NREMT exam practice 8

Question 1

You and your partner are about to lift a loaded stretcher from the ground. Which technique best protects your back?

Accepted Answer

In a power lift you stand with your feet shoulder-width apart, keep your back straight and locked, hold the load close to your body, and rise by straightening your legs. Your legs, not your back, do the work.

Question 2

You arrive in daylight at a two-car crash on a busy highway. A fire engine is parked at an angle to block the lane, and you park behind it with your emergency lights on. Before you step out to walk to the patients, what do you put on along with your gloves?

Accepted Answer

Being struck by a passing vehicle is one of the leading dangers at roadway scenes. Wear a high-visibility reflective vest whenever you work on or near a roadway, day or night, even when the scene is blocked by other vehicles.

Question 3

You use the Cincinnati Prehospital Stroke Scale on several patients. For each finding, decide whether it is normal or abnormal.

Accepted Answer

The Cincinnati scale checks three things: facial droop (both sides should move equally when smiling), arm drift (both arms should stay up or move the same), and speech (the right words, clearly spoken). One abnormal finding is enough to suspect a stroke.

Question 4

Sort each patient by the position you transport them in.

Accepted Answer

Patients in respiratory distress usually breathe best sitting up. An unresponsive patient without suspected spine injury who is breathing adequately goes on the side so the airway can drain. Spinal motion restriction and low blood pressure without breathing trouble call for lying flat.

Question 5

While cleaning up after a call, you are stuck in the finger by a used lancet from the patient's blood glucose check. What do you do?

Accepted Answer

After a needlestick, wash the site with soap and water and report it at once to your supervisor or designated infection control officer, following your service's exposure plan. Medicine to prevent HIV after an exposure works best when started within hours, so medical evaluation must not wait.

Question 6

You are writing a patient care report for a 61-year-old man with chest discomfort. Sort each piece of information as subjective or objective.

Accepted Answer

Subjective information is what the patient, family, or bystanders tell you: complaints, feelings, and their account of events. Objective information is what you can see, hear, feel, or measure yourself, such as vital signs and physical findings.

Question 7

A patient in respiratory distress needs high-flow oxygen by nonrebreather mask. Arrange the steps for setting up the cylinder and applying the mask. One step does not belong.

Accepted Answer

Crack the valve first to clear dust, attach the regulator, then open the cylinder and check for leaks and pressure. Connect the nonrebreather, set the flow high enough to keep the reservoir full, prefill the bag, and only then place the mask on the patient. Oil or grease near pressurized oxygen can ignite.

Question 8

During the primary assessment you listen to how each patient is breathing. Sort each sound by the problem it most likely points to.

Accepted Answer

Snoring means the tongue or soft tissue is partly blocking the airway, and a manual maneuver such as a head-tilt chin-lift or jaw thrust opens it. Gurgling means liquid is in the airway and needs suction. Stridor is a high-pitched sound on inhalation from swelling or narrowing high in the airway, as in allergic swelling or croup. Wheezing comes from narrowed small airways in the lungs, as in asthma.

Question 9

A 5-year-old boy is in cardiac arrest at a playground. Your partner has run back to the ambulance for the AED and the bag-valve mask, so you are doing CPR alone with a pocket mask. Which compression-to-ventilation ratio and compression depth are correct?

Accepted Answer

A single rescuer uses 30 compressions to 2 breaths for a child, the same ratio as for an adult. The ratio changes to 15 to 2 only when two rescuers do child CPR. Compress at least one-third of the depth of the chest, which is about 2 inches in a child. About 1 1/2 inches is the infant depth.

Question 10

Before you dress each burn, you estimate its depth. Sort each burn by depth.

Accepted Answer

A superficial burn involves only the outer layer of skin: red, painful, and without blisters. A partial-thickness burn reaches into the dermis: blisters, moist or mottled skin, and intense pain. A full-thickness burn goes through all the layers of skin: dry, leathery, white, brown, or charred, with little or no pain where the nerve endings are destroyed.

Question 11

A pickup truck has rolled into a ditch and is resting on its driver's side. The driver is still inside, talking, and says his neck hurts. When your partner touches the truck, it rocks. The fire department is a few minutes away. What do you do?

Accepted Answer

A vehicle that moves when touched is not safe to climb on or enter. It is stabilized with cribbing or struts before anyone gets on or in it. Until then, stay off and out, keep talking to the driver, tell him to hold still, and pass what you know to the arriving rescue crew.

Question 12

A 74-year-old woman's husband says she went to bed at 10:30 p.m. talking normally. He heard her get up to use the bathroom around 2:00 a.m. but did not see or speak with her. At 6:15 a.m. he woke and found her unable to lift her right arm, with slurred speech. Because of her speech difficulty, she cannot tell you how she felt during the night. It is now 6:40 a.m. What time do you report as her last known well?

Accepted Answer

Last known well is the last time someone actually knew the patient was at their normal baseline. Hearing her move around does not show she was free of symptoms, so the last confirmed normal time is when she went to bed. If a patient can reliably report being normal at a later time, that time can be used, so always ask.

Question 13

A 22-year-old fell onto a short wooden garden stake. It went through his right cheek into his mouth and moves freely. He is spitting blood, gurgling, and struggling to breathe. What do you do with the stake?

Accepted Answer

Impaled objects are normally stabilized in place, but an object through the cheek is the exception when it threatens the airway, because bleeding into the mouth cannot be controlled with it in place. Remove it in the direction it entered if it comes out easily, pack dressing material between the cheek and the teeth, dress the outside, suction, and position the patient so blood drains out of the mouth.

Question 14

You are assessing young children who are having trouble breathing. For each finding, decide whether it fits a child who is still compensating (respiratory distress) or one who has progressed to respiratory failure.

Accepted Answer

In respiratory distress the child is working hard but still compensating: alert or agitated, breathing fast, using extra muscles, with a fast heart rate. Respiratory failure begins when the child tires: the mental status falls, breathing slows or becomes irregular, and the heart rate drops. A child in failure needs assisted ventilation now.

Question 15

A teenager has fallen into a fast-moving creek and is clinging to a branch about 25 feet from the bank, too far to reach with a pole. You are not trained in water rescue, and the fire department's water rescue team is on the way. You have a rope throw bag. What do you do?

Accepted Answer

Water rescue follows reach, throw, row, go: use the lowest-risk method that will work. When the patient is too far to reach, throw a rope or flotation device from shore. Rescuers without training should never enter moving water, and a rope tied to a rescuer in a current can pull the rescuer under.

Question 16

A 34-year-old man is found on a bathroom floor with a syringe beside him. He does not respond when you tap him and shout. He is not breathing, and you feel no pulse after checking for 10 seconds. Your partner has naloxone and the AED. What do you do first?

Accepted Answer

A patient with no pulse is in cardiac arrest whatever caused it. High-quality CPR and early use of the AED come first. Naloxone may be given once CPR is under way, but it is not proven to help a patient with no pulse and must never delay compressions.

Question 17

A 19-year-old driver who rolled his car is strapped to a long backboard with a cervical collar in place. On the way to the hospital he becomes nauseated and suddenly begins vomiting large amounts. What do you do?

Accepted Answer

A patient who vomits while lying flat can breathe the vomit into his lungs. When he is secured to a backboard, turn the board and patient together as one unit onto the side, so the vomit drains out while the spine stays in line, and suction what is left in the mouth.

Question 18

A 68-year-old man had his larynx removed for cancer and breathes through a permanent stoma in the front of his neck. He is unresponsive, breathing 4 times a minute, and has a pulse. You have suctioned the stoma. How do you ventilate him?

Accepted Answer

After a total laryngectomy the trachea opens only at the stoma, so air given through the mouth and nose never reaches the lungs. A small round infant or child mask seals well over the stoma for bag-mask ventilation. If air escapes from the mouth and nose, as can happen after a partial laryngectomy, close them while you ventilate.

Question 19

You are called to a 27-year-old woman in labor at 39 weeks. When you check for crowning, you see a loop of umbilical cord coming out of the vagina ahead of the baby. The cord is pulsing. What do you do?

Accepted Answer

With a prolapsed cord, the baby's head presses the cord against the pelvis and cuts off the baby's blood and oxygen supply. Position the mother with her hips raised (or knee-chest), insert gloved fingers to hold the presenting part off the cord, keep the exposed cord moist with sterile dressings, give oxygen, tell her not to push, and transport without delay.

Question 20

A 31-year-old woman who is 36 weeks pregnant collapsed at home. She is unresponsive, not breathing, and has no pulse. Her uterus is well above her navel. You have her flat on her back on the floor and your partner is attaching the AED. How do you perform CPR?

Accepted Answer

Late in pregnancy, the uterus presses on the large vessels in the abdomen when the woman lies on her back, so less blood returns to the heart during compressions. Keep her flat on a firm surface for good compressions, and have a rescuer push the uterus to her left with both hands the whole time CPR goes on. The best care for the baby is good CPR for the mother.

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