, Question 1
In North Carolina, an EMT is dispatched to a scene where law enforcement has
secured a patient with an active psychiatric emergency. Which of the following
best describes the EMT's legal scope of practice regarding restraint
application?
A. EMTs may apply chemical restraints under NC EMS protocols to
ensure patient safety during transport.
B. EMTs may apply physical restraints only if authorized by medical
direction and if the patient poses an immediate danger to self or others.
C. EMTs may apply physical restraints without medical direction if the
patient is combative and refuses care.
D. EMTs may never apply restraints; this is exclusively a law
enforcement function.
Correct Answer: B - EMTs may apply physical restraints only if
authorized by medical direction and if the patient poses an
immediate danger to self or others.
RATIONALE
In NC, EMTs may apply restraints only with medical direction
authorization and when there is an immediate threat of harm; this
balances patient rights with safety. Chemical restraints are outside
EMT scope, and law enforcement does not have exclusive authority
when medical need exists. Option C omits required medical direction,
and D is incorrect because EMTs can restrain under specific
conditions.
Question 2
A patient with a severe asthma exacerbation is being ventilated with a
bag-valve-mask. Which of the following best explains why a slow, controlled
ventilation rate is preferred over rapid ventilation?
A. Rapid ventilation increases intrathoracic pressure, reducing venous
return and potentially causing hypotension.
Page 2
, B. Slow ventilation prevents gastric insufflation, which is the primary
concern in asthma.
C. Rapid ventilation causes hypercarbia, which worsens bronchospasm.
D. Slow ventilation allows for better oxygenation but increases the risk of
barotrauma.
Correct Answer: A - Rapid ventilation increases intrathoracic
pressure, reducing venous return and potentially causing
hypotension.
RATIONALE
Rapid ventilation increases intrathoracic pressure, impeding venous
return and cardiac output, leading to hypotension-a critical concern in
asthma. While gastric insufflation is possible, it is not the primary
reason for slow ventilation. Rapid ventilation causes hypocarbia, not
hypercarbia, and slow ventilation actually reduces barotrauma risk.
Question 3
During a primary assessment, which of the following findings is most
indicative of inadequate perfusion requiring immediate intervention?
A. Capillary refill of 2 seconds in a cool environment
B. Radial pulse present but weak and rapid
C. Pale, cool, clammy skin with altered mental status
D. Respiratory rate of 24 breaths/min with mild accessory muscle use
Correct Answer: C - Pale, cool, clammy skin with altered mental
status
RATIONALE
Pale, cool, clammy skin with altered mental status reflects systemic
hypoperfusion and is a late sign of shock, demanding immediate
intervention. Weak radial pulse and mild tachypnea may indicate
compensated shock but are less definitive. Capillary refill of 2 seconds
is within normal limits.
Page 3
, Question 4
A patient with a suspected opioid overdose presents with pinpoint pupils,
respiratory depression, and unresponsiveness. After administering naloxone,
the patient's respiratory rate improves but remains 8/min. What is the most
appropriate next action?
A. Administer a second dose of naloxone immediately.
B. Begin assisted ventilations with a bag-valve-mask.
C. Apply a non-rebreather mask at 15 L/min.
D. Place the patient in the recovery position and monitor.
Correct Answer: B - Begin assisted ventilations with a
bag-valve-mask.
RATIONALE
Assisted ventilations are indicated for inadequate respiratory rate
despite naloxone, as the goal is to support oxygenation and
ventilation. A second naloxone dose may be given but is not the
immediate priority over ventilation. Non-rebreather is insufficient for
hypoventilation, and recovery position alone does not address
inadequate breathing.
Question 5
Which of the following mechanisms of injury is most likely to produce a
tension pneumothorax that requires needle decompression?
A. Blunt trauma to the anterior chest with rib fractures
B. Penetrating injury to the lateral chest with a small entry wound
C. Fall from height landing on the feet with bilateral femur fractures
D. Crush injury to the pelvis with associated hematuria
Correct Answer: B - Penetrating injury to the lateral chest with a
small entry wound
Page 4
In North Carolina, an EMT is dispatched to a scene where law enforcement has
secured a patient with an active psychiatric emergency. Which of the following
best describes the EMT's legal scope of practice regarding restraint
application?
A. EMTs may apply chemical restraints under NC EMS protocols to
ensure patient safety during transport.
B. EMTs may apply physical restraints only if authorized by medical
direction and if the patient poses an immediate danger to self or others.
C. EMTs may apply physical restraints without medical direction if the
patient is combative and refuses care.
D. EMTs may never apply restraints; this is exclusively a law
enforcement function.
Correct Answer: B - EMTs may apply physical restraints only if
authorized by medical direction and if the patient poses an
immediate danger to self or others.
RATIONALE
In NC, EMTs may apply restraints only with medical direction
authorization and when there is an immediate threat of harm; this
balances patient rights with safety. Chemical restraints are outside
EMT scope, and law enforcement does not have exclusive authority
when medical need exists. Option C omits required medical direction,
and D is incorrect because EMTs can restrain under specific
conditions.
Question 2
A patient with a severe asthma exacerbation is being ventilated with a
bag-valve-mask. Which of the following best explains why a slow, controlled
ventilation rate is preferred over rapid ventilation?
A. Rapid ventilation increases intrathoracic pressure, reducing venous
return and potentially causing hypotension.
Page 2
, B. Slow ventilation prevents gastric insufflation, which is the primary
concern in asthma.
C. Rapid ventilation causes hypercarbia, which worsens bronchospasm.
D. Slow ventilation allows for better oxygenation but increases the risk of
barotrauma.
Correct Answer: A - Rapid ventilation increases intrathoracic
pressure, reducing venous return and potentially causing
hypotension.
RATIONALE
Rapid ventilation increases intrathoracic pressure, impeding venous
return and cardiac output, leading to hypotension-a critical concern in
asthma. While gastric insufflation is possible, it is not the primary
reason for slow ventilation. Rapid ventilation causes hypocarbia, not
hypercarbia, and slow ventilation actually reduces barotrauma risk.
Question 3
During a primary assessment, which of the following findings is most
indicative of inadequate perfusion requiring immediate intervention?
A. Capillary refill of 2 seconds in a cool environment
B. Radial pulse present but weak and rapid
C. Pale, cool, clammy skin with altered mental status
D. Respiratory rate of 24 breaths/min with mild accessory muscle use
Correct Answer: C - Pale, cool, clammy skin with altered mental
status
RATIONALE
Pale, cool, clammy skin with altered mental status reflects systemic
hypoperfusion and is a late sign of shock, demanding immediate
intervention. Weak radial pulse and mild tachypnea may indicate
compensated shock but are less definitive. Capillary refill of 2 seconds
is within normal limits.
Page 3
, Question 4
A patient with a suspected opioid overdose presents with pinpoint pupils,
respiratory depression, and unresponsiveness. After administering naloxone,
the patient's respiratory rate improves but remains 8/min. What is the most
appropriate next action?
A. Administer a second dose of naloxone immediately.
B. Begin assisted ventilations with a bag-valve-mask.
C. Apply a non-rebreather mask at 15 L/min.
D. Place the patient in the recovery position and monitor.
Correct Answer: B - Begin assisted ventilations with a
bag-valve-mask.
RATIONALE
Assisted ventilations are indicated for inadequate respiratory rate
despite naloxone, as the goal is to support oxygenation and
ventilation. A second naloxone dose may be given but is not the
immediate priority over ventilation. Non-rebreather is insufficient for
hypoventilation, and recovery position alone does not address
inadequate breathing.
Question 5
Which of the following mechanisms of injury is most likely to produce a
tension pneumothorax that requires needle decompression?
A. Blunt trauma to the anterior chest with rib fractures
B. Penetrating injury to the lateral chest with a small entry wound
C. Fall from height landing on the feet with bilateral femur fractures
D. Crush injury to the pelvis with associated hematuria
Correct Answer: B - Penetrating injury to the lateral chest with a
small entry wound
Page 4
