California EMT Examination with
Practice Questions And Correct Answers
(Verified Answers)
1. In a patient with severe asthma exacerbation, which combination of capnography
waveform and clinical sign best indicates impending respiratory failure requiring
immediate intubation?
A. Shark-fin pattern with prolonged expiratory phase and accessory muscle use
B. Normal rectangular waveform with mild tachypnea
C. Curare cleft with decreased tidal volume
D. Sine wave pattern with bradypnea and altered mental status
Answer: D. Sine wave pattern with bradypnea and altered mental status
Rationale: A sine wave pattern on capnography indicates severe bronchospasm and
fatigue, often preceding respiratory arrest; combined with bradypnea and altered mental
status, it signals imminent failure. Shark-fin suggests obstruction but not failure; normal
waveform is reassuring; curare cleft is seen with spontaneous breaths during paralysis.
2. A patient with a suspected opioid overdose presents with pinpoint pupils,
respiratory depression, and a systolic BP of 70 mm Hg. After administering naloxone,
which parameter must be prioritized to prevent complications?
A. Pain scale
B. End-tidal CO2
C. Pupillary response
D. Glasgow Coma Scale
Answer: B. End-tidal CO2
Rationale: End-tidal CO2 provides real-time feedback on ventilation and helps prevent
hypercapnia or over-ventilation; hypotension may worsen with abrupt reversal, so
monitoring ventilation is critical. Pain scale and pupil size are secondary; GCS changes
lag behind ventilatory status.
Page 1 of 77
,3. Which of the following best explains why a patient with a tension pneumothorax
may exhibit tracheal deviation away from the affected side, while a massive
hemothorax typically does not?
A. Tension pneumothorax causes mediastinal shift due to trapped air; hemothorax
compresses without shift.
B. Hemothorax increases intrathoracic pressure equally on both sides.
C. Tracheal deviation occurs only with hemothorax due to blood volume.
D. Both conditions cause tracheal deviation, but hemothorax is slower.
Answer: A. Tension pneumothorax causes mediastinal shift due to trapped air;
hemothorax compresses without shift.
Rationale: Tension pneumothorax creates one-way valve air trapping, shifting
mediastinum; hemothorax compresses lung but does not typically shift mediastinum unless
massive. Other options misstate pathophysiology.
4. A patient with a suspected cervical spine injury requires airway management.
Which technique is most appropriate to minimize spinal movement while ensuring
patency?
A. Head-tilt chin-lift
B. Jaw-thrust with manual in-line stabilization
C. Oropharyngeal airway alone
D. Nasopharyngeal airway with hyperextension
Answer: B. Jaw-thrust with manual in-line stabilization
Rationale: Jaw-thrust with manual in-line stabilization maintains neutral alignment and
opens the airway without extending the neck, reducing secondary injury. Head-tilt and
hyperextension risk further damage; airway adjuncts alone do not address positioning.
Page 2 of 77
,5. In a mass casualty incident, which triage system is currently recommended by the
California EMS Authority for prioritizing patients based on physiologic parameters
and resource availability?
A. START
B. JumpSTART
C. SALT
D. ESI
Answer: C. SALT
Rationale: SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport) is endorsed
by California EMS and FEMA for its flexibility and inclusion of lifesaving interventions.
START is older and less granular; JumpSTART is pediatric; ESI is for emergency
department triage.
6. A patient with a suspected acute ischemic stroke has a blood glucose of 45 mg/dL.
According to current AHA/ASA guidelines, what is the immediate priority?
A. Administer aspirin
B. Correct hypoglycemia
C. Obtain CT scan
D. Start thrombolytics
Answer: B. Correct hypoglycemia
Rationale: Hypoglycemia can mimic stroke and must be corrected immediately; it is a
contraindication to thrombolytics. Aspirin and thrombolytics are not given until
hemorrhage is excluded; CT is important but after glucose correction.
Page 3 of 77
, 7. Which of the following best describes the mechanism of action of epinephrine in
anaphylaxis, and why is it preferred over antihistamines as first-line therapy?
A. Alpha-1 agonism causes vasoconstriction and reduces edema; antihistamines only
block histamine.
B. Beta-2 agonism causes bronchodilation; antihistamines also bronchodilate.
C. Epinephrine inhibits mast cell degranulation; antihistamines do not.
D. Epinephrine is longer-acting; antihistamines have rapid onset.
Answer: A. Alpha-1 agonism causes vasoconstriction and reduces edema;
antihistamines only block histamine.
Rationale: Epinephrine's alpha-1 effects reverse hypotension and mucosal edema, while
beta-2 relieves bronchospasm; antihistamines do not address cardiovascular collapse.
Other options misstate pharmacology.
8. A patient with a history of heart failure presents with dyspnea, bibasilar crackles,
and a BP of 160/90 mm Hg. Which prehospital intervention is most appropriate
according to current guidelines?
A. Administer nitroglycerin and CPAP
B. Administer fluids and dopamine
C. Administer albuterol and ipratropium
D. Administer furosemide and morphine
Answer: A. Administer nitroglycerin and CPAP
Rationale: Nitroglycerin reduces preload and CPAP improves oxygenation in acute
cardiogenic pulmonary edema; this combination is first-line. Fluids worsen failure;
bronchodilators are for bronchospasm; furosemide and morphine are no longer routine
prehospital.
Page 4 of 77
Practice Questions And Correct Answers
(Verified Answers)
1. In a patient with severe asthma exacerbation, which combination of capnography
waveform and clinical sign best indicates impending respiratory failure requiring
immediate intubation?
A. Shark-fin pattern with prolonged expiratory phase and accessory muscle use
B. Normal rectangular waveform with mild tachypnea
C. Curare cleft with decreased tidal volume
D. Sine wave pattern with bradypnea and altered mental status
Answer: D. Sine wave pattern with bradypnea and altered mental status
Rationale: A sine wave pattern on capnography indicates severe bronchospasm and
fatigue, often preceding respiratory arrest; combined with bradypnea and altered mental
status, it signals imminent failure. Shark-fin suggests obstruction but not failure; normal
waveform is reassuring; curare cleft is seen with spontaneous breaths during paralysis.
2. A patient with a suspected opioid overdose presents with pinpoint pupils,
respiratory depression, and a systolic BP of 70 mm Hg. After administering naloxone,
which parameter must be prioritized to prevent complications?
A. Pain scale
B. End-tidal CO2
C. Pupillary response
D. Glasgow Coma Scale
Answer: B. End-tidal CO2
Rationale: End-tidal CO2 provides real-time feedback on ventilation and helps prevent
hypercapnia or over-ventilation; hypotension may worsen with abrupt reversal, so
monitoring ventilation is critical. Pain scale and pupil size are secondary; GCS changes
lag behind ventilatory status.
Page 1 of 77
,3. Which of the following best explains why a patient with a tension pneumothorax
may exhibit tracheal deviation away from the affected side, while a massive
hemothorax typically does not?
A. Tension pneumothorax causes mediastinal shift due to trapped air; hemothorax
compresses without shift.
B. Hemothorax increases intrathoracic pressure equally on both sides.
C. Tracheal deviation occurs only with hemothorax due to blood volume.
D. Both conditions cause tracheal deviation, but hemothorax is slower.
Answer: A. Tension pneumothorax causes mediastinal shift due to trapped air;
hemothorax compresses without shift.
Rationale: Tension pneumothorax creates one-way valve air trapping, shifting
mediastinum; hemothorax compresses lung but does not typically shift mediastinum unless
massive. Other options misstate pathophysiology.
4. A patient with a suspected cervical spine injury requires airway management.
Which technique is most appropriate to minimize spinal movement while ensuring
patency?
A. Head-tilt chin-lift
B. Jaw-thrust with manual in-line stabilization
C. Oropharyngeal airway alone
D. Nasopharyngeal airway with hyperextension
Answer: B. Jaw-thrust with manual in-line stabilization
Rationale: Jaw-thrust with manual in-line stabilization maintains neutral alignment and
opens the airway without extending the neck, reducing secondary injury. Head-tilt and
hyperextension risk further damage; airway adjuncts alone do not address positioning.
Page 2 of 77
,5. In a mass casualty incident, which triage system is currently recommended by the
California EMS Authority for prioritizing patients based on physiologic parameters
and resource availability?
A. START
B. JumpSTART
C. SALT
D. ESI
Answer: C. SALT
Rationale: SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport) is endorsed
by California EMS and FEMA for its flexibility and inclusion of lifesaving interventions.
START is older and less granular; JumpSTART is pediatric; ESI is for emergency
department triage.
6. A patient with a suspected acute ischemic stroke has a blood glucose of 45 mg/dL.
According to current AHA/ASA guidelines, what is the immediate priority?
A. Administer aspirin
B. Correct hypoglycemia
C. Obtain CT scan
D. Start thrombolytics
Answer: B. Correct hypoglycemia
Rationale: Hypoglycemia can mimic stroke and must be corrected immediately; it is a
contraindication to thrombolytics. Aspirin and thrombolytics are not given until
hemorrhage is excluded; CT is important but after glucose correction.
Page 3 of 77
, 7. Which of the following best describes the mechanism of action of epinephrine in
anaphylaxis, and why is it preferred over antihistamines as first-line therapy?
A. Alpha-1 agonism causes vasoconstriction and reduces edema; antihistamines only
block histamine.
B. Beta-2 agonism causes bronchodilation; antihistamines also bronchodilate.
C. Epinephrine inhibits mast cell degranulation; antihistamines do not.
D. Epinephrine is longer-acting; antihistamines have rapid onset.
Answer: A. Alpha-1 agonism causes vasoconstriction and reduces edema;
antihistamines only block histamine.
Rationale: Epinephrine's alpha-1 effects reverse hypotension and mucosal edema, while
beta-2 relieves bronchospasm; antihistamines do not address cardiovascular collapse.
Other options misstate pharmacology.
8. A patient with a history of heart failure presents with dyspnea, bibasilar crackles,
and a BP of 160/90 mm Hg. Which prehospital intervention is most appropriate
according to current guidelines?
A. Administer nitroglycerin and CPAP
B. Administer fluids and dopamine
C. Administer albuterol and ipratropium
D. Administer furosemide and morphine
Answer: A. Administer nitroglycerin and CPAP
Rationale: Nitroglycerin reduces preload and CPAP improves oxygenation in acute
cardiogenic pulmonary edema; this combination is first-line. Fluids worsen failure;
bronchodilators are for bronchospasm; furosemide and morphine are no longer routine
prehospital.
Page 4 of 77
