EMT Basic (NREMT) practice questions and exam guide

A crew is dispatched to a residence for a "person down in the basement." A neighbor says the furnace has been acting up and that two other people inside also feel dizzy. The EMTs should FIRST:

1. Enter and rapidly remove the patient from the basement to fresh air
2. Stage outside, request the fire department, and have occupants come out if able
3. Open the ground-floor windows to ventilate the house before descending
4. Enter wearing surgical masks and eye protection to limit any inhalation

Answer: B — Stage outside, request the fire department, and have occupants come out if able

B) Correct - multiple people with similar symptoms in an enclosed space suggests an unseen atmospheric hazard such as carbon monoxide, so the crew stays out, has occupants self-evacuate if they can, and lets fire personnel with meters and breathing apparatus enter. A) The classic trap of rushing to a visible patient before the scene has been made safe. C) Ventilating is a fire department task performed with respiratory protection, and entering to open windows still exposes the crew. D) A common misconception - surgical masks provide no protection against gases or an oxygen-deficient atmosphere.

You are dispatched to a two-vehicle collision reported as 'one person hurt.' On arrival you see two heavily damaged vehicles and count five occupants, two of whom are out walking. Which action should be taken FIRST?

1. Begin treating the most severely injured patient you can see
2. Update dispatch with the actual patient count and request additional resources
3. Move the walking occupants into your ambulance for evaluation
4. Complete a full primary assessment on each patient in turn before calling for help

Answer: B — Update dispatch with the actual patient count and request additional resources

B) Correct — the number of patients is a size-up element, and when it exceeds what was reported the immediate step is to correct the count and get help rolling, since additional units take time to arrive. A) Committing your only crew to one patient before help is requested leaves the rest of the scene unmanaged. C) Moving ambulatory patients has a role in triage, but it does not come before requesting the resources the scene needs. D) Sequentially assessing five patients before calling for help delays care to everyone.

Scene safety differs from patient assessment in that scene safety is:

1. Performed once at arrival and documented in the narrative
2. The responsibility of the incident commander rather than the individual EMT
3. An ongoing process reassessed throughout the entire call
4. Completed only when law enforcement declares the scene secure

Answer: C — An ongoing process reassessed throughout the entire call

C) Correct — conditions change, so safety is evaluated continuously from dispatch through transport. A) The one-time view is the most common misconception and leads to crews being caught out by developing hazards. B) Command coordinates but does not relieve each provider of personal responsibility for their own safety. D) A police declaration is helpful on violent scenes but does not address mechanical, environmental, or atmospheric hazards.

While caring for a shooting victim inside a residence, the EMT notices a handgun on the floor near the patient. Law enforcement is on scene and has already secured the weapon. The BEST action is to:

1. Unload the weapon and secure it in a locked compartment aboard the ambulance
2. Leave the weapon undisturbed, note its location, and inform law enforcement
3. Move the weapon into an adjoining room so that it is out of the patient's reach
4. Hand the weapon to a family member on scene to hold for safekeeping

Answer: B — Leave the weapon undisturbed, note its location, and inform law enforcement

B) Correct - evidence is preserved wherever patient care allows, and weapons at a crime scene are handled by law enforcement rather than by EMS. A) Handling and unloading a firearm destroys evidence, exceeds the EMT's role, and creates an unnecessary hazard for the crew. C) Moving the weapon even a short distance alters the scene; that step is reserved for situations where police are not present and the weapon poses an immediate threat, which is not the case here. D) Family members may themselves be involved parties, which makes this the least safe of the four options.

An EMT notes a starred windshield, a bent steering wheel, and an unbuckled seat belt in a car whose driver is standing outside. Which conclusion is BEST supported?

1. The driver was ejected through the windshield and climbed back into the vehicle before your arrival
2. The driver was unrestrained and struck the interior, suggesting a significant mechanism
3. The damage is largely cosmetic, since the driver is ambulatory and talking to you
4. The airbag deployed on impact and absorbed most of the energy of the collision

Answer: B — The driver was unrestrained and struck the interior, suggesting a significant mechanism

B) Correct — interior deformity plus an unused restraint indicates the occupant absorbed impact energy directly, a significant mechanism regardless of how well he currently appears. A) Ejection cannot be inferred from a starred windshield alone, and nothing described supports it. C) Ambulatory status does not exclude serious injury; this is the classic underestimation error the findings are meant to counter. D) A bent steering wheel and starred windshield argue against effective airbag energy absorption, and no deployment was reported.

A patient with a known seizure disorder is postictal and confused. His airway is patent, breathing is adequate, and skin signs are normal. Which finding during the primary assessment would MOST change the EMT's impression that the altered mental status is simply postictal?

1. He does not remember the events immediately before the seizure began
2. His level of responsiveness continues to decline over successive reassessments
3. He is incontinent of urine, and his clothing was soaked when the crew arrived
4. He has a deep laceration along the lateral edge of his tongue that is oozing blood

Answer: B — His level of responsiveness continues to decline over successive reassessments

A) Wrong. Amnesia surrounding the event is expected after a seizure and does not change the impression. B) Correct. A postictal state should improve steadily, so progressive decline points to an ongoing threat such as hypoxia, hypoglycemia, or intracranial bleeding, and the mental status change becomes the emergency. C) Wrong. Incontinence is a common seizure finding, true but not discriminating between postictal state and another cause. D) Wrong. A bitten tongue is dramatic but supports that a seizure occurred rather than suggesting a different cause for the confusion.

A patient involved in an industrial accident has a partially amputated hand that bystanders find horrifying. He is quiet, cool, and pale, with a respiratory rate of 30 and a thready pulse. The EMT's assessment priority should be driven by the understanding that:

1. the amputation alone accounts for every one of these findings
2. a quiet, cooperative trauma patient is a reassuring finding
3. the grotesque injury may be masking a quieter, more lethal problem
4. distal hand injuries commonly bleed enough to cause this

Answer: C — the grotesque injury may be masking a quieter, more lethal problem

C) Correct - the theme of trauma assessment is that the most shocking injury is often not the fatal one; the quiet patient with cool skin and rapid breathing is showing signs of internal blood loss. A) A controlled hand injury seldom accounts for this whole shock picture, and accepting it as the explanation stops the search for the real bleeding. B) A quiet trauma patient is often an ominously hypoperfused one rather than a stable one, so silence is a warning rather than reassurance. D) Distal extremity injuries rarely bleed enough to produce these findings once bleeding is controlled.

A 6-month-old is carried out by a parent. The infant is limp, does not track the EMT's face, and makes no cry during handling. The MOST accurate interpretation of this appearance is:

1. The infant is comfortable and low priority, because an infant who is not crying is not in significant distress
2. The infant's priority cannot be determined until a full set of vital signs and a blood glucose reading are obtained
3. The infant is simply asleep after a feeding, and the limp posture is a normal sleeping infant's muscle tone
4. The infant is a high-priority patient because poor tone and absent interactiveness indicate a significantly abnormal appearance

Answer: D — The infant is a high-priority patient because poor tone and absent interactiveness indicate a significantly abnormal appearance

A) Wrong. This is the common misconception that a quiet infant is a well infant; a silent, limp infant is often the sickest one in the room. B) Wrong. This reverses the order of assessment, since the general impression is formed before and outranks any number. C) Wrong. It is plausible, but a sleeping infant retains muscle tone and rouses with handling, which this infant does not. D) Correct. Muscle tone, interactiveness, consolability, gaze, and cry make up appearance in a young child, and limpness with no gaze or cry is the pediatric equivalent of altered mental status.

You are assessing a patient who weighs approximately 400 pounds and is complaining of difficulty breathing while lying flat. Which is the BEST approach to evaluating breathing during the primary assessment?

1. Rely on chest wall rise alone, which is easy to see in larger patients because of the greater chest circumference
2. Assume breathing is adequate as long as the patient can speak two or three words at a time without stopping
3. Defer the breathing assessment until the patient has been moved to the ambulance and can be positioned properly
4. Use the patient's speech pattern, work of breathing, position of comfort, and pulse oximetry together, since chest rise may be difficult to see

Answer: D — Use the patient's speech pattern, work of breathing, position of comfort, and pulse oximetry together, since chest rise may be difficult to see

A) Wrong. This is a common misconception, because excess soft tissue makes visible chest excursion less reliable, not more. B) Wrong. Speaking only two or three words at a time indicates severe distress, so treating it as reassuring is a serious misread. C) Wrong. Delaying the assessment of breathing until after the patient is moved is never acceptable in the primary assessment. D) Correct. Body habitus can hide chest excursion, so several converging indicators are used together, and sitting the patient up often improves both the assessment and the patient's breathing.

During the primary assessment, which combination BEST reflects the elements an EMT uses to judge whether breathing is adequate?

1. Rate, depth, effort and regularity
2. Blood pressure, pulse and skin temperature
3. Pupil size, grip strength and orientation
4. Lung sounds in all fields, oxygen saturation trend and peak flow

Answer: A — Rate, depth, effort and regularity

A) Correct — adequacy of breathing is determined by how fast, how deep, how hard and how regularly the patient breathes. B) lists circulatory parameters, which are assessed in the next step. C) lists neurologic findings unrelated to ventilatory adequacy. D) mixes detailed and equipment-based measures beyond what the rapid primary survey uses to judge adequacy.

Adult burns — head represents what % of TBSA per Rule of 9s?

1. 4%
2. 9%
3. 18%
4. 36%

Answer: B — 9%

A) Pediatric arm/leg approx. B) Correct — adult head = 9%. C) Trunk anterior or posterior. D) Both legs combined.

An EMT is called for "back pain" in a 68-year-old. The patient describes sudden severe tearing back pain, appears pale, and has noticeably different pulse strength between the arms. The EMT should MOST appropriately treat this as:

1. a musculoskeletal strain appropriate for evaluation at a later time
2. a psychiatric complaint, given the unusually dramatic quality of the description
3. an expected finding of age-related degenerative disease of the spine
4. a potentially time-critical presentation requiring high-priority transport

Answer: D — a potentially time-critical presentation requiring high-priority transport

D) Correct - sudden severe tearing pain with pallor and unequal pulse strength between the arms is an ominous vascular presentation and must be handled as high priority. A) Treating it as an ordinary back strain that can wait misses a genuine life threat. B) The description is a symptom report from the patient, not evidence of a psychiatric condition. C) Attributing sudden severe pain to chronic degenerative change is a dangerous misconception in this age group.

An 82-year-old fell at home and is alert but her blood pressure is 108/70 with a heart rate of 78. Her daughter says she takes a beta-blocker daily. The EMT should recognize that this vital sign combination:

1. may mask the tachycardic response to shock because beta-blockers blunt heart rate elevation
2. rules out significant blood loss because the heart rate is within normal limits
3. confirms the patient is hemodynamically stable and can be transported without urgency
4. indicates the fall was caused by a cardiac dysrhythmia rather than a mechanical trip

Answer: A — may mask the tachycardic response to shock because beta-blockers blunt heart rate elevation

A) Correct - beta-blockers blunt the normal compensatory tachycardia seen in early shock, so a geriatric patient on this medication class can be significantly hypoperfused while showing a deceptively normal or even low heart rate; the EMT must rely more heavily on skin signs, mentation, and trending blood pressure. B) A normal-looking heart rate does not rule out blood loss in this population; that is the core misconception this question tests. C) A single reassuring-looking vital sign set should not be read as stability given the medication history. D) The vitals given do not indicate a dysrhythmia, and assuming a cardiac cause without evidence is an unsupported leap.

APGAR is assessed at:

1. At 1 minute only, and then recorded on the patient care report
2. At 1 minute and again at 5 minutes after the delivery of the newborn
3. Whenever the mother or another family member asks how the baby is doing
4. Only after arrival at the receiving hospital's newborn nursery

Answer: B — At 1 minute and again at 5 minutes after the delivery of the newborn

B) Correct - the APGAR score is assigned at 1 minute and again at 5 minutes, with additional scoring at intervals thereafter if the score remains low. A) A single 1-minute score misses the trend, which is what indicates whether resuscitation is working. C) Scoring is tied to fixed time points, not to when a family member asks. D) Waiting until hospital arrival loses the newborn's earliest and most useful assessment window, and it does not replace immediate newborn care.

A patient with a chief complaint of "leg swelling for two weeks" is now also short of breath at rest with a sudden onset today. Which statement is MOST accurate?

1. The chronic leg swelling is the priority since it started first
2. The new acute shortness of breath is the priority problem
3. The two findings are unrelated and only the leg should be assessed
4. The chief complaint cannot change once stated

Answer: B — The new acute shortness of breath is the priority problem

B) Correct — the acute change in breathing outranks the chronic complaint and reframes the call; the presenting complaint is not always the life threat. A) Chronological order does not establish priority. C) Dismissing a possible relationship narrows thinking prematurely. D) The EMT's understanding of the problem is expected to evolve as assessment proceeds.

Open pneumothorax (sucking chest wound) management?

1. Seal the wound completely with an airtight dressing taped on all four sides
2. Apply an occlusive dressing taped on three sides so that it acts as a vent flap
3. Leave the wound open so trapped air can escape freely from the chest
4. Pack the wound with gauze and maintain firm direct pressure over it

Answer: B — Apply an occlusive dressing taped on three sides so that it acts as a vent flap

B) Correct - a three-sided dressing prevents air from being drawn in during inspiration while allowing trapped air to escape during exhalation, and the patient is monitored for tension physiology. A) A fully sealed dressing can convert an open pneumothorax into a tension pneumothorax if air accumulates with no route out; if this is used, the dressing must be burped when tension develops. C) Leaving the defect open allows air to be pulled into the pleural space with every breath and worsens lung collapse. D) Packing is used for junctional and extremity wounds, not chest wounds, where it risks driving material into the pleural space.

An EMT arrives to find an adult who is unresponsive, apneic, and pulseless after being pulled from a pool. Which sequence is MOST appropriate?

1. Suction the airway, deliver five rescue breaths, and then recheck for a pulse before compressing
2. Apply the AED and complete an analysis before starting any chest compressions
3. Perform abdominal thrusts to expel the water the patient swallowed
4. Begin compressions and ventilations, applying the AED as soon as it is ready

Answer: D — Begin compressions and ventilations, applying the AED as soon as it is ready

D) Correct - a pulseless drowning patient receives immediate high-quality CPR with ventilation, and the AED is used as soon as it is available. A) The pulse has already been found absent; delaying compressions for suctioning and a series of breaths postpones circulation. B) Withholding compressions while the AED is readied wastes perfusion time; compressions continue until the device is ready to analyze. C) Abdominal thrusts to remove swallowed water are not indicated and risk regurgitation and aspiration.

After delivery of the head, your next action is:

1. Apply gentle downward traction on the head to deliver the anterior shoulder
2. Clamp and cut the umbilical cord immediately so the infant can be dried
3. Suction per protocol only if the airway is obstructed, and check for a nuchal cord
4. Stimulate the infant by rubbing the back and flicking the soles to prompt a first breath

Answer: C — Suction per protocol only if the airway is obstructed, and check for a nuchal cord

C) Correct - after the head delivers, routine bulb suction is no longer recommended, so suction only for an obstructed airway and immediately check whether the cord is wrapped around the neck. A) Pulling on the head risks brachial plexus injury; delivery of the shoulders should be allowed to proceed with support rather than traction. B) The cord is clamped and cut after delivery is complete, not while the body is still in the birth canal. D) Drying and stimulation are the right actions but belong after the infant is fully delivered, not at the point the head has just emerged.

Patient with foreign body airway obstruction who can speak and cough forcefully — best action?

1. Begin abdominal thrusts immediately, since any airway obstruction requires prompt removal
2. Deliver five back blows between the shoulder blades to dislodge the object
3. Encourage the patient to keep coughing forcefully and monitor closely
4. Begin chest compressions to raise airway pressure and expel the object

Answer: C — Encourage the patient to keep coughing forcefully and monitor closely

A) Abdominal thrusts are reserved for the patient whose cough has become ineffective or who cannot speak; using them now can convert a partial obstruction into a complete one. B) Back blows belong to infant management and to the adult with an ineffective cough, not to a patient moving air well. C) Correct - a forceful cough generates more airway pressure than any maneuver the EMT can apply, so the patient is encouraged, monitored closely for deterioration, and transported. D) Chest compressions are for the unresponsive patient, and are not an intervention for someone who is speaking.

A semi-conscious patient gags when you attempt to insert an OPA. Best next action?

1. Force the OPA past the gag
2. Withhold any airway adjunct
3. Remove the OPA and consider an NPA
4. Insert a second OPA in the other side of the mouth

Answer: C — Remove the OPA and consider an NPA

A) Gagging risks vomiting and aspiration. C) Correct — NPA is tolerated by patients with intact gag reflex provided no midface trauma. B) Patient still needs airway management. D) Not an established technique.

During a vehicle rescue, which task BEST fits the EMT's role in simple access?

1. Cutting the roof posts with a powered rescue saw so that the roof can be folded back to open a clear extrication path for the crew
2. Spreading the jammed door frame apart with hydraulic tools to widen the opening enough to reach the patient
3. Stabilizing the vehicle with cribbing and step chocks before anyone attempts to enter the passenger compartment
4. Trying the door handles and reaching the patient through an already broken window without using specialized tools

Answer: D — Trying the door handles and reaching the patient through an already broken window without using specialized tools

D) Correct - simple access means reaching the patient without tools: trying the doors, rolling down windows, or using an opening that already exists. A) Cutting structural posts is complex access requiring rescue training and powered equipment. B) Hydraulic spreading is likewise complex access performed by trained rescue personnel. C) Vehicle stabilization is an essential rescue task performed before entry, but it is a rescue function rather than what simple access describes.

Adult competent and alert refusing care — best step?

1. Transport the patient against their stated wishes, since refusal always creates liability
2. Leave the scene once the patient says no, since documentation is only required after treatment
3. Determine decision-making capacity, inform of risks/alternatives, document refusal, advise call-back
4. Sedate the patient so a complete assessment can be finished before any refusal is honored

Answer: C — Determine decision-making capacity, inform of risks/alternatives, document refusal, advise call-back

A) Transporting a patient with capacity against their will is battery, not risk management. B) Refusals require the most careful documentation of any call, not the least. C) Correct — confirm capacity, explain risks and alternatives in terms the patient understands, document the refusal, and tell the patient to call back if anything changes. D) Sedating a competent adult to override a refusal is both outside EMT scope and a serious violation of autonomy.

An EMT contacts medical control and receives an order that seems inappropriate for the patient's condition. The EMT's BEST next action is to:

1. Carry out the order exactly as given, because the physician providing online direction holds the license under which the EMT is operating
2. Repeat the order back and question it, and if it still appears inappropriate, do not perform it and document the exchange
3. Perform a modified version of the order that the EMT believes is safer, then report the change to the physician on arrival
4. Terminate radio contact and carry out the standing orders for this complaint instead, since offline protocols override a disputed order

Answer: B — Repeat the order back and question it, and if it still appears inappropriate, do not perform it and document the exchange

B) Correct - orders are always echoed back for verification, and an EMT who believes an order is inappropriate or harmful must question it; if it is confirmed and still appears harmful, the EMT does not perform it and documents the interaction. A) A common misconception: operating under a physician's license does not transfer responsibility, and the provider who performs the act remains accountable for it. C) Improvising an unauthorized variation exceeds the EMT's authority and creates a hidden deviation, and reporting it afterward does not make it authorized. D) Standing orders do not override an order already given, and cutting off contact skips the clarification step that resolves most such situations.

An EMT is writing the narrative of a patient care report after a fall call. Which entry is the BEST example of an objective finding rather than a subjective interpretation?

1. "Patient was clearly intoxicated and was uncooperative with the crew throughout assessment and transport."
2. "Patient appeared to be faking the leg pain to get attention from the crew."
3. "Odor of an alcoholic beverage noted; patient pulled arm away twice during splinting."
4. "Patient's family is negligent and should not be left in charge of his care."

Answer: C — "Odor of an alcoholic beverage noted; patient pulled arm away twice during splinting."

C) Correct — objective documentation records what the EMT directly observed or measured, described in neutral terms, and leaves the conclusions to the reader. A) Tempting because intoxication often seems obvious, but "intoxicated" and "uncooperative" are conclusions the EMT cannot verify and are legally damaging. B) A judgment about the patient's honesty that the EMT has no way to establish and that is indefensible in court. D) An accusation about third parties; a suspicion of neglect belongs in a report to the appropriate agency, not as an editorial conclusion in the narrative.

What is the safest approach to a patient with a suspected spinal injury during size-up?

Approach from the front so the patient does not turn the head, identify yourself, and instruct them to hold still while manual stabilization is applied.

EMT priority on arrival at scene?

Scene size-up: scene safety, BSI/PPE, mechanism of injury (MOI) or nature of illness (NOI), number of patients, additional resources.

State the adult CPR compression rate, depth, and compression-to-ventilation ratio.

Follow current guidelines and local protocol: rate 100 to 120 compressions per minute; depth at least 2 inches (5 cm) and not more than 2.4 inches (6 cm); ratio 30 compressions to 2 breaths without an advanced airway. In a child, compress about one third of the anterior-posterior chest diameter. Allow full recoil and minimize interruptions.

What is the EMT's first priority on every call?

Personal safety, then the safety of the crew, the patient, and bystanders, in that order. An injured EMT cannot help anyone.

Direct pressure bleeding control?

First step. Apply firm pressure with gloved hand or dressing. If saturates, add layers — don't remove.

What is the rescue breathing rate for an adult in respiratory arrest who still has a pulse?

1 breath every 6 seconds, about 10 breaths per minute, each delivered over about one second with just enough volume to produce visible chest rise. Do not compress a patient who has a pulse; reassess the pulse frequently and begin compressions immediately if it is lost. Follow current guidelines and local protocol.