NREMT EMT CERTIFICATION
COMPREHENSIVE EXAM REVIEW
(2026/2027) QUESTIONS AND ANSWERS
1. A 68-year-old male with a history of COPD presents with severe respiratory distress. He is
sitting in a tripod position, using accessory muscles, and has a respiratory rate of 28
breaths/min. His pulse oximetry is 84%. What is the most appropriate initial management for
this patient?
A. Begin CPAP at 5 to 10 cm H2O if no contraindications exist.
B. Initiate positive pressure ventilation with a BVM.
C. Place the patient on a non-rebreather mask at 15 L/min.
D. Provide oxygen via nasal cannula at 2 L/min to avoid suppressing his hypoxic drive.
Answer: A
Conceptual Explanation: For a patient in severe respiratory distress (accessory muscle
use, tripod position) with a history of COPD, CPAP is the gold standard if the patient is
conscious and can follow commands. It helps keep the alveoli open and reduces the work of
breathing. A non-rebreather may not be sufficient, and BVM is reserved for respiratory
failure (lethargy, inadequate rate/volume).
,2. A 22-year-old female was involved in a high-speed motor vehicle collision. She is pale, cool,
and diaphoretic. Her vital signs are: BP 88/60, P 130, R 24. Which stage of shock is this patient
likely experiencing?
A. Compensated shock
B. Decompensated shock
C. Irreversible shock
D. Distributive shock
Answer: B
Conceptual Explanation: Decompensated shock is characterized by a drop in blood
pressure (hypotension). In compensated shock, the body maintains blood pressure through
increased heart rate and vasoconstriction. Once the systolic BP falls below 90 mmHg in an
adult with other signs of shock, it is considered decompensated.
3. While assessing a 74-year-old female complaining of chest pain, you find her pulse is
irregular and she feels lightheaded. She has a history of atrial fibrillation. Which of the
following is the most concerning complication associated with this rhythm?
A. Hyperglycemia
B. Pulmonary edema
C. Ischemic stroke
D. Hypovolemic shock
, Answer: C
Conceptual Explanation: Atrial fibrillation causes the atria to quiver rather than contract
effectively, which can lead to blood stasis and the formation of clots. These clots can travel
to the brain, causing an embolic (ischemic) stroke.
4. A 4-year-old male is found in respiratory distress with a ‘seal-like’ barking cough and low-
grade fever. What is the most likely diagnosis?
A. Croup
B. Epiglottitis
C. Asthma
D. Bronchiolitis
Answer: A
Conceptual Explanation: Croup (laryngotracheobronchitis) typically presents with a
barking cough and stridor in young children. Epiglottitis is more acute, involves a high
fever, and the child usually presents with drooling and no cough.
5. Which of the following findings is part of Cushing’s Triad, indicating increased intracranial
pressure?
A. Tachycardia, hypotension, and irregular respirations
B. Bradycardia, hypotension, and Cheyne-Stokes respirations
C. Tachycardia, hypertension, and tachypnea
COMPREHENSIVE EXAM REVIEW
(2026/2027) QUESTIONS AND ANSWERS
1. A 68-year-old male with a history of COPD presents with severe respiratory distress. He is
sitting in a tripod position, using accessory muscles, and has a respiratory rate of 28
breaths/min. His pulse oximetry is 84%. What is the most appropriate initial management for
this patient?
A. Begin CPAP at 5 to 10 cm H2O if no contraindications exist.
B. Initiate positive pressure ventilation with a BVM.
C. Place the patient on a non-rebreather mask at 15 L/min.
D. Provide oxygen via nasal cannula at 2 L/min to avoid suppressing his hypoxic drive.
Answer: A
Conceptual Explanation: For a patient in severe respiratory distress (accessory muscle
use, tripod position) with a history of COPD, CPAP is the gold standard if the patient is
conscious and can follow commands. It helps keep the alveoli open and reduces the work of
breathing. A non-rebreather may not be sufficient, and BVM is reserved for respiratory
failure (lethargy, inadequate rate/volume).
,2. A 22-year-old female was involved in a high-speed motor vehicle collision. She is pale, cool,
and diaphoretic. Her vital signs are: BP 88/60, P 130, R 24. Which stage of shock is this patient
likely experiencing?
A. Compensated shock
B. Decompensated shock
C. Irreversible shock
D. Distributive shock
Answer: B
Conceptual Explanation: Decompensated shock is characterized by a drop in blood
pressure (hypotension). In compensated shock, the body maintains blood pressure through
increased heart rate and vasoconstriction. Once the systolic BP falls below 90 mmHg in an
adult with other signs of shock, it is considered decompensated.
3. While assessing a 74-year-old female complaining of chest pain, you find her pulse is
irregular and she feels lightheaded. She has a history of atrial fibrillation. Which of the
following is the most concerning complication associated with this rhythm?
A. Hyperglycemia
B. Pulmonary edema
C. Ischemic stroke
D. Hypovolemic shock
, Answer: C
Conceptual Explanation: Atrial fibrillation causes the atria to quiver rather than contract
effectively, which can lead to blood stasis and the formation of clots. These clots can travel
to the brain, causing an embolic (ischemic) stroke.
4. A 4-year-old male is found in respiratory distress with a ‘seal-like’ barking cough and low-
grade fever. What is the most likely diagnosis?
A. Croup
B. Epiglottitis
C. Asthma
D. Bronchiolitis
Answer: A
Conceptual Explanation: Croup (laryngotracheobronchitis) typically presents with a
barking cough and stridor in young children. Epiglottitis is more acute, involves a high
fever, and the child usually presents with drooling and no cough.
5. Which of the following findings is part of Cushing’s Triad, indicating increased intracranial
pressure?
A. Tachycardia, hypotension, and irregular respirations
B. Bradycardia, hypotension, and Cheyne-Stokes respirations
C. Tachycardia, hypertension, and tachypnea
