NREMT EMT — All Questions

A diabetic patient who is conscious, able to swallow, and has an altered mental status with likely low blood sugar should receive:

• a.Nitroglycerin
• b.Aspirin
• c.Activated charcoal
• d.Oral glucose✓

A conscious diabetic with a protected airway and suspected hypoglycemia is treated with oral glucose. The patient must be able to swallow and protect the airway to receive anything by mouth.

The classic signs of a stroke can be quickly screened using:

• a.The Cincinnati Prehospital Stroke Scale (facial droop, arm drift, speech)✓
• b.The Glasgow Coma Scale, scoring eye, verbal, and motor response
• c.The rule of nines, which divides the body into percentages
• d.OPQRST alone, the mnemonic used to characterize pain

The Cincinnati Prehospital Stroke Scale checks for facial droop, arm drift, and abnormal speech, and any one abnormal finding suggests a possible stroke and the need for rapid transport. The Glasgow Coma Scale grades overall level of consciousness rather than screening for stroke, the rule of nines estimates burn area, and OPQRST is a way to describe pain.

Where the EMT's scope permits, for a patient having a severe allergic reaction (anaphylaxis) with prescribed medication available, the EMT may assist with:

• a.A tube of oral glucose
• b.Activated charcoal by mouth
• c.Chewable aspirin tablets
• d.An epinephrine auto-injector✓

Anaphylaxis is treated with epinephrine, and an EMT may assist a patient with their own prescribed auto-injector where protocol allows. Epinephrine reverses the airway swelling and low blood pressure caused by the reaction. Oral glucose treats low blood sugar, activated charcoal is used for some ingested poisons, and aspirin is used for suspected cardiac chest pain.

An epinephrine auto-injector is most commonly injected into the:

• a.Upper arm muscle
• b.Buttock or hip area
• c.Lateral (outer) thigh✓
• d.Abdomen or flank

The epinephrine auto-injector is delivered into the outer thigh muscle, which can be done through clothing and allows rapid absorption. The upper arm, the buttock, and the abdomen are not injection sites for an auto-injector.

The most important consideration before giving any oral medication or glucose is:

• a.The patient can swallow and protect their airway✓
• b.Whether the patient has eaten recently
• c.The patient's systolic blood pressure is normal
• d.The patient has taken the medication before

Anything given by mouth requires the patient to be able to swallow and protect the airway, so an unresponsive or severely altered patient should not receive oral medications or glucose. Recent food intake is worth recording in the history but does not by itself bar an oral medication, a normal blood pressure is a check tied to drugs such as nitroglycerin rather than a general requirement for anything oral, and having taken the medication before says nothing about whether the patient can swallow it now.

A tonic-clonic (grand mal) seizure is actively occurring. The EMT's priority is to:

• a.Hold the patient still and place a padded object between the teeth to protect the tongue
• b.Restrain the arms and legs firmly to stop the convulsive movements
• c.Insert an oropharyngeal airway during the convulsion to keep the airway open
• d.Protect the patient from injury and manage the airway, without forcing anything into the mouth✓

During an active tonic-clonic seizure, protect the patient from injury and manage the airway, but do not restrain the limbs and do not force anything between the teeth. Objects placed in the mouth risk broken teeth, airway obstruction and bitten fingers, forcible restraint can cause fractures and dislocations, and an oral airway cannot be placed safely against clenched jaws. After the seizure, place the patient in the recovery position and give oxygen as needed.

Activated charcoal may be indicated (per protocol/medical direction) for:

• a.Certain oral poisonings in an alert patient who can protect the airway✓
• b.Ingestion of a petroleum distillate such as gasoline or kerosene
• c.Ingestion of a strong acid or alkali such as drain cleaner
• d.Any unresponsive poisoning patient, to bind the drug early

Activated charcoal can bind some ingested poisons in an alert patient able to protect the airway, when directed by protocol or medical control. It is withheld after petroleum distillates because vomiting and aspiration injure the lungs worse than the swallowed product, after strong acids and alkalis because it does not bind them and it obscures the view for later endoscopy, and in patients with a decreased level of consciousness because they cannot protect the airway.

A postictal patient (after a seizure) is typically:

• a.Ready to walk and refuse care
• b.Combative and requiring restraint by default
• c.Confused, drowsy, and gradually improving✓
• d.Fully alert immediately with no confusion

The postictal phase after a seizure involves confusion, drowsiness, and gradual recovery of orientation. Support the airway, provide reassurance, and monitor as the patient recovers.

Time of symptom onset is especially critical to determine and report in patients with suspected:

• a.A minor sprain
• b.Motion sickness
• c.Stroke✓
• d.A common cold

Knowing when stroke symptoms began determines eligibility for time-sensitive treatments like clot-dissolving therapy. EMTs should establish and clearly report the last-known-well time.

The mnemonic SAMPLE is used to gather a patient's:

• a.The percentage of body surface burned, using the rule of nines
• b.History (Signs/symptoms, Allergies, Medications, Past history, Last intake, Events)✓
• c.The level of responsiveness, using Alert, Verbal, Painful, Unresponsive
• d.The character of the pain: onset, quality, region, severity and time

SAMPLE stands for Signs and symptoms, Allergies, Medications, Pertinent past history, Last oral intake, and Events leading up to the call, giving a structured medical history. Burned body surface is estimated with the rule of nines, level of responsiveness is graded with AVPU, and the character of pain is drawn out with OPQRST.

The OPQRST mnemonic is primarily used to assess:

• a.The characteristics of pain or a chief complaint✓
• b.The patient's past medical history and allergies
• c.The adequacy of the airway and breathing
• d.The extent of burns on the body surface

OPQRST (Onset, Provocation, Quality, Region and radiation, Severity, Time) explores the nature of pain or a chief complaint and helps characterize symptoms such as chest or abdominal pain. Past history and allergies come from SAMPLE, airway and breathing are judged in the primary assessment, and burn extent is estimated with the rule of nines.

A woman in her third trimester complains of dizziness when lying flat on her back. The best position is:

• a.Left lateral recumbent (tilted onto her left side)✓
• b.Sitting fully upright with the legs dependent
• c.Supine with the legs elevated (Trendelenburg)
• d.Right lateral recumbent, onto her right side

Late in pregnancy the uterus can compress the inferior vena cava when the mother lies supine, cutting venous return and causing dizziness and hypotension. Because the vena cava lies to the right of the spine, tilting her onto the left side lifts the uterus off it. Turning onto the right side does far less, sitting upright does not address caval compression, and raising the legs while she stays flat leaves the uterus resting on the vessel.

During normal childbirth, once the infant's head delivers, the EMT should:

• a.Apply firm traction to the head to speed the delivery
• b.Clamp and cut the cord before the shoulders deliver
• c.Hold the head back until the ambulance reaches a hospital
• d.Support the head and check whether the cord is around the neck✓

As the head delivers, support it gently and check for a nuchal cord (umbilical cord around the neck). Never pull on the infant; allow the body to deliver with the contractions. Pulling on the head can injure the infant's neck and brachial plexus, and cutting the cord before the body is out removes the infant's only source of oxygen while the chest is still compressed. Holding the head back to reach a hospital does not stop labor and risks injury to both mother and infant.

The first priority for a newborn immediately after delivery is to:

• a.Clamp and cut the umbilical cord before doing anything else
• b.Suction the mouth and nose deeply before drying and warming
• c.Dry, warm, position, and stimulate the newborn, keeping the airway clear✓
• d.Check a blood glucose and give oral glucose if it is low

A newborn is dried, kept warm, positioned, and stimulated, with the airway cleared as needed, because preventing heat loss and getting the infant breathing are the immediate priorities. Cord clamping can wait until the infant is breathing and warm, deep suctioning is not routine and can provoke bradycardia, and glucose is not part of immediate newborn care in the field.

A patient exhibiting a behavioral emergency who is a potential danger requires the EMT to prioritize:

• a.Applying physical restraints to every such patient on arrival
• b.Leaving the patient alone in a quiet room until they calm down
• c.Completing a full head-to-toe physical exam before anything else
• d.Scene safety and their own and the patient's safety, requesting help as needed✓

Behavioral emergencies require attention to scene safety first, protecting the crew and the patient and summoning law enforcement or extra resources as needed. Restraint is a last resort for a patient who is a danger, applied only within local policy, leaving a potentially dangerous patient unattended abandons them and risks harm to them or to others, and a detailed physical exam is not possible until the situation is controlled.

Fruity (acetone) breath odor, deep rapid breathing, and excessive thirst in a diabetic suggest:

• a.A stroke causing an irregular breathing pattern
• b.Hyperglycemia / diabetic ketoacidosis (high sugar)✓
• c.Hypoglycemia from a missed meal after insulin
• d.An allergic reaction with airway involvement

Fruity breath, deep rapid (Kussmaul) breathing, and thirst point to high blood sugar and diabetic ketoacidosis, which develops gradually and requires oxygen support and transport. Low blood sugar instead comes on quickly with pale, sweaty skin and no fruity odor, a stroke produces focal deficits such as one-sided weakness or speech loss rather than thirst, and an allergic reaction brings hives, swelling and wheezing.

Which set represents normal adult vital sign ranges?

• a.Pulse 40 to 60, respirations 4 to 8, systolic BP about 60 to 80
• b.Pulse 20 to 40, respirations 40 to 50, systolic BP about 40 to 60
• c.Pulse 60 to 100, respirations 12 to 20, systolic BP roughly 90 to 140✓
• d.Pulse 120 to 160, respirations 30 to 40, systolic BP about 70 to 90

A typical resting adult has a pulse of 60 to 100, respirations of 12 to 20, and a systolic blood pressure roughly in the 90 to 140 range. Values well outside these suggest a problem requiring assessment. The fast pulse and fast respiratory rate in one of the other sets are closer to what is expected in an infant than in an adult, and the remaining sets pair a slow pulse and slow breathing with a systolic pressure low enough to signal shock.

A patient who responds only when you pinch their shoulder but does not respond to your voice is classified on the AVPU scale as:

• a.Alert and following commands
• b.Responsive to Painful stimulus✓
• c.Responsive to Verbal stimulus
• d.Unresponsive to all stimuli

AVPU stands for Alert, Verbal, Painful, Unresponsive. A patient who reacts only to a painful stimulus is scored as 'P' (Painful). An alert patient is awake and interacting before you touch them, and a verbal patient reacts when spoken to, which this patient did not. Unresponsive is reserved for a patient who does not react to a painful stimulus at all, so any reaction to the pinch rules it out.

Cool, clammy skin in a diabetic patient with a rapid onset of altered mental status most often indicates:

• a.Dehydration from vomiting
• b.Slowly rising blood sugar
• c.A brief fainting episode
• d.Low blood sugar (hypoglycemia)✓

Hypoglycemia commonly causes cool, clammy, sweaty skin with rapid onset of altered mental status. If the patient can swallow, oral glucose is indicated. A rising blood sugar builds over hours to days and usually presents with warm, dry skin and thirst rather than this sudden picture. Dehydration and a simple faint do not explain mental status that stays altered, and treating either one first delays the sugar this patient needs.

A patient with difficulty breathing and a history of asthma is prescribed a metered-dose inhaler. Under a typical EMS protocol with medical direction, the EMT may:

• a.Give the patient a family member's inhaler if it is the same drug
• b.Withhold all help because giving medication is outside the EMT role
• c.Assist the patient in using their own prescribed inhaler per protocol✓
• d.Give oral glucose, which relaxes the airway during an attack

EMTs may help a patient self-administer their own prescribed inhaler for respiratory distress, following local protocol and medical direction. Confirm the medication, dose, and expiration and that it is prescribed to that patient. An inhaler prescribed to someone else is not that patient's medication, whatever the label says, and refusing to help at all misreads the assisting role that protocols grant. Oral glucose treats low blood sugar and has no effect on bronchospasm.

Severe lower abdominal or shoulder pain, dizziness, and signs of shock in a woman of childbearing age with a missed period may indicate:

• a.A muscle strain from lifting, with referred pain
• b.A urinary tract infection with bladder pain
• c.A possible ectopic pregnancy with internal bleeding✓
• d.Ovulation pain in the middle of the cycle

A ruptured ectopic pregnancy bleeds internally and produces lower abdominal pain, shoulder pain from blood irritating the diaphragm, and shock, so it needs oxygen, shock care, and rapid transport. A muscle strain and ovulation pain do not cause shock, ovulation pain is also ruled out by the missed period, and a urinary tract infection typically brings burning on urination and fever rather than hypotension.

The primary treatment an EMT provides for most poisonings by inhalation is to:

• a.Enter immediately and begin ventilating the patient in place
• b.Move the patient to fresh air and provide oxygen once the scene is safe✓
• c.Administer activated charcoal to bind the inhaled toxin
• d.Induce vomiting to clear the poison from the stomach

For inhaled poisons, first ensure scene safety, then remove the patient to fresh air and give high-concentration oxygen. Entering a contaminated atmosphere without the right protection and training simply produces a second patient. Activated charcoal binds some swallowed poisons and does nothing about a gas already in the lungs, and inducing vomiting is no longer used for poisoning by any route.

A patient with a possible opioid overdose has slow, shallow breathing. The EMT's first priority is to:

• a.Check a blood glucose level before doing anything else
• b.Walk the patient around to keep them awake
• c.Support ventilation and oxygenation with a bag-valve mask✓
• d.Give oral glucose between the cheek and gum

The immediate life threat in opioid overdose is respiratory depression, so support ventilation with a bag-valve mask and oxygen first. Naloxone may follow where protocol allows, but airway and breathing come first. Walking a patient does not restore respiratory drive, anything placed in the mouth risks aspiration in a patient who cannot protect the airway, and a glucose reading, while worth obtaining, does not treat hypoventilation.

During delivery, if the umbilical cord presents first (prolapsed cord), the EMT should:

• a.Position the mother to relieve pressure (knees to chest or hips elevated), keep pressure off the cord, and transport rapidly✓
• b.Have the mother stand and walk to the ambulance so that gravity moves the baby down and delivery progresses
• c.Gently pull on the cord to move it aside, then deliver the baby normally on the scene and clamp the cord
• d.Push the cord back into the birth canal, hold it in place, and wait for the head to deliver on its own

A prolapsed cord is squeezed between the presenting part and the pelvis and cuts off the baby's oxygen supply, so relieve the pressure by positioning the mother hips-up or knees-to-chest, gently keep the presenting part off the cord, and transport immediately. Standing and walking increases the pressure on the cord, pulling on the cord can tear it or shear the placenta, and pushing it back inside does not relieve the compression while the delay costs the baby oxygen.

A patient reporting a sudden severe headache, described as the worst of their life, with vomiting should be evaluated for:

• a.Low blood sugar only
• b.Motion sickness
• c.A simple tension headache to ignore
• d.A possible stroke or brain bleed✓

A sudden severe headache, often called the worst of one's life, can indicate bleeding in the brain and is a possible stroke. This requires oxygen support, monitoring, and rapid transport.

Hives, itching, swelling of the face and tongue, and wheezing after a bee sting indicate:

• a.A systemic allergic reaction possibly progressing to anaphylaxis✓
• b.Hypoglycemia brought on by the stress of being stung
• c.An asthma attack triggered by exertion in the heat
• d.A local reaction confined to the area of the sting

Hives away from the sting site, facial and airway swelling, and wheezing are signs of a body-wide response, which marks a systemic allergic reaction that may become anaphylaxis. Prepare to assist with epinephrine and support the airway and breathing. A local reaction stays confined to the sting site, asthma alone does not cause hives or facial swelling, and low blood sugar produces altered mental status and sweating rather than hives.

A patient having a seizure that does not stop, or repeated seizures without regaining consciousness, is called:

• a.A febrile seizure caused by a high temperature
• b.A postictal state following a single seizure
• c.A simple partial seizure with awareness intact
• d.Status epilepticus, a life-threatening emergency✓

Status epilepticus is a prolonged seizure, or repeated seizures without recovery of consciousness in between, and is life-threatening because of the hypoxia it produces. It requires airway support, oxygen, and rapid transport for definitive treatment. A postictal state is the recovery period after a seizure has already stopped, a febrile seizure is a brief seizure in a young child with a fever, and a simple partial seizure involves one part of the body with awareness intact.

Nitroglycerin assists a cardiac patient primarily by:

• a.Dilating blood vessels to reduce the heart's workload✓
• b.Constricting blood vessels to raise blood pressure
• c.Dissolving a clot already in a coronary artery
• d.Slowing the heart rate to reduce oxygen demand

Nitroglycerin dilates blood vessels, reducing the workload on the heart and improving blood flow to the heart muscle. Because that same dilation lowers blood pressure, adequate pressure must be confirmed before assisting. It does not constrict vessels, it does not dissolve a clot that has already formed (that is the work of hospital fibrinolytics or catheter treatment), and it does not slow the heart rate.

A 24-year-old with type 1 diabetes is unresponsive after taking her usual insulin and skipping meals. She has snoring respirations and no gag reflex. Under the standard EMT scope of practice in most states, the crew should:

• a.Open the airway, ventilate as needed, and transport rapidly✓
• b.Administer 25 g of dextrose intravenously, the definitive treatment for hypoglycemia at every EMS level
• c.Place oral glucose gel between her cheek and gum, since buccal absorption does not require the patient to swallow
• d.Insert an oral airway before placing the glucose gel

An unresponsive patient with no gag reflex must receive nothing by mouth, so opening the airway, ventilating as needed and transporting rapidly is what the EMT scope offers here. Oral glucose gel is the tempting choice because it is described as absorbing through the mucosa, but it is still a bolus of gel in the mouth of a patient who cannot swallow or protect her airway, and inability to swallow is a stated contraindication. An oral airway holds the tongue forward but does nothing to stop aspiration, so it does not make gel safe, and intravenous dextrose requires vascular access and sits above the EMT level in essentially every system.

A conscious patient with a history of diabetes is confused but can follow simple commands and swallow. No blood glucose reading is available and the crew cannot tell whether the sugar is high or low. Under most EMS protocols the EMT should:

• a.Withhold sugar until the hospital can measure a blood glucose, because giving glucose to a hyperglycemic patient can trigger ketoacidosis
• b.Give oral glucose, since untreated hypoglycemia is the more immediate threat✓
• c.Assume hyperglycemia, which is far more common in insulin users
• d.Give oral glucose only once a glucometer reading confirms hypoglycemia

When the crew genuinely cannot tell high from low in a patient who is awake and able to swallow, most protocols favor giving oral glucose: hypoglycemia injures the brain within minutes, while a tube of glucose adds little to an already high sugar over a short transport. Withholding sugar until the hospital can measure it is the strongest competing choice, but ketoacidosis develops over hours to days and is not set off by one dose of oral glucose. Requiring a meter reading first is reasonable when a meter is at hand, but none is available here and treatment should not wait for one. Hyperglycemia being more common in insulin users does not make it the greater emergency.

A patient stung by a wasp has itching and hives. Which additional finding means the reaction should be treated as anaphylaxis rather than a mild or localized allergic reaction?

• a.Itching that began within five minutes of the sting
• b.A previous reaction to a sting several years ago
• c.Airway swelling or signs of shock✓
• d.Hives spreading over more than half the body

Anaphylaxis is defined by involvement beyond the skin: respiratory compromise such as stridor, wheezing or tongue and throat swelling, or circulatory compromise such as hypotension, dizziness and weak pulses. Widespread hives are the most tempting finding because they look dramatic, but skin findings alone, however extensive, remain a skin reaction. Rapid onset and a prior reaction raise suspicion without meeting the definition; persistent vomiting and cramping abdominal pain, on the other hand, do count as a second body system.

A patient in anaphylaxis improves dramatically minutes after an epinephrine auto-injector is used. He now feels well and asks to sign a refusal. The strongest medical reason to urge transport is:

• a.The epinephrine must be reversed at the hospital with a medication that blocks its effects
• b.Symptoms can return hours later in a biphasic reaction as the epinephrine wears off✓
• c.Any patient given a medication by EMS is legally required to be transported
• d.An auto-injector dose is too small for an adult and must be repeated

Anaphylaxis can recur hours after it appears to resolve, and epinephrine's effect is short-lived, so a patient who needed it requires evaluation and a period of observation. The belief that epinephrine has to be reversed at the hospital is the most common misconception in this scenario; there is no routine reversal agent and none is needed. A competent adult may still legally refuse, which is precisely why the crew has to explain the risk of a returning reaction rather than claim transport is mandatory, and the adult auto-injector delivers a full adult dose.

Ten minutes after an epinephrine auto-injector was used, a patient's wheezing and facial swelling are worsening again, and a second auto-injector prescribed to the patient is on scene. In most EMS systems the EMT should:

• a.Wait a full thirty minutes before any repeat dose, as that is the standard interval
• b.Contact medical direction about a second dose✓
• c.Give the second injection into the same thigh as the first
• d.Withhold more epinephrine, since only a paramedic may give a repeat dose

Anaphylaxis that worsens again after one dose is exactly the situation in which a repeat dose may be authorized, and in most systems that authorization comes from on-line medical direction or an explicit standing order rather than the crew's own judgment. Withholding epinephrine on the belief that only paramedics may repeat it is both wrong and dangerous, since EMTs administer or assist with epinephrine in many systems. There is no universal thirty-minute rule; re-dose intervals are set by protocol, and the customary practice is to use the other thigh rather than reinjecting the same spot.

A farm worker is found beside a pesticide sprayer with pinpoint pupils, heavy drooling and tearing, vomiting, and loss of bladder control. After the crew is protected and the patient has been decontaminated, the EMT's next priority is:

• a.Give activated charcoal to bind the pesticide remaining in the stomach
• b.Administer naloxone, since the pinpoint pupils point to an opioid overdose
• c.Frequent suctioning and assisted ventilation with oxygen✓
• d.Give oxygen by non-rebreather mask without suctioning

Organophosphate poisoning is a cholinergic crisis in which the airway fills with secretions and the patient dies of respiratory failure, so suctioning and ventilatory support come first. Naloxone is the tempting answer because of the pinpoint pupils, but it reverses opioids only and does nothing about the drooling, tearing and bronchial secretions; the antidotes are atropine and pralidoxime, which in most systems are carried at the ALS level or as auto-injectors an EMT may use only where protocol permits. A non-rebreather cannot push oxygen through an airway full of secretions and does not support failing ventilation, and activated charcoal has no role in an agent absorbed through skin and lungs.

A family is found drowsy with headaches in a garage where a gasoline generator has been running. On room air, each of them has a pulse oximeter reading of 99%. The correct interpretation is:

• a.A pulse oximeter cannot distinguish carboxyhemoglobin from oxyhemoglobin, so the reading is falsely reassuring✓
• b.The high reading confirms adequate oxygenation, so carbon monoxide poisoning is unlikely
• c.The reading is falsely high because carbon monoxide constricts the fingertip vessels, and warming the hand will correct it
• d.Carbon monoxide drives the reading below 90%, so these numbers argue against exposure

A standard pulse oximeter reads carboxyhemoglobin much as it reads oxyhemoglobin, so a poisoned patient can show 99% while the blood carries very little usable oxygen. The history — an engine running in an enclosed space and several people with the same headache and drowsiness — therefore outweighs the number entirely. Carbon monoxide does not push the displayed saturation down, and it does not work by constricting the fingertip vessels; poor perfusion does make an oximeter unreliable, but that is not what is happening here. Only CO-oximetry or a hospital blood level measures it, and field care is removal from the source plus high-concentration oxygen.

A 22-year-old is agitated and paranoid, with dilated pupils, drenching sweat, a heart rate of 148 and a blood pressure of 178/104, after taking an unknown drug. This pattern is most consistent with:

• a.Opioid overdose, given the sweating and altered mental status
• b.Benzodiazepine overdose with paradoxical excitement
• c.Stimulant (sympathomimetic) intoxication✓
• d.Organophosphate exposure, which also causes heavy sweating and agitation

Tachycardia, hypertension, dilated pupils, sweating and agitation form the sympathomimetic pattern seen with cocaine, amphetamines and similar drugs, and the EMT's concerns are hyperthermia, seizures and cardiac events. Organophosphate poisoning is the closest competitor because it also produces drenching sweat, but it constricts the pupils, slows the heart and floods the airway with secretions. Opioids cause pinpoint pupils with slow, shallow breathing, and sedatives depress rather than raise the heart rate and blood pressure.

A worker has spilled a dry powdered industrial chemical across both forearms. After putting on gloves and eye protection, the EMT should first:

• a.Wipe the powder away with a wet towel
• b.Flush immediately with large volumes of low-pressure water for twenty minutes
• c.Neutralize the powder with a mild acid or base before rinsing it away
• d.Brush the dry powder off the skin, then flush with water✓

Brushing the dry chemical away first removes most of the agent and avoids the violent reaction some dry chemicals have with water; irrigation follows once the bulk of the powder is gone. Immediate flushing is the strongest competing answer, because copious irrigation is correct for liquid chemical exposures, and it is exactly the step that can make a water-reactive powder worse. Wiping with a wet towel adds water for the same reason and grinds the chemical into the skin, and neutralizing is never a field maneuver, since acid-base reactions release heat and can add a thermal burn to the chemical one.

A man's slurred speech and right-sided weakness came on suddenly and then cleared completely over about twenty minutes. He now feels normal and does not want to be transported. The most accurate thing to tell him is:

• a.Symptoms that clear within twenty-four hours rule out a clot, so seeing his doctor next week is enough
• b.Because the weakness resolved on its own, this was almost certainly a migraine
• c.This may have been a transient ischemic attack, a warning that a stroke may follow soon✓
• d.He only needs to be seen if the weakness comes back on the same side

Deficits that resolve completely are typically a transient ischemic attack, and the risk of a completed stroke is highest in the days immediately afterward, so this patient needs urgent evaluation rather than reassurance. The most tempting error is treating resolution as proof that nothing happened; imaging and workup are what separate a transient attack from a small stroke, and no crew can make that call in the field. A competent adult may still refuse, so the crew should document the advice given and keep encouraging transport.

A bystander describes a witnessed collapse. Which feature most suggests a seizure rather than simple fainting?

• a.A few seconds of lightheadedness and nausea before the fall
• b.Pale, sweaty skin with color returning within a minute
• c.Prolonged confusion after the episode✓
• d.A brief jerking of the arms and legs during the collapse

A postictal period of minutes to tens of minutes of confusion, sleepiness or headache is the most reliable discriminator, because a syncope patient is usually oriented again within a minute of lying flat. Brief jerking during the event is the strongest competing finding and the classic trap: convulsive syncope from cerebral hypoperfusion produces a few seconds of twitching, so movement alone does not settle the question and the recovery pattern matters more. A lightheaded, nauseated warning and pale sweaty skin with color returning quickly both fit ordinary vasovagal syncope.

An EMT is treating a 70-year-old with new confusion and no sign of injury. Among the many causes of altered mental status, which one can an EMT most often both recognize and begin correcting in the field?

• a.An expanding subdural hematoma from an unwitnessed fall days earlier
• b.Low blood sugar, corrected with oral glucose✓
• c.Uremia from kidney failure, recognized by the odor of the breath
• d.Sepsis from a urinary tract infection

Hypoglycemia is the reversible cause an EMT is actually equipped for: it is common, the history and skin signs point to it, blood glucose measurement is within many EMT scopes, and oral glucose corrects it in a patient who can swallow. A subdural bleed is the strongest competing answer because it is common in older adults on blood thinners and changes the destination hospital, but nothing an EMT carries reverses it. Uremia and urinary sepsis also belong on the differential of new confusion in an older adult, yet an EMT can confirm and treat only the low sugar.

A 76-year-old woke at 2 a.m. severely short of breath and is now wheezing. Which additional finding points to congestive heart failure rather than an asthma attack?

• a.Swollen ankles and a need to sleep propped on several pillows✓
• b.A forty-year smoking history with a barrel-shaped chest
• c.A dry cough that started after he climbed the stairs
• d.Wheezing heard loudest on exhalation through pursed lips, easing with a rescue inhaler

Dependent edema and orthopnea, along with waking at night gasping for air, are the fluid-overload findings of heart failure, and the wheeze of so-called cardiac asthma comes from fluid in the airways rather than bronchospasm. Pursed-lip exhalation that responds promptly to a bronchodilator is the hardest finding to separate, since heart failure patients can also wheeze, but prompt relief from a rescue inhaler points to reactive airway disease. A long smoking history with a barrel chest suggests COPD, and an exertional cough is nonspecific.

A 4-year-old sits upright and very still, drooling, with a muffled voice, a high fever, and no cough. This presentation should raise the greatest concern for:

• a.An aspirated foreign body
• b.Epiglottitis✓
• c.Croup before the barking cough appears
• d.Asthma triggered by a viral illness

Drooling, a muffled voice, high fever, an absent cough and a child who insists on sitting still and upright form the classic epiglottitis picture. Croup is the strongest competitor because it is far more common at this age, but croup causes a barking cough with inspiratory stridor and usually a low-grade fever, and it does not typically produce drooling or a muffled voice, so an absent cough argues against croup rather than for an early stage of it. An aspirated foreign body can cause sudden distress and drooling but not a high fever, and asthma produces wheezing and lower airway findings. Management is what makes the distinction matter: keep the child calm and in a position of comfort with a caregiver, give blow-by oxygen only if it is tolerated, never inspect the throat or use a tongue depressor, and transport with airway equipment ready.

A 68-year-old man has sudden tearing abdominal pain radiating to his back, a pulsating mass above the umbilicus, and cool, mottled legs. The EMT should:

• a.Treat this as renal colic, since pain radiating to the back is typical of a stone
• b.Palpate the mass in all four quadrants to estimate how large it has become
• c.Apply firm pressure over the mass to slow the internal bleeding
• d.Avoid deep palpation, give oxygen if indicated, and transport rapidly✓

Tearing abdominal or back pain with a pulsatile mass and poor perfusion in the legs suggests an abdominal aortic aneurysm; nothing can be fixed in the field, so gentle handling, oxygen as indicated, shock care and rapid transport to a surgical center are the treatment. Kidney stone pain is the strongest competing explanation and can look identical at first, but a stone does not produce a pulsating mass or mottled legs, and treating this patient as low priority costs the diagnosis. Deep palpation and pressure over the mass risk rupture and are never used.

A patient reports several days of black, tarry, foul-smelling stools and now becomes dizzy when he stands up. This most likely indicates:

• a.Hemorrhoidal bleeding at the anus, which turns black as the blood dries
• b.A medication side effect rather than blood loss
• c.Bleeding low in the colon, where stool darkens as it sits
• d.Bleeding high in the digestive tract, such as from a stomach ulcer✓

Melena, meaning black tarry foul stool, is blood that has been digested during a slow passage from the upper gastrointestinal tract, classically a peptic ulcer or esophageal varices, and the dizziness on standing says enough volume has been lost to matter, so this is a shock patient. Hemorrhoidal bleeding is the tempting answer, but blood from the anus arrives undigested and bright red, and the same holds for the lower colon: it is stomach acid and digestive enzymes, not time sitting in the bowel, that turn blood black. Iron tablets and bismuth medicines also darken stool, which is why the foul odor and the orthostatic symptoms are the findings that push this toward true blood loss.

A man who missed his last two dialysis sessions is weak and short of breath. Which action is most appropriate?

• a.Lay him flat with the legs raised to relieve the weakness
• b.Take the blood pressure in the fistula arm, where the shunt gives a truer reading
• c.Encourage him to drink water, since dehydration causes the weakness
• d.Take the blood pressure in the arm without the fistula✓

The limb holding an arteriovenous fistula or graft is protected: no blood pressure cuff, no tourniquet and no venipuncture on that side, because pressure can clot the access the patient's life depends on. Missed dialysis leaves a patient volume overloaded and hyperkalemic, so shortness of breath here suggests pulmonary edema and he is at real risk of a lethal arrhythmia. That is also why laying him flat with the legs raised is the wrong instinct, since it shifts still more fluid into an already overloaded chest, and why encouraging him to drink is actively harmful. Sit him up, give oxygen as indicated, and transport promptly.

An 82-year-old nursing home resident is newly confused and weak, with a respiratory rate of 26, a heart rate of 112, warm skin, and a normal temperature. The EMT should most suspect:

• a.A stroke, since sudden confusion in an older adult usually means a bleed or clot
• b.Dehydration, since the nursing home may have missed her fluids
• c.Sepsis, since older adults often fail to mount a fever✓
• d.A reaction to a newly started medication

Older adults with serious infection often present with confusion, rapid breathing and a fast pulse and no fever at all, sometimes even with a low temperature, so a normal reading never excludes sepsis. Stroke is the tempting alternative because new confusion is dramatic, but strokes usually produce focal findings such as facial droop, one-sided weakness or speech loss rather than tachypnea and tachycardia. Dehydration and a new medication both belong on the list and are worth asking about, but they do not account for a respiratory rate of 26 with a heart rate of 112 and warm skin. Aging itself does not cause confusion: new confusion in an older adult is a symptom to be explained, not a baseline.

A large man is combative and incoherent, sweating profusely and appearing not to feel pain. Once law enforcement and enough personnel are on scene and restraint has been decided on, the EMT should:

• a.Secure him face down on the stretcher, which best protects the crew during the transport
• b.Apply metal handcuffs yourself and remove them only at the hospital
• c.Sandwich him between two long backboards to limit movement
• d.Restrain him supine or on his side rather than prone, and monitor breathing✓

Prone and hog-tie restraint is the position associated with restraint asphyxia deaths, because the chest cannot expand against the stretcher in a patient who is already hyperthermic, acidotic and exhausted. Restrain face up or on the side with no weight on the back, keep airway and breathing under continuous watch, and expect sudden deterioration, including cardiac arrest. Sandwiching a patient between boards is the strongest competing answer because it looks like it simply controls movement, but it splints the chest for the same reason prone restraint kills. Handcuffing is a law enforcement function, and an officer with a key rides along whenever cuffs stay on.

A runner collapses during a race on a hot, humid day. He is confused and combative, his skin is hot, and he feels extremely warm to the touch. The single most important field treatment is:

• a.Slow cooling with a fan alone, to avoid shivering and rebound heating
• b.Oral electrolyte drinks and rest in the shade until he improves
• c.Sponge him with rubbing alcohol to speed evaporation
• d.Immediate aggressive whole-body cooling✓

Altered mental status with a very high core temperature is heat stroke, and survival depends on how fast the temperature falls, so remove him from the heat, take off the clothing, and cool aggressively while transporting, using cold water immersion where it is available or wetting the skin with fans plus ice packs to the neck, armpits and groin. Cooling slowly to avoid shivering is the strongest competing answer, because shivering really does generate heat, but a delayed fall in core temperature is the far greater danger and shivering is managed rather than avoided. Alcohol sponging is a folk remedy that is absorbed through the skin and is not used, and nothing goes in the mouth of a confused patient, which rules out oral electrolyte drinks.

A woman in active labor says the baby is coming. Which single finding most reliably tells the EMT to prepare to deliver on scene rather than transport?

• a.Contractions about five minutes apart in a first pregnancy
• b.The membranes rupturing as the crew arrived on scene
• c.Crowning of the baby's head at the vaginal opening✓
• d.A bloody show of mucus passed about an hour ago

Crowning, meaning the presenting part is visible and bulging at the perineum with each contraction, means delivery is happening now, and preparing to deliver where the crew stands is safer than transporting through the birth. Contraction timing is the closest competitor and is worth recording, but contractions five minutes apart in a first labor commonly leave hours to go. Ruptured membranes and bloody show mark the progress of labor without predicting how soon the baby will arrive.

A woman at 34 weeks of pregnancy has a blood pressure of 168/110, marked swelling of the hands and face, a severe headache, and spots in her vision. Besides rapid transport, the EMT's most important action is:

• a.Transport quietly on her left side and be prepared for a seizure✓
• b.Have her walk out to the ambulance rather than wait for the stair chair
• c.Keep her supine and flat for the whole transport
• d.Give fluids and sugar by mouth for likely dehydration

This picture is severe preeclampsia, and the danger is an eclamptic seizure, so the EMT's contribution is minimizing stimulation with a quiet, dim, gentle ride while positioning her on her left side to keep the uterus off the vena cava, plus early hospital notification. Lying flat on the back is the closest competing position and is the trap here: at 34 weeks the uterus compresses the vena cava and drops cardiac output, which is why left lateral positioning is used instead. Exertion such as walking raises blood pressure rather than lowering it, and nothing goes by mouth for a patient who may seize or need urgent surgery.