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NREMT Paramedic Cognitive Exam practice questions

217 free questions with answers and explanations.

Practice test
  1. 51.A 25-year-old female is experiencing a severe asthma attack. She is receiving nebulized albuterol and ipratropium, but her condition is not improving, and she remains in severe respiratory distress with an SpO2 of 88%. Her breath sounds are diminished, and wheezing is less prominent. This change in breath sounds indicates:Airway, Respiration & Ventilation
  2. 52.A 65-year-old male with a history of COPD is experiencing an acute exacerbation. He is alert but fatigued, with a respiratory rate of 26 breaths/min and shallow. His SpO2 is 87% on 2 L/min nasal cannula. You apply a non-rebreather mask at 10 L/min, and his SpO2 improves to 90%. What is the most appropriate next step in his respiratory management?Airway, Respiration & Ventilation
  3. 53.A 60-year-old male with a history of heart failure presents with acute onset of severe dyspnea, orthopnea, and pink, frothy sputum. Auscultation reveals diffuse crackles (rales) bilaterally. His SpO2 is 85% on room air. What is the MOST appropriate initial ventilatory support?Airway, Respiration & Ventilation
  4. 54.A 40-year-old male is intubated and being mechanically ventilated in the field. Suddenly, his SpO2 drops from 98% to 80%, breath sounds become absent on the left, and he becomes hypotensive. The endotracheal tube (ETT) is still at the correct depth marking at the lip. What is the MOST likely cause of this sudden deterioration?Airway, Respiration & Ventilation
  5. 55.A 5-year-old child weighing 44 lbs (20 kg) is experiencing severe respiratory distress due to an asthma exacerbation. After administering albuterol via nebulizer, the patient's condition has not improved, and he remains tachypneic with significant retractions and diffuse wheezing. What is the appropriate dose of intravenous (IV) methylprednisolone to administer?Airway, Respiration & Ventilation
  6. 56.A 68-year-old male is found unresponsive and apneic. You immediately begin bag-valve-mask (BVM) ventilation. After several ventilations, you notice significant gastric distension and hear gurgling sounds from the patient's stomach. What is the MOST appropriate immediate action to address this?Airway, Respiration & Ventilation
  7. 57.A 4-year-old child presents with sudden onset of severe inspiratory stridor, high fever (103°F/39.4°C), drooling, and appears anxious, preferring to sit in the 'tripod' position. The child's voice is muffled. What is the most critical immediate intervention?Airway, Respiration & Ventilation
  8. 58.A 6-month-old infant is apneic and pulseless. After initiating CPR, you are preparing to ventilate with a bag-valve-mask (BVM). What is the appropriate ventilation rate for this infant during CPR?Airway, Respiration & Ventilation
  9. 59.A 70-year-old male with a history of heart failure and recent surgery presents with sudden onset of severe shortness of breath, sharp chest pain that worsens with inspiration, and a feeling of impending doom. His SpO2 is 86% on room air, heart rate 110 bpm, and respiratory rate 30 breaths/min. Lung sounds are clear bilaterally. Which of the following is the most likely cause of his symptoms?Airway, Respiration & Ventilation
  10. 60.A 55-year-old male is found unresponsive with sonorous respirations and an SpO2 of 85%. He has a strong radial pulse. After opening the airway with a head-tilt-chin-lift maneuver, his SpO2 improves to 92% and respirations become less noisy but remain shallow at 8 breaths per minute. What is the most appropriate next step in airway management?Airway, Respiration & Ventilation
  11. 61.A 30-year-old male with a history of asthma is experiencing a severe exacerbation. His peak expiratory flow (PEF) is 40% of his personal best. He is alert but anxious, with prolonged expiratory phase and diffuse wheezing. Which of the following medications is indicated to address the bronchoconstriction?Airway, Respiration & Ventilation
  12. 62.A 35-year-old male is found unresponsive after a suspected opiate overdose. His respiratory rate is 4 breaths per minute and shallow. He has pinpoint pupils and is cyanotic. After administering naloxone, you continue to ventilate with a BVM. What is the MOST appropriate ventilation rate for this adult patient?Airway, Respiration & Ventilation
  13. 63.A 55-year-old male is found unresponsive with sonorous respirations and an SpO2 of 85%. He has no signs of trauma. After opening the airway with a head-tilt chin-lift maneuver, his SpO2 improves slightly to 88%, but sonorous respirations persist. What is the MOST appropriate next intervention to maintain airway patency?Airway, Respiration & Ventilation
  14. 64.A 45-year-old male is found unresponsive after a suspected opioid overdose. His respirations are slow and shallow at 6 breaths per minute, and his SpO2 is 82% on room air. Pupils are pinpoint. What is the MOST immediate and critical intervention?Airway, Respiration & Ventilation
  15. 65.During bag-valve-mask (BVM) ventilation of an apneic patient, you observe gastric distension developing. Which of the following is the most appropriate action to minimize this complication?Airway, Respiration & Ventilation
  16. 66.A 28-year-old asthmatic patient presents with severe respiratory distress, audible wheezing, and an SpO2 of 89% despite receiving bronchodilator treatments and high-flow oxygen via a non-rebreather mask. She is becoming drowsy and her respiratory effort is diminishing. What is the most appropriate next intervention?Airway, Respiration & Ventilation
  17. 67.A 72-year-old female with a history of COPD presents with increasing shortness of breath over the past 24 hours. She is alert but anxious, tripodding, and using accessory muscles to breathe. Her respiratory rate is 28 breaths per minute, SpO2 90% on 2 L/min nasal cannula, and she has diminished breath sounds with expiratory wheezes. What is the most appropriate initial oxygen delivery device for this patient?Airway, Respiration & Ventilation
  18. 68.A 50-year-old male is found unconscious with agonal respirations. His pulse is weak and thready at 120 bpm. You are preparing to insert a supraglottic airway device. Which of the following is an absolute contraindication for the insertion of a supraglottic airway?Airway, Respiration & Ventilation
  19. 69.A 72-year-old male with a history of COPD is experiencing an acute exacerbation. He is alert and oriented, speaking in short sentences, and has diffuse wheezing bilaterally. His SpO2 is 90% on room air. Which of the following is the MOST appropriate oxygen therapy goal for this patient?Airway, Respiration & Ventilation
  20. 70.A 55-year-old male with a history of chronic bronchitis presents with acute onset of severe dyspnea, pursed-lip breathing, and a productive cough. His respiratory rate is 28 breaths/min, SpO2 is 89% on room air, and he has diffuse wheezing. Which of the following interventions is most appropriate to improve his oxygenation and ventilation?Airway, Respiration & Ventilation
  21. 71.A 28-year-old female with a history of severe asthma is experiencing an acute exacerbation. She is sitting upright, speaking in single words, and has audible wheezing. Her peak expiratory flow rate (PEFR) is 40% of her personal best. What is the MOST appropriate next intervention after administering a bronchodilator?Airway, Respiration & Ventilation
  22. 72.A 45-year-old construction worker has sustained a crush injury to the chest from a falling beam. He is conscious but in severe respiratory distress, with paradoxical chest wall movement noted on the left side. His SpO2 is 86% on room air. What is the most important initial ventilatory intervention for this patient?Airway, Respiration & Ventilation
  23. 73.A 40-year-old male is found unresponsive with shallow, gurgling respirations at a rate of 6 breaths/min. His pulse is weak and rapid. After opening the airway, what is the most appropriate immediate intervention to address his breathing?Airway, Respiration & Ventilation
  24. 74.A 6-month-old infant is experiencing severe respiratory distress with signs of increased work of breathing, including nasal flaring, grunting, and intercostal retractions. Breath sounds are diminished bilaterally, and the SpO2 is 88% on room air. The infant is lethargic. What is the MOST appropriate initial oxygen delivery device for this patient?Airway, Respiration & Ventilation
  25. 75.A 2-year-old child presents with mild respiratory distress, wheezing, and a history of recent upper respiratory infection. The child's parents report episodes of coughing and difficulty breathing, especially at night. On auscultation, diffuse expiratory wheezes are noted. Supplemental oxygen via nasal cannula at 2 L/min maintains SpO2 at 94%. What is the most likely diagnosis?Airway, Respiration & Ventilation
  26. 76.A 70-year-old female presents with acute onset of severe shortness of breath, anxiety, and a feeling of impending doom. She is afebrile, and her SpO2 is 92% on room air. Auscultation reveals diffuse wheezing bilaterally, without crackles. She has no history of asthma or COPD. What is the MOST likely cause of her respiratory distress?Airway, Respiration & Ventilation
  27. 77.A 3-year-old child presents with a sudden onset of high fever (103°F/39.4°C), severe sore throat, drooling, and inspiratory stridor. The child is sitting upright, leaning forward with the neck hyperextended (tripod position). The parents report the child has not been vaccinated. What is the MOST appropriate immediate action?Medical
  28. 78.A 62-year-old male with a history of hypertension and hyperlipidemia presents with sudden onset of right-sided facial droop, left-sided arm weakness, and slurred speech. His last known normal (LKN) was 2 hours ago. His blood glucose is 110 mg/dL. Which of the following is the most critical prehospital action?Medical
  29. 79.A 32-year-old female presents with acute onset of severe, crampy lower abdominal pain, vaginal spotting, and a positive pregnancy test. She appears pale and diaphoretic, and her vital signs are BP 88/50 mmHg, HR 124 bpm, RR 22 bpm, SpO2 98% on room air. Her abdomen is diffusely tender upon palpation. Which of the following is the most appropriate initial intervention?Medical
  30. 80.A 22-year-old male presents with acute onset of severe, excruciating pain in his right testicle, accompanied by swelling and redness. He denies recent trauma. The pain began suddenly about 3 hours ago. Upon examination, the right testicle is elevated and exquisitely tender. What is the most likely diagnosis?Medical
  31. 81.A 5-year-old child ingested an unknown quantity of caustic drain cleaner. On arrival, the child is conscious, drooling, and complaining of severe oral and throat pain. The child's airway appears patent but is swelling. What is the most important immediate action for the paramedic?Medical
  32. 82.A 5-year-old child is found unresponsive by his parents. He has a known history of Type 1 Diabetes Mellitus. His blood glucose level is 35 mg/dL. He is pale, diaphoretic, and has a weak, rapid pulse. He does not have an intact gag reflex. What is the MOST appropriate immediate intervention?Medical
  33. 83.A 40-year-old male presents with sudden onset of severe, colicky right flank pain radiating to his groin. He reports recent nausea and vomiting. He is pacing restlessly and unable to find a comfortable position. His vital signs are BP 140/90 mmHg, HR 100 bpm, RR 18 bpm. Which of the following is the most appropriate initial intervention?Medical
  34. 84.A 32-year-old female presents with acute onset of severe, crampy lower abdominal pain, vaginal spotting, and lightheadedness. She states her last menstrual period was 8 weeks ago and she has a history of pelvic inflammatory disease (PID). Her vital signs are BP 90/60 mmHg, HR 120 bpm, RR 22 bpm, SpO2 98% on room air. Abdominal examination reveals diffuse tenderness, more prominent in the lower quadrants, with guarding. Based on her presentation, what is the most immediate life-threatening concern?Medical
  35. 85.A 35-year-old male is found unconscious in a cold garage. His skin is cold to the touch, and he has shivering that has now ceased. His core body temperature is estimated at 90°F (32.2°C). His heart rate is 40 bpm and irregular, and his breathing is shallow at 8 bpm. What is the most appropriate rewarming strategy for this patient?Medical
  36. 86.A 25-year-old male is found unresponsive after intentionally ingesting an unknown quantity of acetaminophen approximately 6 hours ago. He is currently asymptomatic but drowsy. What is the most critical initial intervention for this patient in the prehospital setting?Medical
  37. 87.A 28-year-old female presents with sudden onset of severe, sharp, unilateral lower abdominal pain, accompanied by light vaginal bleeding and dizziness. She missed her last menstrual period and reports a positive home pregnancy test. Her blood pressure is 90/60 mmHg, heart rate 118 bpm, and respiratory rate 22 bpm. Which of the following is the most immediate priority for management?Medical
  38. 88.A 40-year-old male presents with sudden onset of severe, colicky right flank pain radiating to his groin. He describes the pain as 9/10 and is constantly shifting positions, unable to find comfort. He denies fever or dysuria. His vital signs are stable. Which of the following is the most appropriate initial prehospital intervention?Medical
  39. 89.A 6-year-old child presents with a sudden onset of high fever (103.5°F/39.7°C), severe sore throat, difficulty swallowing, and drooling. The child is sitting upright, leaning forward with an extended neck (tripod position), and has inspiratory stridor. Which of the following is the most appropriate initial intervention?Medical
  40. 90.A 62-year-old male with a history of hypertension and hyperlipidemia presents with sudden onset of right-sided weakness, facial droop, and expressive aphasia. His blood pressure is 180/100 mmHg, heart rate 88 bpm, respirations 16 breaths/min, and SpO2 98% on room air. Pupils are equal and reactive. What is the MOST appropriate initial management for this patient?Medical
  41. 91.A 22-year-old male presents with acute onset of severe, excruciating pain in his right testicle for the past 3 hours. He denies trauma. On examination, the right testicle is swollen, exquisitely tender, and appears to be sitting higher than the left. The cremasteric reflex is absent on the right. Which of the following is the most appropriate next step in management?Medical
  42. 92.A 25-year-old male presents to the emergency department after intentionally ingesting an unknown quantity of acetaminophen approximately 4 hours ago. He is currently asymptomatic. His vital signs are stable. What is the MOST critical management consideration for this patient?Medical
  43. 93.A 68-year-old male presents with sudden onset of severe, unilateral headache, photophobia, and a stiff neck. He reports a history of hypertension. His Glasgow Coma Scale (GCS) is 14 (E4, V4, M6). Vital signs are BP 180/100 mmHg, HR 60 bpm, RR 16 bpm, SpO2 98% on room air. Pupils are equal and reactive. What is the most likely cause of his symptoms?Medical
  44. 94.A 5-year-old child ingested an unknown quantity of caustic drain cleaner approximately 15 minutes ago. On arrival, the child is crying, has burns around the mouth, and is drooling profusely. Which of the following is the most appropriate initial intervention?Medical
  45. 95.A 60-year-old male with a history of chronic obstructive pulmonary disease (COPD) is found by his family to be confused and extremely short of breath. He is cyanotic and using accessory muscles to breathe. His respirations are 30 breaths/min and shallow. SpO2 is 82% on room air. What is the MOST appropriate initial oxygen therapy for this patient?Medical
  46. 96.A 16-year-old female is found unconscious in her bedroom after her friends reported she had been 'huffing' from an aerosol can. She is unresponsive to verbal or painful stimuli. Her skin is pale and clammy. Respirations are shallow at 8 breaths/min, pulse 110 bpm, and BP 90/50 mmHg. What is the MOST critical immediate intervention?Medical
  47. 97.A 72-year-old female resident of a nursing home is found by staff to be lethargic, disoriented, and hypotensive (BP 80/50 mmHg). Her skin is warm and flushed, and she has a temperature of 101.8°F (38.8°C), pulse 118 bpm, and respiratory rate 24 bpm. Her medical history includes diabetes and recurrent urinary tract infections. Which of the following is the most appropriate initial treatment strategy?Medical
  48. 98.A 24-year-old female presents with a sudden onset of severe, sharp, unilateral lower abdominal pain, which started about 2 hours ago. She reports her last menstrual period was 6 weeks ago and has been trying to conceive. She feels lightheaded and her vital signs are BP 90/50 mmHg, HR 118 bpm, RR 20 bpm, SpO2 98%. On examination, her abdomen is tender to palpation in the left lower quadrant with some guarding. What is the most critical immediate concern?Medical
  49. 99.A 35-year-old male is found unconscious in an unheated garage. His skin is cold to the touch, and he is shivering uncontrollably. His core body temperature is measured at 92°F (33.3°C). His heart rate is 50 bpm, and respiratory rate is 10 bpm. Which of the following is the most appropriate initial rewarming strategy?Medical
  50. 100.A 30-year-old female presents with generalized weakness, fatigue, and a 'butterfly rash' across her face. She also reports joint pain in her hands and wrists. She states these symptoms have been worsening over several months. Her vital signs are stable. Which of the following is the most likely underlying condition?Medical