmer because
patients who are in danger of drowning are in a state of blind panic and will make
every attempt to keep themselves afloat, even if it means forcing the rescuer
underwater.
4. How should you classify a patient's nature of illness if he or she has a low blood
glucose level, bizarre behavior, and shallow breathing?
A. Behavioral emergency
B. Altered mental status
C. Respiratory emergency
D. Cardiac compromise
Correct Answer: B. Altered mental status
Reason: The nature of illness (NOI) is the medical equivalent to mechanism of injury
(MOI). Altered mental status should be the suspected NOI in any patient with any
fluctuation in level of consciousness, which can range from bizarre behavior to
complete unresponsiveness. Causes of an altered mental status include hypo- or
hyperglycemia, head trauma, stroke, behavioral crises, drug overdose, and shock,
among others.
5. A young female is unresponsive after overdosing on an unknown type of drug. Her
respirations are slow and shallow and her pulse is slow and weak. Which of the
following drugs is the LEAST likely cause of her condition?
A. Seconal
B. Heroin
C. Cocaine
D. Valium
Correct Answer: C. Cocaine
Reason: Of the drugs listed, cocaine would be the least likely cause of the patient's
condition. Cocaine is a central nervous system (CNS) stimulant; you would expect
her to be hypertensive, tachycardic, tachypneic, and perhaps even violent. Heroin,
Valium, and Seconal are all CNS depressants and could explain her condition. Heroin
is an illegal narcotic (opiate), Valium is a benzodiazepine sedative-hypnotic drug,
and Seconal is a barbiturate. Narcotics, benzodiazepines, and barbiturates are all
CNS depressants. When taken in excess, they cause a decreased level of
consciousness, respiratory depression, bradycardia, and hypotension.
6. Activated charcoal is contraindicated for a patient who is:
A. conscious and alert and has ingested a large amount of Motrin.
3
,B. emotionally upset and has ingested two bottles of aspirin.
C. agitated and claims to have ingested a bottle of Tylenol.
D. awake and alert and has swallowed a commercial drain cleaner.
Correct Answer: D. awake and alert and has swallowed a commercial drain cleaner.
Reason: Activated charcoal adsorbs (sticks to) many ingested substances,
preventing them from being absorbed into the body by the stomach or intestines. In
some cases, you may give activated charcoal to patients who have ingested certain
substances, if approved by medical control or local protocol. Activated charcoal is
contraindicated for patients who have ingested an acid or alkali (ie, drain cleaner) or
a petroleum product (ie, gasoline), who have a decreased level of consciousness and
cannot protect their own airway, or who are unable to swallow.
7. The MOST obvious way to reduce heat loss from radiation and convection is to:
A. move away from a cold object.
B. increase metabolism by shivering.
C. wear a thick wind-proof jacket.
D. move to a warmer environment.
Correct Answer: D. move to a warmer environment.
Reason: In a cold environment, the body has two ways of staying warm: generating
heat (thermogenesis) and reducing heat loss. Radiation is the transfer of heat by
radiant energy. The body can lose heat by radiation, such as when a person stands
in a cold room. Convection occurs when heat is transferred to circulating air, as
when cool air moves across the body's surface. A person standing in windy cold
weather, wearing lightweight clothing, is losing heat to the environment mostly by
convection. The quickest and most obvious way to decrease heat loss from radiation
and convection is to move out of the cold environment and seek shelter from wind.
Shivering increases the body's metabolism and is a mechanism for generating heat,
not reducing heat loss. Layers of clothing trap air and provide excellent insulation;
thus, layered clothing decreases heat loss better than a single, thick jacket.
Conduction is the direct transfer of heat from a part of the body to a colder object by
direct contact, as when a warm hand touches cold metal or ice. The most obvious
way to decrease heat loss by conduction is to remove your hand from the cold
object.
4
,8. A near-drowning is MOST accurately defined as:
A. complications within 24 hours following submersion in water.
B. immediate death due to prolonged submersion in water.
C. survival for at least 24 hours following submersion in water.
D. death greater than 24 hours following submersion in water.
Correct Answer: C. survival for at least 24 hours following submersion in water.
Reason: Collectively, drowning and near-drowning are referred to as submersion
injuries. Drowning is defined as death after submersion in a liquid medium, usually
water. In a drowning, death is either immediate or occurs within 24 hours following
submersion. Near-drowning is defined as survival, at least temporarily (24 hours),
after submersion. It should be noted, however, that complications such as
pneumonia and pulmonary edema can cause death greater than 24 hours following
submersion. For this reason, all patients with a submersion injury should be
transported to the hospital, even if they appear fine at the scene.
9. A young woman reports significant weight loss over the last month, persistent fever,
and night sweats. When you assess her, you note the presence of dark purple lesions
covering her trunk and upper extremities. You should suspect:
A. end-stage cancer.
B. HIV/AIDS.
C. tuberculosis.
D. rheumatic fever.
Correct Answer: B. HIV/AIDS.
Reason: Weight loss, fever, and night sweats could indicate tuberculosis or
HIV/AIDS; however, the dark purple lesions on the skin, which are called Kaposi's
sarcoma, are malignant skin tumors and are a classic finding in patients in the later
stages of AIDS.
10. A 48-year-old male became acutely hypoxic, experienced a seizure, and is now
postictal. The MOST effective way to prevent another seizure is to:
A. dim the lights in the back of the ambulance.
B. place him in the recovery position.
C. administer high-flow supplemental oxygen.
D. give him oral glucose if he can swallow.
Correct Answer: C. administer high-flow supplemental oxygen.
Reason: You should administer high-flow oxygen to all patients who are actively
seizing and to patients who experienced a seizure and are postictal. This is
especially true if the seizure was caused by hypoxia. Increasing the oxygen content
of the blood, which minimizes hypoxia, may prevent another seizure. The recovery
position is appropriate for uninjured patients with a decreased level of
5
, consciousness and adequate breathing; it will help maintain the airway and facilitate
drainage of secretions from the mouth, but will not prevent another seizure. Oral
glucose may prevent another seizure if hypoglycemia was the cause of the seizure.
You should dim the lights in the back of the ambulance to help prevent any seizure,
not just those that are caused by hypoxia.
11. Which of the following conditions would be the LEAST likely to be present in a
patient who was submerged in water?
A. Spinal injury
B. Gastric distention
C. Hyperglycemia
D. Laryngospasm
Correct Answer: C. Hyperglycemia
Reason: Many factors can contribute to or result from a submersion injury (eg,
drowning, near-drowning). It is not uncommon for a person to experience a spinal
injury after diving head first into shallow water, especially if he or she is under the
influence of alcohol. When a swimmer panics, he or she initially swallows large
amounts of water, resulting in gastric distention. Gastric distention can cause
aspiration if the patient regurgitates water during rescue breathing; protect the
airway! During the panic phase, the victim expends a tremendous amount of energy
(and glucose) from flailing around in the water, possibly resulting in hypoglycemia.
Inhaling even a small amount of fresh or salt water can severely irritate the larynx,
which sends the muscles of the larynx and vocal cords into spasm (laryngospasm),
resulting in airway blockage and hypoxia.
12. A 42-year-old male presents with fever, a severe headache, and a stiff neck. He is
conscious, but confused. His wife tells you that he does not have any medical
problems and does not take any medications. You should be MOST suspicious for:
A. acute stroke.
B. influenza.
C. meningitis.
D. tuberculosis. (
Correct Answer: C. meningitis.
Reason: Meningitis is an inflammation of the protective coverings of the brain and
spinal cord (meninges). Common signs and symptoms of meningitis include fever,
headache, neck stiffness (nuchal rigidity), and vomiting. An altered mental status is
common in severe cases. Meningococcal meningitis, caused by a bacterium, is the
most contagious and potentially fatal type of meningitis. The patient's signs and
symptoms are not consistent with acute stroke, tuberculosis (TB), or influenza (the
flu). Although fever is common with both TB and the flu, neither causes neck
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, stiffness. Acute stroke may be associated with a headache, especially a hemorrhagic
stroke; however, stroke patients typically do not have a fever.
13. All of the following are signs of gastrointestinal bleeding, EXCEPT:
A. melena.
B. hematemesis.
C. tachycardia.
D. hemoptysis.
Correct Answer: D. hemoptysis.
Reason: Signs and symptoms of gastrointestinal (GI) bleeding include abdominal
pain; vomiting blood (hematemesis); the passage of dark, tarry stools (melena); and
bright red rectal bleeding (hematochezia). If blood loss is significant, the patient may
have signs of shock (eg, tachycardia, diaphoresis, tachypnea, hypotension).
Hemoptysis (coughing up blood) is a sign of a pulmonary injury, not GI bleeding.
14. A 24-year-old female presents with a rash to her left leg and swollen, painful knee
joints. She tells you that she and her friends returned from a hiking trip in the
mountains a week ago. She is conscious and alert with a blood pressure of 112/62 mm
Hg, a pulse of 84 beats/min, and respirations of 14 breaths/min. Her symptoms are
MOST likely the result of:
A. Rocky Mountain spotted fever.
B. tetanus.
C. Lyme disease.
D. a localized allergic reaction.
Correct Answer: C. Lyme disease.
Reason: The patient's symptoms and her history of a recent hiking trip are
consistent with Lyme disease, which was the result of a tick bite. Ticks can carry two
infectious diseases: Lyme disease and Rocky Mountain spotted fever. Both are
spread through the tick's saliva, which is injected into the skin when the tick
attaches itself. The first symptom of Lyme disease, a rash that may spread to several
parts of the body, begins about 3 days after the bite of an infected tick. The rash may
eventually resemble a target bull's-eye pattern in one third of patients. After a few
more days or weeks, painful swelling of the joints, particularly the knees, occurs. If
recognized and treated promptly with antibiotics, many patients recover completely.
Rocky Mountain spotted fever, which is not limited to the Rocky Mountains, occurs
within 7 to 10 days after being bitten by an infected tick. Its symptoms include
nausea, vomiting, headache, weakness, paralysis, and possibly cardiopulmonary
failure.
15. A 50-year-old woman who is conscious and alert complains of a severe migraine
headache. When caring for her, you should generally avoid:
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,A. transporting her in a supine position.
B. shining a light into her pupils.
C. dimming the lights in the ambulance.
D. applying ice packs to her forehead.
Correct Answer: B. shining a light into her pupils.
Reason: Patients with migraine or cluster headaches typically have photophobia
(light sensitivity). Any type of bright light, especially if shone directly into the eyes,
will cause the patient with a headache unnecessary severe pain. Dimming the lights
in the ambulance and making the patient as comfortable as possible are the
treatments of choice for a patient with a headache. Some patients benefit from ice
packs applied to the forehead; just be sure to wrap the ice pack with roller gauze.
Oxygen also should be administered as needed. Typically, the patient will prefer to
lie supine or on the side
16. A patient who overdosed on heroin would be expected to present with:
A. tachycardia.
B. hyperpnea.
C. hypotension.
D. dilated pupils.
Correct Answer: C. hypotension.
Reason: Heroin is a Schedule I (illegal) narcotic that is typically injected. As with all
narcotics, legal or illegal, overdose causes depression of the central nervous system
(CNS), resulting in a decreased level of consciousness; bradycardia; hypotension;
and slow, shallow (reduced tidal volume) breathing. Hyperpnea (deep breathing)
would not be present in a patient who overdosed on a narcotic. In a narcotic
overdose, the pupils are typically constricted (miosis). Barbiturates, such as
phenobarbital, are also CNS depressants and cause the same symptoms seen with
narcotic overdose. The patient's pupils, however, are typically dilated (mydriasis),
not constricted.
17. When caring for any patient with a decreased level of consciousness, your primary
concern should be the:
A. potential for airway compromise.
B. patient's blood glucose level.
C. possibility of a spinal injury.
D. possibility of a drug overdose.
Correct Answer: A. potential for airway compromise.
Reason: Altered mental status could be caused by a high or low blood glucose level,
drug overdose, or head injury, among other causes. Furthermore, the possibility of a
spinal injury should be considered if the patient was injured. However, your primary
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, concern should be the status of the patient's airway. Patients with a decreased level
of consciousness are at risk for aspiration if vomiting occurs. Unless spinal trauma
is present or the patient is breathing inadequately (eg, fast or slow rate, shallow
breathing [reduced tidal volume]), place him or her in the recovery position to
facilitate drainage if vomiting occurs. Remember this: no airway, no patient!
18. A 16-year-old, 125-pound male ingested a bottle of aspirin approximately 20
minutes ago. Medical control orders you to administer activated charcoal in a dose of 1
g/kg. How much activated charcoal should you administer?
A. 54 g
B. 60 g
C. 51 g
D. 57 g
Correct Answer: D. 57 g
Reason: First, you must determine the patient's weight in kilograms (kg). Either of
the following formulae can be used to convert pounds to kilograms: Formula 1:
weight (in pounds) ÷ 2.2 = weight in kg. Formula 2: weight (in pounds) ÷ 2 - 10% =
weight in kg. On the basis of the above formulae, a 125-pound patient weighs 57 kg.
Using formula 1, the equation is as follows: 125 (weight in pounds) ÷ 2.2 = 56.81 (57
[rounded to the nearest tenth]). Using formula 2, the equation is as follows: 125
(weight in pounds) ÷ 2 = 62.5 (63 [rounded to the nearest tenth] - 6.3 (10% of 63) =
56.7 (57 [rounded to the nearest tenth]). Since the drug order is for 1 g/kg, you
should administer 57 g of activated charcoal to your 125-pound patient.
19. Which of the following is the MOST significant finding in a patient with a severe
headache?
A. Pain in both legs
B. Chest discomfort
C. Unilateral weakness
D. Abdominal tenderness
Correct Answer: C. Unilateral weakness
Reason: Unilateral weakness (weakness on one side of the body) is a clinically
significant finding in a patient with a headache because it could indicate a stroke
(ischemic or hemorrhagic). Abdominal, chest, and leg pain are not common
complaints associated with a headache, although they should be noted and
investigated if they are present.
20. When caring for a patient with severe hypothermia who is in cardiac arrest, you
should:
A. perform rescue breathing only.
B. perform BLS and transport.
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, C. avoid using the AED.
D. hyperventilate the patient.
Correct Answer: B. perform BLS and transport.
Reason: Patients with severe hypothermia (core body temperature < 86°F) who are in
cardiac arrest should be managed with basic life support (chest compressions and
ventilations), passive external rewarming (ie, removal of wet clothing, applying warm
blankets) and rapid transport to the hospital where they can be actively rewarmed.
Because cold muscle is a poor conductor of electricity, defibrillation, if indicated,
should be limited to 1 attempt until the patient's body temperature has been
increased. Cardiac arrest patients with severe hypothermia generally do not respond
to defibrillation. Hyperventilation should be avoided as this may increase
intrathoracic pressure and impair blood flow back to the heart.
21. You should not attempt to actively rewarm a patient with moderate or severe
hypothermia in the field because:
A. rewarming too quickly can cause a fatal cardiac dysrhythmia.
B. the risk of inadvertently inducing hyperthermia is too high.
C. it is painful for the patient and you cannot give analgesic drugs.
D. active rewarming has been shown to cause severe hypertension.
Correct Answer: A. rewarming too quickly can cause a fatal cardiac dysrhythmia.
Reason: When caring for a patient with hypothermia, your goal is to prevent further
heat loss; this involves removing wet clothing, applying warm blankets, and allowing
the patient's body temperature to rise gradually and naturally (passive rewarming). If
the patient is moderately or severely hypothermic, you should not try to rewarm him
or her actively (placing heat on or into the body). Rewarming too quickly may cause
a fatal cardiac dysrhythmia, such as ventricular fibrillation (V-Fib). Active rewarming
may also cause rewarming shock, a condition in which the blood vessels dilate when
heat is applied to the body, resulting in significant hypotension. For these reasons,
active rewarming should only be performed in the controlled setting of a hospital.
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