NREMT Practice Exam 4

Which organs are contained in the right upper quadrant of the abdomen?

Chest pain associated with stable angina may be caused by

Your patient is a 65-year-old female complaining of chest pressure. The EKG shows a wide complex tachycardia at a rate of 200 beats per minute. The patient’s vital signs are P = 200, RR = 26, and BP 90/60. Which of the following answers is the best treatment for this patient?

What does the P of the AVPU acronym mean?

What are the components of the focused history and physical exam?

What does pulse pressure refer to?

A 56-year-old male experienced a syncopal episode and is now complaining of intense chest pressure. His vital signs are RR = 26, P = 110, and BP = 80/64. Crackles can be auscultated in both lower lung fields. Which of the following conditions best defines the patient’s presentation?

An elderly male is complaining of a sudden onset of severe pain in his right leg. The affected extremity is cool to the touch and pale. The temperature and pulse in the patient’s left leg is normal. You suspect

Answer questions 9–11 on the basis of the following information.

You arrive at a golf course to find a 45-year-old male unconscious and responsive to pain but only with movement. The patient was struck in the head by a golf ball traveling at high velocity. His eyes are closed; pupil examination reveals his left pupil is 2 mm, and the right is 8 mm and not reactive to light. This patient moves upper extremities to localized pain and moves lower extremities spontaneously. He is breathing full deep respirations at a rate of 24 per minute.

You would expect the vital signs of this patient generally to follow which of the following groupings?

Treatment of this patient would include which of the following?

A patient with a closed head injury should be closely monitored for all of the following EXCEPT

Your patient, a car accident victim, complains of seeing “a dark curtain” in front of one eye. What should you suspect?

Treatment for a patient in cardiogenic shock who is complaining of chest pressure should include

Signs and symptoms of traumatic asphyxia includes which of the following?

An adult patient has burns covering her head and upper back. Using the rule of nines, this patient’s burns cover what percentage of her body surface area?

How would you classify a burn that is pearly white and almost painless?

Which of the following conditions indicates the need for rapid transport?

What is the Glasgow Coma Scale Score for a patient who opens her eyes in response to pain, speaks incomprehensibly, and withdraws in response to pain?

Your patient is a 23-year-old man who complains of abdominal pain. The patient states that the pain began suddenly and was originally located only in the area around the umbilicus. Now, however, it has moved to the right lower quadrant. The patient also complains of nausea and vomiting, and he has a fever of 102° F. Examination displays rebound tenderness.

What condition should you suspect?

A 42-year-old male complains of sudden, intense pain that is centered in his lower back. He is pale, cool, and diaphoretic, especially below the level of his umbilicus. He is tachycardic and hypotensive. Which of the following conditions best describes the patient presentation?

Your patient is an 76-year-old male who is complaining of malaise. He has no medical history and takes no medications. His BP is 112/70, pulse is 60 and irregular, respirations 20, lungs clear and equal bilaterally, skin is warm and dry. Figure 5.1 depicts his ECG. Prehospital management of this patient includes which of the following?

What does the initial symptom of infection with HIV primarily consist of?

A 63-year-old male is complaining of substernal chest pain radiating to his left arm and jaw. He is diaphoretic and cool to the touch. The cardiac monitor shows sinus tachycardia. The patient’s vital signs are BP = 136/70, P = 118, and RR = 16. You have administered oxygen and established an IV. What should you do now?

Your patient is a 78-year-old woman who is complaining of diffuse abdominal pain, nausea, and vomiting. Physical examination reveals abdominal distention and absent bowel sounds. You should suspect she has which of the following conditions?

Atypical signs and symptoms of myocardial infarction that are commonly seen in elderly patients include all of the following EXCEPT

Which breathing pattern is characteristic of diabetic ketoacidosis or other types of metabolic acidosis?

Normal vesicular breath sounds are usually described as having which of the following characteristics?

What is the purpose of the OPQRST mnemonic?

Your patient is a 70-year-old male. He complains of chest pain that began while he was raking leaves. You perform an initial assessment and a focused history and physical examination and administer oxygen and nitroglycerin. The patient then states that he feels much better. What is he most likely suffering from?

A 25-year-old female complains of diffuse lower-abdominal pain, vaginal discharge, and low-grade fever. Which of the following conditions best describes the patient’s presentation?

What do the signs and symptoms of hypertensive crisis include?

Why are vital sign changes not a good early indicator of shock in a young healthy adult?

During an emergency delivery, the newborn’s head presents in the canal. After suctioning, how can you assist with the delivery of the anterior shoulder?

The physiological cause of the anxiety and restlessness that make up the classic early signs of shock are a direct result of which of the following phenomena?

Answer questions 35–37 on the basis of the following information.

You arrive to find a 65-year-old male in acute respiratory distress. You hear wheezes from across the room, and you note extreme accessory muscle use. The patient has assumed a tripod position and is breathing through pursed lips. Your physical exam reveals a barrel chest and stained fingernails. Vital signs are blood pressure, 160/90; pulse, 100, strong and irregular with atrial fibrillation on the cardiac monitor; and respiratory rate, 40, with shallow and labored breathing. Ausculation of the chest reveals wheezes and diminished lung sounds throughout all fields.

What is this patient most likely suffering from?

Which of the following medications would not be used to treat this patient’s condition?

Why is this patient breathing through pursed lips?

Under what circumstance could the pulse oximetry reading show a falsely elevated reading in a patient?

Which statement about airway obstruction caused by the tongue is incorrect?

Which technique should you use to open the airway of a trauma patient?

What is bronchiolitis caused by?

Answer questions 42–44 on the basis of the following information.

Your patient is a 30-year-old female who is complaining of a generalized rash and dyspnea after eating shellfish. The patient has small itchy, red welts all over her body and says her tongue feels like it is swollen. She complains of difficulty moving air in and difficulty catching a full breath. This patient’s vital signs show a blood pressure of 110/60; a pulse of 100, strong and regular; and a respiratory rate of 36. Her breathing is somewhat shallow and labored.

This patient is exhibiting the signs and symptoms of

Medications used to treat this patient may include which of the following?

This patient needs close monitoring because she could progress into which of the following conditions?

After placing an endotracheal tube, you note that breath sounds are much stronger on the right side of the chest than on the left. What does this suggest?

You have just delivered a baby girl. Evaluation reveals that the infant cries loudly and has a heart rate of 140, her body is pink but the extremities are blue, and she is actively moving all extremities. Her APGAR score is

Causes of third-trimester bleeding include

What is an assessment finding of pulsus paradoxus associated with?

The term tracheal tugging refers to which of the following?

A dull sound heard during chest percussion may be associated with which condition?

Pulse oximetry allows you to continuously record which of the following?

Your patient is a 66-year-old man who is extremely thin but has a noticeably distorted barrel-shaped chest. He reports a history of dyspnea that has recently gotten worse. You note that he purses his lips when breathing, but hypoxia is not apparent. In addition to monitoring vital signs, breath sounds, and the ECG, starting an IV, and transporting the patient, what other treatments should you give to this patient?

A 28-year-old woman is complaining of a sudden onset of severe abdominal pain that radiates to her shoulder. Her BP = 88/60, P = 110, and R = 20. Her skin is cool, pale, and clammy. She states that her last normal menstrual period was 6–8 weeks ago. Which of the following conditions best describes the patient presentation?

What respiratory pattern is characteristic of Kussmaul’s respiration?

Which of the following factors increases the amount of energy necessary for the patient to expend for respiration?

What does it mean if the pH of normal urine is 6.0 and the pH of distilled water is 7.0?

Your patient is a 6-year-old child who is conscious but not breathing because of an airway obstruction. What is the first thing you should do for this patient?

You should attempt to remove foreign material from a patient’s airway with forceps only in what situation?

Answer questions 59–63 on the basis of the following information.

Your patient is a 29-year-old female complaining of the sudden onset of severe shortness of breath and chest pain. She indicates that she is recovering from surgery to her left femur after an automobile crash.

What is this patient most likely suffering from?

You would expect to find which of the following in this patient?

This patient’s physiological problems are most likely due to what cardiac problem?

Proper management of this patient includes which of the following?

Which of the following conditions is a common cause of this patient’s problem?

Which of the following combinations are the only two situations in which a prehospital provider should place a gloved hand into the vagina?

A patient suspected of showing early signs of shock should usually be placed supine with his or her feet elevated. When is this position contraindicated?

Which statement about deflation of the PASG/ MAST in the field setting is correct?

Which of the following statements is true regarding a single limb presentation during an emergency delivery?

When responding to the scene of a hazardous materials incident, the EMS crew should approach from

How should you position a patient with a suspected CVA and no other pertinent history?

The vital signs of a patient experiencing the later stages of increased intracranial pressure will be characterized by which of the following?

The T wave on an ECG tracing represents which of the following events?

You are analyzing a patient’s heart rate on an ECG strip. You note that there are 13 complexes within one 6-second interval. You would record the heart rate as which of the following?

Normal atrial depolarization is seen on the Lead II ECG strip as which of the following waveforms?

Which of the following is an abnormal finding on an ECG strip?

An EMS crew attempts to resuscitate a 50-yearold male in cardiac arrest and is not successful. The family sues the EMS organization for negligence. The crew will need to prove that its actions during the resuscitation

How does the Valsalva maneuver improve a too-rapid heartbeat?

Which dysrhythmia may be a sign of digitalis toxicity?

Your patient is a 67-year-old man who has a pulse and whose ECG strip shows ventricular tachycardia. What should you do after administering oxygen and placing an IV line?

Which of the following is a risk factor for the formation of atherosclerosis?

The pain caused by myocardial infarction is usually relieved only by the use of which of the following medications?

During a multi casualty incident, the first two arriving paramedics should assume which roles?

All of the following are components of an incident command system EXCEPT

Why are patients who present with pulmonary edema usually assumed to have had a myocardial infarction?

What is the primary goal of management for a patient with left ventricle failure and pulmonary edema?

Your patient is a 68-year-old male with a history of two prior AMIs. Your assessment findings include a pulse rate of 124, peripheral edema, and jugular vein distention. The patient denies any chest pain or breathing difficulty. What condition should you suspect?

Your patient is an 82-year-old female with a suspected MI. While en route to the hospital, you note that her systolic blood pressure, which had been stable, has started to drop, and that she is becoming confused. At the same time, her heart rhythm converts to sinus tachycardia. What should you should suspect is happening?

Your patient is a 65-year-old male who is complaining of pain in his abdomen, back, and flanks. His blood pressure is 90/60. On examination, you note that the femoral pulses are markedly weaker than the radial pulses. What should you do next?

Which of the following are signs and symptoms of acute pulmonary embolism?

Your patient is a 67-year-old female who complains of increasing leg pain and tenderness. The skin over the affected area is warm and red, and Homan’s sign is positive. Vital signs are unremarkable. How should you treat this patient?

In general, the court deems an emancipated minor to be one who

1. is married.

2. is economically independent.

3. maintains a separate home.

4. is in the military.

What is the initial energy setting for defibrillation in an adult cardiac arrest patient?

Carotid sinus massage is used for patients with which dysrhythmia?

External cardiac pacing is used for which of the following rhythms?

What is the usual dosage and route of administration of diazepam given before synchronized cardioversion?

Which drug is used in management of congestive heart failure?

Which heart sounds are normal findings on auscultation?

Which set of vital signs is suggestive of left ventricular heart failure with pulmonary edema?

Answer questions 98–103 on the basis of the following information.

You respond for a 44-year-old male diabetic who is complaining of a general feeling of weakness. During your questioning, you learn that he has been “constantly thirsty and hungry.” His breath has a fruity odor, and his level of consciousness appears to be diminishing.

Which diabetic emergency is this patient most likely suffering from?

Which vital signs would you expect from this patient?

This patient’s symptoms are most likely due to which condition?

Which of the following statements is the most accurate with regard to this patient?

During transport, this patient slips into unconsciousness, and his breathing becomes very deep and rapid. What is this pattern called?

What does appropriate treatment for this patient include?

After a critical incident, a “defusing” should be done

Asymmetrical movement during respiration typically suggests which condition?

Your patient suffers a head trauma that results in a transient loss of consciousness followed by a complete return of function. What is the term for this condition?

What is the proper procedure for aligning a fractured long bone?

When would you bandage and splint limb injuries on scene?

What should you always do if your examination of a limb suggests that it is fractured?

Which type of wound would most likely require a tourniquet?

A patient with hypoglycemia may present with which of the following signs or symptoms?

What is the primary reason that diazepam is given to a seizure patient?

What is the correct dosage and route of administration of epinephrine for a patient in anaphylaxis?

What is the role of beta agonists like albuterol in the treatment of anaphylaxis?

During a multicasualty incident, a conscious patient presents with a fractured femur, a palpable radial pulse, and a respiratory rate of 24/ min. According to START, this patient would be placed into what triage category?

What do the symptoms of acetaminophen overdose include?

Prehospital administration of sodium bicarbonate may be ordered for a patient who has overdosed on which of the following drugs?

Your patient is a 19-year-old female who has been stung by a stingray while swimming. What should you do after ensuring airway breathing and circulation are intact?

Which drug can cause users to behave violently and aggressively?

Which of the following patients shows signs and symptoms of heat exhaustion?

Which of the following activities are performed by the EMT-Paramedic in the field?

1. maintaining and preparing of emergency care equipment and supplies

2. directing and coordinating patient transport by selecting the best methods

3. assigning priorities of emergency treatment

4. initiating and continuing emergency treatment

Which of the following statements about care of a near-drowning victim is correct?

Which of the following are the signs and symptoms of air embolism?

You are interviewing a 43-year-old woman with a long history of schizophrenia. She appears to try to cooperate, but there are long periods of silence in your conversation while she listens to her “voices.” How should you respond during her silence?

A patient with bipolar disorder usually suffers from which of the following?

Answer questions 126–128 on the basis of the following information.

You respond to a 12-year-old male who is wheezing and having difficulty breathing. The patient has a long history of asthma and states that he used his inhaler but that it didn’t help much. Upon examination, you discover that the patient is tachycardic and tachypneic with a nonproductive cough.

What is the primary goal in treating this patient?

This patient’s condition might have been triggered by any of the following EXCEPT

Treatment for this patient includes which of the following medications?

Diazepam and lorazepam are examples of which of the following?

Starting an IV on an alert patient who refuses one could result in your being held liable for which of the following?

A 5-year-old male has multiple injuries in various stages of healing, including raccoon eyes and a new suspected broken leg. On questioning, his mother states that he fell out of his bunk bed, but his sister, age 9, says that “Daddy beat him.” The mother insists that her husband will take the child to the hospital when he gets home from work. How should you proceed?

Until ruled out by a physician, documented fever in an infant younger than three months old is always considered to result from which of the following?

What does appropriate management of a child with epiglottitis consist of?

Answer questions 134–138 on the basis of the following information.

You respond to the residence of a 4-year-old male who was found in his backyard, head down in a 5-gallon bucket of water. The child, according to the mother, was in the water for approximately four minutes. The child is cyanotic, pulseless, and apneic. The ECG shows he is in asystole. The child weighs approximately 40 pounds.

A physician at the scene of an incident instructs you to provide care for a patient that you know to be inappropriate given the patient’s present condition. Your best course of action will be to

Which of the following would be the most reliable method for determining the proper medication dosing for this pediatric patient?

All of the following medications can be given through the endotracheal tube to pediatric patients EXCEPT

After endotracheal intubation of this patient, which of the following steps should be done first?

After the first round of ACLS drugs, the patient converts to a sinus bradycardia at a rate of 40 beats per minute. What is the drug of choice for managing this patient’s bradycardia?

Knee injuries and hip dislocations that occur during a motor vehicle crash are often the result of which pathway of energy transfer?

A high-velocity bullet passes through the body. Besides the direct damage caused by the bullet, what other related condition could cause harm to the patient?

Your patient is a 5-year-old girl who presents with breathing difficulty of rapid onset. She is sitting upright and drooling. Her temperature is 104.6° F. What should you suspect?

An injury to the brain opposite the site of a blunt force impact is called

One way to determine the size of the endotracheal tube to use in a child is to use the following equation: 16 + the child’s age divided by 4. Another consideration is the size of the child’s

What should you do in order to preserve physical evidence in cases of suspected sexual assault?

A 17-year-old male complains of a steadily worsening headache several days after being struck in the head during football practice. Which of the following injuries best describes this patient’s presentation?

When should you examine a woman who is about to give birth for crowning?

Your patient is a 32-year-old woman who reports that she is 14 weeks pregnant. She complains of abdominal cramping and vaginal bleeding. How should you proceed?

What is the cause of the supine-hypotensive syndrome in the pregnant patient?

Which of the following is a differential sign or symptom of spinal shock associated with trauma?

During a normal delivery, you would tell the mother to stop pushing when what occurs?

What is the appropriate treatment for a prolapsed cord?

Immediately after delivery, how should you position the neonate?

A patient who complains of a sudden and painless complete loss of vision in one eye is most likely suffering from

The first step in the resuscitation of a distressed neonate is to

All but which of the following statements about supplying supplemental oxygen to a neonate is correct?

How much intravenous fluid should you administer to a distressed neonate who weighs 2 kg?

A patient was hit several times in the left chest with the large end of a pool cue. The patient is in severe respiratory distress with tachycardia and tachypnea. Crepitus can be felt over the left anterior fourth, fifth, sixth, and seventh rib area. Lung sounds are clear and equal, but diminished. Which of the following conditions best describes the patient’s presentation?

Which statement describes a tiered EMS system?

A patient is found lying supine on the floor with a stab wound to her right anterior chest, just below the breast. The patient is having difficulty breathing, with cool, clammy skin signs. No JVD is noted. Breath sounds are absent over the right side. This patient most likely is experiencing a

Which activity is an example of indirect medical control?

Answer questions 161–165 on the basis of the following information.

You respond to reports of a bus collision. Upon arrival, it appears that you have approximately 35 patients.

What is your first priority?

The first parameter to assess when using the START triage algorithm should be

A male patient is found to have a respiratory rate of 38. This would place him in which of the following categories?

Another male patient is found to have a respiratory rate of 28 and a radial pulse of 84. He is confused about the incident. This patient would be placed in which of the following categories?

A female patient is found to have no spontaneous respirations. What should you do next?

A person with a serious illness can delegate the right to make medical decisions to someone else by enacting which of the following legal documents?

What is the legal term for an intentional deviation from the accepted standard of care that results in harm to a patient?

You are acting under the doctrine of implied consent when you treat which of the following patients?

Your patient is a 28-year-old man who is suffering a seizure. You monitor his condition during the seizure and throughout the postictal period, but when the patient recovers, he refuses transport or further treatment. What should you do next?

A wrestler feels his shoulder “pop” when his opponent twists his arm during a hold. There is immediate pain and loss of range of motion in the shoulder. What is the patient’s likely injury?

All of the following are correct statements about the care of patients who are contaminated by hazardous material EXCEPT

Your unit is the first to arrive at the scene of a bombing at a large office building. The purpose of your initial size-up of the incident is to

At a major incident response, which of the following is the responsibility of the staging officer?

Which statement about the triage operation at a mass-casualty incident is correct?

Using the START triage method at a multiple casualty accident scene, you encounter a patient who is making no spontaneous respiratory effort despite attempts at repositioning. What should you do next?

You have responded to a home for an unknown emergency. Your patient, a 74-year-old male named George Evans, has been found at home in rigor mortis with dependent lividity. The best thing to tell his family initially is

All but which of the following statements about use of disposable gloves and infection control are true?

A 72-year-old man trips and falls while walking to his bathroom. Physical findings include a lateral rotation of the left foot and knee. The patient has tenderness and a protrusion in the left groin area. You suspect

When is use of “reasonable” force or use of restraints permissible for a patient?

Tertiary injuries from a blast include