NREMT EMT — All Questions

What is the normal resting respiratory rate for a healthy adult?

• a.20 to 30 breaths per minute
• b.6 to 10 breaths per minute
• c.12 to 20 breaths per minute✓
• d.30 to 40 breaths per minute

A healthy adult at rest breathes about 12 to 20 times per minute. Rates persistently above or below this range suggest respiratory distress and warrant closer assessment and possible ventilatory support.

Which airway adjunct is contraindicated in a patient with an intact gag reflex?

• a.Bag-valve mask
• b.Oropharyngeal airway✓
• c.Nasal cannula
• d.Nasopharyngeal airway

An oropharyngeal (oral) airway stimulates the gag reflex and can cause vomiting or laryngospasm if the reflex is intact. It should only be used in patients who are unresponsive with no gag reflex.

A nonrebreather mask should generally be run at what oxygen flow rate?

• a.10 to 15 L/min✓
• b.1 to 2 L/min
• c.2 to 4 L/min
• d.4 to 6 L/min

A nonrebreather mask requires 10 to 15 L/min to keep the reservoir bag inflated and deliver a high oxygen concentration (roughly 80 to 90 percent). Lower flow rates fail to keep the reservoir filled between breaths.

A nasal cannula can deliver oxygen concentrations in approximately what range?

• a.50 to 60 percent
• b.24 to 44 percent✓
• c.60 to 70 percent
• d.80 to 90 percent

At 1 to 6 L/min a nasal cannula delivers roughly 24 to 44 percent oxygen. It is best for patients needing low-concentration oxygen who cannot tolerate a mask.

What is the correct first step when a responsive adult is choking and cannot speak, cough, or breathe?

• a.Deliver abdominal thrusts (Heimlich maneuver)✓
• b.Begin chest compressions immediately
• c.Lay the patient supine and start rescue breaths
• d.Perform a blind finger sweep

A responsive adult with a complete airway obstruction should receive abdominal thrusts until the object is expelled or the patient becomes unresponsive. Blind finger sweeps are avoided because they can push the object deeper.

How should you size an oropharyngeal airway before insertion?

• a.From the corner of the mouth to the earlobe (or angle of the jaw)✓
• b.By matching its width to the patient's little finger
• c.From the tip of the nose to the earlobe, as for a nasal airway
• d.By choosing the largest size that will pass the front teeth

An oral airway is measured from the corner of the mouth to the earlobe or angle of the mandible. A properly sized airway holds the tongue forward without obstructing the airway. Measuring from the nostril to the earlobe is how a nasopharyngeal airway is sized, and finger width is a rule of thumb sometimes taught for a nasal airway's diameter, not for the length of an oral one. Simply taking the largest device that fits past the teeth risks an airway long enough to reach the larynx and provoke vomiting.

Which finding best indicates adequate ventilation while using a bag-valve mask?

• a.The bag empties easily each time with little resistance
• b.Visible, gentle rise and fall of the chest with each breath✓
• c.A tight mask seal with no audible air leak around it
• d.A gradual swelling of the upper abdomen as air is given

Effective bag-valve-mask ventilation is confirmed by watching the chest rise gently with each squeeze. A bag that empties with little resistance often means air is escaping around the mask instead of reaching the lungs, and a good seal by itself says nothing about the volume actually delivered. A swelling upper abdomen is gastric distention, a sign that air is entering the stomach because ventilation is too fast or too forceful.

What maneuver is preferred to open the airway of an unresponsive patient with suspected cervical spine injury?

• a.Sniffing position with neck extension
• b.Recovery position roll
• c.Head-tilt/chin-lift
• d.Jaw-thrust maneuver✓

The jaw-thrust maneuver opens the airway while keeping the head and neck in a neutral, in-line position. This minimizes spinal movement compared with the head-tilt/chin-lift.

A patient breathing 6 times per minute with shallow effort is best managed by an EMT with:

• a.Positive-pressure ventilation with a bag-valve mask and supplemental oxygen✓
• b.Coaching the patient to breathe faster and more deeply on their own
• c.A nasal cannula at 2 L/min while watching the respiratory rate
• d.A nonrebreather mask alone at high flow, with no assisted breaths

A rate of 6 with shallow depth produces an inadequate minute volume, so the patient needs assisted positive-pressure ventilation rather than passive oxygen. Coaching cannot fix breathing that is already failing, and a nasal cannula or a nonrebreather enriches only the air the patient can move on their own; neither increases tidal volume.

Stridor, a high-pitched sound heard on inspiration, most commonly indicates:

• a.Fluid collecting in the lower airways
• b.Upper airway obstruction or narrowing✓
• c.A normal sound heard over the trachea
• d.A pneumothorax on the affected side

Stridor is produced by turbulent airflow through a narrowed upper airway, such as from swelling or a foreign body, and signals a potentially serious airway threat. Fluid in the lower airways produces crackles or wheezing instead, and a pneumothorax typically causes diminished sounds on one side rather than a high-pitched inspiratory noise.

Which patient is the best candidate for a nasopharyngeal airway?

• a.A semiconscious patient with an intact gag reflex who needs airway support✓
• b.A patient with suspected skull base fracture and clear fluid from the nose
• c.A patient in cardiac arrest with severe facial trauma
• d.A fully alert patient with no distress

A nasopharyngeal airway is tolerated by patients with an intact gag reflex, making it useful for semiconscious patients. It is avoided with suspected basilar skull fracture because of the risk of intracranial misplacement.

What is the appropriate ventilation rate for an apneic adult with a pulse (rescue breathing)?

• a.1 breath every 6 seconds (about 10 per minute)✓
• b.1 breath every 2 seconds (about 30 a minute)
• c.1 breath every 30 seconds (2 per minute)
• d.1 breath every 15 seconds (4 per minute)

For an adult in respiratory arrest with a pulse, deliver one breath about every 6 seconds, roughly 10 breaths per minute. Each breath should be given over about one second with visible chest rise. A breath every 2 to 3 seconds is the faster rate used for an infant or child with a pulse, and delivering it to an adult risks hyperventilation, gastric inflation and reduced venous return. Breaths spaced 15 or 30 seconds apart leave the apneic patient without effective ventilation between them.

Cyanosis (bluish skin, lips, or nail beds) is a sign of:

• a.Inadequate oxygenation✓
• b.Excellent perfusion
• c.Normal skin in cold weather with no clinical concern
• d.Hyperventilation only

Cyanosis reflects poor oxygenation of the blood and is a late, serious sign of hypoxia. It requires immediate airway management and oxygen therapy.

When suctioning an adult's airway, you should apply suction for no longer than:

• a.30 seconds at a time
• b.2 minutes at a time
• c.60 seconds at a time
• d.15 seconds at a time✓

Suction an adult for no more than 15 seconds per attempt because suctioning also removes oxygen and can cause hypoxia. Reoxygenate the patient between attempts.

Agonal respirations in an unresponsive patient should be treated as:

• a.Inadequate breathing requiring ventilatory support✓
• b.A sign that spontaneous breathing is returning
• c.Slow but adequate breathing that needs no support
• d.Obstruction that an oral airway alone will fix

Agonal (gasping) respirations are ineffective and do not provide adequate ventilation, often occurring around cardiac arrest. The patient needs assisted ventilation and, if pulseless, CPR. Gasping is a sign of a dying brainstem rather than of recovery, and it moves too little air to oxygenate no matter how it is counted. An oral airway only holds the tongue clear; it adds no volume, so it cannot correct agonal breathing on its own.

A patient with a history of COPD is in severe respiratory distress with low oxygen saturation. The EMT should:

• a.Provide high-concentration oxygen and support ventilation as needed✓
• b.Give only room air
• c.Give a nasal cannula at 1 L/min regardless of distress
• d.Withhold oxygen entirely to avoid suppressing respiratory drive

Never withhold needed oxygen from a hypoxic patient because of COPD concerns. Treat hypoxia with high-concentration oxygen and assist ventilations if breathing is inadequate.

Which sound suggests fluid in the lower airways, such as in pulmonary edema?

• a.Crackles (rales)✓
• b.Silence with good chest rise
• c.Snoring
• d.Stridor

Crackles, or rales, are produced by air moving through fluid in the alveoli and small airways. They are commonly heard in pulmonary edema and some pneumonias.

The primary purpose of the recovery position for an unresponsive, breathing patient without trauma is to:

• a.Raise the oxygen saturation without giving oxygen
• b.Slow the heart rate and lower the blood pressure
• c.Help keep the airway open and allow drainage of secretions✓
• d.Prevent heat loss from the patient during transport

The lateral recovery position lets the tongue fall forward and lets secretions or vomit drain from the mouth, protecting the airway. It does not change how much oxygen the blood carries, does not slow the heart, and does nothing for body temperature. It is used for unresponsive patients who are breathing adequately with no suspected spinal injury.

Accessory muscle use, nasal flaring, and tripod positioning are signs of:

• a.Anxiety with no true respiratory problem
• b.Adequate breathing requiring no intervention
• c.Increased work of breathing / respiratory distress✓
• d.Improving effort as distress resolves

These findings show the patient is working hard to breathe and is in respiratory distress. Early recognition allows oxygen therapy and ventilatory support before respiratory failure. Blaming the picture on anxiety, or calling breathing adequate because air is still moving, delays that support. These signs also mark worsening rather than improvement: as the patient tires, the effort falls away and the rate slows, which is a late and dangerous change.

What oxygen flow rate is typically used with a bag-valve mask to maximize delivered oxygen concentration?

• a.15 L/min✓
• b.4 L/min
• c.2 L/min
• d.6 L/min

A BVM connected to an oxygen reservoir at 15 L/min can deliver nearly 100 percent oxygen. Adequate flow keeps the reservoir bag full so each ventilation delivers high-concentration oxygen.

What is the recommended compression rate for adult CPR?

• a.60 to 80 per minute
• b.80 to 100 per minute
• c.140 to 160 per minute
• d.100 to 120 per minute✓

High-quality CPR uses a compression rate of 100 to 120 per minute. Rates that are too slow or too fast reduce cardiac output and coronary perfusion.

What is the correct compression-to-ventilation ratio for one-rescuer adult CPR?

• a.5:1
• b.10:2
• c.30:2✓
• d.15:2

Single-rescuer adult CPR uses 30 compressions to 2 breaths. This ratio maximizes chest compressions while still providing ventilation.

What is the minimum compression depth for an adult during CPR?

• a.About 3 inches (7.5 cm)
• b.About 1.5 inches (4 cm)
• c.At least 2 inches (5 cm)✓
• d.About 1 inch (2.5 cm)

Adult chest compressions should be at least 2 inches (5 cm) but not more than 2.4 inches (6 cm) deep. Adequate depth is essential to generate blood flow.

For two-rescuer CPR on a child, the compression-to-ventilation ratio is:

• a.30:2
• b.15:2✓
• c.5:1
• d.10:2

When two rescuers perform CPR on an infant or child, the ratio is 15:2. With a single rescuer, the child ratio is 30:2, the same as adults.

The single most important intervention to improve survival that an EMT can deliver for witnessed sudden cardiac arrest is:

• a.Rapid transport to the hospital before starting CPR
• b.Oxygen by non-rebreather mask before compressions
• c.A precordial thump followed by a pulse check
• d.Early defibrillation with an AED plus high-quality CPR✓

Early defibrillation combined with early high-quality CPR offers the best chance of survival in cardiac arrest from a shockable rhythm. Every minute of delay to defibrillation reduces survival. Loading and driving first only delays the shock, and a mask delivers no oxygen to the tissues while there is no circulation to carry it. A precordial thump is not part of EMT care and does not reliably convert a shockable rhythm.

When an AED advises 'no shock advised' but the patient remains pulseless, you should:

• a.Give a second analysis right away without CPR
• b.Wait 5 minutes before doing anything
• c.Immediately resume CPR starting with compressions✓
• d.Remove the pads and transport

A 'no shock advised' message means the rhythm is not shockable, so resume CPR immediately beginning with chest compressions. The AED will reanalyze after about two minutes of CPR.

How deep should chest compressions be for an infant?

• a.About 1 inch, because an infant chest is small
• b.At least 2 inches (5 cm), the depth used for adults
• c.About 1.5 inches (4 cm), roughly one third of chest depth✓
• d.3 inches, pressing as deeply as the chest allows

Infant compressions should be about 1.5 inches (4 cm), roughly one third the depth of the chest, delivered with two fingers or the two-thumb encircling technique. At least 2 inches (5 cm) is the adult depth and is too deep for an infant, while pressing only about an inch does not move enough blood, and pressing as hard as the chest allows risks injury without improving flow.

A conscious adult reports crushing chest pressure radiating to the left arm. After ensuring no contraindications, the EMT may assist with:

• a.Oral glucose
• b.Chewable aspirin✓
• c.A tourniquet
• d.Activated charcoal

For suspected acute coronary syndrome, EMTs may assist with chewable aspirin, which reduces clot formation, if the patient has no allergy or contraindication. Aspirin improves outcomes in heart attack.

Under a typical EMS protocol, before assisting a patient with their own prescribed nitroglycerin for chest pain, the EMT must confirm:

• a.That the chest pain has lasted longer than twenty minutes, since the drug is only for prolonged pain
• b.That the patient has no aspirin allergy, because aspirin is always given alongside nitroglycerin
• c.That the patient has eaten recently, because nitroglycerin irritates an empty stomach
• d.Adequate blood pressure (typically systolic above 90 to 100 mmHg) and no recent erectile dysfunction drugs✓

Nitroglycerin dilates blood vessels and can cause dangerous hypotension, so an adequate blood pressure must be confirmed first, and it is contraindicated after recent erectile dysfunction medication because the combination can drop pressure severely. How long the pain has lasted, whether the patient can tolerate aspirin, and when the patient last ate do not determine whether it is safe to assist with the dose.

During CPR, allowing the chest to fully recoil between compressions is important because it:

• a.Moves air in and out of the lungs, so fewer breaths are needed
• b.Lets the rescuer reach a faster compression rate with less effort
• c.Prevents broken ribs by lifting all pressure off the sternum
• d.Allows the heart to refill with blood, improving the next compression's output✓

Full chest recoil lets the heart refill with blood between compressions, so the next push moves more blood. Leaning on the chest reduces venous return and lowers CPR effectiveness. Recoil does not provide effective ventilation and does not replace rescue breaths, it does not make a faster rate the goal, and it does not prevent rib fractures.

If a patient in cardiac arrest has a transdermal medication patch on the chest where an AED pad must go, you should:

• a.Place the pad directly over the patch and press firmly
• b.Withhold defibrillation until a paramedic arrives
• c.Remove the patch and wipe the area before applying the pad✓
• d.Leave the patch in place and lower the shock energy

A medication patch under an AED pad can block energy delivery or cause a skin burn, so the patch is removed and the skin wiped before the pad goes on. Defibrillation should not be delayed waiting for a paramedic, and an automated external defibrillator selects its own energy, so there is no setting for the operator to turn down.

What is the compression rate for infant and child CPR?

• a.80 to 100 per minute
• b.60 to 80 per minute
• c.140 to 160 per minute
• d.100 to 120 per minute✓

The compression rate for infants and children is the same as for adults, 100 to 120 per minute. Consistent rate and depth are key to effective CPR at all ages.

The purpose of minimizing interruptions in chest compressions is to:

• a.Maintain coronary and cerebral blood flow✓
• b.Allow extra breaths between cycles
• c.Reduce the chance of breaking ribs
• d.Let the AED charge its capacitor faster

Blood flow generated by compressions falls quickly when compressions stop and takes time to rebuild. Minimizing interruptions keeps perfusion to the heart and brain as high as possible. Pausing to add breaths trades that perfusion for ventilation the arrested patient needs far less, and rib injury is not what the pause is meant to prevent. The AED charges on its own timer, which is why compressions continue while it charges.

A patient becomes unresponsive and pulseless while you are attaching monitoring equipment. Your immediate action is to:

• a.Give two rescue breaths first
• b.Begin high-quality chest compressions✓
• c.Search for a medical bracelet first
• d.Check blood glucose

For an unresponsive, pulseless adult, start chest compressions immediately following the compressions-airway-breathing sequence. Early compressions are the priority in cardiac arrest.

Under standard resuscitation guidance, AED pads for a small child when pediatric pads are unavailable should be:

• a.Cut down with trauma shears so the two pads fit without touching
• b.Placed using adult pads, one on the chest and one on the back if needed to avoid overlap✓
• c.Withheld entirely, because an adult shock dose is unsafe for a child
• d.Placed side by side on the upper chest so both stay off the abdomen

If pediatric pads or a pediatric setting are unavailable, adult pads may be used on a child, with one pad on the front of the chest and one on the back when that is what it takes to keep the pads from touching. Pads must not be cut or trimmed, because that changes the surface the current passes through, and defibrillation should not be withheld from a child in cardiac arrest.

Which is a classic sign that a patient may be having a heart attack in addition to chest pain?

• a.Sharp pain that worsens only when the chest wall is pressed
• b.Warm, dry, pink skin with a strong radial pulse
• c.Diaphoresis (heavy sweating), nausea, and shortness of breath✓
• d.Slow, deep, effortless breathing with normal skin color

Acute coronary syndrome often presents with heavy sweating, nausea, and shortness of breath alongside the chest discomfort, and recognizing those associated signs helps identify a heart attack when the chest pain itself is atypical. Pain reproduced by pressing on the chest wall more often points to a musculoskeletal cause, and warm, dry, pink skin with easy, unlabored breathing is not part of the classic picture.

Hands-only CPR by bystanders is encouraged for adults primarily because:

• a.Rescue breaths mostly fill the stomach and do more harm than good
• b.Continuous compressions maintain blood flow and bystanders are more willing to act✓
• c.Chest compressions alone restart the heart, so an AED is not needed
• d.Compression-only CPR is the preferred approach for young children too

For sudden cardiac arrest in an adult, continuous chest compressions keep blood moving and bystanders are far more willing to act when mouth-to-mouth is not required, which improves survival. Compressions do not restart the heart by themselves and do not replace defibrillation, and children in arrest more often need rescue breaths because the cause is usually respiratory.

Where should the heel of the hand be placed for adult chest compressions?

• a.On the upper sternum, just below the collarbones
• b.On the center of the chest, on the lower half of the sternum✓
• c.Over the left nipple, directly above the heart's apex
• d.On the upper abdomen just below the xiphoid process

Compressions are delivered on the lower half of the sternum in the center of the chest. Correct hand placement maximizes cardiac output and reduces injury. Compressing the upper sternum will not squeeze the ventricles effectively, and moving off to the left side pushes on ribs rather than on the sternum. Pressing on the upper abdomen compresses the liver and stomach instead of the heart and risks injury and regurgitation.

A conscious patient with a suspected heart attack should generally be placed in what position if no hypotension or altered mental status is present?

• a.Prone, to ease the work of breathing
• b.Flat and supine to rest the heart
• c.Head-down Trendelenburg position
• d.A position of comfort, often sitting up✓

A conscious cardiac patient who is not hypotensive is usually most comfortable sitting up, which can ease breathing and reduce the work of the heart. Lying flat, lying face down, or tipping the head down does not help and can make breathing harder. Keep the patient calm and limit exertion.

The main reason to switch compressors about every 2 minutes during CPR is to:

• a.Let the ventilator catch up on missed breaths
• b.Prevent rescuer fatigue that reduces compression quality✓
• c.Comply with the AED, which requires a new compressor
• d.Give the patient a rest from the pressure on the chest

Compression quality falls off with fatigue, often before the rescuer notices it, so compressors change about every two minutes, ideally during a rhythm check. The change is not driven by ventilations, not requested by the AED, and not a break for the patient.

After an AED delivers a shock, the rescuer should:

• a.Immediately resume chest compressions✓
• b.Wait for the AED to advise again before touching the patient
• c.Check for a pulse for 30 seconds
• d.Remove the pads

Immediately after a shock, resume CPR starting with compressions for about two minutes before the next rhythm analysis. This minimizes the pause in blood flow and improves outcomes.

For an unresponsive adult who is not breathing normally, how should you check for a pulse and for how long?

• a.Brachial pulse for up to 10 seconds
• b.Radial pulse for a full 30 seconds
• c.Apical pulse listened to for 60 seconds
• d.Carotid pulse for no more than 10 seconds✓

In an unresponsive adult, check the carotid pulse for no more than 10 seconds. If no definite pulse is felt within that time, begin chest compressions. The brachial site is the one used for an infant, and the radial pulse can be absent in a patient who still has a central pulse, so neither settles the question in an adult. Listening for an apical pulse takes equipment and time that a pulseless patient does not have.

What is the first-line method to control severe, life-threatening external bleeding from an extremity?

• a.Direct pressure, and a tourniquet if pressure fails or bleeding is massive✓
• b.Packing the wound with ice to constrict the bleeding vessels
• c.Elevating the injured limb well above the level of the heart
• d.Pressing a proximal arterial pressure point instead of the wound

Severe extremity bleeding is controlled first with firm direct pressure, and a tourniquet is applied if that fails or the bleeding is immediately life-threatening. Ice, elevation, and proximal pressure points do not reliably stop a major bleed and they delay the measures that do. Rapid hemorrhage control is a top priority in trauma.

When applying a commercial tourniquet, you should tighten it until:

• a.You can still slide a finger under the strap when it is set
• b.The distal pulse weakens but can still be felt
• c.The bright red bleeding stops and the distal pulse is eliminated✓
• d.The patient reports the pressure has become painful

A tourniquet must be tightened enough to stop arterial bleeding, which also eliminates the distal pulse. A tourniquet that only slows bleeding can worsen blood loss. A strap loose enough to admit a finger, or one that leaves a palpable pulse below it, still lets arterial blood into the limb while blocking venous return, so the wound keeps bleeding. Pain is not the endpoint either: a correctly applied tourniquet hurts, and a patient in shock may feel little.

Which are early signs of shock (hypoperfusion)?

• a.Falling blood pressure as the first sign
• b.High blood pressure and dry skin
• c.Rapid pulse; pale, cool, clammy skin; and anxiety✓
• d.Slow pulse and warm, flushed skin

Early shock produces a rapid, weak pulse with pale, cool, clammy skin and restlessness or anxiety. Falling blood pressure is a late sign because the body compensates first.

After applying a tourniquet, you should note and communicate:

• a.Only the amount of blood lost
• b.The patient's pain level instead
• c.The time the tourniquet was applied✓
• d.The brand of device applied

The application time of a tourniquet must be documented and reported so hospital staff know how long the limb has been without circulation. Write it clearly, often on the patient or the device. Estimated blood loss, pain and the type of device are all worth reporting, but none of them tells the receiving team how long the limb has been ischemic, which is what drives their decisions about the limb.

Under a typical EMS protocol, a patient with a suspected spinal injury who is breathing adequately should be:

• a.Positioned with the head turned to the side
• b.Manually stabilized in a neutral, in-line position✓
• c.Asked to move the neck to test its range first
• d.Placed prone on the stretcher for transport

Suspected spinal injuries are managed with manual in-line stabilization keeping the head neutral until fully immobilized or cleared. Unnecessary movement risks worsening a spinal cord injury. Turning the head to the side or placing the patient prone moves the very segment being protected and makes reassessment of the airway and chest harder. Asking the patient to move the neck to find the limits of motion can convert an unstable fracture into a cord injury; tenderness and deficit are assessed without moving the spine.

How should a partial-thickness (second-degree) burn without gross contamination be initially covered?

• a.With ice packs applied directly on the skin
• b.With a tight elastic wrap
• c.With butter or ointment
• d.With a clean, dry sterile dressing✓

Burns are covered with a clean, dry sterile dressing to reduce contamination and pain. Avoid ointments, butter, ice, or breaking blisters, which can worsen injury or infection.

The 'rule of nines' is used to estimate:

• a.The Glasgow Coma Scale score after a head injury
• b.The percentage of total body surface area burned✓
• c.The respiratory rate in an injured patient
• d.The volume of blood lost from an open wound

The rule of nines estimates the percentage of total body surface area burned, which gauges burn severity and guides triage and transport decisions. It has nothing to do with scoring consciousness, counting respirations, or measuring blood loss.

An impaled object in a patient's forearm should generally be:

• a.Pushed in deeper for stability
• b.Removed quickly to control bleeding
• c.Stabilized in place with bulky dressings✓
• d.Wrapped tightly against the skin

Impaled objects are stabilized in place and not removed in the field, because removal can cause severe bleeding or further injury. The exception is an object obstructing the airway or interfering with CPR.