NREMT Test Prep Questions and
Answers
When ventilating an apneic patient with a bag-valve-mask device, each breath should
be delivered over:
A) 1 second.
B) 2 seconds.
C) 3 seconds.
D) 4 seconds. - Correct Answers -A) 1 second.
When ventilating any apneic patient, each breath should be delivered over a period of 1
second—just enough to produce visible chest rise. Excessive ventilation duration and/or
volume increases the likelihood of gastric distention, especially if the patient's airway is
not secured with an advanced device (ie, ET tube, multilumen airway, supraglottic
airway), and may result in increased intrathoracic pressure, decreased venous return to
the heart, and decreased cardiac output.
A 70-year-old woman with severe respiratory distress is found lying supine in her bed.
She is conscious, but confused, and her skin is pale and clammy. Her husband states
that she has congestive heart failure and hypertension, and that her breathing difficulty
began suddenly. The EMT should:
A) assist the patient's ventilations with a bag-mask device.
B) elevate the patient's upper body and administer oxygen.
C) auscultate the patient's lungs and apply the pulse oximeter.
D) suspect pulmonary edema and begin treatment with CPAP. - Correct Answers -B)
elevate the patient's upper body and administer oxygen.
The patient's clinical presentation and medical history suggests acute pulmonary
edema. The EMT should immediately sit the patient up in order to make it easier for her
to breathe. If she continues to lie supine, she will become increasingly hypoxic and may
stop breathing altogether. Administer high-flow oxygen and further assess the patient
(ie, breath sounds, pulse oximetry, etc). If her breath sounds reveal crackles and she is
able to follow verbal commands, treatment with continuous positive airway pressure
(CPAP) should be considered. If she is not able to follow verbal commands, begin
assisting her ventilations with a bag-mask device. Monitor her oxygen saturation, and if
available, end-tidal carbon dioxide (ETCO2).
A 78-year-old woman complains of pain to her right groin area after she fell. Her right
leg is straight but is externally rotated and shorter than the left. The EMT should suspect
a:
A) pelvic girdle fracture.
B) proximal femur fracture.
C) posterior hip dislocation.
,D) symphysis pubis fracture. - Correct Answers -B) proximal femur fracture.
Fractures of the proximal (upper) end of the femur are common fractures, especially in
older patients and patients with osteoporosis. Although these fractures are often called
hip fractures, they rarely involve the hip joint. Instead, the fracture occurs at the neck of
the femur. Patient with displaced fractures of the proximal femur present with a very
characteristic deformity. The leg is straight but is externally rotated and shorter than the
uninjured leg. Pain is typically located in the hip region or in the groin or inner aspect of
the thigh. Posterior dislocation of the hip most commonly occurs as a result of a motor
vehicle crash in which the knee meets with a direct force, such as the dashboard, and
the entire femur is driven posteriorly, dislocating the hip joint. Patients with a posterior
hip dislocation typically lie with the hip joint flexed (the knee joint drawn up toward the
chest) and the thigh rotated internally. Pelvic fractures, including those of the symphysis
pubis, typically do not cause shortening or lengthening of an extremity, nor are they
typically associated with internal or external rotation of the legs. Fracture of the
symphysis pubis is characterized by palpable pain over the pubic bone.
A woman struck the steering wheel with her chest when her car collided with a tree. She
is conscious and alert; however, she is tachypneic and diaphoretic and her pulse is
rapid and irregular. What should you do?
A) Apply the AED and administer oxygen
B) Administer oxygen and protect her spine
C) Administer oxygen and position her on her side
D) Ventilate with a bag-mask device and apply a c-collar - Correct Answers -B)
Administer oxygen and protect her spine
Based on the mechanism of injury and the patient's clinical presentation (especially her
rapid, irregular pulse), a myocardial contusion should be suspected. Large myocardial
contusions can reduce the pumping function of the heart, resulting in shock. One cannot
diagnose a myocardial contusion in the prehospital setting, and there is no specific
treatment for this type of injury; therefore, prompt transport is essential. Treatment for
the patient in this scenario includes supplemental oxygen (nasal cannula or
nonrebreathing mask, depending on her oxygen saturation), spinal motion restriction (ie,
c-collar, backboard, etc), and keeping her warm.
What type of injury occurs when a joint is twisted or stretched beyond its normal range
of motion, resulting in swelling but no deformity?
A) Sprain
B) Strain
C) Fracture
D) Dislocation - Correct Answers -A) Sprain
A sprain occurs when a joint is twisted or stretched beyond its normal range of motion.
As a result, the supporting capsule and ligaments are stretched or torn, resulting in
injury to the ligaments, articular cartilage, synovial membrane, and tendons crossing the
joint. Signs of a sprain include pain, swelling, ecchymosis, and increased motion of the
joint. While a sprain is considered to be a partial dislocation, it is not associated with
deformity. A dislocation is a disruption of a joint in which the bond ends are no longer in
contact. The supporting ligaments are often torn, usually completely, allowing the bone
,ends to separate from each other; this results in deformity of the joint. A strain (pulled
muscle) is a stretching or tearing of the muscle and/or tendon, causing pain, swelling,
and bruising of the soft tissues in the area; deformity does not occur with a strain.
During your assessment of a patient who experienced blunt facial trauma, you note the
presence of a hyphema. This indicates:
A) a fracture of the nasal bone.
B) an orbital blowout fracture.
C) direct trauma to the eyeball.
D) that the pupils are unequal. - Correct Answers -C) direct trauma to the eyeball.
Some patients with blunt trauma to the eyeball (globe) may present with a hyphema, or
bleeding into the anterior chamber of the eye, that obscures a portion of or the entire
iris. This condition may seriously impair vision and should be considered a sight-
threatening emergency. A fracture of the orbital floor (blowout fracture) is characterized
by double vision and an inability of the patient to move his or her eyes above the midline
(paralysis of upward gaze) following blunt facial trauma. In an orbital blowout fracture,
fragments of fractured bone can entrap some of the muscles that control eye
movement. Anisocoria is the term used to describe unequal pupils. Unequal pupils
following head trauma indicates increased intracranial pressure.
Which of the following would MOST likely cause a reduction in tidal volume?
A) Flaring of the nostrils
B) Accessory muscle use
C) Unequal chest expansion
D) Increased minute volume - Correct Answers -C) Unequal chest expansion
Unequal (asymmetrical) or minimal expansion of the chest results in a decrease in the
amount of air inhaled per breath (tidal volume). Accessory muscle use and nasal flaring
are signs of increased work of breathing, which represents an attempt to maintain
adequate tidal volume (and therefore, minute volume). An increase in tidal volume,
respiratory rate, or both would result in an increase in minute volume. It should be
noted, however, that a markedly fast respiratory rate would cause a natural decrease in
tidal volume. For example, a patient breathing at a rate of 45 breaths/min would likely
only inhale air into the anatomic dead space before promptly exhaling it.
Assuming a dead space volume of 150 mL, which of the following would yield the lowest
minute alveolar ventilation?
A) Respiratory rate, 10 breaths/min; tidal volume, 500 mL
B) Respiratory rate, 16 breaths/min; tidal volume, 300 mL
C) Respiratory rate, 12 breaths/min; tidal volume, 400 mL
D) Respiratory rate, 14 breaths/min; tidal volume, 350 mL - Correct Answers -B)
Respiratory rate, 16 breaths/min; tidal volume, 300 mL
Minute alveolar ventilation is the amount of air that moves in and out of the alveoli each
minute. In calculating minute alveolar ventilation, you must subtract the dead space
volume from the tidal volume first, and then multiply that number by the respiratory rate.
Of the options listed, a tidal volume of 300 mL and a respiratory rate of 16 breaths/min
yields the lowest value (2,400 mL [2.4 L]).
, Medications such as albuterol (Ventolin) relieve respiratory distress by:
A) constricting the bronchioles in the lungs.
B) contracting the smaller airways in the lungs.
C) relaxing the smooth muscle of the bronchioles.
D) dilating the large mainstem bronchi of the airway. - Correct Answers -C) relaxing the
smooth muscle of the bronchioles.
Medications such as albuterol (Ventolin), metaproterenol (Alupent), and levalbuterol
(Xopenex) are in a class of drugs called bronchodilators. They relax the smooth muscle
found within the bronchioles in the lungs, which causes them to dilate. This effect opens
the air passages and improves the patient's ability to breathe.
Tidal volume is defined as the:
A) volume of air inhaled or exhaled per breath.
B) volume of air that remains in the upper airway.
C) total volume of air that the lungs are capable of holding.
D) volume of air moved in and out of the lungs each minute. - Correct Answers -A)
volume of air inhaled or exhaled per breath.
Tidal volume (VT) is the amount of air that is inhaled or exhaled per breath; it is
normally about 500 mL in an average adult male. Tidal volume is assessed by noting
the depth of a patient's breathing. Shallow breathing, for example, indicates a reduced
tidal volume. The volume of air that remains in the upper respiratory tract (eg, larger
bronchi, trachea) is called dead space volume (VD); it is approximately 30% of the adult
male's tidal volume and does not participate in pulmonary gas exchange.
A patient with slow shallow breathing has a large volume of blood and secretions in his
oropharnx. What should you do?
A) Suction his airway until it is clear and ventilate with a bag-mask device.
B) Insert a nasopharyngeal airway and suction the airway for 30 seconds.
C) Turn the patient onto his side and provide immediate transport.
D) Insert an oropharyngeal airway and suction for 10 to 15 seconds. - Correct Answers -
A) Suction his airway until it is clear and ventilate with a bag-mask device.
Slow, shallow breathing should be treated with assisted ventilation. However, if the
patient has blood, vomitus, or other secretions in the airway, they must be removed first.
Suction the oropharynx until it is clear, and then begin ventilation assistance. Fifteen or
30 seconds of suction may not be enough time to remove all of the secretions.
Ventilating a patient with secretions in the airway virtually assures aspiration, and
mortality dramatically increases if aspiration occurs. Insert the appropriate airway
adjunct after the airway is clear of secretions, continue to ventilate, and monitor the
airway for ongoing secretions; provide additional suctioning as needed.
An elderly man is found lying unresponsive in his garage. The patient's wife did not
witness the event that led to his unresponsiveness. You should:
A) assess the patient's respirations.
B) apply supplemental oxygen.
C) thoroughly suction his oropharynx.
Answers
When ventilating an apneic patient with a bag-valve-mask device, each breath should
be delivered over:
A) 1 second.
B) 2 seconds.
C) 3 seconds.
D) 4 seconds. - Correct Answers -A) 1 second.
When ventilating any apneic patient, each breath should be delivered over a period of 1
second—just enough to produce visible chest rise. Excessive ventilation duration and/or
volume increases the likelihood of gastric distention, especially if the patient's airway is
not secured with an advanced device (ie, ET tube, multilumen airway, supraglottic
airway), and may result in increased intrathoracic pressure, decreased venous return to
the heart, and decreased cardiac output.
A 70-year-old woman with severe respiratory distress is found lying supine in her bed.
She is conscious, but confused, and her skin is pale and clammy. Her husband states
that she has congestive heart failure and hypertension, and that her breathing difficulty
began suddenly. The EMT should:
A) assist the patient's ventilations with a bag-mask device.
B) elevate the patient's upper body and administer oxygen.
C) auscultate the patient's lungs and apply the pulse oximeter.
D) suspect pulmonary edema and begin treatment with CPAP. - Correct Answers -B)
elevate the patient's upper body and administer oxygen.
The patient's clinical presentation and medical history suggests acute pulmonary
edema. The EMT should immediately sit the patient up in order to make it easier for her
to breathe. If she continues to lie supine, she will become increasingly hypoxic and may
stop breathing altogether. Administer high-flow oxygen and further assess the patient
(ie, breath sounds, pulse oximetry, etc). If her breath sounds reveal crackles and she is
able to follow verbal commands, treatment with continuous positive airway pressure
(CPAP) should be considered. If she is not able to follow verbal commands, begin
assisting her ventilations with a bag-mask device. Monitor her oxygen saturation, and if
available, end-tidal carbon dioxide (ETCO2).
A 78-year-old woman complains of pain to her right groin area after she fell. Her right
leg is straight but is externally rotated and shorter than the left. The EMT should suspect
a:
A) pelvic girdle fracture.
B) proximal femur fracture.
C) posterior hip dislocation.
,D) symphysis pubis fracture. - Correct Answers -B) proximal femur fracture.
Fractures of the proximal (upper) end of the femur are common fractures, especially in
older patients and patients with osteoporosis. Although these fractures are often called
hip fractures, they rarely involve the hip joint. Instead, the fracture occurs at the neck of
the femur. Patient with displaced fractures of the proximal femur present with a very
characteristic deformity. The leg is straight but is externally rotated and shorter than the
uninjured leg. Pain is typically located in the hip region or in the groin or inner aspect of
the thigh. Posterior dislocation of the hip most commonly occurs as a result of a motor
vehicle crash in which the knee meets with a direct force, such as the dashboard, and
the entire femur is driven posteriorly, dislocating the hip joint. Patients with a posterior
hip dislocation typically lie with the hip joint flexed (the knee joint drawn up toward the
chest) and the thigh rotated internally. Pelvic fractures, including those of the symphysis
pubis, typically do not cause shortening or lengthening of an extremity, nor are they
typically associated with internal or external rotation of the legs. Fracture of the
symphysis pubis is characterized by palpable pain over the pubic bone.
A woman struck the steering wheel with her chest when her car collided with a tree. She
is conscious and alert; however, she is tachypneic and diaphoretic and her pulse is
rapid and irregular. What should you do?
A) Apply the AED and administer oxygen
B) Administer oxygen and protect her spine
C) Administer oxygen and position her on her side
D) Ventilate with a bag-mask device and apply a c-collar - Correct Answers -B)
Administer oxygen and protect her spine
Based on the mechanism of injury and the patient's clinical presentation (especially her
rapid, irregular pulse), a myocardial contusion should be suspected. Large myocardial
contusions can reduce the pumping function of the heart, resulting in shock. One cannot
diagnose a myocardial contusion in the prehospital setting, and there is no specific
treatment for this type of injury; therefore, prompt transport is essential. Treatment for
the patient in this scenario includes supplemental oxygen (nasal cannula or
nonrebreathing mask, depending on her oxygen saturation), spinal motion restriction (ie,
c-collar, backboard, etc), and keeping her warm.
What type of injury occurs when a joint is twisted or stretched beyond its normal range
of motion, resulting in swelling but no deformity?
A) Sprain
B) Strain
C) Fracture
D) Dislocation - Correct Answers -A) Sprain
A sprain occurs when a joint is twisted or stretched beyond its normal range of motion.
As a result, the supporting capsule and ligaments are stretched or torn, resulting in
injury to the ligaments, articular cartilage, synovial membrane, and tendons crossing the
joint. Signs of a sprain include pain, swelling, ecchymosis, and increased motion of the
joint. While a sprain is considered to be a partial dislocation, it is not associated with
deformity. A dislocation is a disruption of a joint in which the bond ends are no longer in
contact. The supporting ligaments are often torn, usually completely, allowing the bone
,ends to separate from each other; this results in deformity of the joint. A strain (pulled
muscle) is a stretching or tearing of the muscle and/or tendon, causing pain, swelling,
and bruising of the soft tissues in the area; deformity does not occur with a strain.
During your assessment of a patient who experienced blunt facial trauma, you note the
presence of a hyphema. This indicates:
A) a fracture of the nasal bone.
B) an orbital blowout fracture.
C) direct trauma to the eyeball.
D) that the pupils are unequal. - Correct Answers -C) direct trauma to the eyeball.
Some patients with blunt trauma to the eyeball (globe) may present with a hyphema, or
bleeding into the anterior chamber of the eye, that obscures a portion of or the entire
iris. This condition may seriously impair vision and should be considered a sight-
threatening emergency. A fracture of the orbital floor (blowout fracture) is characterized
by double vision and an inability of the patient to move his or her eyes above the midline
(paralysis of upward gaze) following blunt facial trauma. In an orbital blowout fracture,
fragments of fractured bone can entrap some of the muscles that control eye
movement. Anisocoria is the term used to describe unequal pupils. Unequal pupils
following head trauma indicates increased intracranial pressure.
Which of the following would MOST likely cause a reduction in tidal volume?
A) Flaring of the nostrils
B) Accessory muscle use
C) Unequal chest expansion
D) Increased minute volume - Correct Answers -C) Unequal chest expansion
Unequal (asymmetrical) or minimal expansion of the chest results in a decrease in the
amount of air inhaled per breath (tidal volume). Accessory muscle use and nasal flaring
are signs of increased work of breathing, which represents an attempt to maintain
adequate tidal volume (and therefore, minute volume). An increase in tidal volume,
respiratory rate, or both would result in an increase in minute volume. It should be
noted, however, that a markedly fast respiratory rate would cause a natural decrease in
tidal volume. For example, a patient breathing at a rate of 45 breaths/min would likely
only inhale air into the anatomic dead space before promptly exhaling it.
Assuming a dead space volume of 150 mL, which of the following would yield the lowest
minute alveolar ventilation?
A) Respiratory rate, 10 breaths/min; tidal volume, 500 mL
B) Respiratory rate, 16 breaths/min; tidal volume, 300 mL
C) Respiratory rate, 12 breaths/min; tidal volume, 400 mL
D) Respiratory rate, 14 breaths/min; tidal volume, 350 mL - Correct Answers -B)
Respiratory rate, 16 breaths/min; tidal volume, 300 mL
Minute alveolar ventilation is the amount of air that moves in and out of the alveoli each
minute. In calculating minute alveolar ventilation, you must subtract the dead space
volume from the tidal volume first, and then multiply that number by the respiratory rate.
Of the options listed, a tidal volume of 300 mL and a respiratory rate of 16 breaths/min
yields the lowest value (2,400 mL [2.4 L]).
, Medications such as albuterol (Ventolin) relieve respiratory distress by:
A) constricting the bronchioles in the lungs.
B) contracting the smaller airways in the lungs.
C) relaxing the smooth muscle of the bronchioles.
D) dilating the large mainstem bronchi of the airway. - Correct Answers -C) relaxing the
smooth muscle of the bronchioles.
Medications such as albuterol (Ventolin), metaproterenol (Alupent), and levalbuterol
(Xopenex) are in a class of drugs called bronchodilators. They relax the smooth muscle
found within the bronchioles in the lungs, which causes them to dilate. This effect opens
the air passages and improves the patient's ability to breathe.
Tidal volume is defined as the:
A) volume of air inhaled or exhaled per breath.
B) volume of air that remains in the upper airway.
C) total volume of air that the lungs are capable of holding.
D) volume of air moved in and out of the lungs each minute. - Correct Answers -A)
volume of air inhaled or exhaled per breath.
Tidal volume (VT) is the amount of air that is inhaled or exhaled per breath; it is
normally about 500 mL in an average adult male. Tidal volume is assessed by noting
the depth of a patient's breathing. Shallow breathing, for example, indicates a reduced
tidal volume. The volume of air that remains in the upper respiratory tract (eg, larger
bronchi, trachea) is called dead space volume (VD); it is approximately 30% of the adult
male's tidal volume and does not participate in pulmonary gas exchange.
A patient with slow shallow breathing has a large volume of blood and secretions in his
oropharnx. What should you do?
A) Suction his airway until it is clear and ventilate with a bag-mask device.
B) Insert a nasopharyngeal airway and suction the airway for 30 seconds.
C) Turn the patient onto his side and provide immediate transport.
D) Insert an oropharyngeal airway and suction for 10 to 15 seconds. - Correct Answers -
A) Suction his airway until it is clear and ventilate with a bag-mask device.
Slow, shallow breathing should be treated with assisted ventilation. However, if the
patient has blood, vomitus, or other secretions in the airway, they must be removed first.
Suction the oropharynx until it is clear, and then begin ventilation assistance. Fifteen or
30 seconds of suction may not be enough time to remove all of the secretions.
Ventilating a patient with secretions in the airway virtually assures aspiration, and
mortality dramatically increases if aspiration occurs. Insert the appropriate airway
adjunct after the airway is clear of secretions, continue to ventilate, and monitor the
airway for ongoing secretions; provide additional suctioning as needed.
An elderly man is found lying unresponsive in his garage. The patient's wife did not
witness the event that led to his unresponsiveness. You should:
A) assess the patient's respirations.
B) apply supplemental oxygen.
C) thoroughly suction his oropharynx.
