FISDAP PARAMEDIC FINAL EXAM 2026/2027
|Practice Questions and Rationales | NREMT-
Style | Pass
1. A 62-year-old male is unresponsive, apneic, and pulseless. After 2 minutes of CPR and one
shock, you reassess the rhythm and see a organized rhythm at 40/min with a palpable carotid
pulse. What is your next priority?
A. Begin chest compressions at 100–120/min
B. Provide rescue breaths at 10/min
C. Obtain a 12-lead ECG and assess blood pressure
D. Administer 1 mg epinephrine IV
Correct Answer: C
Rationale: After ROSC (return of spontaneous circulation), the priority is post-cardiac arrest
care — assess hemodynamics, obtain a 12-lead, and manage blood pressure. Compressions are
no longer indicated with a pulse. Epinephrine is not first-line for a stable post-ROSC patient with
a pulse.
2. Which of the following best describes the purpose of PEEP in a patient with acute
pulmonary edema?
A. It reduces preload and improves alveolar recruitment
B. It increases venous return to the heart
C. It decreases functional residual capacity
D. It inhibits surfactant production
Correct Answer: A
Rationale: PEEP (positive end-expiratory pressure) improves oxygenation by recruiting
collapsed alveoli and reduces preload/afterload, which is beneficial in cardiogenic pulmonary
edema. It does not increase venous return; it actually decreases it.
3. A patient with a tracheostomy is in respiratory distress. You suction the tube and note
resistance. What is the most appropriate next step?
A. Instill 5 mL of normal saline and suction again
B. Remove the inner cannula and reassess
,C. Hyperventilate with a BVM
D. Advance the suction catheter forcefully
Correct Answer: B
Rationale: If suctioning meets resistance, the inner cannula may be obstructed. Removing
and cleaning/replacing it is the appropriate next step. Routine saline instillation is no longer
recommended. Forceful catheter advancement can cause trauma.
4. Select all that apply. Which findings indicate inadequate oxygenation in a patient receiving
high-flow oxygen?
A. SpO₂ of 89% on 15 L/min NRB
B. Respiratory rate of 28/min
C. Cyanosis of the lips and nail beds
D. PaCO₂ of 35 mmHg
E. Altered mental status
Correct Answers: A, C, E
Rationale: SpO₂ <90% on high-flow oxygen, cyanosis, and altered mental status are signs of
inadequate oxygenation. Tachypnea alone may be compensatory, and a normal PaCO₂ does not
indicate oxygenation status.
5. A 24-year-old asthmatic is in severe distress with silent chest. What does "silent chest"
indicate?
A. Improvement in bronchospasm
B. Complete airway obstruction and impending respiratory arrest
C. Mild exacerbation
D. Pneumothorax
Correct Answer: B
Rationale: A silent chest indicates such severe bronchospasm that airflow is minimal — a
life-threatening sign of impending respiratory failure requiring immediate intervention.
6. What is the correct compression-to-ventilation ratio for a 6-year-old child with two
rescuers?
A. 30:2
B. 15:2
,C. 10:2
D. 5:1
Correct Answer: B
Rationale: For pediatric patients (pre-pubescent) with two rescuers, the ratio is 15:2. For
adults or single-rescuer pediatric, it is 30:2.
7. A patient with COPD has a SpO₂ of 84%. What is the target SpO₂ range?
A. 88–92%
B. 94–98%
C. 90–94%
D. 85–90%
Correct Answer: A
Rationale: In COPD patients with CO₂ retention risk, target SpO₂ is 88–92%. Over-
oxygenation can suppress hypoxic drive and worsen hypercapnia.
8. Which device delivers the highest concentration of oxygen?
A. Nasal cannula
B. Simple face mask
C. Venturi mask
D. Non-rebreather mask
Correct Answer: D
Rationale: A non-rebreather mask with a reservoir can deliver up to 90–100% FiO₂ at 10–15
L/min. Venturi delivers precise but lower concentrations.
9. A patient is choking and has a strong, effective cough. What should you do?
A. Perform abdominal thrusts
B. Encourage continued coughing
C. Perform blind finger sweeps
D. Begin CPR
Correct Answer: B
Rationale: With a strong, effective cough, the patient can still move air. Encourage coughing
, and monitor. Abdominal thrusts are for severe obstruction with ineffective cough. Blind finger
sweeps are contraindicated.
10. What is the most common cause of upper airway obstruction in an unresponsive patient?
A. Foreign body
B. Tongue
C. Laryngeal spasm
D. Epiglottitis
Correct Answer: B
Rationale: In an unresponsive patient, loss of muscle tone causes the tongue to fall back
and obstruct the airway — the most common cause. This is why head-tilt/chin-lift or jaw-thrust
is performed.
11–20: Section 1 continued
11. A patient requires intubation but has a suspected cervical spine injury. Which technique is
preferred?
A. Head-tilt/chin-lift
B. Jaw-thrust with manual stabilization
C. Hyperextension
D. Blind nasotracheal
Correct Answer: B
Rationale: Jaw-thrust with manual in-line stabilization minimizes cervical spine movement.
12. What is the maximum time for a single intubation attempt before oxygenation should be
restored?
A. 10 seconds
B. 20 seconds
C. 30 seconds
D. 45 seconds
Correct Answer: C
Rationale: Attempts should be limited to 30 seconds; if unsuccessful, reoxygenate with BVM
before reattempting.
|Practice Questions and Rationales | NREMT-
Style | Pass
1. A 62-year-old male is unresponsive, apneic, and pulseless. After 2 minutes of CPR and one
shock, you reassess the rhythm and see a organized rhythm at 40/min with a palpable carotid
pulse. What is your next priority?
A. Begin chest compressions at 100–120/min
B. Provide rescue breaths at 10/min
C. Obtain a 12-lead ECG and assess blood pressure
D. Administer 1 mg epinephrine IV
Correct Answer: C
Rationale: After ROSC (return of spontaneous circulation), the priority is post-cardiac arrest
care — assess hemodynamics, obtain a 12-lead, and manage blood pressure. Compressions are
no longer indicated with a pulse. Epinephrine is not first-line for a stable post-ROSC patient with
a pulse.
2. Which of the following best describes the purpose of PEEP in a patient with acute
pulmonary edema?
A. It reduces preload and improves alveolar recruitment
B. It increases venous return to the heart
C. It decreases functional residual capacity
D. It inhibits surfactant production
Correct Answer: A
Rationale: PEEP (positive end-expiratory pressure) improves oxygenation by recruiting
collapsed alveoli and reduces preload/afterload, which is beneficial in cardiogenic pulmonary
edema. It does not increase venous return; it actually decreases it.
3. A patient with a tracheostomy is in respiratory distress. You suction the tube and note
resistance. What is the most appropriate next step?
A. Instill 5 mL of normal saline and suction again
B. Remove the inner cannula and reassess
,C. Hyperventilate with a BVM
D. Advance the suction catheter forcefully
Correct Answer: B
Rationale: If suctioning meets resistance, the inner cannula may be obstructed. Removing
and cleaning/replacing it is the appropriate next step. Routine saline instillation is no longer
recommended. Forceful catheter advancement can cause trauma.
4. Select all that apply. Which findings indicate inadequate oxygenation in a patient receiving
high-flow oxygen?
A. SpO₂ of 89% on 15 L/min NRB
B. Respiratory rate of 28/min
C. Cyanosis of the lips and nail beds
D. PaCO₂ of 35 mmHg
E. Altered mental status
Correct Answers: A, C, E
Rationale: SpO₂ <90% on high-flow oxygen, cyanosis, and altered mental status are signs of
inadequate oxygenation. Tachypnea alone may be compensatory, and a normal PaCO₂ does not
indicate oxygenation status.
5. A 24-year-old asthmatic is in severe distress with silent chest. What does "silent chest"
indicate?
A. Improvement in bronchospasm
B. Complete airway obstruction and impending respiratory arrest
C. Mild exacerbation
D. Pneumothorax
Correct Answer: B
Rationale: A silent chest indicates such severe bronchospasm that airflow is minimal — a
life-threatening sign of impending respiratory failure requiring immediate intervention.
6. What is the correct compression-to-ventilation ratio for a 6-year-old child with two
rescuers?
A. 30:2
B. 15:2
,C. 10:2
D. 5:1
Correct Answer: B
Rationale: For pediatric patients (pre-pubescent) with two rescuers, the ratio is 15:2. For
adults or single-rescuer pediatric, it is 30:2.
7. A patient with COPD has a SpO₂ of 84%. What is the target SpO₂ range?
A. 88–92%
B. 94–98%
C. 90–94%
D. 85–90%
Correct Answer: A
Rationale: In COPD patients with CO₂ retention risk, target SpO₂ is 88–92%. Over-
oxygenation can suppress hypoxic drive and worsen hypercapnia.
8. Which device delivers the highest concentration of oxygen?
A. Nasal cannula
B. Simple face mask
C. Venturi mask
D. Non-rebreather mask
Correct Answer: D
Rationale: A non-rebreather mask with a reservoir can deliver up to 90–100% FiO₂ at 10–15
L/min. Venturi delivers precise but lower concentrations.
9. A patient is choking and has a strong, effective cough. What should you do?
A. Perform abdominal thrusts
B. Encourage continued coughing
C. Perform blind finger sweeps
D. Begin CPR
Correct Answer: B
Rationale: With a strong, effective cough, the patient can still move air. Encourage coughing
, and monitor. Abdominal thrusts are for severe obstruction with ineffective cough. Blind finger
sweeps are contraindicated.
10. What is the most common cause of upper airway obstruction in an unresponsive patient?
A. Foreign body
B. Tongue
C. Laryngeal spasm
D. Epiglottitis
Correct Answer: B
Rationale: In an unresponsive patient, loss of muscle tone causes the tongue to fall back
and obstruct the airway — the most common cause. This is why head-tilt/chin-lift or jaw-thrust
is performed.
11–20: Section 1 continued
11. A patient requires intubation but has a suspected cervical spine injury. Which technique is
preferred?
A. Head-tilt/chin-lift
B. Jaw-thrust with manual stabilization
C. Hyperextension
D. Blind nasotracheal
Correct Answer: B
Rationale: Jaw-thrust with manual in-line stabilization minimizes cervical spine movement.
12. What is the maximum time for a single intubation attempt before oxygenation should be
restored?
A. 10 seconds
B. 20 seconds
C. 30 seconds
D. 45 seconds
Correct Answer: C
Rationale: Attempts should be limited to 30 seconds; if unsuccessful, reoxygenate with BVM
before reattempting.
