FISDAP Paramedic Final Exam Study Guide: 200+ Verified
Practice Questions & Detailed Rationales | NCLEX-Style Scenarios
for Cardiology, Trauma, OB/GYN, & Peds | 2026/2027 Edition –
Guaranteed Pass
1. A 68-year-old male presents with sudden onset of "tearing" chest pain radiating to
his back. His blood pressure in the right arm is 160/90 and in the left arm is 130/70.
What should you suspect?
A) Myocardial Infarction
B) Pulmonary Embolism
C) Aortic Dissection
D) Tension Pneumothorax
Answer: C) Aortic Dissection
Asymmetric blood pressure readings in the upper extremities combined with tearing pain
radiating to the back are classic signs of a thoracic aortic dissection.
2. A 24-year-old female is found unconscious after an overdose of Amitriptyline. Her
ECG shows a wide QRS complex and a prolonged QT interval. What is the priority
medication?
A) Activated Charcoal
B) Sodium Bicarbonate
C) Magnesium Sulfate
D) Amiodarone
Answer: B) Sodium Bicarbonate
TCAs (Tricyclic Antidepressants) cause sodium channel blockade; Sodium Bicarbonate
helps narrow the QRS and prevent lethal arrhythmias.
3. You are treating a 4-year-old in cardiac arrest. The child weighs approximately 18
kg. What is the initial defibrillation energy setting?
A) 20 Joules
B) 36 Joules
C) 72 Joules
D) 100 Joules
Answer: B) 36 Joules
Pediatric defibrillation starts at 2 J/kg. (18kg x 2 = 36).
,4. A patient has a suspected spinal cord injury at the level of C3-C4. What is the most
significant respiratory concern?
A) Loss of intercostal muscle function
B) Loss of diaphragmatic drive
C) Excessive secretions
D) Upper airway obstruction
Answer: B) Loss of diaphragmatic drive
The phrenic nerve (C3, C4, C5) controls the diaphragm. Injury at this level often leads to
respiratory arrest.
5. A 45-year-old male with a history of renal failure presents with peaked T-waves on
his ECG. Which medication should be administered to stabilize the cardiac
membrane?
A) Calcium Chloride
B) Insulin and D50
C) Albuterol
D) Sodium Bicarbonate
Answer: A) Calcium Chloride
While Insulin/D50 and Albuterol lower potassium, Calcium Chloride (or Gluconate) is the
first-line treatment to stabilize the myocardium in hyperkalemia.
6. Which of the following is the most reliable indicator of correct ET tube placement
in a patient with adequate perfusion?
A) Bilateral breath sounds
B) Absence of epigastric sounds
C) Waveform Capnography
D) Condensation in the tube
Answer: C) Waveform Capnography
Waveform capnography (EtCO2) is the gold standard for verifying and monitoring tube
placement.
7. A 22-year-old male was struck in the chest with a baseball. He immediately
collapsed into cardiac arrest. The monitor shows V-Fib. This is known as:
A) Myocardial Contusion
B) Commotio Cordis
C) Cardiac Tamponade
D) Traumatic Aortic Rupture
Answer: B) Commotio Cordis
, This is a lethal disruption in heart rhythm caused by a blunt blow to the chest during a
specific phase of the cardiac cycle.
8. A patient presents with a suspected organophosphate poisoning. You observe
miosis, bradycardia, and excessive salivation. What is the primary drug and dose?
A) Atropine 0.5 mg
B) Atropine 2 mg to 5 mg
C) Epinephrine 1 mg
D) Diazepam 5 mg
Answer: B) Atropine 2 mg to 5 mg
Organophosphate poisoning requires massive doses of Atropine (until secretions dry up),
far exceeding the standard bradycardia dose.
9. A pregnant patient at 34 weeks gestation is in a major MVC. She is hypotensive
and tachycardic. How should she be positioned during transport?
A) Supine with legs elevated
B) Left lateral recumbent
C) Prone
D) Semi-Fowlers
Answer: B) Left lateral recumbent
This prevents "Supine Hypotensive Syndrome" by moving the uterus off the inferior vena
cava.
10. You are suctioning a 56-year-old patient with thick secretions. What is the
maximum time you should apply suction per attempt?
A) 5 seconds
B) 10-15 seconds
C) 20-30 seconds
D) Until the airway is clear
Answer: B) 10-15 seconds
Suctioning longer than 15 seconds causes significant hypoxia and potential vagal
stimulation.
11. A 30-year-old male presents with muffled heart sounds, JVD, and narrowing pulse
pressure (Beck’s Triad). What is the likely diagnosis?
A) Tension Pneumothorax
B) Cardiac Tamponade
C) Flail Chest
D) Hemothorax
, Answer: B) Cardiac Tamponade
Beck’s Triad (Muffled sounds, JVD, Hypotension/Narrow pulse pressure) indicates fluid in
the pericardial sac.
12. A patient in V-Fib has received one shock and two minutes of CPR. What is the
next drug/dose?
A) Amiodarone 300 mg
B) Epinephrine 1 mg 1:10,000
C) Lidocaine 1.5 mg/kg
D) Atropine 1 mg
Answer: B) Epinephrine 1 mg 1:10,000
In ACLS, Epinephrine is typically given after the second shock (or during the second round
of CPR).
13. A 10-year-old is having an acute asthma attack. You have already administered
Albuterol. The patient is still struggling. What is the next logical step?
A) IV Magnesium Sulfate
B) Intubation
C) Ipratropium Bromide (Atrovent)
D) Needle Decompression
Answer: C) Ipratropium Bromide (Atrovent)
Combined "DuoNeb" therapy is more effective than Albuterol alone in the acute phase.
14. A patient is found at a fire scene with soot in their airway and altered mental
status. SpO2 is 100%. What is the most likely cause of their condition?
A) Hypoxia
B) Carbon Monoxide poisoning
C) Heat Stroke
D) Pulmonary Edema
Answer: B) Carbon Monoxide poisoning
Pulse oximeters cannot distinguish between oxyhemoglobin and carboxyhemoglobin, often
leading to a "false high" 100% reading.
15. Which of the following is a sign of Cushing’s Triad?
A) Hypotension, Tachycardia, Tachypnea
B) Hypertension, Bradycardia, Irregular Respirations
C) Narrow pulse pressure, JVD, Muffled sounds
D) Tachycardia, Hypotension, Flat neck veins
Practice Questions & Detailed Rationales | NCLEX-Style Scenarios
for Cardiology, Trauma, OB/GYN, & Peds | 2026/2027 Edition –
Guaranteed Pass
1. A 68-year-old male presents with sudden onset of "tearing" chest pain radiating to
his back. His blood pressure in the right arm is 160/90 and in the left arm is 130/70.
What should you suspect?
A) Myocardial Infarction
B) Pulmonary Embolism
C) Aortic Dissection
D) Tension Pneumothorax
Answer: C) Aortic Dissection
Asymmetric blood pressure readings in the upper extremities combined with tearing pain
radiating to the back are classic signs of a thoracic aortic dissection.
2. A 24-year-old female is found unconscious after an overdose of Amitriptyline. Her
ECG shows a wide QRS complex and a prolonged QT interval. What is the priority
medication?
A) Activated Charcoal
B) Sodium Bicarbonate
C) Magnesium Sulfate
D) Amiodarone
Answer: B) Sodium Bicarbonate
TCAs (Tricyclic Antidepressants) cause sodium channel blockade; Sodium Bicarbonate
helps narrow the QRS and prevent lethal arrhythmias.
3. You are treating a 4-year-old in cardiac arrest. The child weighs approximately 18
kg. What is the initial defibrillation energy setting?
A) 20 Joules
B) 36 Joules
C) 72 Joules
D) 100 Joules
Answer: B) 36 Joules
Pediatric defibrillation starts at 2 J/kg. (18kg x 2 = 36).
,4. A patient has a suspected spinal cord injury at the level of C3-C4. What is the most
significant respiratory concern?
A) Loss of intercostal muscle function
B) Loss of diaphragmatic drive
C) Excessive secretions
D) Upper airway obstruction
Answer: B) Loss of diaphragmatic drive
The phrenic nerve (C3, C4, C5) controls the diaphragm. Injury at this level often leads to
respiratory arrest.
5. A 45-year-old male with a history of renal failure presents with peaked T-waves on
his ECG. Which medication should be administered to stabilize the cardiac
membrane?
A) Calcium Chloride
B) Insulin and D50
C) Albuterol
D) Sodium Bicarbonate
Answer: A) Calcium Chloride
While Insulin/D50 and Albuterol lower potassium, Calcium Chloride (or Gluconate) is the
first-line treatment to stabilize the myocardium in hyperkalemia.
6. Which of the following is the most reliable indicator of correct ET tube placement
in a patient with adequate perfusion?
A) Bilateral breath sounds
B) Absence of epigastric sounds
C) Waveform Capnography
D) Condensation in the tube
Answer: C) Waveform Capnography
Waveform capnography (EtCO2) is the gold standard for verifying and monitoring tube
placement.
7. A 22-year-old male was struck in the chest with a baseball. He immediately
collapsed into cardiac arrest. The monitor shows V-Fib. This is known as:
A) Myocardial Contusion
B) Commotio Cordis
C) Cardiac Tamponade
D) Traumatic Aortic Rupture
Answer: B) Commotio Cordis
, This is a lethal disruption in heart rhythm caused by a blunt blow to the chest during a
specific phase of the cardiac cycle.
8. A patient presents with a suspected organophosphate poisoning. You observe
miosis, bradycardia, and excessive salivation. What is the primary drug and dose?
A) Atropine 0.5 mg
B) Atropine 2 mg to 5 mg
C) Epinephrine 1 mg
D) Diazepam 5 mg
Answer: B) Atropine 2 mg to 5 mg
Organophosphate poisoning requires massive doses of Atropine (until secretions dry up),
far exceeding the standard bradycardia dose.
9. A pregnant patient at 34 weeks gestation is in a major MVC. She is hypotensive
and tachycardic. How should she be positioned during transport?
A) Supine with legs elevated
B) Left lateral recumbent
C) Prone
D) Semi-Fowlers
Answer: B) Left lateral recumbent
This prevents "Supine Hypotensive Syndrome" by moving the uterus off the inferior vena
cava.
10. You are suctioning a 56-year-old patient with thick secretions. What is the
maximum time you should apply suction per attempt?
A) 5 seconds
B) 10-15 seconds
C) 20-30 seconds
D) Until the airway is clear
Answer: B) 10-15 seconds
Suctioning longer than 15 seconds causes significant hypoxia and potential vagal
stimulation.
11. A 30-year-old male presents with muffled heart sounds, JVD, and narrowing pulse
pressure (Beck’s Triad). What is the likely diagnosis?
A) Tension Pneumothorax
B) Cardiac Tamponade
C) Flail Chest
D) Hemothorax
, Answer: B) Cardiac Tamponade
Beck’s Triad (Muffled sounds, JVD, Hypotension/Narrow pulse pressure) indicates fluid in
the pericardial sac.
12. A patient in V-Fib has received one shock and two minutes of CPR. What is the
next drug/dose?
A) Amiodarone 300 mg
B) Epinephrine 1 mg 1:10,000
C) Lidocaine 1.5 mg/kg
D) Atropine 1 mg
Answer: B) Epinephrine 1 mg 1:10,000
In ACLS, Epinephrine is typically given after the second shock (or during the second round
of CPR).
13. A 10-year-old is having an acute asthma attack. You have already administered
Albuterol. The patient is still struggling. What is the next logical step?
A) IV Magnesium Sulfate
B) Intubation
C) Ipratropium Bromide (Atrovent)
D) Needle Decompression
Answer: C) Ipratropium Bromide (Atrovent)
Combined "DuoNeb" therapy is more effective than Albuterol alone in the acute phase.
14. A patient is found at a fire scene with soot in their airway and altered mental
status. SpO2 is 100%. What is the most likely cause of their condition?
A) Hypoxia
B) Carbon Monoxide poisoning
C) Heat Stroke
D) Pulmonary Edema
Answer: B) Carbon Monoxide poisoning
Pulse oximeters cannot distinguish between oxyhemoglobin and carboxyhemoglobin, often
leading to a "false high" 100% reading.
15. Which of the following is a sign of Cushing’s Triad?
A) Hypotension, Tachycardia, Tachypnea
B) Hypertension, Bradycardia, Irregular Respirations
C) Narrow pulse pressure, JVD, Muffled sounds
D) Tachycardia, Hypotension, Flat neck veins
