NREMT exam practice 6

Question 1

A utility worker went down into a sewer manhole and stopped answering. A coworker climbed down to help and also collapsed. Neither is moving. What do you do?

Accepted Answer

Two people collapsing in the same confined space points to a toxic or oxygen-poor atmosphere. Rescuers without specialized training and breathing equipment become the next patients. Keep everyone out and get a trained team.

Question 2

A responsive adult has had pain in the lower right abdomen since last night. During your focused secondary assessment, how do you palpate the abdomen?

Accepted Answer

Palpate gently, starting away from the pain and ending at the painful quadrant. Touching the painful area first can make the patient guard and tense the whole abdomen, which hides findings in the other quadrants.

Question 3

A medical helicopter has landed in the field you secured for it, and its rotor blades are still turning. You need to bring the patient to the aircraft. How do you approach?

Accepted Answer

Approach a helicopter only when a crew member signals you, and from the front or the side the crew directs, where the pilot can see you. Stay well away from the tail rotor, which is hard to see when it is spinning.

Question 4

You are called to a second-floor apartment for chest pain. At the door you find an alert man who weighs about 450 pounds sitting on the floor of a narrow hallway. The scene is safe. When do you request a lift assist crew?

Accepted Answer

Scene size-up includes deciding whether you need more help and calling for it right away. Extra crews take time to arrive, so requesting them at the door means they are on the way while you assess and treat.

Question 5

A 25-year-old cut the palm of her hand while slicing a bagel. She is alert, the bleeding is controlled, and she has no other complaints. She did not fall or strike anything. How do you do her secondary assessment?

Accepted Answer

With no significant mechanism and an alert patient who can say where it hurts, the secondary assessment focuses on the injured area. For a hand wound that includes checking circulation, movement and sensation beyond the injury.

Question 6

Sort each patient by the type of consent that allows you to treat them.

Accepted Answer

Expressed consent comes from an alert adult with decision-making capacity, given in words or by action. Implied consent applies in an emergency when the patient cannot consent, or is a minor whose parent or guardian cannot be reached, on the assumption that they would agree to care.

Question 7

A 61-year-old man collapsed in a store. He does not respond when you tap him and shout. About every 8 seconds he takes a slow, noisy gasp. You do not feel a carotid pulse within 10 seconds. A bystander tells you he is still breathing. Your partner has the AED. What do you do?

Accepted Answer

Occasional gasps are agonal breathing, not normal breathing. An unresponsive adult with no normal breathing and no definite pulse is in cardiac arrest. Start compressions at once and use the AED as soon as it is ready.

Question 8

A 40-year-old woman at a restaurant grabbed her throat while eating steak. She is coughing forcefully, and between coughs she tells you, "It's stuck." Her skin color is normal. What do you do?

Accepted Answer

A patient who can speak and cough forcefully has a mild obstruction with good air exchange. Her own cough is the best way to clear it. Do not interfere, but stay close and act at once if the cough becomes weak or silent or she can no longer speak.

Question 9

An adult has just stopped having a seizure. He is unresponsive and snoring, his jaw is clenched, and he gags when you try to open his mouth. He has no head or facial injury. A head-tilt, chin-lift helps but does not stop the snoring. Which airway adjunct do you use?

Accepted Answer

A nasopharyngeal airway is tolerated by patients who still have a gag reflex and can be placed when the jaw is clenched. It is avoided when there is serious head or facial trauma, which this patient does not have.

Question 10

You are ventilating an adult who has a slow pulse and is not breathing, using a bag-valve mask with oxygen. Which findings show your ventilations are adequate? Select every finding that applies.

Accepted Answer

Adequate ventilation shows as visible chest rise and fall, improving oxygen saturation and skin color, and a heart rate returning toward normal when hypoxia had slowed it. A swelling abdomen and rising resistance point to air going into the stomach or an airway problem.

Question 11

While you ventilate an unresponsive adult with a bag-valve mask, you notice the upper abdomen is becoming swollen and firm. The chest is still rising with each breath. What do you change?

Accepted Answer

Air goes into the stomach when breaths are too large, too fast, or given through a poorly opened airway. Reposition the airway and give each breath over about 1 second with only enough volume to make the chest rise. Pushing on the stomach can cause vomiting and aspiration.

Question 12

An alert adult with asthma is wheezing and short of breath. Her prescribed albuterol metered-dose inhaler is with her, and medical direction approves helping her use it. Arrange the steps. One step does not belong.

Accepted Answer

Check the right patient, drug, dose and expiration, shake the inhaler, have the patient breathe out, then press the canister as she begins a slow, deep breath so the medicine is carried into the lungs. Holding the breath lets it settle before she breathes out, and reassessment shows whether it worked.

Question 13

After a call, the stretcher mattress has dried blood on it. You are wearing gloves. How do you get it ready for the next patient?

Accepted Answer

Blood and other soil block disinfectant from reaching germs, so a surface is cleaned first and then disinfected. A disinfectant only works if the surface stays wet with it for the contact time printed on its label.

Question 14

A man was stabbed in the crease of the groin. Bright red blood is spurting from the wound, which is too close to the torso for a tourniquet. Firm pressure with your gloved hand has not stopped the bleeding. You carry hemostatic gauze. What do you do next?

Accepted Answer

Bleeding at a junction such as the groin cannot be controlled with a tourniquet. Pack hemostatic gauze into the wound so it presses on the bleeding vessel, then hold firm, direct pressure on top for several minutes, as the gauze maker directs.

Question 15

You were giving abdominal thrusts to a man choking on food when he went limp. You lower him to the floor. He is unresponsive. Arrange the steps of care. One step does not belong.

Accepted Answer

Once a choking adult becomes unresponsive, start CPR, beginning with compressions, which can also push the object out. Each time you open the airway to give breaths, look in the mouth and remove an object only if you can see it, then attempt the breath.

Question 16

A construction worker spilled dry powdered lime on both forearms. The powder is still on his skin, and he says it is starting to burn. The scene is safe and you are wearing gloves and eye protection. What do you do first?

Accepted Answer

With a dry chemical, brush away as much as possible before using water. Some dry chemicals, lime included, react with water and give off heat or spread over more skin. Once the powder is off, flush with large amounts of water and keep flushing on the way.

Question 17

Ten minutes ago you delivered a healthy baby, and the placenta followed. The mother is still bleeding heavily from the vagina and has soaked through two pads. Her pulse has risen from 92 to 118. The baby is breathing well. What do you do?

Accepted Answer

Heavy bleeding after the placenta delivers usually means the uterus is not contracting. Firm massage of the top of the uterus (the fundus) through the lower abdomen helps it tighten and squeeze the bleeding vessels closed. Treat for shock and transport without delay.

Question 18

You are called to a mobile home for a man with burned hands. From the open door you smell a strong ammonia-like odor and see glass jars, plastic tubing, a camp stove and stained coffee filters on the kitchen table. The man is lying on the kitchen floor, moaning. What do you do?

Accepted Answer

The odor and equipment point to an illegal drug lab, which can hold toxic fumes, fire and explosion hazards, and sometimes armed occupants or traps. Do not enter. Withdraw to a safe distance, keep others out, and request law enforcement and a hazardous materials team.

Question 19

A motorcyclist was thrown over the handlebars and is unresponsive with a pulse. Your partner holds his head in line. An oral airway is in place, the mouth is clear, and you have a good mask seal, but with a jaw-thrust maneuver you still cannot make the chest rise with the bag-valve mask. What do you do next?

Accepted Answer

The jaw thrust is the first choice when a spinal injury is possible, but an open airway comes first. When a jaw thrust does not open the airway, use a head-tilt chin-lift, keeping the head movement no more than you need.

Question 20

Your protocol allows EMTs to use CPAP for respiratory distress. Which patient is the best candidate?

Accepted Answer

CPAP suits an alert patient who is breathing on their own in moderate to severe distress, such as fluid in the lungs, with an adequate blood pressure. It is avoided with low blood pressure, a suspected pneumothorax, or a patient who cannot protect the airway or is not breathing adequately.

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