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NREMT COGNITIVE EXAM ASSESSMENT
WITH ANSWERS
In which of the following situations would you most likely encounter agonal gasps? A) ANY PT. WHO IS UNRESPONSIVE DUE TO HYPOXIA b) occlusion of the posterior pharynx by the tongue c) shortly after the pt. becomes unresponsive & pulseless d) significant hypoxemia, regardless of the cause - Correct answer c) After an adult cardiac arrest patient has been intubated by a paramedic, you are providing ventilations as your partner performs chest compressions. When ventilating the patient, you should A. deliver 2 breaths during a brief pause in chest compressions. B. deliver each breath over 1 second at a rate of 10 breaths/min C. hyperventilate the patient to maximize carbon dioxide elimination. D. deliver each breath over 2 seconds at a rate of 15 breaths/min. - Correct answer B) deliver each breath over 1 second at a rate of 10 breaths/min. During your assessment of a trauma patient, you note massive facial injuries, weak radial pulses, and clammy skin. What should be your MOST immediate concern? a) potential obstruction of the airway b) internal bleeding and severe shock c) applying 100 % supplemental O d) providing rapid transport to a trauma center - Correct answer a Clinically, reduced tidal volume would MOST likely present with respirations that are: - Correct answer shallow A patient presents with ineffective breathing that has no identifiable pattern. What term is used to describe this type of breathing? - Correct answer Ataxic After an initial attempt to ventilate a patient fails, you reposition the patient's head and reattempt ventilation without success. You should next
A. perform chest compressions, open the airway, and look into the mouth B. use a flow-restricted oxygen-powered ventilation device C. initiate airway obstruction removal techniques and provide transport D. continue to reposition the patient's head at the scene until you are able to secure a patent airway - Correct answer a An unresponsive 60-year-old male is apneic and has a weak, rapid pulse. His O2 saturation reads 79%. You should: a) deliver one breath over 1 second every 5 to 6 seconds b) use a pocket face mask to deliver 12 to 20 breaths / min c) hyperventilate him until his O2 saturation improves d) deliver a min. of 10 breaths/min, each over 1 sec. - Correct answer a You are ventilating an apneic adult with a BVM device and high-flow O2. Her pulse rate is 130 beats/min and she has cyanosis to her face & chest. Which of the following is the MOST reliable indicator of adequately performed ventilations in this patient? a) Slight dissipation of her cyanosis b) noted abdominal rise with each ventilation c) decreased compliance with each ventilation d) a decrease in her heart rate to 90 beats/min - Correct answer d If an adult patient presents with a respiratory rate of 26 breaths/min, your initial action should be to:
- A:evaluate his mental status and the depth of his respirations.
- B:begin assisting his ventilations with a bag-mask device.
- C:apply oxygen via a nonrebreathing mask and take his vital signs.
- D:apply the pulse oximeter and assess his oxygen saturation. - Correct answer a Aspirin may be contraindicated in patients with: a) glaucoma b) diabetes c) stomach ulcers d) ibuprofen allergy - Correct answer c) stomach ulcers
a)... the recovery position is appropriate for uninjured pt. w/ a decreased LOC & adequate breathing; it'll help maintain the airway and facilitate drainage of secretions from the mouth. but will not prevent another seizure b)...oral glucose may prevent another seizure if the cause of the seizure was due to hypoglycemia A 39-year-old male asks you to take him to the hospital because he had a fever, headache, and diarrhea for the past 2 days. His B.P. is 120/60 mm Hg, his pulse is 110 beats/min and his respirations are 16 breaths/min. You should: a) ask him if has a history of HIV infection or hepatitis b) transport him to the hospital in a position of comfort c) request an ALS ambulance to the scene to start an IV line d) advise him that he can drive himself to his family physician - Correct answer b ... pt. is requesting EMS transport, failure to comply constitutes abandonment a ... unethical to ask A 40-year-old male with a history of depression and schizophrenia appears frightened and tells you that he sees snakes everywhere. You should: A) tell him that you do not see any snakes, but they are obviously scaring him. B) let him know that going to the hospital will keep him safe from the snakes. C) advise him that you suspect he has not been compliant with his medications. D) let him know that it is important for him to be transported as soon as possible. - Correct answer A B ... The patient in this scenario, although scared, is not violent. In cases such as this, you should be prepared to spend extra time with the patient; it may take longer to assess, listen to, and prepare the patient for transport.
C...Just because he is experiencing an acute crisis does not mean that he has not been taking his medications; to make that assumption is merely speculation. A behavioral crisis is MOST accurately defined as: - Correct answer any reaction to an event that interferes with the activities of daily living or has become unacceptable to the patient, family, or community. Your assessment of the newborn reveals that she has a patent airway, is breathing adequately, and has a heart rate of 130 beats/min. Her face and trunk are pink, but her hands and feet are cyanotic. You have clamped and cut the umbilical cord, but the placenta has not yet delivered. You should: A) massage the lower part of the mother's uterus until the placenta delivers. B) give the newborn high-flow oxygen via a nonrebreathing mask and transport. C) reassess the newborn every 5 minutes and transport after the placenta delivers. D) keep the newborn warm, give oxygen to the mother if needed, and transport. - Correct answer D A newborn has a heart rate of 130 beats/min, cyanosis of the hands and feet, and rapid respirations. The infant cries when you flick the soles of its feet and resists attempts to straighten its legs. You should assign an Apgar score of: A) 7 B) 8 C) 9 D) 10 - Correct answer c) 9 A 5-year-old boy was struck by a car and is found lying 15 feet away. Based on the child's age and mechanism of injury, you should suspect that the PRIMARY injury occurred to the: A) head. B) pelvis. C) lower legs. D) upper thorax. - Correct answer b
units are available to answer emergency calls. Notifying the receiving facility, contacting medical control, and performing a detailed assessment of your patient all can occur while you are en route to the hospital. A 10-year-old child was struck by a car while crossing the street. He has bilateral femur fractures and a head injury. His father has been notified and is 20 minutes away from the scene. The EMT should: A) contact medical control to see if he/she will take custody of the child. B) attempt to contact the child's mother to see if she can be there sooner. C) begin immediate transport and have law enforcement update the father. D) stabilize the child at the scene until the father arrives and gives consent. Feedback : - Correct answer c The child in this scenario is critically-injured and needs immediate treatment and transport. In the interest of the child, it should be presumed that the parents would give consent to treat and transport if they were at the scene (implied consent). Begin emergency care, transport without delay, and ask a law enforcement officer to apprise the child's parents of your transport destination. At the scene of a mass-casualty incident, you notice a bystander who is emotionally upset. An appropriate action to take would be to: A) tell the bystander to leave the scene at once. B) have the bystander assist you with patient care. C) notify the police and have the bystander removed. D) assign the bystander a simple, non-patient-care task. - Correct answer d One of the most effective ways to reduce stress in a bystander at the scene of a mass-casualty incident is to assign the bystander a task that is not related to patient care. This may involve assisting other bystanders who are having difficulties as well or providing water to the rescuers. An obviously distressed bystander should not simply be sent away from the scene, but should be looked at as a patient as well. Clearly, if the bystander becomes aggressive or violent, law enforcement personnel should get involved. A 52-year-old woman crashed her minivan into a tree. She is pinned at the legs by the steering wheel and is semiconscious. After gaining access to the patient, you should:
A) perform a primary assessment and provide any lifesaving care before extrication. B) immediately apply high-flow oxygen to the patient and allow extrication to begin. C) rapidly assess her from head to toe, obtain vital signs, and apply a cervical collar. D) have the fire department disentangle the patient and quickly remove her from the car. - Correct answer a Unless there is an immediate threat of fire, explosion, or other danger, you should perform a primary assessment and begin any lifesaving care as soon as you have gained access to the patient. If you wait to do this until after the patient has been disentangled, it may be too late; the patient may already be dead. After you have assessed the patient and treated any immediate threats to life, allow extrication to commence. Once the patient has been freed from the vehicle, continue any lifesaving care and perform a rapid head-to-toe assessment to identify and treat other life-threatening injuries. Another EMT can obtain vital signs as you rapidly assess the patient. Prepare for immediate transport after the rapid head-to-toe assessment has been performed and spinal precautions have been taken (if indicated). Your partner, a veteran EMT of 20 years, has been showing up late to work with increasing frequency over the last several shifts. When he arrives, he is in a bad mood and is clearly not interested in being at work. His behavior is MOST consistent with: A) burnout. B) delirium. C) drug use. D) acute stress. - Correct answer Your partner's behavior is consistent with burnout. Burnout is a condition of chronic fatigue, irritability, and frustration that results from mounting stress over time. Although burnout typically manifests after years of service in EMS, some EMTs begin to experience it in a very short period of time, especially if they work in EMS systems with a high call volume and low morale. Some people with burnout abuse drugs or alcohol; if you suspect this behavior, you should report it to your supervisor
C) look for the presence of an exit wound. D) evaluate the pulses proximal to the wound. - Correct answer c When assessing a patient who sustained a gunshot wound, you should routinely look for an exit wound, which may be difficult to find. Exit wounds can be a source of continued bleeding, both externally and internally. They may or may not follow the same path as the entrance wound. This is why it is important to conduct a thorough examination of the patient. Ice can be applied to the wound, but only after the wound has been covered by a sterile dressing and any bleeding has been controlled. Determining why the patient was shot is the responsibility of law enforcement, not the EMT. If the wound is close to an extremity, pulse, motor, and sensory function should be assessed distal to the wound. Which of the following signs would you expect to see in the early stages of shock? A) Hypotension B) Restlessness C) Thready pulses D) Unconsciousness - Correct answer b In the early stages of shock, decreased perfusion to the brain causes the patient to become restless and anxious. As shock progresses, the pulse becomes thready (weak), signifying a falling blood pressure (hypotension), and the patient eventually loses consciousness. It is critical to recognize the early signs of shock and initiate immediate care and rapid transport. You should not rely on the blood pressure as an indicator of perfusion in any patient; by the time hypotension manifests, the patient's compensatory mechanisms have failed and he or she is in decompensated shock. Internal or external bleeding would be especially severe in a patient: A) with hemophilia. B) who takes aspirin. C) with heart disease.
D) who is hypotensive. - Correct answer a Hemophilia is a condition in which the patient lacks one or more of the blood's clotting factors. There are several forms of hemophilia, most of which are hereditary and some of which are severe. Sometimes bleeding occurs spontaneously in patients with hemophilia. Because the patient's blood does not clot, all injuries, no matter how minor they appear, are potentially serious. Aspirin does not destroy the blood's clotting factors; it decreases the ability of platelets to stick together. Although this may cause prolonged bleeding time, the patient with hemophilia, who lacks key clotting factors, will bleed for a much longer period of time. Many patients with heart disease take aspirin daily to prevent clot formation in a coronary artery. When blood pressure is low (hypotension), the driving force of the blood through the blood vessels is reduced; as a result, bleeding tends to be less severe relative to patients with high blood pressure. Unfortunately, hypotension indicates decompensated shock. A man was stabbed in the right side of the chest, lateral to the nipple. He is tachypneic, tachycardic, and diaphoretic. His jugular veins are collapsed and breath sounds are difficult to hear on the right side. You should suspect a: A) hemothorax. B) ruptured spleen. C) liver laceration. D) pneumothorax. - Correct answer a Based on the injury location and the patient's clinical presentation, you should suspect a hemothorax. In addition to the lung, there is a TON of vasculature in the thoracic cavity that can easily be injured by a penetrating injury. Because the patient is losing blood, one would expect flattened or collapsed jugular veins and profound shock. In addition, because blood is filling the right hemithorax, breath sounds may be weak or absent on the affected side. Although a liver injury cannot be completely ruled out, the injury is above where the liver is located anatomically. If a pneumothorax is present, it is likely in conjunction with the hemothorax (hemopneumothorax). The spleen is located in the upper left quadrant; this patient's injury is on the right side. Which of the following injury mechanisms involves axial loading?
You are dispatched to the scene of a motorcycle crash. Upon arrival, you find the patient lying face down approximately 25 feet from his bike. He is not wearing a helmet and is moaning. You should: A) apply a cervical collar. B) stabilize his head manually. C) log roll him into a supine position. D) evaluate the status of his airway. - Correct answer b The mechanism of injury for this patient was significant. In his present position (prone), you cannot effectively assess his airway. Therefore, your first action should be to manually stabilize his head. Then, you must log roll him into a supine position, keeping his head in an in-line position. If possible, log roll him directly onto a long backboard. After the patient is supine, assess the status of his airway, assess his breathing adequacy, administer high-flow oxygen or begin assisted ventilations if needed, and continue with your primary assessment. Apply a cervical collar as soon as possible, but assess his posterior neck first. A young male has a large laceration to his lateral neck, directly over his jugular vein. His airway is patent and his breathing is adequate. Your MOST immediate priority should be to: A) apply high-flow oxygen via a nonrebreathing mask. B) perform a rapid assessment to detect other injuries. C) obtain vital signs to determine if he is hypotensive. D) keep air out of the wound and control the bleeding. - Correct answer d Jugular vein lacerations pose two immediate life threats: entrainment of air into the wound (which may cause a fatal air embolism) and severe external bleeding. The patient's airway is patent and his breathing is adequate; therefore, your most immediate priority is to apply an occlusive dressing directly over the wound, which will keep air from entering the venous circulation, and then cover the occlusive dressing with bulky dressings to control the external bleeding. Apply oxygen if it is clinically indicated (ie, low SpO2). The need to perform a rapid head-to-toe assessment is based on the presence of a significant mechanism of injury (MOI). If a significant MOI is present, the rapid assessment is performed only after problems with the airway, breathing, and circulation have been addressed. Vital signs are
typically obtained after the rapid assessment, although they can be obtained by another EMT as you perform the rapid assessment. A woman struck the steering wheel with her chest when her car collided with a tree. She is conscious and alert; however, she is tachypneic and diaphoretic and her pulse is rapid and irregular. What should you do? A) Apply the AED and administer oxygen B) Administer oxygen and protect her spine C) Administer oxygen and position her on her side D) Ventilate with a bag-mask device and apply a c-collar - Correct answer b Based on the mechanism of injury and the patient's clinical presentation (especially her rapid, irregular pulse), a myocardial contusion should be suspected. Large myocardial contusions can reduce the pumping function of the heart, resulting in shock. One cannot diagnose a myocardial contusion in the prehospital setting, and there is no specific treatment for this type of injury; therefore, prompt transport is essential. Treatment for the patient in this scenario includes supplemental oxygen (nasal cannula or nonrebreathing mask, depending on her oxygen saturation), spinal motion restriction (ie, c-collar, backboard, etc), and keeping her warm. A lateral recumbent position would likely not be comfortable for her. She does not require ventilation assistance at this point. The AED is not indicated because she is not in cardiac arrest. In contrast to an incision, a laceration: A) is a jagged cut. B) is a superficial injury. C) bleeds more severely. D) usually involves an artery. - Correct answer a A laceration is a jagged cut caused by a sharp object or a blunt force that tears the tissue, whereas an incision is a sharp, smooth cut. The depth of the injury can vary; it can extend through the skin and subcutaneous tissue or into the underlying muscles and adjacent nerves and blood vessels. Lacerations and incisions can involve arteries, veins, or both, potentially resulting in severe bleeding.
has a fractured pelvis and is bleeding internally. Therefore, after completing your primary assessment and initiating shock treatment (eg, high-flow oxygen, applying blankets), you should perform a rapid head-to-toe assessment to assess for other injuries and then prepare for immediate transport. Spinal precautions should be considered. Do not log roll the patient; doing so compresses the pelvis and may cause further injury. You should also avoid palpating his pelvis; this will only cause further pain and may cause additional injury. Palpation of the pelvis is performed to assess its stability, not to elicit crepitus. Consider applying a pelvic binder device or tying a sheet around his hips in order to reduce the space within the pelvis; doing so may help slow internal bleeding. A detailed secondary exam of a critically injured patient at the scene is not appropriate; it takes too long to perform and should be done en route to the hospital if time permits. Which of the following injury mechanisms is associated with hangings? A) Distraction B) Subluxation C) Axial loading D) Hyperextension - Correct answer a Injury to the cervical spine following a hanging occurs via distraction, or stretching, of the vertebrae and spinal cord. A subluxation is a partial or incomplete dislocation; it is an injury, not an injury mechanism. Injuries related to hyperextension mechanisms are common in patients who strike their head on the windshield during a motor-vehicle crash. Axial loading is a mechanism of injury in which the spinal column is compressed vertically. Injuries caused by axial loading include cervical spine injuries after diving head first into shallow water and lumbar spine injuries after a fall from a significant height in which the patient lands feet first. The presence of subcutaneous emphysema following blunt trauma to the anterior neck should make you MOST suspicious for a: A) pneumothorax. B) fractured larynx. C) ruptured esophagus. D) carotid artery injury. - Correct answer b
Crushing or blunt trauma to the anterior neck can injure the trachea or larynx. Once the cartilages of the upper airway and larynx are fractured, they do not spring back to their normal position. Such a fracture can lead to loss of voice, airway obstruction, and leakage of air into the soft tissues of the neck. Air leakage into the soft tissues is called subcutaneous emphysema. Subcutaneous emphysema may also be observed in patients with a tension pneumothorax, although it is typically located in the chest. Esophageal rupture would likely present with difficulty swallowing (dysphagia) and vomiting blood (hematemesis). You should suspect injury to a carotid artery or jugular vein if you observe a rapidly expanding hematoma to the neck following blunt trauma. Which of the following statements regarding heatstroke is correct? A) Not all patients experiencing heatstroke have dry skin. B) Heatstroke is caused by a hyperactive sweating mechanism. C) Heatstroke is more likely to occur when the humidity is low. D) As core body temperature rises, the patient becomes more agitated. - Correct answer a Heatstroke occurs when the body is exposed to more heat than it can eliminate and normal mechanisms for eliminating heat, such as sweating, are overwhelmed. The core body temperature then rises rapidly to the point where tissues are destroyed. Heatstroke can develop in patients during prolonged vigorous physical activity or when they are in a closed, poorly ventilated, hot and humid space. High humidity impairs a person's ability to eliminate heat via the sweating mechanism. Many patients with heatstroke have hot, dry, flushed skin; however, early in the course of heatstroke, the skin may be moist due to residual perspiration, as with exertional heatstroke. As the core body temperature rises, the patient's level of consciousness decreases. Untreated heatstroke will result in death. In contrast to a patient with a blood glucose level of 25 mg/dL, a patient with a blood glucose level of 800 mg/dL would be expected to present with: A) profuse diaphoresis and pallor. B) an acute alteration in mentation. C) tachycardia and poor skin turgor. D) a rapid, shallow breathing pattern. - Correct answer c
Because the patient is able to speak only in minimal-word sentences (two- word dyspnea), is experiencing severe respiratory distress, and is confused (a likely sign of hypoxemia), it is unlikely that she is ventilating adequately. Therefore, you should assist her ventilations with a bag-valve-mask (BVM) device. If her breathing continues as it is, she will become increasingly hypoxemic and may lose consciousness. Because this patient is conscious, you must explain to her that every time she takes in a breath, the BVM device will be squeezed so that an adequate volume of air can be delivered. Clearly, this can cause the patient great anxiety, so your reassurance during this procedure is important. If the patient will not tolerate your attempts to assist her ventilations, apply oxygen via a nonrebreathing mask and monitor her closely. Your assessment of a 5-year-old child reveals that he is unresponsive with a respiratory rate of 8 breaths/min and a heart rate of 50 beats/min. Treatment for this child should include: A) high-flow oxygen via nonrebreathing mask and rapid transport. B) oxygen via a nasal cannula at 6 L/min and rapid transport. C) positive-pressure ventilation, chest compressions, and rapid transport. D) back slaps and chest thrusts while attempting artificial ventilations. - Correct answer c A heart rate less than 60 beats/min in an infant or child, especially when accompanied by signs of poor perfusion and inadequate breathing, should be treated with positive-pressure ventilation, chest compressions, and rapid transport. Respirations of 8 breaths/min and a heart rate of 50 beats/min will not maintain adequate oxygenation and perfusion in a child. Passive oxygenation (ie, nasal cannula, nonrebreathing mask) is not appropriate for a child with inadequate ventilation, especially when accompanied by bradycardia. Back slaps and chest thrusts are indicated for a responsive infant with a severe foreign body upper airway obstruction. The primary clinical feature associated with exposure to a vesicant agent is: A) tachycardia. B) skin blistering. C) vomiting blood. D) muscle twitching. - Correct answer b
The primary route of exposure to blister agents, or vesicants, is the skin. If vesicants are left on the skin or clothing long enough, they produce vapors that can enter the respiratory tract. Vesicants cause burn-like blisters to form on the victim's skin as well as in the respiratory tract (if inhaled). Vesicant agents include sulfur mustard (H), Lewisite (L), and phosgene oxime (CX). The symbols H, L, and CX are military designations. Vesicants usually cause the most damage to damp or moist areas of the body, such as the armpits, groin, and respiratory tract. A rapid heart rhythm, usually at a rate of 150 to 200 beats/min, that originates in the ventricles and can cause hemodynamic compromise is called: A) asystole. B) ventricular fibrillation. C) ventricular tachycardia. D) pulseless electrical activity. - Correct answer c Ventricular tachycardia (V-Tach) is a rapid heart rhythm, usually at a rate of 150 to 200 beats/min, that originates in the ventricle instead of the atrium. V-Tach usually does not allow adequate time between beats for the left ventricle to fill with blood; therefore, the blood pressure may fall. V-Tach may occur with or without a pulse. Ventricular fibrillation (V-Fib) is a disorganized, chaotic dysrhythmia that does not produce a pulse; it occurs when cardiac cells randomly discharge to the point that regular cardiac contraction is impossible. Asystole (flatline) represents an absence of cardiac electrical and mechanical activity; obviously, asystole does not produce a pulse. Pulseless electrical activity (PEA) is a phenomenon in which organized electrical activity is present on the cardiac monitor, despite the absence of a pulse. You respond to a baseball field for a person who was struck by lightning. When you arrive, you see one patient who appears confused and is ambulatory; a second patient who is conscious, sitting on the ground, and holding his arm; and a third patient who is supine and motionless. After requesting additional responders, you should: A) assess the motionless victim and perform CPR and defibrillation if necessary.
