EMT-I/85 – Emergency Medical Technician
Intermediate/85 Certification Exam Updated 2026
| 450+ Practice Questions & Verified Answers |
Comprehensive EMS Study Guide, Intermediate
EMT Exam Prep Test Bank, Patient Assessment,
Airway Management, Trauma Care, Medical
Emergencies, Pharmacology, Cardiac Emergencies,
Pediatric & Obstetric Care, EMS Operations,
Detailed Rationales
Question 1: A 45-year-old male is found unresponsive with a respiratory rate
of 6 breaths per minute and an oxygen saturation of 88% on room air. After
opening the airway and providing positive pressure ventilation with a BVM
and 100% oxygen, the patient’s heart rate drops from 80 to 42 beats per
minute. What is the most appropriate immediate action?
A. Decrease the ventilation rate to allow for hypercapnia to stimulate the heart rate
B. Administer atropine 0.5 mg IV push for the bradycardia
C. Continue ventilations and prepare for immediate endotracheal intubation
D. Assess the adequacy of ventilations and verify proper BVM technique
CORRECT ANSWER: D. Assess the adequacy of ventilations and verify proper
BVM technique
Rationale: The drop in heart rate following positive pressure ventilation in a patient
with bradycardia is often due to a vagal response or decreased venous return from
excessive ventilation pressures. The immediate step is to assess and correct ventilation
technique to ensure adequate but not excessive tidal volumes and rates. Atropine may
be indicated later if the bradycardia persists despite corrected ventilation and
oxygenation.
Question 2: Which of the following ECG findings is most consistent with an
acute inferior wall ST-elevation myocardial infarction (STEMI)?
A. ST-segment elevation in leads V1-V4
B. ST-segment elevation in leads II, III, and aVF
C. ST-segment depression in leads I and aVL
D. Tall, peaked T-waves in leads V3-V6
CORRECT ANSWER: B. ST-segment elevation in leads II, III, and aVF
Rationale: The inferior wall of the heart is supplied by the right coronary artery in most
patients. ST-segment elevation in leads II, III, and aVF is the classic ECG pattern for an
inferior STEMI. Leads V1-V4 indicate an anterior infarction, while ST depression in I
and aVL is reciprocal and supports a lateral or inferior injury.
,Question 3: You are treating a 32-year-old female who experienced a
generalized tonic-clonic seizure that lasted 4 minutes. She is now postictal
with a GCS of 12 and has not regained full consciousness. What is the priority
in your ongoing management?
A. Rapidly administer 10 mg of diazepam IV to prevent a second seizure
B. Start an IV and draw blood for electrolyte analysis
C. Assess for a focused neurologic deficit and establish a patent airway
D. Transport immediately with lights and sirens to the nearest stroke center
CORRECT ANSWER: C. Assess for a focused neurologic deficit and establish a
patent airway
Rationale: In the postictal state, the patient is at high risk for airway compromise due to
a decreased level of consciousness. The priority is to reassess airway patency and
breathing while performing a rapid neurologic exam to rule out a persistent deficit that
may indicate a structural cause like a stroke. Benzodiazepines are not indicated
prophylactically unless status epilepticus recurs.
Question 4: A patient with a known history of COPD presents with severe
respiratory distress. You note diminished breath sounds, a prolonged
expiratory phase, and use of accessory muscles. His pulse oximetry is 85% on
a non-rebreather mask. What is the most appropriate initial ventilation
strategy?
A. Intubate immediately with rapid sequence intubation
B. Apply CPAP at 5 cm H2O and monitor for improvement
C. Initiate BiPAP with an inspiratory pressure of 10 cm H2O and an expiratory pressure
of 5 cm H2O
D. Ventilate with a BVM at 20 breaths per minute using room air
CORRECT ANSWER: C. Initiate BiPAP with an inspiratory pressure of 10 cm
H2O and an expiratory pressure of 5 cm H2O
Rationale: In the EMT-I/85 scope, BiPAP is a powerful tool for acute COPD
exacerbations with respiratory failure. It provides inspiratory positive airway pressure to
reduce work of breathing and expiratory pressure to stent open airways, improving
alveolar ventilation. CPAP alone does not assist with the expiratory flow limitation seen
in COPD. BVM ventilation can cause barotrauma and is less controlled.
Question 5: You are managing a 58-year-old male with acute chest pain. He is
nauseated and diaphoretic. His blood pressure is 90/60 mmHg and his heart
rate is 110 bpm. An ECG shows ST-segment elevation in leads V1-V4. Which of
the following medications is contraindicated in this patient?
,A. Aspirin
B. Nitroglycerin
C. Morphine
D. Heparin
CORRECT ANSWER: B. Nitroglycerin
Rationale: Nitroglycerin is relatively contraindicated in patients with an acute inferior or
right ventricular infarction, particularly when they present with hypotension (SBP < 90
mmHg) and bradycardia or tachycardia. Nitroglycerin reduces preload and can
precipitously drop blood pressure, leading to cardiovascular collapse. Aspirin and
morphine are generally safe and indicated for management of acute MI.
Question 6: A 28-year-old male sustains a blunt trauma to the chest during a
motorcycle accident. He is tachypneic and has decreased breath sounds on the
left side. His trachea is deviated to the right. What is the most critical
immediate intervention?
A. Place a large-bore IV catheter in the left second intercostal space at the midclavicular
line
B. Secure the airway with endotracheal intubation
C. Apply a three-sided occlusive dressing to the left chest wall
D. Administer a fluid bolus of 1000 mL of normal saline
CORRECT ANSWER: A. Place a large-bore IV catheter in the left second
intercostal space at the midclavicular line
Rationale: This patient is presenting with classic signs of a tension pneumothorax:
tracheal deviation to the contralateral side and decreased breath sounds on the affected
side. Immediate needle decompression (thoracentesis) is the life-saving intervention to
release the trapped air before it causes obstructive shock.
Question 7: Which of the following is the correct adult dose of epinephrine for
a patient in cardiac arrest with a non-shockable rhythm (PEA/Asystole)?
A. 1 mg 1:10,000 IV/IO every 3-5 minutes
B. 0.1 mg 1:1,000 IV/IO every 3-5 minutes
C. 1 mg 1:1,000 IV/IO every 3-5 minutes
D. 0.1 mg 1:10,000 IV/IO every 3-5 minutes
CORRECT ANSWER: A. 1 mg 1:10,000 IV/IO every 3-5 minutes
Rationale: In the setting of cardiac arrest, standard dosing for epinephrine is 1 mg of a
1:10,000 solution (0.1 mg/mL) administered intravenously or intraosseously every 3 to 5
minutes for all arrest rhythms. The 1:1,000 concentration is used primarily for
anaphylaxis or severe asthma when given intramuscularly.
, Question 8: A patient presents with signs of shock after a multiple-vehicle
collision. Your assessment reveals a distended neck vein and muffled heart
sounds. What condition should be suspected, and what is the immediate
intervention?
A. Tension pneumothorax; needle decompression
B. Cardiac tamponade; pericardiocentesis
C. Flail chest; positive pressure ventilation
D. Pulmonary contusion; fluid restriction
CORRECT ANSWER: B. Cardiac tamponade; pericardiocentesis
Rationale: Beck's triad (hypotension, distended neck veins, and muffled heart sounds)
is the classic presentation of cardiac tamponade, often caused by blunt or penetrating
trauma. This is a compressive condition that prevents ventricular filling, requiring
immediate needle pericardiocentesis to relieve the pressure and improve cardiac output.
Question 9: In the context of a patient with severe sepsis, which of the
following findings indicates that the patient is in compensated shock rather
than decompensated shock?
A. Lactic acidosis with a pH of 7.20
B. Hypotension with a systolic blood pressure of 80 mmHg
C. Tachycardia and narrowing pulse pressure
D. Anuria and acute kidney injury
CORRECT ANSWER: C. Tachycardia and narrowing pulse pressure
Rationale: Compensated shock is characterized by the body's physiologic attempts to
maintain perfusion. This includes tachycardia, peripheral vasoconstriction (cool skin),
and narrowing pulse pressure. Hypotension is a hallmark of decompensated shock
where compensatory mechanisms fail, and organ damage begins.
Question 10: You are treating a patient with a suspected opiate overdose. The
patient is apneic with a heart rate of 50 bpm. After initiating BVM ventilations,
what is the most appropriate next step for reversal?
A. Administer 2 mg of naloxone IV/IM
B. Administer 0.4 mg of naloxone IV/IM
C. Administer 0.1 mg of naloxone IV/IM
D. Administer 5 mg of naloxone IV/IM
CORRECT ANSWER: B. Administer 0.4 mg of naloxone IV/IM
Intermediate/85 Certification Exam Updated 2026
| 450+ Practice Questions & Verified Answers |
Comprehensive EMS Study Guide, Intermediate
EMT Exam Prep Test Bank, Patient Assessment,
Airway Management, Trauma Care, Medical
Emergencies, Pharmacology, Cardiac Emergencies,
Pediatric & Obstetric Care, EMS Operations,
Detailed Rationales
Question 1: A 45-year-old male is found unresponsive with a respiratory rate
of 6 breaths per minute and an oxygen saturation of 88% on room air. After
opening the airway and providing positive pressure ventilation with a BVM
and 100% oxygen, the patient’s heart rate drops from 80 to 42 beats per
minute. What is the most appropriate immediate action?
A. Decrease the ventilation rate to allow for hypercapnia to stimulate the heart rate
B. Administer atropine 0.5 mg IV push for the bradycardia
C. Continue ventilations and prepare for immediate endotracheal intubation
D. Assess the adequacy of ventilations and verify proper BVM technique
CORRECT ANSWER: D. Assess the adequacy of ventilations and verify proper
BVM technique
Rationale: The drop in heart rate following positive pressure ventilation in a patient
with bradycardia is often due to a vagal response or decreased venous return from
excessive ventilation pressures. The immediate step is to assess and correct ventilation
technique to ensure adequate but not excessive tidal volumes and rates. Atropine may
be indicated later if the bradycardia persists despite corrected ventilation and
oxygenation.
Question 2: Which of the following ECG findings is most consistent with an
acute inferior wall ST-elevation myocardial infarction (STEMI)?
A. ST-segment elevation in leads V1-V4
B. ST-segment elevation in leads II, III, and aVF
C. ST-segment depression in leads I and aVL
D. Tall, peaked T-waves in leads V3-V6
CORRECT ANSWER: B. ST-segment elevation in leads II, III, and aVF
Rationale: The inferior wall of the heart is supplied by the right coronary artery in most
patients. ST-segment elevation in leads II, III, and aVF is the classic ECG pattern for an
inferior STEMI. Leads V1-V4 indicate an anterior infarction, while ST depression in I
and aVL is reciprocal and supports a lateral or inferior injury.
,Question 3: You are treating a 32-year-old female who experienced a
generalized tonic-clonic seizure that lasted 4 minutes. She is now postictal
with a GCS of 12 and has not regained full consciousness. What is the priority
in your ongoing management?
A. Rapidly administer 10 mg of diazepam IV to prevent a second seizure
B. Start an IV and draw blood for electrolyte analysis
C. Assess for a focused neurologic deficit and establish a patent airway
D. Transport immediately with lights and sirens to the nearest stroke center
CORRECT ANSWER: C. Assess for a focused neurologic deficit and establish a
patent airway
Rationale: In the postictal state, the patient is at high risk for airway compromise due to
a decreased level of consciousness. The priority is to reassess airway patency and
breathing while performing a rapid neurologic exam to rule out a persistent deficit that
may indicate a structural cause like a stroke. Benzodiazepines are not indicated
prophylactically unless status epilepticus recurs.
Question 4: A patient with a known history of COPD presents with severe
respiratory distress. You note diminished breath sounds, a prolonged
expiratory phase, and use of accessory muscles. His pulse oximetry is 85% on
a non-rebreather mask. What is the most appropriate initial ventilation
strategy?
A. Intubate immediately with rapid sequence intubation
B. Apply CPAP at 5 cm H2O and monitor for improvement
C. Initiate BiPAP with an inspiratory pressure of 10 cm H2O and an expiratory pressure
of 5 cm H2O
D. Ventilate with a BVM at 20 breaths per minute using room air
CORRECT ANSWER: C. Initiate BiPAP with an inspiratory pressure of 10 cm
H2O and an expiratory pressure of 5 cm H2O
Rationale: In the EMT-I/85 scope, BiPAP is a powerful tool for acute COPD
exacerbations with respiratory failure. It provides inspiratory positive airway pressure to
reduce work of breathing and expiratory pressure to stent open airways, improving
alveolar ventilation. CPAP alone does not assist with the expiratory flow limitation seen
in COPD. BVM ventilation can cause barotrauma and is less controlled.
Question 5: You are managing a 58-year-old male with acute chest pain. He is
nauseated and diaphoretic. His blood pressure is 90/60 mmHg and his heart
rate is 110 bpm. An ECG shows ST-segment elevation in leads V1-V4. Which of
the following medications is contraindicated in this patient?
,A. Aspirin
B. Nitroglycerin
C. Morphine
D. Heparin
CORRECT ANSWER: B. Nitroglycerin
Rationale: Nitroglycerin is relatively contraindicated in patients with an acute inferior or
right ventricular infarction, particularly when they present with hypotension (SBP < 90
mmHg) and bradycardia or tachycardia. Nitroglycerin reduces preload and can
precipitously drop blood pressure, leading to cardiovascular collapse. Aspirin and
morphine are generally safe and indicated for management of acute MI.
Question 6: A 28-year-old male sustains a blunt trauma to the chest during a
motorcycle accident. He is tachypneic and has decreased breath sounds on the
left side. His trachea is deviated to the right. What is the most critical
immediate intervention?
A. Place a large-bore IV catheter in the left second intercostal space at the midclavicular
line
B. Secure the airway with endotracheal intubation
C. Apply a three-sided occlusive dressing to the left chest wall
D. Administer a fluid bolus of 1000 mL of normal saline
CORRECT ANSWER: A. Place a large-bore IV catheter in the left second
intercostal space at the midclavicular line
Rationale: This patient is presenting with classic signs of a tension pneumothorax:
tracheal deviation to the contralateral side and decreased breath sounds on the affected
side. Immediate needle decompression (thoracentesis) is the life-saving intervention to
release the trapped air before it causes obstructive shock.
Question 7: Which of the following is the correct adult dose of epinephrine for
a patient in cardiac arrest with a non-shockable rhythm (PEA/Asystole)?
A. 1 mg 1:10,000 IV/IO every 3-5 minutes
B. 0.1 mg 1:1,000 IV/IO every 3-5 minutes
C. 1 mg 1:1,000 IV/IO every 3-5 minutes
D. 0.1 mg 1:10,000 IV/IO every 3-5 minutes
CORRECT ANSWER: A. 1 mg 1:10,000 IV/IO every 3-5 minutes
Rationale: In the setting of cardiac arrest, standard dosing for epinephrine is 1 mg of a
1:10,000 solution (0.1 mg/mL) administered intravenously or intraosseously every 3 to 5
minutes for all arrest rhythms. The 1:1,000 concentration is used primarily for
anaphylaxis or severe asthma when given intramuscularly.
, Question 8: A patient presents with signs of shock after a multiple-vehicle
collision. Your assessment reveals a distended neck vein and muffled heart
sounds. What condition should be suspected, and what is the immediate
intervention?
A. Tension pneumothorax; needle decompression
B. Cardiac tamponade; pericardiocentesis
C. Flail chest; positive pressure ventilation
D. Pulmonary contusion; fluid restriction
CORRECT ANSWER: B. Cardiac tamponade; pericardiocentesis
Rationale: Beck's triad (hypotension, distended neck veins, and muffled heart sounds)
is the classic presentation of cardiac tamponade, often caused by blunt or penetrating
trauma. This is a compressive condition that prevents ventricular filling, requiring
immediate needle pericardiocentesis to relieve the pressure and improve cardiac output.
Question 9: In the context of a patient with severe sepsis, which of the
following findings indicates that the patient is in compensated shock rather
than decompensated shock?
A. Lactic acidosis with a pH of 7.20
B. Hypotension with a systolic blood pressure of 80 mmHg
C. Tachycardia and narrowing pulse pressure
D. Anuria and acute kidney injury
CORRECT ANSWER: C. Tachycardia and narrowing pulse pressure
Rationale: Compensated shock is characterized by the body's physiologic attempts to
maintain perfusion. This includes tachycardia, peripheral vasoconstriction (cool skin),
and narrowing pulse pressure. Hypotension is a hallmark of decompensated shock
where compensatory mechanisms fail, and organ damage begins.
Question 10: You are treating a patient with a suspected opiate overdose. The
patient is apneic with a heart rate of 50 bpm. After initiating BVM ventilations,
what is the most appropriate next step for reversal?
A. Administer 2 mg of naloxone IV/IM
B. Administer 0.4 mg of naloxone IV/IM
C. Administer 0.1 mg of naloxone IV/IM
D. Administer 5 mg of naloxone IV/IM
CORRECT ANSWER: B. Administer 0.4 mg of naloxone IV/IM
