NREMT exam practice 7

Question 1

During size-up you decide whether you can go to the patient or must wait at a safe distance. Sort each call by what you do on arrival.

Accepted Answer

Stage at a safe distance whenever there is a known or likely threat of violence that has not been controlled, such as an armed person or an attacker still present. Go in when nothing you see or hear suggests danger, and keep watching as you work.

Question 2

A factory worker caught his forearm in a machine. The machine is locked out and the scene is safe. He is awake and shouting for help, and bright red blood is spurting from a deep cut on his forearm and pooling on the floor. What do you do first?

Accepted Answer

Bleeding this heavy can kill within minutes, so it is controlled the moment you find it, before the rest of the primary assessment. A patient who is shouting has an open airway and is breathing for now.

Question 3

A patient has severe bleeding from a deep wound on the lower thigh, and you are applying a windlass tourniquet. Arrange the steps. One step does not belong.

Accepted Answer

Place the tourniquet above the wound on bare skin away from a joint, pull the strap snug, twist the windlass until the bleeding stops, lock it, and record the time. Once on, a tourniquet stays on until hospital staff take over.

Question 4

A soccer player has a painful, deformed lower leg. Before splinting, you felt a strong pulse in the foot. You apply a padded rigid splint and secure the straps. Now you cannot find the pulse in the foot, and the toes are pale and cool. What do you do?

Accepted Answer

Check pulse, movement and sensation below the injury before and after splinting. If the pulse is lost after the splint goes on, the splint is the likely cause: loosen it, reassess, and readjust it. If the pulse does not return, transport promptly and follow protocol or medical direction.

Question 5

An alert adult with pneumonia is breathing fast but adequately, and his oxygen saturation is 85 percent. You decide to give oxygen by nonrebreather mask at 15 liters per minute. What do you do before you place the mask on his face?

Accepted Answer

The nonrebreather works because the patient breathes from a reservoir bag full of oxygen. Turn the flow on and fill the bag first (covering the valve inside the mask speeds this), then place the mask and keep the flow high enough that the bag does not collapse when the patient breathes in.

Question 6

At a chemical spill, the hazardous materials team has set up hot, warm, and cold zones. You are an EMT on an ambulance crew with no hazmat suit or hazmat technician training. Where do you take over patient care?

Accepted Answer

The hot zone holds the contamination, the warm zone is where decontamination happens, and the cold zone is the clean area outside. EMS crews without hazmat protection and training receive patients in the cold zone after decontamination.

Question 7

You bring a stable patient with abdominal pain into a busy emergency department. No nurse is free, and the triage line is long. Dispatch radios you about another call. What do you do?

Accepted Answer

Care must pass to someone with at least your level of training. Leaving a patient before a nurse or doctor accepts care is abandonment. Tell dispatch you are still waiting to transfer care so they can send another unit.

Question 8

You are called to a 58-year-old woman who feels weak and dizzy. The scene is safe and you have put on gloves. Arrange the steps of your primary assessment in order. One step does not belong in the primary assessment.

Accepted Answer

The primary assessment for a responsive medical patient moves from a general impression to the level of responsiveness, then airway, breathing and circulation, and ends with a decision on transport priority. The SAMPLE history belongs to the secondary assessment, after life threats are found and managed.

Question 9

A 66-year-old woman's daughter called because her mother suddenly started slurring her words 30 minutes ago. When you check her with the Cincinnati Prehospital Stroke Scale, her smile is even and both arms stay up with her eyes closed, but her speech is slurred when she repeats a sentence. How do you interpret this?

Accepted Answer

Any one abnormal finding on the Cincinnati Prehospital Stroke Scale (facial droop, arm drift or abnormal speech) is a positive screen. Treat her as a possible stroke: note the last known well time, notify the hospital early and transport promptly.

Question 10

You are in a small kitchen with a 30-year-old man who called for chest pain. He becomes loud and angry as you ask him questions, and a knife block sits on the counter beside him. Which actions help keep you and your partner safe? Select every action that applies.

Accepted Answer

With a patient who is becoming agitated, keep a clear exit, stay alert to anything that could be used as a weapon, and use a calm voice to de-escalate. Keep your partner with you, stay facing the patient, and leave and call law enforcement if the situation gets worse.

Question 11

You call online medical direction about a patient with chest pain. The physician says, "Assist the patient with one more nitroglycerin tablet under the tongue, then recheck the blood pressure in 5 minutes." What do you do before carrying out the order?

Accepted Answer

Repeating an order back, sometimes called the echo technique, lets the physician catch any misunderstanding before the medication is given. If an order seems unclear or wrong, ask the physician to repeat or explain it. Document the order and who gave it.

Question 12

You are ventilating an unresponsive adult with a bag-valve mask by yourself. He has a thick beard, and with every squeeze you hear air hissing out around the mask while his chest barely rises. Your partner has just finished setting up the oxygen. What is the best next step?

Accepted Answer

One rescuer often cannot hold a tight seal and squeeze the bag at the same time, especially over a beard. With two rescuers, one uses both hands to seal the mask and lift the jaw while the other squeezes. This is the preferred technique whenever a second rescuer is free.

Question 13

A hiker spent the night outdoors in wet boots. Several toes on each foot are white, hard and numb. He is sitting at the trailhead. You are about to move him to your warm ambulance for a 20-minute transport, and the feet will not be exposed to cold again. Which actions are appropriate? Select every action that applies.

Accepted Answer

Frozen tissue is easily damaged. Remove wet clothing, handle the area gently, and protect it with loose, dry dressings with padding between the toes. Do not rub it, break blisters, let the patient walk on it, or apply direct heat.

Question 14

A family of four is brought out of a house where a gas furnace has been malfunctioning. The father has a severe headache, is nauseated, and is slow to answer questions. His pulse oximeter reads 99% on room air. How should you treat him?

Accepted Answer

A standard pulse oximeter cannot tell carbon monoxide bound to hemoglobin from oxygen, so it can show a normal reading in a patient who is badly poisoned. Treat the history and the symptoms: suspected carbon monoxide exposure gets high-flow oxygen by nonrebreather mask.

Question 15

You find a 71-year-old man in cardiac arrest, and your partner starts compressions while you open the AED. When you bare his chest, you see a firm lump about the size of a matchbox under the skin just below his right collarbone, right where the upper pad would go. What do you do?

Accepted Answer

A lump under the collarbone is likely an implanted pacemaker or defibrillator. A pad placed directly over it can block part of the shock. Move the pad at least about an inch away from the device, or use front-and-back placement, and do not delay the shock.

Question 16

A 62-year-old man with diabetes is found by his wife with new weakness of his right arm and slurred speech. He is awake, his airway is clear, and his breathing is adequate. Which assessment is most important to complete before you decide this is a stroke?

Accepted Answer

Low blood sugar can cause one-sided weakness and slurred speech that look exactly like a stroke, especially in a patient with diabetes. Checking the blood glucose is quick, and a low reading changes his treatment right away.

Question 17

A sedan struck a tree head-on. The steering wheel airbag deployed, but the passenger-side airbag in the dashboard did not. The passenger is awake, complaining of neck pain, and still seated. The scene is otherwise stable. How do you position yourself while you assess her?

Accepted Answer

An airbag that did not deploy in a crash can still go off later and seriously injure anyone in its path. Keep yourself out of the space in front of it, approach from the side, and do not tamper with it. Rescue crews disable or manage the airbag system.

Question 18

A motorcyclist was thrown from his bike. His right thigh is swollen and angulated midway between the hip and knee. You are considering a traction splint for that leg. Which additional finding means you should not use one?

Accepted Answer

A traction splint pushes against the pelvis and pulls on the leg, so it is used only for an isolated mid-thigh femur fracture. A pelvic injury, or an injury to the hip, knee, lower leg or ankle on the same side, means you do not use one. An unstable pelvis also suggests serious internal bleeding and calls for rapid transport.

Question 19

An 8-month-old was found limp in her crib. She is unresponsive and was breathing only a few gasps a minute. You have been giving bag-mask ventilations with oxygen, and the chest rises with each breath. The brachial pulse is now 50 per minute, and her skin is pale and mottled. Your partner has the AED. What do you do next?

Accepted Answer

In an infant or child, a pulse below 60 per minute with signs of poor perfusion, even though ventilation and oxygenation are adequate, is treated with CPR. Start compressions, keep ventilating, and attach the AED once CPR is under way.

Question 20

A 67-year-old man with COPD has been struggling to breathe for two days. When you arrived he was sitting upright, breathing 34 times a minute and answering in short phrases. You placed him on oxygen. Ten minutes later his respiratory rate is 10, his breaths are shallow, his head keeps dropping forward, and he opens his eyes only when you speak loudly. What do you do now?

Accepted Answer

A rate that falls from very fast to slow while the patient becomes drowsy is not improvement. It means he is tiring out and heading into respiratory failure. Shallow breaths at 10 a minute with a falling level of responsiveness are inadequate breathing, and he needs ventilations with a bag-valve mask and oxygen.

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