NREMT Practice Questions
Prepare for NREMT with more than an answer.
- 1
Which of the following describes the pathophysiology of distributive shock?
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Correct answer: C
Distributive shock (e.g., septic, anaphylactic, neurogenic) is caused by massive systemic vasodilation. This increases the size of the 'container' (the vascular system) without a change in the amount of fluid. The blood volume becomes insufficient to fill the dilated vessels and perfuse tissues, leading to a state of 'relative hypovolemia'. Cardiogenic shock is a pump problem, and hypovolemic shock is a fluid loss problem.
- 2
You are assessing a newborn baby immediately after a precipitous delivery in the patient's home. The baby is cyanotic, limp, and has a heart rate of 80 bpm. What is the most important initial intervention?
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Correct answer: C
According to neonatal resuscitation guidelines, if a newborn's heart rate is below 100 bpm after initial steps (drying, warming, stimulating), the most critical intervention is to provide positive-pressure ventilations (PPV). Most neonatal bradycardia is due to hypoxia, and correcting ventilation and oxygenation will typically resolve the heart rate. Chest compressions are only initiated if the heart rate remains below 60 bpm despite effective PPV.
- 3
When arriving on the scene of a potential crime, such as a shooting or stabbing, what is the EMT's primary responsibility regarding evidence?
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Correct answer: B
The absolute priority for EMS is patient care. However, providers should be mindful that they are in a crime scene. They should not actively collect evidence but should aim to preserve it by disturbing the scene as little as possible. This includes noting the patient's position, not cutting through holes in clothing from bullets or weapons if possible, and avoiding moving items unnecessarily. This balances the need for medical care with the legal requirements of the investigation.
- 4
A patient with a history of end-stage renal disease (ESRD) who missed their dialysis appointment is most likely to experience which life-threatening electrolyte imbalance?
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Correct answer: A
The kidneys are responsible for excreting potassium. In ESRD, this function is lost. When a patient misses dialysis, potassium levels can build up in the blood, leading to hyperkalemia. Severe hyperkalemia is cardiotoxic and can cause fatal dysrhythmias, such as peaked T waves, widened QRS, and eventually ventricular fibrillation or asystole. This is the most immediate life-threatening complication of a missed dialysis treatment.
- 5
You are caring for a patient with a tension pneumothorax. After performing a needle decompression in the second intercostal space, midclavicular line, you hear a rush of air, and the patient's vital signs initially improve. Five minutes later, the patient's respiratory distress returns, and their blood pressure begins to drop again. What is the most likely cause and appropriate next step?
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Correct answer: B
When a tension pneumothorax reaccumulates after a successful initial decompression, the most common cause is that the catheter has become occluded (e.g., by a blood clot) or has kinked. The underlying air leak is still present, allowing the pleural space to refill with air. The appropriate management is to perform a second needle decompression, typically adjacent to the first site, to re-establish a patent opening for air to escape.
- 6
You are dispatched to a public park for a 6-year-old child who was stung by a bee and is now having difficulty breathing. The child is lethargic, has widespread urticaria, and audible stridor. Her mother states she has a prescribed epinephrine auto-injector. Which of the following is the most appropriate initial action?
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Correct answer: B
The child is exhibiting signs of severe anaphylaxis (stridor, lethargy, difficulty breathing), which is a life-threatening emergency. The definitive treatment is epinephrine. Assisting with the patient's own prescribed auto-injector is the most critical and immediate intervention. While oxygen is important, it does not reverse the underlying pathophysiology of anaphylaxis. Transport and contacting medical control are also necessary steps, but they follow the life-saving administration of epinephrine.
- 7
During the primary assessment of an unresponsive adult patient rescued from a house fire, you note soot around the mouth and nose, singed facial hair, and a hoarse voice. The patient's respirations are shallow at 28 breaths per minute. What is the most significant concern for this patient?
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Correct answer: C
The presence of soot, singed facial hair, and a hoarse voice are classic signs of a significant inhalation injury. This can lead to rapid and severe swelling (edema) of the upper airway, resulting in complete obstruction. While carbon monoxide poisoning and shock are also serious concerns, the most immediate life-threat that must be anticipated and managed is the loss of a patent airway.
- 8
You are managing a 78-year-old female with a history of CHF who is in severe respiratory distress. She is sitting upright, anxious, and has audible crackles in all lung fields. Her SpO2 is 85% on a non-rebreather mask. Vital signs are BP 190/110, P 120, R 32. Which intervention is indicated for this patient?
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Correct answer: C
This patient's presentation is classic for acute cardiogenic pulmonary edema. CPAP is the primary intervention for these patients. It works by increasing intrathoracic pressure, which decreases venous return (preload) and pushes fluid out of the alveoli back into the capillaries, improving gas exchange. The patient meets the criteria for CPAP: alert, able to follow commands, in severe respiratory distress, and hypertensive. Bronchodilators are for bronchoconstriction (e.g., asthma/COPD), and laying the patient supine would worsen their condition.
- 9
While assessing a 34-year-old male involved in a high-speed motor vehicle collision, you note that he has no palpable radial pulses but does have a palpable carotid pulse. This finding generally suggests the patient's systolic blood pressure is at least:
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Correct answer: C
The presence of peripheral versus central pulses can provide a rough estimation of systolic blood pressure (SBP). The presence of a carotid pulse indicates an SBP of at least 60-70 mmHg. If a femoral pulse were present, it would suggest an SBP of 70-80 mmHg, and a radial pulse suggests an SBP of at least 80-90 mmHg. The absence of a radial pulse but presence of a carotid pulse strongly suggests significant hypotension, likely in the 60-70 mmHg range.
- 10
You are called to a nursing home for an 88-year-old male with an altered mental status. Staff reports he has had a productive cough and fever for two days. He is lethargic, with hot, flushed skin. Vital signs are: BP 88/50, P 124, R 26, SpO2 91%, Temp 102.8°F. Which of the following conditions is most likely responsible for his presentation? (Select TWO)
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Correct answer: A, C
The patient's history of infection (cough, fever) combined with signs of systemic inflammatory response and organ dysfunction (AMS, hypotension, tachycardia, tachypnea) are classic indicators of sepsis.
The productive cough and fever strongly suggest a respiratory infection, with pneumonia being a very common cause in elderly patients. The pneumonia is the likely source of the systemic infection leading to sepsis.
