NREMT EXAM 2023 Questions and Answers

NREMT EXAM 2023 Questions and Answers You and your partner Xavier arrive at a sushi bar to a call of a man choking. You find him sitting in a back booth, very pale and diaphoretic. He tells you in a whisper that he has a chunk of fish caught in his throat. What would you do next? - ANSWER Encourage him to cough it up. The ability to speak signifies that it is likely high enough in the airway to cough up Unless his airway is completely blocked, you should not attempt Heimlich thrusts. If he can speak there is a chance he can work the obstruction out himself. What must you do first before inserting an oral airway? - ANSWER Measure it measure oral airways from the corner of the mouth to the earlobe or jawline. You are dispatched to a possible cardiac arrest. You arrive 10 minutes from the time of the call. You and your partner enter the residence to find a man in his 50's lying supine on the living room floor. His wife says that he "just collapsed" while eating dinner. Which of the following treatment choices is most appropriate at this time according to AHA Guidelines? - ANSWER Perform 30 compressions and then look inside the mouth before attempting to ventilate When a patient collapses while eating you should always suspect a possible Foreign Body Airway Obstruction. A visual check of the mouth with each airway opening/ventilation cycle is now recommended by AHA. AHA guidelines now recommend attaching the AED and attempting to defibrillate as soon as you have one available. If someone has audible inspiratory stridor they may have - ANSWER An upper airway obstruction Stridor on inspiration = upper airway obstruction, life threatening Stridor on exhalation = lower airway restriction. You have an unconscious patient. What do you do? - ANSWER ABCs, History taking, Rapid full body scan ABCs are part of the primary survey, which is then followed by history taking, and then the secondary assessment. A rapid full body scan is the first step of the secondary assessment. When someone has an upper airway obstruction you may hear sounds like? - ANSWER High pitched wheezing when they breath in Upper airway obstructions are often characterized by high pitched sounds when the patient inhales. You and your partner Sue have just arrived on scene to an unknown injury/ illness. You see a man lying against the side of a convenience store who appears unconscious. One of the witnesses tells you that the man was standing there and then just fell over hitting his head on the building and sliding down into the sitting position. As you check his pulse and respirations you find that he is breathing shallow at about 10 per minute, and his pulse is rapid. What would you do first for this patient? - ANSWER Maintain c spine and move him to a supine position, then open his airway fall = c-spine and airway A call has come in for a possible drowning. You and your partner respond to a public swimming pool a few blocks from the station. A 9-year-old boy apparently slipped while running, hit his head on the edge of the pool, and fell in. He has no pulse and he is not breathing. What would be your best choice of action? - ANSWER Take manual stabilization of the boy's head and neck while additional rescuers ventilate at about 13 breaths per minute and provide at least 100 compressions per minute. two person health care provider CPR performed on a child should be done at a 15:2 ratio (13 breaths a min). A child is breathing at 32 breaths per minute. This would be considered ______________. - ANSWER above range Child respiration rates = 20 and 30. You arrive on scene with your partner Leonard to the report of a child appearing lethargic. Upon entering the house, you see a 9-year-old girl lying on the couch. Her father says she has been breathing strangely and began vomiting about 45 minutes ago. During your assessment, you determine she needs to be transported to the ER immediately. Which of the following sets of vitals would lead you to believe this girl is in need of immediate transport? - ANSWER BP 100/58, respirations of 14 per minute and a pulse of 130 The respirations are too slow and the pulse is too fast When approaching a pediatric patient, what important information can you gain from a distance? - ANSWER The patient's appearance, work of breathing, and the circulation to the skin How would you suction a newborn infant? - ANSWER The mouth first and then the nose Respirations in a newborn would be considered normal at ______________. - ANSWER 60 breaths per minute normal respiratory rate for a newborn is between 40 and 60 however this drops to 30 - 40 after the first few minutes of life. An adult and a child's airway are much different from each other. Which answer most correctly describes this relationship? - ANSWER Child's airway is narrower at the Cricoid ring and the tongue is larger in proportion to the mouth You are assisting your partner who is preparing to intubate a 79 year old woman. You are managing the BVM and begin ventilating and preoxygenating the patient at what rate? - ANSWER 12-20 breaths a minute for 1-2 minutes A Transient Ischemic Attack (TIA) will usually stop after: - ANSWER 10-15 minutes symptoms persist longer than 15 minutes = treat as Cerebrovascular Accident (stroke). The final diagnosis of TIA is made if the symptoms resolve within 24 hours. You arrive on scene with your partner to a call of "man down". You pull into the driveway of the house in a very exclusive part of town. In the driveway a man is lying face up with his eyes closed. After making sure the scene is safe, what actions will help you gather the most information in the shortest period of time? - ANSWER Check his pulse with your hand while you put your ear near his mouth and look down at the sternum for chest rise You are assessing an 84 year old man. Upon auscultation of the lungs you discover crackles or rale sounds. He is complaining of chest pain and congestion. These signs and symptoms can indicate? - ANSWER Left ventricular failure crackles, chest pain, congestion = left ventricular failure. The pump portion of the heart is unable to pump efficiently and fluid begins to back up into the lungs. During an assessment of a 78 year old woman you find her skin to be cool, moist, and pale. What would you suspect? - ANSWER Hypoperfusion Pale, Cool, skin = lack of oxygen (hypoperfusion) A 57 year old woman is complaining of chest pain. Her blood pressure is 109/88 and her respirations are at 22 per minute. What condition does the patient's blood pressure indicate? - ANSWER Low pulse pressure The pulse pressure is the difference between the systolic and diastolic measurements of the blood pressure. 109 systolic - 88 diastolic = 21 mmHg. In trauma a low pulse pressure suggests significant blood loss. If the pulse pressure is extremely low, i.e. 25 mmHg or less, the cause may be low stroke volume, as in Congestive Heart Failure and/or shock. A low pulse pressure can also be caused by aortic valve stenosis and cardiac tamponade. The three basic causes of shock are? - ANSWER Poor pump function, fluid loss, and vessel dilation The basic causes of shock are poor heart function, loss of blood and fluid, and dilation of vessels. You are called to the scene of a man down. Dispatch reports the man is pulseless and bystanders are doing CPR. According to the NREMT Cardiac Arrest Management/AED skill sheet, which of the following sequences is appropriate? - ANSWER Complete one cycle of CPR, Attach the AED, Have everyone stand clear during rhythm check one cycle of CPR should be performed prior to attaching AED Which of the following choices is a normal systolic blood pressure in a child? - ANSWER Greater than 70 mm Hg child's systolic blood pressure = 80-110 mm Hg You are treating a female patient who is complaining of chest pain. She is diaphoretic with a blood pressure of 98/50. You have her medications on board which includes a prescription for nitroglycerin. Medical control has instructed you to administer 1 nitroglycerin tablet sublingually. How would you respond? - ANSWER Repeat the vital signs to medical control and ask if they still wish to have you administer the nitroglycerin with the blood pressure that low Administering nitroglycerin is contraindicated in patients with a blood pressure of less than 100 (Systolic) You and your partner whom you have been working with for two years are called to a house where a woman is having chest pain and complaining of shortness of breath. She is diaphoretic and has a pulse of 110, respirations of 22, and a blood pressure of 140/80. She says she has no cardiac or respiratory history. You should? - ANSWER Perform your assessment, put her on O2 at 15 lpm, and transport Upon assessment of a 55 year old male, you find his blood pressure to be 124/75 his pulse is 122 and his respirations are 18. It would be stated that this man is? - ANSWER Tachycardic A pulse over 100 = Tachycardic. What does the letter P stand for in DCAPBTLS? - ANSWER penetrations Deformity - contusions - abrasions - penetrations (punctures) - burns - tenderness - lacerations - swelling You and your partner Hugh arrive on scene to find a car that has hit a tree at approximately 30 miles an hour. There is front end damage to the vehicle and both occupants are still strapped into the front seat. Both airbags in the front deployed and both patients appear to be alert and oriented. What should you do? - ANSWER After putting on collars, put both patients on back boards using a KED sled or similar device A 30 mile an hour collision with a tree is significant and would require spinal immobilization and proper extrication techniques for a seated patient. A symptom is_____________while a sign is________________. - ANSWER Subjective / objective A symptom is subjective as it is based upon the patient's perception, like feeling nauseous. A sign is objective because it is based upon factual findings, like a rash or deformed arm. Which of the following is NOT a high priority condition? severe pain childbirth poor general impression unresponsiveness - ANSWER childbirth Unless the childbirth is complicated, it is not a high priority condition You and your partner Grimes are called to the scene of a stabbing. There are two patients reported. A woman with a stab wound to the URQ and a man with a stab wound to the LRQ. The woman with the wound in the URQ is having problems breathing, has a pulse of 103, respirations of 35, and they are shallow. The patient with the stab wound to the LRQ is complaining of severe abdominal pain and has a pulse of 48 and a respiration rate of 24. Which patient is most likely to have a low blood pressure? Why? - ANSWER The man, because of the nature and location of the injury, he may be losing blood internally. His pulse is too slow as well The man with the pulse of 48 and a knife wound to the lower right quadrant suggests internal bleeding which would lower the blood pressure. What is a hemorrhage? - ANSWER Severe bleeding Hemorrhage or severe bleeding is the leading cause of shock or hypoperfusion. During shock, the blood vessels contract, making the skin ______. - ANSWER Cool The skin gets cool during shock. What is a burn that involves the epidermis and the dermis but no underlying tissue? - ANSWER Partial thickness burn Superficial is just the epidermis, secondary or partial thickness is epidermis and dermis. Your patient has suffered a chainsaw vs. leg injury. His wife who is a nurse tells dispatch that he has lost about 400 mL of blood. You know that a person can lose approximately___________ before they are in any real danger. - ANSWER 500 mL Approximately 500 mL. A small child can die from blood loss of 300 mL. With regard to the SAMPLE history, a patient's pale skin would be considered __________. - ANSWER A sign If you can visibly witness it, then it is a sign. A patient would have to give you a symptom verbally or otherwise. Checking the brachial pulse should be done where on the body? - ANSWER The cubital fossa The brachial pulse can be felt on the medial aspect of the elbow in the crease (cubital fossa). The brachial can also be assessed on the medial side of the arm, between the bicep and tricep, in between the elbow and the armpit. You and your partner Antone arrive on scene to find a woman in her 30's lying on a couch. Which of the following would determine your next actions? - ANSWER The patient's level of consciousness Whether or not a person is conscious or unconscious would determine what you do next. Determining LOC, comes even before ABC's. The outer most layer of skin tissue is called? - ANSWER The epidermis The epidermis is the outer layer. Inside that is the dermis and further below that is the subcutaneous layer. Which question would help you determine the patient's chief complaint? - ANSWER What can I do for you? You arrive on scene to find a female patient actively having contractions every 10-12 minutes apart. A visual inspection of the patient reveals no visible crowning. Which stage of labor would you consider this patient to be in? - ANSWER 1st stage of labor The first stage of labor is dilation of the cervix. This can have contractions at varying intervals, and can also have some blood spotting or the breaking of the 'waters'. It ends when the cervix is fully dilated. The second stage of labor begins at that point and continues until the baby has been fully delivered. The third stage is the delivery of the umbilicus and placenta. The fourth stage is usually referred to as the period of time after delivery of the placenta and is not referenced in all textbooks. In the pre-hospital setting it is difficult to know if your patient is still in the first or second stage of labor since we don't check for cervical dilation. One good way to know is to understand that the urge to push comes after the cervix is dilated, so this is a great indicator that the patient has moved beyond stage 1 and is now in stage 2. The femoral artery is located where in relation to the carotid artery? - ANSWER Inferior The femoral artery is in the leg which is below the carotid artery in the neck. Below something = inferior. The Adam's apple is also known as? - ANSWER The thyroid cartilage That protrusion superior to the cricoid cartilage in the neck is called the thyroid cartilage, or Adam's apple. After the baby's head has delivered you should? - ANSWER Suction the mouth and nose then check if the cord is wrapped around the infant's neck As soon as the head has exited the vagina you should suction the mouth and nose and check to see that the cord is not wrapped around the baby's neck. Syncope is another word for what? - ANSWER fainting Which pressure represents the heart during the relaxation phase? - ANSWER Diastolic The bottom pressure or diastolic is the pressure of the vessels during the relaxation phase of the heart beating. You arrive on scene of an unknown medical to find a man and a woman unconscious in their kitchen. You are finishing a rapid trauma assessment on the woman when your partner says she smells something odd and is feeling dizzy. Your best course of action would be to: - ANSWER Remove yourself from the scene and advise dispatch of the situation This situation would lead you to assume the area may be contaminated with a hazardous substance. At this point you should revert back to scene safety and remove yourself from the environment. While removing the patient with you may be possible, you would not want to put O2 on them first. You are called to the scene of a woman who is having difficulty breathing. Upon arrival you notice several people surrounding the woman who seems to be agitated. Your scene assessment determines it to be safe and you approach the woman who is in the tripod position. Her breathing is rapid and shallow. She states her ribs hurt after being struck with a punch from her husband. You should? - ANSWER Treat the patient if the situation appears safe and inform law enforcement of the possible assault when the time is appropriate If you believe the scene to be safe and begin treating the patient, it would be prudent to inform the police of the supposed attack. Communication on the radio is a very important part of the EMS system, and messages should be: - ANSWER In plain English Speaking as simply as possible, in plain English, is recommended over using codes and radio cliches. Words like "yes" and "no" are hard to distinguish and should be substituted with "affirmative" and "negative" or something easier to understand.