Complete NREMT Exam Preparation and Practice Question Review 2025

A client presents with hypotension, pulmonary crackles, cool clammy skin, and jugular vein distension after an acute myocardial infarction. Which type of shock does this presentation indicate? • Hypovolemic shock • Neurogenic shock • Cardiogenic shock • Septic shock Rationale: Cardiogenic shock occurs when the heart fails to pump effectively after myocardial damage, leading to low cardiac output, pulmonary congestion, and elevated jugular venous pressure. Hypovolemic shock lacks fluid volume; neurogenic has bradycardia and warm skin; septic shock presents with vasodilation and fever. A trauma patient presents with hypotension, distended neck veins, and muffled heart sounds. Which type of shock is this consistent with? • Obstructive shock • Hypovolemic shock • Distributive shock • Cardiogenic shock Rationale: These findings describe Beck’s triad—JVD, hypotension with narrow pulse pressure, and muffled heart sounds—indicating cardiac tamponade, a form of obstructive shock. Hypovolemic shock shows flat neck veins; distributive shock has vasodilation and warm skin; cardiogenic shock presents with pulmonary edema. Beck’s triad consists of which clinical findings? • Jugular vein distention, muffled heart sounds, and narrowing pulse pressure • Tachycardia, bounding pulse, and warm skin • Bradycardia, hypotension, and sweating • Cyanosis, tachypnea, and hypothermia Rationale: Beck’s triad defines cardiac tamponade. It reflects decreased venous return and impaired cardiac filling due to pericardial pressure. The other sets of signs describe unrelated hemodynamic states. A patient presents with warm, flushed skin, bounding pulse, and hypotension due to severe infection. Which type of shock is most likely? • Cardiogenic shock • Hypovolemic shock • Distributive shock (septic) • Obstructive shock Rationale: Septic shock, a distributive type, results from widespread vasodilation due to inflammatory mediators. Cardiogenic shock presents with pulmonary congestion; hypovolemic with cold clammy skin; obstructive with mechanical interference of cardiac output. Which of the following best defines hypovolemic shock? • The heart fails to contract effectively • There is inadequate circulating blood volume to maintain perfusion • Widespread dilation of blood vessels causes blood pooling • Mechanical obstruction reduces cardiac output Rationale: Hypovolemic shock results from blood or fluid loss, reducing venous return and cardiac output. Cardiogenic relates to heart pump failure; distributive to vasodilation; obstructive to mechanical barriers. The most effective immediate intervention for any type of shock is: • Administering antibiotics • Giving sedatives • Providing high-flow oxygen and controlling the cause (bleeding, obstruction, etc.) • Encouraging ambulation Rationale: High-flow oxygen improves tissue perfusion, while managing the underlying cause stabilizes circulation. Antibiotics only help in sepsis; sedatives worsen hypotension; ambulation decreases venous return. If the brain is deprived of oxygen, what occurs after approximately 6 minutes? • Full recovery of brain function • Permanent brain damage • Mild confusion • Cardiac arrhythmia Rationale: After 4 minutes without oxygen, brain cells begin dying; by 6 minutes, irreversible brain injury develops. At 10 minutes, death is likely. During management of a conscious choking adult, which sequence of actions should the rescuer follow? • Chest compressions followed by rescue breaths • Five back blows followed by five abdominal thrusts, alternating until object expulsion or collapse • Heimlich maneuver only • Blind finger sweep and rescue breathing Rationale: Alternating back blows and abdominal thrusts generates pressure changes to clear the airway. Finger sweeps risk pushing the object deeper unless it is visible. Rescue breathing is only for unresponsive patients. In a choking infant who remains conscious, which steps are correct? • Blind finger sweeps after each back blow • Five back blows with the infant’s head lower than the body, followed by five chest thrusts using two fingers • Five abdominal thrusts and then five rescue breaths • Chest compressions only Rationale: Infants cannot receive abdominal thrusts due to organ injury risk. Use alternating back blows and chest thrusts until the obstruction clears or the infant becomes unresponsive. During CPR, which of the following compression-to-ventilation ratios is correct for a tworescuer pediatric team? • 30:2 • 10:1 • 15:2 • 20:5 Rationale: In children and infants, two-rescuer CPR uses a 15:2 ratio to deliver more frequent ventilations. The 30:2 ratio applies to single rescuers regardless of age. A client with chest trauma has absent breath sounds on the right side, tracheal deviation to the left, and severe respiratory distress. What is the likely diagnosis? • Pulmonary embolism • Tension pneumothorax