EMT-I/85 – Emergency Medical Technician
Intermediate/85 Comprehensive Certification Exam
Updated 2026 | 550+ Practice Questions & Verified
Answers | Ultimate Intermediate EMS Study Guide,
National EMT Exam Prep, Airway Management,
Trauma & Medical Emergencies, Cardiac Care, IV
Therapy, Pharmacology, Pediatric & Obstetric
Emergencies, Patient Assessment, EMS Operations,
Detailed Rationales
Question 1: A 45-year-old male is involved in a high-speed motor vehicle
collision. He is conscious but confused, with a respiratory rate of 8 breaths per
minute and shallow depth. Which of the following is the MOST appropriate
initial action?
A. Apply a non-rebreather mask at 15 L/min
B. Perform a head-tilt, chin-lift maneuver
C. Assist his ventilations with a bag-valve-mask device and supplemental oxygen
D. Insert a nasopharyngeal airway
CORRECT ANSWER: C. Assist his ventilations with a bag-valve-mask device
and supplemental oxygen
Rationale: The patient's respiratory rate of 8 is below the normal range, indicating
respiratory failure. The priority is to provide positive pressure ventilation with a BVM
and supplemental oxygen to correct hypoxia and hypercapnia. Simply applying oxygen
or opening the airway without providing ventilations is insufficient.
Question 2: Which of the following electrocardiographic findings is most
consistent with a primary pacemaker failure to capture?
A. Pacemaker spikes that occur without any visible P-wave or QRS complex following
them
B. Pacemaker spikes that occur at a fixed, regular rate, independent of the underlying
rhythm
C. Pacemaker spikes that are followed by a wide QRS complex with a left bundle branch
block morphology
D. Pacemaker spikes that are followed by a P-wave but no QRS complex
CORRECT ANSWER: A. Pacemaker spikes that occur without any visible P-
wave or QRS complex following them
Rationale: Failure to capture occurs when the pacemaker's electrical stimulus is
insufficient to depolarize the myocardium. This is seen as pacemaker spikes that are not
followed by a cardiac complex (P-wave or QRS). The other options describe different
pacemaker functions or characteristics.
,Question 3: In the context of defibrillation for a patient in pulseless ventricular
tachycardia, how does the electrical current primarily terminate the
arrhythmia?
A. By stimulating the vagus nerve to slow the heart rate
B. By causing a brief asystole, allowing the sinoatrial node to resume control
C. By depolarizing a critical mass of myocardial cells simultaneously, ending the re-
entrant circuit
D. By mechanically compressing the heart between the defibrillator pads
CORRECT ANSWER: C. By depolarizing a critical mass of myocardial cells
simultaneously, ending the re-entrant circuit
Rationale: Defibrillation works by delivering a high-energy shock that depolarizes a
sufficient mass of the myocardium. This simultaneous depolarization stops the chaotic
re-entrant circuits of V-Fib or pulseless V-Tach, allowing the heart's intrinsic pacemakers
to resume normal electrical activity.
Question 4: An EMT-I/85 is preparing to administer a medication via the
endotracheal route. Which of the following is an appropriate medication and
dosage for this route?
A. Atropine 0.5 mg
B. Epinephrine 2.0 mg
C. Lidocaine 1.0 mg/kg
D. Naloxone 0.4 mg
CORRECT ANSWER: C. Lidocaine 1.0 mg/kg
Rationale: The recommended endotracheal dose for Lidocaine is 2-4 mg/kg, often
simplified to 2.5 mg/kg. 1.0 mg/kg is a lower dose that may be used for other
indications but is a recognized starting point for some protocols. The ET route is used
for Lidocaine, Atropine, Epinephrine, and Naloxone (often remembered by the
mnemonic "LEAN"). Atropine and Epinephrine ET doses are typically 2-3 times the IV
dose (e.g., Atropine 2 mg, Epinephrine 2-2.5 mg), and Naloxone is given at 2 mg.
Question 5: A patient with a history of asthma is in respiratory distress. You
hear diminished breath sounds and no wheezing. This clinical finding is MOST
concerning for which condition?
A. Anaphylaxis
B. A spontaneous pneumothorax
C. A severe asthma exacerbation with impending respiratory failure ("silent chest")
D. A pulmonary embolism
,CORRECT ANSWER: C. A severe asthma exacerbation with impending
respiratory failure ("silent chest")
Rationale: In severe asthma, bronchoconstriction and mucus plugging can become so
extensive that airflow is critically reduced or absent, leading to a "silent chest." This is a
life-threatening sign indicating that the patient is not moving enough air to generate
wheezing and is at high risk for respiratory arrest.
Question 6: Which of the following is the MOST appropriate method to confirm
proper placement of an endotracheal tube in a perfusing patient?
A. Listening for breath sounds over the epigastrium
B. Visualizing the tube passing through the vocal cords
C. Observing for bilateral chest rise and fall
D. Continuous waveform capnography
CORRECT ANSWER: D. Continuous waveform capnography
Rationale: Continuous waveform capnography is considered the gold standard for
confirming and continuously monitoring ET tube placement. It provides a real-time,
quantitative measurement of exhaled CO2, which is a more reliable indicator of tracheal
placement than clinical signs like auscultation or visualization alone, which can be
misleading.
Question 7: What is the primary physiological effect of positive end-expiratory
pressure (PEEP) in the management of a patient with pulmonary edema?
A. It increases cardiac output by increasing venous return
B. It decreases intrathoracic pressure to facilitate blood flow
C. It recruits and stabilizes alveoli, improving oxygenation and ventilation/perfusion
matching
D. It causes alveolar collapse by increasing surface tension
CORRECT ANSWER: C. It recruits and stabilizes alveoli, improving
oxygenation and ventilation/perfusion matching
Rationale: PEEP works by maintaining a positive pressure in the airways at the end of
expiration. This prevents alveolar collapse (atelectasis), recruits collapsed alveoli, and
improves the ventilation/perfusion (V/Q) mismatch, thereby enhancing oxygenation.
Question 8: A 58-year-old male presents with acute onset of right-sided chest
pain and dyspnea. He is tachypneic and has unilateral decreased breath
sounds on the right. His trachea is deviated to the left. Which of the following
is the MOST likely diagnosis?
, A. Right-sided pneumonia
B. Right-sided tension pneumothorax
C. Right-sided pleural effusion
D. Acute myocardial infarction
CORRECT ANSWER: B. Right-sided tension pneumothorax
Rationale: The classic presentation of a tension pneumothorax includes severe
respiratory distress, unilateral decreased breath sounds, hyperresonance to percussion,
and tracheal deviation to the contralateral (opposite) side. The tracheal deviation is a
key sign of the mediastinal shift caused by the accumulating air in the pleural space.
Question 9: Which of the following is a contraindication for the use of a
nasopharyngeal airway (NPA)?
A. A conscious patient
B. A suspected skull fracture
C. A history of nasal polyps
D. A possible cervical spine injury
CORRECT ANSWER: B. A suspected skull fracture
Rationale: The primary contraindication for an NPA is a suspected basilar skull fracture.
Inserting the airway into the nasal cavity could potentially pass through a fracture line
and enter the cranial vault, causing severe injury and infection.
Question 10: How does Nitroglycerin primarily exert its therapeutic effect in a
patient with acute coronary syndrome?
A. It increases myocardial contractility
B. It causes vasodilation, reducing preload and afterload, and dilates coronary arteries
C. It increases the heart rate to improve cardiac output
D. It blocks platelet aggregation to prevent clot formation
CORRECT ANSWER: B. It causes vasodilation, reducing preload and afterload,
and dilates coronary arteries
Rationale: Nitroglycerin is a vasodilator. Its primary effects are venous dilation
(reducing preload) and arterial dilation (reducing afterload). It also dilates the coronary
arteries, improving blood flow to the ischemic myocardium, thus relieving chest pain.
Question 11: In an adult patient, what is the single most important
intervention during the immediate post-resuscitation phase following a cardiac
arrest?
Intermediate/85 Comprehensive Certification Exam
Updated 2026 | 550+ Practice Questions & Verified
Answers | Ultimate Intermediate EMS Study Guide,
National EMT Exam Prep, Airway Management,
Trauma & Medical Emergencies, Cardiac Care, IV
Therapy, Pharmacology, Pediatric & Obstetric
Emergencies, Patient Assessment, EMS Operations,
Detailed Rationales
Question 1: A 45-year-old male is involved in a high-speed motor vehicle
collision. He is conscious but confused, with a respiratory rate of 8 breaths per
minute and shallow depth. Which of the following is the MOST appropriate
initial action?
A. Apply a non-rebreather mask at 15 L/min
B. Perform a head-tilt, chin-lift maneuver
C. Assist his ventilations with a bag-valve-mask device and supplemental oxygen
D. Insert a nasopharyngeal airway
CORRECT ANSWER: C. Assist his ventilations with a bag-valve-mask device
and supplemental oxygen
Rationale: The patient's respiratory rate of 8 is below the normal range, indicating
respiratory failure. The priority is to provide positive pressure ventilation with a BVM
and supplemental oxygen to correct hypoxia and hypercapnia. Simply applying oxygen
or opening the airway without providing ventilations is insufficient.
Question 2: Which of the following electrocardiographic findings is most
consistent with a primary pacemaker failure to capture?
A. Pacemaker spikes that occur without any visible P-wave or QRS complex following
them
B. Pacemaker spikes that occur at a fixed, regular rate, independent of the underlying
rhythm
C. Pacemaker spikes that are followed by a wide QRS complex with a left bundle branch
block morphology
D. Pacemaker spikes that are followed by a P-wave but no QRS complex
CORRECT ANSWER: A. Pacemaker spikes that occur without any visible P-
wave or QRS complex following them
Rationale: Failure to capture occurs when the pacemaker's electrical stimulus is
insufficient to depolarize the myocardium. This is seen as pacemaker spikes that are not
followed by a cardiac complex (P-wave or QRS). The other options describe different
pacemaker functions or characteristics.
,Question 3: In the context of defibrillation for a patient in pulseless ventricular
tachycardia, how does the electrical current primarily terminate the
arrhythmia?
A. By stimulating the vagus nerve to slow the heart rate
B. By causing a brief asystole, allowing the sinoatrial node to resume control
C. By depolarizing a critical mass of myocardial cells simultaneously, ending the re-
entrant circuit
D. By mechanically compressing the heart between the defibrillator pads
CORRECT ANSWER: C. By depolarizing a critical mass of myocardial cells
simultaneously, ending the re-entrant circuit
Rationale: Defibrillation works by delivering a high-energy shock that depolarizes a
sufficient mass of the myocardium. This simultaneous depolarization stops the chaotic
re-entrant circuits of V-Fib or pulseless V-Tach, allowing the heart's intrinsic pacemakers
to resume normal electrical activity.
Question 4: An EMT-I/85 is preparing to administer a medication via the
endotracheal route. Which of the following is an appropriate medication and
dosage for this route?
A. Atropine 0.5 mg
B. Epinephrine 2.0 mg
C. Lidocaine 1.0 mg/kg
D. Naloxone 0.4 mg
CORRECT ANSWER: C. Lidocaine 1.0 mg/kg
Rationale: The recommended endotracheal dose for Lidocaine is 2-4 mg/kg, often
simplified to 2.5 mg/kg. 1.0 mg/kg is a lower dose that may be used for other
indications but is a recognized starting point for some protocols. The ET route is used
for Lidocaine, Atropine, Epinephrine, and Naloxone (often remembered by the
mnemonic "LEAN"). Atropine and Epinephrine ET doses are typically 2-3 times the IV
dose (e.g., Atropine 2 mg, Epinephrine 2-2.5 mg), and Naloxone is given at 2 mg.
Question 5: A patient with a history of asthma is in respiratory distress. You
hear diminished breath sounds and no wheezing. This clinical finding is MOST
concerning for which condition?
A. Anaphylaxis
B. A spontaneous pneumothorax
C. A severe asthma exacerbation with impending respiratory failure ("silent chest")
D. A pulmonary embolism
,CORRECT ANSWER: C. A severe asthma exacerbation with impending
respiratory failure ("silent chest")
Rationale: In severe asthma, bronchoconstriction and mucus plugging can become so
extensive that airflow is critically reduced or absent, leading to a "silent chest." This is a
life-threatening sign indicating that the patient is not moving enough air to generate
wheezing and is at high risk for respiratory arrest.
Question 6: Which of the following is the MOST appropriate method to confirm
proper placement of an endotracheal tube in a perfusing patient?
A. Listening for breath sounds over the epigastrium
B. Visualizing the tube passing through the vocal cords
C. Observing for bilateral chest rise and fall
D. Continuous waveform capnography
CORRECT ANSWER: D. Continuous waveform capnography
Rationale: Continuous waveform capnography is considered the gold standard for
confirming and continuously monitoring ET tube placement. It provides a real-time,
quantitative measurement of exhaled CO2, which is a more reliable indicator of tracheal
placement than clinical signs like auscultation or visualization alone, which can be
misleading.
Question 7: What is the primary physiological effect of positive end-expiratory
pressure (PEEP) in the management of a patient with pulmonary edema?
A. It increases cardiac output by increasing venous return
B. It decreases intrathoracic pressure to facilitate blood flow
C. It recruits and stabilizes alveoli, improving oxygenation and ventilation/perfusion
matching
D. It causes alveolar collapse by increasing surface tension
CORRECT ANSWER: C. It recruits and stabilizes alveoli, improving
oxygenation and ventilation/perfusion matching
Rationale: PEEP works by maintaining a positive pressure in the airways at the end of
expiration. This prevents alveolar collapse (atelectasis), recruits collapsed alveoli, and
improves the ventilation/perfusion (V/Q) mismatch, thereby enhancing oxygenation.
Question 8: A 58-year-old male presents with acute onset of right-sided chest
pain and dyspnea. He is tachypneic and has unilateral decreased breath
sounds on the right. His trachea is deviated to the left. Which of the following
is the MOST likely diagnosis?
, A. Right-sided pneumonia
B. Right-sided tension pneumothorax
C. Right-sided pleural effusion
D. Acute myocardial infarction
CORRECT ANSWER: B. Right-sided tension pneumothorax
Rationale: The classic presentation of a tension pneumothorax includes severe
respiratory distress, unilateral decreased breath sounds, hyperresonance to percussion,
and tracheal deviation to the contralateral (opposite) side. The tracheal deviation is a
key sign of the mediastinal shift caused by the accumulating air in the pleural space.
Question 9: Which of the following is a contraindication for the use of a
nasopharyngeal airway (NPA)?
A. A conscious patient
B. A suspected skull fracture
C. A history of nasal polyps
D. A possible cervical spine injury
CORRECT ANSWER: B. A suspected skull fracture
Rationale: The primary contraindication for an NPA is a suspected basilar skull fracture.
Inserting the airway into the nasal cavity could potentially pass through a fracture line
and enter the cranial vault, causing severe injury and infection.
Question 10: How does Nitroglycerin primarily exert its therapeutic effect in a
patient with acute coronary syndrome?
A. It increases myocardial contractility
B. It causes vasodilation, reducing preload and afterload, and dilates coronary arteries
C. It increases the heart rate to improve cardiac output
D. It blocks platelet aggregation to prevent clot formation
CORRECT ANSWER: B. It causes vasodilation, reducing preload and afterload,
and dilates coronary arteries
Rationale: Nitroglycerin is a vasodilator. Its primary effects are venous dilation
(reducing preload) and arterial dilation (reducing afterload). It also dilates the coronary
arteries, improving blood flow to the ischemic myocardium, thus relieving chest pain.
Question 11: In an adult patient, what is the single most important
intervention during the immediate post-resuscitation phase following a cardiac
arrest?
