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British Columbia Advanced Care Paramedic Licensing Examination — Written Exam Practice Q, Exams of Health, psychology

American Samoa Community CollegeHealth, psychology

British Columbia Advanced Care Paramedic Licensing Examination — Written Exam Practice Questions And Correct Answers (Verified Answers) Plus Rationale 2026 Q&A| Instant Download Pdf

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2025/2026

Available from 04/16/2026

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British Columbia Advanced Care
Paramedic Licensing Examination —
Written Exam Practice Questions And
Correct Answers (Verified Answers) Plus
Rationale 2026 Q&A| Instant Download
Pdf
1. A 56-year-old patient presents with acute chest pain radiating to the
left arm. Vital signs are BP 88/54 mmHg, HR 110 bpm, RR 24/min, SpO₂
94% on room air. ECG shows ST-elevation in leads II, III, and aVF. Which
of the following is the most appropriate initial intervention?
A. Administer high-flow oxygen and observe
B. Give sublingual nitroglycerin immediately
C. Initiate IV access, administer aspirin, and prepare for rapid transport to a
PCI-capable facility
D. Begin advanced airway management
Rationale: In a patient with inferior STEMI and hypotension, early
reperfusion therapy is critical. Aspirin reduces platelet aggregation, IV access
ensures medication delivery, and rapid transport to a PCI-capable facility
improves survival. Nitroglycerin is contraindicated in hypotension.
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Download British Columbia Advanced Care Paramedic Licensing Examination — Written Exam Practice Q and more Exams Health, psychology in PDF only on Docsity!

British Columbia Advanced Care

Paramedic Licensing Examination —

Written Exam Practice Questions And

Correct Answers (Verified Answers) Plus

Rationale 2026 Q&A| Instant Download

Pdf

  1. A 56-year-old patient presents with acute chest pain radiating to the left arm. Vital signs are BP 88/54 mmHg, HR 110 bpm, RR 24/min, SpO₂ 94% on room air. ECG shows ST-elevation in leads II, III, and aVF. Which of the following is the most appropriate initial intervention? A. Administer high-flow oxygen and observe B. Give sublingual nitroglycerin immediately C. Initiate IV access, administer aspirin, and prepare for rapid transport to a PCI-capable facility D. Begin advanced airway management Rationale: In a patient with inferior STEMI and hypotension, early reperfusion therapy is critical. Aspirin reduces platelet aggregation, IV access ensures medication delivery, and rapid transport to a PCI-capable facility improves survival. Nitroglycerin is contraindicated in hypotension.
  1. During a cardiac arrest, you notice fine ventricular fibrillation on the monitor. After delivering a shock and performing two minutes of CPR, the rhythm remains VF. The next step is: A. Continue CPR for another 10 minutes before reassessment B. Administer epinephrine 1 mg IV/IO and prepare for the next shock C. Begin amiodarone infusion immediately without further shocks D. Intubate the patient before delivering the next shock Rationale: Epinephrine should be administered after the second defibrillation attempt for VF/pulseless VT to improve coronary perfusion. CPR should continue, and defibrillation remains the primary treatment.
  2. A 34-year-old patient is post-renal transplant, presenting with confusion, fever, and hypotension. Which of the following most likely represents septic shock? A. MAP 65 mmHg with HR 85 bpm B. MAP 55 mmHg, HR 120 bpm, lactate 3.5 mmol/L C. BP 130/80 mmHg, HR 95 bpm D. Normal vitals with mild fever Rationale: Septic shock is defined by persistent hypotension requiring vasopressors to maintain MAP ≥65 mmHg and serum lactate >2 mmol/L despite fluid resuscitation. Tachycardia and hypotension with elevated lactate indicate poor perfusion.
  3. You are treating a patient with severe asthma exacerbation. After high- flow oxygen and repeated nebulized albuterol, the patient remains in severe respiratory distress. The next intervention is: A. Initiate non-invasive ventilation immediately B. Administer IV magnesium sulfate and consider continuous nebulized bronchodilators

A. Rapid IV fluids B. Immediate needle decompression or chest tube placement C. High-dose epinephrine D. Endotracheal intubation Rationale: Tension pneumothorax is a reversible cause of traumatic arrest. Immediate decompression restores venous return and cardiac output, which is critical before fluid resuscitation or medications.

  1. A 70-year-old patient presents with altered mental status, bradycardia (HR 38 bpm), and hypotension. ECG shows third-degree AV block. The first-line intervention is: A. Administer IV atropine only B. Prepare for transcutaneous pacing while considering atropine C. Immediate dopamine infusion without pacing D. Observation only Rationale: Third-degree AV block with hemodynamic instability requires pacing. Atropine can be tried if the block is above the AV node, but pacing readiness is essential. Dopamine may be adjunctive if pacing is delayed.
  2. A patient with severe sepsis shows lactate of 5 mmol/L after fluid resuscitation. Which intervention should be prioritized? A. Start antibiotics after lactate normalizes B. Limit fluids and observe C. Administer vasopressors to maintain MAP ≥65 mmHg D. Immediate hemodialysis Rationale: Persistent elevated lactate despite fluids indicates ongoing tissue hypoperfusion. Vasopressors like norepinephrine are indicated to restore adequate perfusion. Early antibiotics should already be started.
  1. Which of the following is the preferred sedative agent for rapid sequence intubation in a patient with hypotension? A. Etomidate B. Midazolam C. Ketamine D. Propofol Rationale: Ketamine maintains or increases blood pressure and cardiac output, making it preferable in hypotensive patients. Etomidate is hemodynamically stable but can cause adrenal suppression. Propofol and midazolam may worsen hypotension.
  2. A patient presents with massive upper GI bleeding and shock. After securing IV access, which is the next priority? A. Begin proton pump inhibitor infusion only B. Prepare for endoscopy after vitals normalize C. Rapid fluid resuscitation with crystalloids and blood products D. Administer antiemetics and monitor Rationale: Hemodynamic stabilization with fluids and blood products is critical to maintain perfusion before definitive interventions like endoscopy.
  3. Which of the following is the most sensitive early indicator of hypovolemic shock in trauma? A. Blood pressure <90 mmHg B. Heart rate >100 bpm and tachycardia C. Altered mental status only D. Urine output <20 mL/hr Rationale: Tachycardia is an early compensatory response to hypovolemia and often precedes hypotension. Blood pressure changes are a late sign.
  1. Which clinical finding distinguishes neurogenic shock from other forms of shock? A. Cold, clammy extremities B. Tachycardia with hypotension C. Hypotension with bradycardia and warm extremities D. Elevated central venous pressure Rationale: Neurogenic shock involves loss of sympathetic tone, leading to vasodilation, hypotension, and bradycardia with warm, flushed skin, unlike other shock types.
  2. A patient has severe hypothermia with a core temperature of 28°C. Which intervention is most appropriate initially? A. Immediate defibrillation for VF B. Rapid IV fluids at room temperature C. Passive and active external rewarming, warm IV fluids D. Administer sedatives to prevent shivering Rationale: In severe hypothermia, slow controlled rewarming with warm fluids and external heat is preferred. Defibrillation may fail until core temperature rises >30°C.
  3. In a patient with acute stroke, which sign indicates a contraindication to thrombolytic therapy? A. Hemiparesis B. Aphasia C. Facial droop D. Intracranial hemorrhage on CT scan Rationale: Thrombolytics are contraindicated in intracranial hemorrhage due to the risk of worsening bleeding. Neurologic deficits alone are indications, not contraindications.
  1. Which of the following best describes permissive hypotension in trauma? A. Target SBP >140 mmHg B. Immediate aggressive fluid resuscitation to normalize BP C. Allowing lower-than-normal BP to avoid dislodging clots in uncontrolled hemorrhage D. No fluids until surgical control Rationale: Permissive hypotension maintains organ perfusion while reducing the risk of dislodging clots and worsening bleeding prior to definitive hemorrhage control.
  2. Which intervention is first-line for a patient with symptomatic bradycardia and hypotension? A. IV dopamine infusion only B. Oral atropine C. Atropine IV 0.5 mg and repeat every 3 – 5 minutes as needed D. Immediate transvenous pacing only Rationale: IV atropine is the first-line treatment for symptomatic bradycardia. If ineffective, transcutaneous or transvenous pacing may be necessary.
  3. Which of the following is the most accurate definition of shock? A. Any low blood pressure B. Heart rate >100 bpm C. Inadequate tissue perfusion leading to cellular dysfunction D. Loss of consciousness Rationale: Shock is defined by the inability of the circulatory system to meet tissue metabolic demands, resulting in cellular hypoxia and dysfunction.
  1. Which of the following is the preferred vasopressor in septic shock? A. Dopamine B. Epinephrine C. Norepinephrine D. Phenylephrine Rationale: Norepinephrine is the first-line vasopressor in septic shock to restore MAP while minimizing tachyarrhythmias.
  2. A patient develops acute pulmonary edema from heart failure. Which intervention provides rapid symptom relief? A. IV antibiotics B. IV diuretics and CPAP or BiPAP C. Immediate intubation without other measures D. Fluid bolus Rationale: Diuretics reduce fluid overload, and positive pressure ventilation improves oxygenation and decreases preload. Intubation is reserved for severe cases or failure of non-invasive support.
  3. In a patient with suspected opioid overdose and respiratory depression, which medication is first-line? A. Diazepam B. Naloxone C. Fentanyl D. Flumazenil Rationale: Naloxone is an opioid antagonist that rapidly reverses respiratory depression. Flumazenil is for benzodiazepine overdose.
  4. Which of the following is the definitive treatment for tension pneumothorax in the prehospital setting?

A. Supplemental oxygen only B. Needle decompression only C. Needle decompression followed by chest tube insertion D. Endotracheal intubation Rationale: Needle decompression relieves pressure immediately; definitive management requires chest tube placement to prevent recurrence.

  1. In a patient with severe trauma and hypotension, which crystalloid solution is preferred initially? A. 0.45% saline B. Dextrose 5% C. 0.9% normal saline or lactated Ringer’s D. Albumin only Rationale: Isotonic crystalloids like NS or LR restore intravascular volume rapidly. Hypotonic solutions may worsen cellular edema, and albumin is not first-line in acute resuscitation.
  2. Which of the following ECG changes is most associated with hypothermia? A. Tall peaked T-waves B. Shortened PR interval C. J-wave (Osborn wave) D. ST-segment elevation only Rationale: The J-wave (Osborn wave) is characteristic of hypothermia and appears as a positive deflection at the QRS-ST junction.
  3. In anaphylactic shock, which physiologic change is primarily responsible for hypotension? A. Reduced cardiac output due to bradycardia B. Massive vasodilation and increased capillary permeability

C. Intramuscular injection into the lateral thigh D. Oral Rationale: IM injection into the lateral thigh ensures rapid absorption and onset. IV is reserved for severe, refractory cases.

  1. A patient in cardiac arrest presents with pulseless VT. What is the first action? A. Administer epinephrine immediately B. Defibrillate immediately C. Intubate first D. Start IV fluids Rationale: Pulseless VT is a shockable rhythm; immediate defibrillation provides the best chance of ROSC.
  2. A patient presents with severe hypoglycemia and altered mental status. Which intervention is most appropriate? A. Oral glucose only B. IV insulin C. IV dextrose 25 – 50% D. Wait and observe Rationale: IV dextrose rapidly restores blood glucose and consciousness in patients unable to swallow safely.
  3. During a prehospital resuscitation, a patient has a massive hemorrhage from a femur fracture. Which intervention best prevents shock? A. Elevate the leg only B. Apply direct pressure, splint, and initiate IV fluids C. Give oral fluids D. Immediate analgesia only

Rationale: Hemorrhage control with direct pressure, immobilization, and volume resuscitation prevents hypovolemic shock.

  1. Which of the following is the initial management of a patient with acute adrenal crisis? A. Oral steroids only B. IV fluids only C. IV hydrocortisone and fluid resuscitation D. Insulin infusion Rationale: Acute adrenal crisis requires prompt IV corticosteroids and fluids to correct hypotension and electrolyte disturbances.
  2. Which of the following is the most sensitive sign of increased intracranial pressure (ICP)? A. Headache only B. Pupillary changes and decreased level of consciousness C. Nausea only D. Hypertension only Rationale: Changes in consciousness and pupillary responses reflect brainstem compromise and are the earliest sensitive indicators of increased ICP.
  3. In a trauma patient, which finding most strongly suggests internal bleeding? A. Bruising on extremities only B. Coughing blood C. Hypotension with tachycardia without external bleeding D. Mild back pain
  1. Which of the following best describes distributive shock? A. Low cardiac output only B. Blood loss only C. Relative hypovolemia due to vasodilation and maldistribution D. Obstruction to venous return Rationale: Distributive shock involves inadequate tissue perfusion despite normal or elevated cardiac output, caused by vasodilation and capillary leak.
  2. In severe asthma, which of the following indicates impending respiratory failure? A. Use of accessory muscles only B. Mild wheezing C. Silent chest, exhaustion, and altered mental status D. SpO₂ 98% on room air Rationale: Silent chest and altered mental status indicate severe airflow limitation and hypoxia, signaling imminent respiratory failure.
  3. Which of the following is first-line therapy for supraventricular tachycardia (SVT) with stable vitals? A. IV amiodarone B. Synchronized cardioversion immediately C. Vagal maneuvers followed by adenosine if unsuccessful D. Beta-blockers only Rationale: SVT with stable vitals can often be terminated with vagal maneuvers; adenosine is the drug of choice if vagal maneuvers fail.
  4. In trauma, which fluid resuscitation strategy is recommended for uncontrolled hemorrhage before surgical control?

A. Large-volume aggressive crystalloid B. Hypotonic solutions C. Permissive hypotension with limited fluids D. No fluids at all Rationale: Permissive hypotension maintains organ perfusion while reducing the risk of dislodging clots and worsening hemorrhage.

  1. Which of the following interventions is most appropriate for a patient with acute stroke within 3 hours of onset? A. Aspirin only B. Anticoagulation immediately C. Thrombolytic therapy if no contraindications D. Hypothermia induction Rationale: IV thrombolysis within the appropriate window improves outcomes in ischemic stroke. Contraindications must be ruled out first.
  2. Which is the most important initial assessment in a patient with suspected spinal cord injury? A. Blood pressure B. Heart rate C. Airway, breathing, and cervical spine stabilization D. Pain level Rationale: Maintaining airway and spinal immobilization prevents secondary injury, which is the immediate priority in spinal trauma.
  3. Which intervention is critical in post-cardiac arrest patients to prevent secondary brain injury? A. Rapid extubation B. Immediate aggressive fluid resuscitation only C. Maintaining normoxia, normocapnia, and targeted temperature

A. Cardiac arrhythmia B. Histamine-mediated smooth muscle contraction in the airways C. Vasoconstriction of peripheral vessels D. Hypovolemia Rationale: Histamine release causes airway smooth muscle contraction, leading to bronchospasm and respiratory distress.

  1. A patient with severe sepsis remains hypotensive after 2 liters of crystalloid. Which next step is recommended? A. Start oral antibiotics only B. Observe and repeat vitals in 30 minutes C. Initiate norepinephrine infusion to maintain MAP ≥65 mmHg D. Begin high-dose steroids immediately Rationale: Persistent hypotension after fluid resuscitation in septic shock requires vasopressors to restore adequate tissue perfusion.
  2. In a patient with bradycardia and hypotension unresponsive to atropine, the next best intervention is: A. IV fluids only B. Observation C. Transcutaneous pacing D. High-dose dopamine Rationale: Transcutaneous pacing provides immediate cardiac output support in symptomatic bradycardia when atropine fails.
  3. Which electrolyte abnormality is associated with torsades de pointes? A. Hypernatremia B. Hypercalcemia

C. Hypomagnesemia D. Hyperkalemia Rationale: Low magnesium can prolong QT interval, predisposing to torsades de pointes, which may lead to ventricular arrhythmias.

  1. A 50-year-old patient presents with hypotension, warm extremities, and tachycardia after a urinary tract infection. Which type of shock is most likely? A. Cardiogenic B. Hypovolemic C. Septic (distributive) shock D. Obstructive Rationale: Warm extremities and hypotension in the context of infection suggest vasodilatory septic shock, a form of distributive shock.
  2. Which medication is first-line for acute management of anaphylactic shock? A. IV diphenhydramine B. IV corticosteroids C. IM epinephrine D. Albuterol inhalation Rationale: Intramuscular epinephrine rapidly reverses airway compromise and hypotension and is life-saving in anaphylaxis.
  3. A patient presents with pulseless electrical activity (PEA). Which is the most appropriate initial management? A. Defibrillation immediately B. High-quality CPR and identify reversible causes C. IV amiodarone only D. Immediate intubation before CPR