Primary Assessment — EMT Basic NREMT practice questions

A 24-year-old sits upright, answers her name correctly, but insists it is 1998 and that she is at her childhood home. Which description of her mental status is MOST accurate?

1. Alert on AVPU, but with altered mental status because she is not oriented to time and place
2. Responsive to verbal stimulus only, since she did not volunteer anything until she was asked a question
3. Neurologically intact, because she gave her own name correctly and is sitting upright
4. Unresponsive on the AVPU scale, because the content of her answers is incorrect

Answer: A — Alert on AVPU, but with altered mental status because she is not oriented to time and place

A) Correct - AVPU level and orientation are separate measures; she is spontaneously alert but disoriented to time and place, which is altered mental status. B) misapplies the verbal level, which is reserved for a patient who does not respond at all until spoken to. C) is a plausible-rationale partial: a correct name is only one of the four spheres of orientation. D) is a large direction reversal - she is sitting up, speaking, and interacting.

A 4-year-old struck by a car is alert with a heart rate at the upper end of normal for age, a normal blood pressure, and slightly delayed capillary refill with cool hands. The MOST accurate interpretation is that this child:

1. is physiologically stable, since her blood pressure is normal for age
2. may be compensating, with normal pressure masking significant blood loss
3. has findings explained entirely by cold ambient air and fright
4. can be reassessed at longer intervals than an adult would need

Answer: B — may be compensating, with normal pressure masking significant blood loss

B) Correct - children maintain blood pressure through vasoconstriction and heart rate until late, so peripheral findings such as capillary refill and skin temperature are more informative than the pressure. A) A normal pressure in an injured child is one of the most dangerous reassurances in pediatric trauma. C) Cold surroundings and fear are convenient explanations but cannot be assumed in a child struck by a car. D) A potentially compensating child needs more frequent, not less frequent, reassessment.

A patient ejected from a rolled vehicle has an obviously angulated, deformed femur and is screaming about his leg. He is also pale with a rapid pulse and shallow breathing. The EMT should recognize that the deformed femur is MOST likely:

1. the only injury requiring attention, since it is clearly the most painful one
2. proof that the patient's shock is coming from the leg and nothing else
3. a reason to delay the rest of the primary assessment until the leg is splinted
4. a dramatic distraction that must not delay finding the true life threat

Answer: D — a dramatic distraction that must not delay finding the true life threat

D) Correct - the loudest and most visible injury pulls attention away from chest, abdominal, or pelvic bleeding that is far more likely to explain the perfusion and breathing changes. A) Pain intensity does not track with lethality, and the screaming patient is not necessarily the sickest one. B) A closed femur fracture contributes to blood loss but rarely explains this entire picture after an ejection. C) Splinting is never permitted to precede the identification and management of life threats.

A 25-year-old is struck by a car and has an obviously deformed, painful femur. He denies any other pain and is fully alert. Which statement about his assessment is MOST correct?

1. His denial of any other pain reliably rules out additional injuries in an alert patient
2. The femur injury can mask pain from other injuries, so the primary assessment must be completed regardless
3. The deformed femur should be splinted and secured before the primary assessment is completed, to control pain and bleeding
4. He can be classified as a low-priority patient because he is fully alert and answering questions

Answer: B — The femur injury can mask pain from other injuries, so the primary assessment must be completed regardless

B) Correct — a severe distracting injury dominates the patient's attention and makes his self-report unreliable, so the EMT completes the systematic primary assessment and treats life threats first. A) Relying on a distracted patient's denial is exactly the trap this scenario sets. C) Splinting is a legitimate intervention placed at the wrong point in the sequence; it must not interrupt the search for life threats. D) Alertness alone does not make a patient low priority when the mechanism is significant.

A patient rescued from a house fire has singed nasal hairs, soot around the mouth, and a hoarse voice, with partial-thickness burns to one arm. Which is the MOST appropriate priority reasoning?

1. The burned arm dictates priority and should be fully dressed before any movement
2. The airway findings make this a high-priority patient requiring rapid transport
3. The patient is low priority because the burn covers a small body surface area
4. Priority should be assigned according to the pain score the patient reports

Answer: B — The airway findings make this a high-priority patient requiring rapid transport

B) Correct - signs of inhalation injury predict progressive airway swelling, and that airway threat makes the patient high priority regardless of how much skin is burned. A) The visible burn is the distracting injury, and dressing it first is the right care delivered at the wrong point in the sequence. C) Body surface area calculations say nothing about the inhalation component, which is the actual life threat here. D) Pain scores guide comfort measures; they never determine priority during the primary assessment.

Which anatomic feature MOST explains why an unresponsive infant's airway can become obstructed when the head is allowed to rest flat on a hard surface?

1. The infant's trachea is proportionally longer than an adult's relative to overall body size
2. The infant's cricoid ring is the widest point along the length of the upper airway
3. The infant's epiglottis is smaller and stiffer than the epiglottis of an adult
4. The infant's occiput is proportionally large, flexing the neck and narrowing the airway

Answer: D — The infant's occiput is proportionally large, flexing the neck and narrowing the airway

D) Correct - the proportionally large back of an infant's head pushes the neck into flexion when the infant is supine on a flat surface, which kinks and narrows the already small airway. A) This reverses the relationship, since the infant airway is proportionally shorter rather than longer. B) This inverts a standard teaching point: in the young child the cricoid region is the narrowest, not the widest, part of the airway. C) This misstates the anatomy, because the infant epiglottis is relatively larger and floppier than an adult's.

An EMT gently assesses the pelvis of an unresponsive patient struck by a car and notes instability with a grinding sensation. The MOST important implication of this finding during the primary assessment is that:

1. the patient is unlikely to be able to walk unaided once the injury has healed
2. the pelvis can hold a large volume of blood and may be the source of shock
3. it is an unreliable finding that should be confirmed by rocking the pelvis a second time
4. the finding effectively rules out intra-abdominal injury as a bleeding source

Answer: B — the pelvis can hold a large volume of blood and may be the source of shock

B) Correct - the pelvic ring and retroperitoneal space can accommodate liters of blood, so instability marks a potentially lethal, invisible bleeding source and sets high priority. A) Long-term function is a legitimate concern but is irrelevant to the immediate survey. C) Repeatedly rocking an unstable pelvis can disrupt clot and worsen bleeding; the finding is not re-tested. D) Pelvic and abdominal injuries frequently occur together; one never excludes the other.

An 18-year-old is pulled from a lake after an unknown period underwater. Which primary-assessment priority does the mechanism MOST directly change?

1. Airway and breathing, because hypoxia is the central problem in submersion
2. Circulation, because significant blood loss is the expected finding in submersion patients
3. Level of consciousness, because an unwitnessed head injury is the usual cause of drowning
4. Skin temperature, because cold-water immersion makes hypothermia the first thing assessed

Answer: A — Airway and breathing, because hypoxia is the central problem in submersion

A) Correct — submersion produces hypoxia first, so airway control and effective ventilation drive both the assessment and the resuscitation, with spinal precautions added when the history suggests a dive or trauma. B) Hemorrhage is not an expected consequence of submersion, so circulation is assessed in its normal place rather than being elevated by the mechanism. C) Head injury does occur, particularly with diving entries, but it is the exception rather than the usual cause, and hypoxia remains the defining problem. D) Hypothermia is a genuine concern after immersion and must be managed, but temperature assessment never displaces airway and breathing in the primary assessment.

A 5-year-old with two days of vomiting is now listless, breathing rapidly, and has mottled skin with cool extremities. Using the pediatric assessment triangle, which statement is MOST accurate?

1. Only work of breathing is abnormal; the child's appearance and circulation to the skin are within normal limits
2. Only appearance is abnormal; the rapid breathing and mottling both reflect dehydration rather than true instability
3. All three sides - appearance, work of breathing, and circulation to skin - are abnormal, indicating a critically ill child
4. The triangle cannot be interpreted until a blood pressure, pulse oximetry reading, and core temperature have been obtained for comparison

Answer: C — All three sides - appearance, work of breathing, and circulation to skin - are abnormal, indicating a critically ill child

C) Correct - listlessness is an abnormal appearance, rapid breathing is abnormal work of breathing, and mottled cool skin is abnormal circulation to skin; all three abnormal identifies a critical child. A) This captures only one abnormal side and misses the appearance and circulation findings that establish severity. B) Appearance is indeed abnormal, but attributing the tachypnea and mottling to dehydration alone dismisses two additional abnormal sides. D) The triangle is deliberately a hands-off, equipment-free tool formed from across the room, so no vital signs are required to apply it.

A 68-year-old man with sudden left-sided weakness has slurred speech, drooling, and a wet, gurgling sound with each breath while lying supine. Which primary-assessment concern is MOST urgent?

1. His inability to walk, which will complicate moving him out to the ambulance
2. His compromised airway protection, evidenced by drooling and gurgling respirations
3. His facial droop, which confirms the stroke and thereby establishes the priority
4. His blood pressure, which needs to be brought down before anything else is done

Answer: B — His compromised airway protection, evidenced by drooling and gurgling respirations

B) Correct - an impaired gag and swallow put stroke patients at immediate risk of aspiration, and gurgling with drooling are airway findings that outrank everything else in the survey. A) A genuine logistical problem, but it is not a life threat and it is not part of the primary assessment. C) The droop supports the stroke impression; it is not the finding that threatens life in the next few minutes. D) Lowering blood pressure is not an EMT field intervention and is not a primary-assessment priority in this patient.

Where is the pulse checked in a responsive versus an unresponsive adult?

Radial pulse in a responsive adult; carotid pulse in an unresponsive adult. Absence of a carotid pulse indicates cardiac arrest.

What is the earliest reliable sign of respiratory distress in an infant?

An increased respiratory rate with retractions and nasal flaring. Grunting and head bobbing indicate severe distress.

Which airway maneuver is used for a patient with suspected spinal injury?

The jaw-thrust maneuver, which opens the airway without extending the neck. Head-tilt chin-lift is used when no spinal injury is suspected.

What resting heart rate range is expected in an infant compared with an adult?

Infants normally run much faster, roughly 100 to 160 beats per minute at rest, while a normal adult is 60 to 100.