NREMT Practice Test Bank - Multiple
Choice
You are assessing a young male who was stabbed in the right lower chest. He is
semiconscious and has labored breathing, collapsed jugular veins, and absent breath
sounds on the right side of his chest. This patient MOST likely has a:
• A:liver laceration.
• B:hemothorax.
• C:pneumothorax.
• D:ruptured spleen. - ANSWER-You selected B; This is correct!
Reason:
You should suspect a hemothorax if a patient with chest trauma presents with shock,
especially if the injury was caused by penetrating trauma. Hemothorax occurs when
blood collects in the pleural space and compresses the lung, resulting in shock and
respiratory compromise. Other signs include collapsed jugular veins (due to low blood
volume), labored breathing, and decreased or absent breath sounds on the side of the
injury. A pneumothorax (air in the pleural space) is also associated with difficulty
breathing and unilaterally decreased or absent breath sounds; however, the jugular
veins are usually not collapsed. If excessive air accumulates within the pleural space,
however, pressure will shift across the mediastinum and affect the uninjured lung
(tension pneumothorax); if this occurs, the jugular veins may become engorged
(distended). Splenic injury is unlikely; the patient's injury is on the right side and the
spleen is on the left. A liver laceration can cause severe shock; however, it is not
associated with unilaterally decreased breath sounds or labored breathing.
A reduction in tidal volume would MOST likely result from:
• A:increased minute volume.
• B:unequal chest expansion.
• C:flaring of the nostrils.
• D:accessory muscle use. - ANSWER-You selected B; This is correct!
Reason:
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 40 breaths/min would likely
only inhale air into the anatomic dead space before promptly exhaling it.
,Medications such as albuterol (Ventolin) relieve respiratory distress by:
• A:contracting the smaller airways in the lungs.
• B:dilating the large mainstem bronchi of the airway.
• C:constricting the bronchioles in the lungs.
• D:relaxing the smooth muscle of the bronchioles. - ANSWER-You selected D; This is
correct!
Reason:
Medications such as albuterol (Ventolin) and metaproterenol (Alupent) 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.
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. - 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.
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. - ANSWER-You selected C; This is correct!
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.
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. - ANSWER-You selected B; This is correct!
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 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.
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 - ANSWER-The correct answer is B;
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.
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 - ANSWER-The correct answer is C;
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.
Activated charcoal is contraindicated for a patient who is:
• A:conscious and alert and has ingested a large amount of Motrin.
, • 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. - ANSWER-You
selected D; This is correct!
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.
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. - ANSWER-you selected D; This is correct!
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.
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. - ANSWER-You
selected C; This is correct!
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
Choice
You are assessing a young male who was stabbed in the right lower chest. He is
semiconscious and has labored breathing, collapsed jugular veins, and absent breath
sounds on the right side of his chest. This patient MOST likely has a:
• A:liver laceration.
• B:hemothorax.
• C:pneumothorax.
• D:ruptured spleen. - ANSWER-You selected B; This is correct!
Reason:
You should suspect a hemothorax if a patient with chest trauma presents with shock,
especially if the injury was caused by penetrating trauma. Hemothorax occurs when
blood collects in the pleural space and compresses the lung, resulting in shock and
respiratory compromise. Other signs include collapsed jugular veins (due to low blood
volume), labored breathing, and decreased or absent breath sounds on the side of the
injury. A pneumothorax (air in the pleural space) is also associated with difficulty
breathing and unilaterally decreased or absent breath sounds; however, the jugular
veins are usually not collapsed. If excessive air accumulates within the pleural space,
however, pressure will shift across the mediastinum and affect the uninjured lung
(tension pneumothorax); if this occurs, the jugular veins may become engorged
(distended). Splenic injury is unlikely; the patient's injury is on the right side and the
spleen is on the left. A liver laceration can cause severe shock; however, it is not
associated with unilaterally decreased breath sounds or labored breathing.
A reduction in tidal volume would MOST likely result from:
• A:increased minute volume.
• B:unequal chest expansion.
• C:flaring of the nostrils.
• D:accessory muscle use. - ANSWER-You selected B; This is correct!
Reason:
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 40 breaths/min would likely
only inhale air into the anatomic dead space before promptly exhaling it.
,Medications such as albuterol (Ventolin) relieve respiratory distress by:
• A:contracting the smaller airways in the lungs.
• B:dilating the large mainstem bronchi of the airway.
• C:constricting the bronchioles in the lungs.
• D:relaxing the smooth muscle of the bronchioles. - ANSWER-You selected D; This is
correct!
Reason:
Medications such as albuterol (Ventolin) and metaproterenol (Alupent) 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.
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. - 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.
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. - ANSWER-You selected C; This is correct!
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.
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. - ANSWER-You selected B; This is correct!
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 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.
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 - ANSWER-The correct answer is B;
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.
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 - ANSWER-The correct answer is C;
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.
Activated charcoal is contraindicated for a patient who is:
• A:conscious and alert and has ingested a large amount of Motrin.
, • 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. - ANSWER-You
selected D; This is correct!
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.
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. - ANSWER-you selected D; This is correct!
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.
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. - ANSWER-You
selected C; This is correct!
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
