NREMT EMT Certification Problem Solving Exam
Questions and With Distinction level Marking scheme
updated 2024/2025
What can a paramedic expect to occur in a closed-head injury patient when the
intracranial pressure increases and the mean arterial pressure decreases?
A. The patient's cerebral blood flow decreases
B. The patient has likely suffered a brainstem herniation
C. A marked increase in the patient's blood glucose level
D. The formation of an intracranial abscess - correct answer a.
When determining an estimated time of death on-scene, what is the terminology used to
describe blood and fluid leaving the areas of the face, nose, and chin assisted by gravity
and allowed to settle in the lowest parts of the body?
A. Dependent lividity
B. Cyanosis
C. Rigor mortis
D. Post-partum blood pooling - correct answer a.
You are intubating a 26-year-old who is apneic. Once the endotracheal tube passes
through the vocal cords, how much farther should the endotracheal tube be advanced
before inflating the cuff and confirming proper placement?
A. 0.5 to 1 inch
B. Less than 1 cm
C. 2 to 3 cm
D. 1 to 2.5 inches - correct answer a.
You are cleaning the back of the truck after transporting a trauma patient to the
emergency department. Which of the following contaminated items should not be
placed in a plastic biohazard bag?
,A. Plastic iv catheter
B. Nasopharyngeal or oral airway
C. French suction catheter
D. Blood-soaked gauze pads - correct answer a.
You suspect that your trauma patient may be experiencing the adverse effects of a
crush injury after being entrapped under a fallen building for several hours before
rescue. He is found to be wheezing with shortness of breath and hypotension with no
obvious sign of chest wall/lung injury or blood loss.
What is the most likely cause of these findings in a crush injury patient?
A. Histamine release
B. Atelectasis from the compressive forces
C. Aortic dissection
D. Thrombin formation - correct answer a.
Your adult asthma patient is experiencing a severe attack characterized by inspiratory
and expiratory wheezes with potential airway compromise due to laryngospasm. Which
of the following interventions would be most appropriate after oxygen therapy is
applied?
A. 2.5 to 5 mg of albuterol solution mixed with 3 ml of 0.9 normal saline and nebulized
with 6-8 lpm of oxygen
B. Rapid sequence intubation with sedation
C. 0.31 mg of levalbuterol nebulized with 6-8 lpm of oxygen
D. 0.3-0.5 ml (1:1000) of epinephrine delivered im/sc; repeat in 15 minutes if needed -
correct answer a.
You are preparing to perform fluid replacement on an adult trauma patient who lost a
significant amount of his circulating blood volume when you note the presence of a
drastic systolic blood pressure decline from 100 mmhg to 86 mmhg systolic after the
patient's bleeding is controlled. The patient has no obvious new bleeding, but his
abdomen is distended and is painful on palpation. There are no obvious masses,
bruises, or deformity, and he has active bowel sounds over the epigastric region.
,Which of the following intravenous fluids would be most appropriate in this situation if
the medical command physician recommends a fluid challenge?
A. 0.9% normal saline
B. 0.45% sodium chloride
C. 0.45% normal saline with 5% dextrose
D. Lactated ringer's solution - correct answer d.
What type of communication system operational mode is required for an ems agency to
be able to communicate simultaneously in both directions while also performing
telemetry transmission?
A. Multiplex mode
B. Duplex mode
C. Simplex mode
D. Complex mode - correct answer a.
You suspect your adult trauma patient has a potential complete spinal cord transection.
If so, which of the following would you expect to find?
A. Total loss of pain and sensation below the waist bilaterally with some loss of
movement below the waist
B. Bradycardia associated with loss in vascular tone
C. Total absence of pain, sensation, and movement (paralysis) below the point of the
transection (injury)
D. Right-sided paralysis with decreased sensation on the opposite side of the body -
correct answer c.
You are on-scene with a patient who you suspect may be experiencing a myocardial
infarction. He is conscious and alert, anxious, and has dilated pupils. He complains of
substernal chest pain and admits to recent cocaine use. How does the use of cocaine
increase the risk of experiencing an acute myocardial infarction?
A. It speeds the heart rate to the point of asystole
B. It causes the blood in the periphery to clot and travel to the coronary arteries
, C. It actually numbs the heart, making coronary perfusion difficult
D. It causes coronary artery constriction and increases the chance of dislodging a
thrombus or plaque - correct answer d.
In which of the following situations would evaluating the st segment elevation of a
patient suffering from a suspected myocardial infarction not be indicated to determine if
an infarction exists?
A. When a pre-existing right bundle branch block is present
B. When the patient is hypotensive
C. In the presence of pulmonary edema
D. In the presence of a left bundle branch block - correct answer d.
If an adult patient is experiencing the signs and symptoms of a myocardial infarction
with perfusing arrhythmias, which of the following pre-hospital interventions will help to
reduce the patient's cardiac preload and afterload?
A. The intravenous administration of 2-4 mg of morphine per a medical-control
physician's order
B. The administration of various medications and dosages to control the specific
dysrhythmias such as procainamide, atropine, verapamil, and others
C. The administration of sublingual nitroglycerin therapy
D. The administration of high-flow oxygen therapy (15 liters per minute) via a non-
rebreather mask - correct answer c.
Your adult patient was entrapped by dirt up to his mid-abdominal area for a few hours
while rescue crews worked to free him. Once on the cardiac monitor, why would tall,
tented t waves become evident quickly?
A. Hyperkalemia caused by the sudden influx of potassium
B. Myocardial ischemia caused by decreased available oxygen for the myocardium
C. Hypokalemia associated with the sudden release of the compressive force
D. Cardiac tamponade associated with increased intrathoracic pressure and blood
pressure - correct answer a.
Questions and With Distinction level Marking scheme
updated 2024/2025
What can a paramedic expect to occur in a closed-head injury patient when the
intracranial pressure increases and the mean arterial pressure decreases?
A. The patient's cerebral blood flow decreases
B. The patient has likely suffered a brainstem herniation
C. A marked increase in the patient's blood glucose level
D. The formation of an intracranial abscess - correct answer a.
When determining an estimated time of death on-scene, what is the terminology used to
describe blood and fluid leaving the areas of the face, nose, and chin assisted by gravity
and allowed to settle in the lowest parts of the body?
A. Dependent lividity
B. Cyanosis
C. Rigor mortis
D. Post-partum blood pooling - correct answer a.
You are intubating a 26-year-old who is apneic. Once the endotracheal tube passes
through the vocal cords, how much farther should the endotracheal tube be advanced
before inflating the cuff and confirming proper placement?
A. 0.5 to 1 inch
B. Less than 1 cm
C. 2 to 3 cm
D. 1 to 2.5 inches - correct answer a.
You are cleaning the back of the truck after transporting a trauma patient to the
emergency department. Which of the following contaminated items should not be
placed in a plastic biohazard bag?
,A. Plastic iv catheter
B. Nasopharyngeal or oral airway
C. French suction catheter
D. Blood-soaked gauze pads - correct answer a.
You suspect that your trauma patient may be experiencing the adverse effects of a
crush injury after being entrapped under a fallen building for several hours before
rescue. He is found to be wheezing with shortness of breath and hypotension with no
obvious sign of chest wall/lung injury or blood loss.
What is the most likely cause of these findings in a crush injury patient?
A. Histamine release
B. Atelectasis from the compressive forces
C. Aortic dissection
D. Thrombin formation - correct answer a.
Your adult asthma patient is experiencing a severe attack characterized by inspiratory
and expiratory wheezes with potential airway compromise due to laryngospasm. Which
of the following interventions would be most appropriate after oxygen therapy is
applied?
A. 2.5 to 5 mg of albuterol solution mixed with 3 ml of 0.9 normal saline and nebulized
with 6-8 lpm of oxygen
B. Rapid sequence intubation with sedation
C. 0.31 mg of levalbuterol nebulized with 6-8 lpm of oxygen
D. 0.3-0.5 ml (1:1000) of epinephrine delivered im/sc; repeat in 15 minutes if needed -
correct answer a.
You are preparing to perform fluid replacement on an adult trauma patient who lost a
significant amount of his circulating blood volume when you note the presence of a
drastic systolic blood pressure decline from 100 mmhg to 86 mmhg systolic after the
patient's bleeding is controlled. The patient has no obvious new bleeding, but his
abdomen is distended and is painful on palpation. There are no obvious masses,
bruises, or deformity, and he has active bowel sounds over the epigastric region.
,Which of the following intravenous fluids would be most appropriate in this situation if
the medical command physician recommends a fluid challenge?
A. 0.9% normal saline
B. 0.45% sodium chloride
C. 0.45% normal saline with 5% dextrose
D. Lactated ringer's solution - correct answer d.
What type of communication system operational mode is required for an ems agency to
be able to communicate simultaneously in both directions while also performing
telemetry transmission?
A. Multiplex mode
B. Duplex mode
C. Simplex mode
D. Complex mode - correct answer a.
You suspect your adult trauma patient has a potential complete spinal cord transection.
If so, which of the following would you expect to find?
A. Total loss of pain and sensation below the waist bilaterally with some loss of
movement below the waist
B. Bradycardia associated with loss in vascular tone
C. Total absence of pain, sensation, and movement (paralysis) below the point of the
transection (injury)
D. Right-sided paralysis with decreased sensation on the opposite side of the body -
correct answer c.
You are on-scene with a patient who you suspect may be experiencing a myocardial
infarction. He is conscious and alert, anxious, and has dilated pupils. He complains of
substernal chest pain and admits to recent cocaine use. How does the use of cocaine
increase the risk of experiencing an acute myocardial infarction?
A. It speeds the heart rate to the point of asystole
B. It causes the blood in the periphery to clot and travel to the coronary arteries
, C. It actually numbs the heart, making coronary perfusion difficult
D. It causes coronary artery constriction and increases the chance of dislodging a
thrombus or plaque - correct answer d.
In which of the following situations would evaluating the st segment elevation of a
patient suffering from a suspected myocardial infarction not be indicated to determine if
an infarction exists?
A. When a pre-existing right bundle branch block is present
B. When the patient is hypotensive
C. In the presence of pulmonary edema
D. In the presence of a left bundle branch block - correct answer d.
If an adult patient is experiencing the signs and symptoms of a myocardial infarction
with perfusing arrhythmias, which of the following pre-hospital interventions will help to
reduce the patient's cardiac preload and afterload?
A. The intravenous administration of 2-4 mg of morphine per a medical-control
physician's order
B. The administration of various medications and dosages to control the specific
dysrhythmias such as procainamide, atropine, verapamil, and others
C. The administration of sublingual nitroglycerin therapy
D. The administration of high-flow oxygen therapy (15 liters per minute) via a non-
rebreather mask - correct answer c.
Your adult patient was entrapped by dirt up to his mid-abdominal area for a few hours
while rescue crews worked to free him. Once on the cardiac monitor, why would tall,
tented t waves become evident quickly?
A. Hyperkalemia caused by the sudden influx of potassium
B. Myocardial ischemia caused by decreased available oxygen for the myocardium
C. Hypokalemia associated with the sudden release of the compressive force
D. Cardiac tamponade associated with increased intrathoracic pressure and blood
pressure - correct answer a.
