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Question 1. Which of the following best defines the legal “duty to act” for an on‑duty police officer in Massachusetts? A) The officer may choose whether to render aid based on personal preference. B) The officer is required to provide emergency medical assistance when a patient is in immediate danger. C) The officer must only call for EMS and may not intervene directly. D) The officer is obligated to transport the patient to a hospital regardless of condition. Answer: B Explanation: Under M.G.L. c. 111, § 201, an on‑duty officer has a legal duty to render aid when a patient’s life is threatened, not merely to summon help. Question 2. In the context of first responder care, “implied consent” is most appropriately applied when: A) The patient verbally agrees to treatment after being informed of risks. B) The patient is unconscious, incapacitated, or otherwise unable to give express consent. C) The patient signs a written waiver before treatment. D) The patient explicitly refuses care. Answer: B Explanation: Implied consent allows responders to provide lifesaving care when the patient cannot give express consent, such as in unconsciousness. Question 3. Which of the following is NOT a component of the “Standard Precautions” that a first responder must follow? A) Hand hygiene before and after patient contact. B) Wearing a surgical mask only when dealing with a known infectious disease. C) Using gloves when contact with blood or bodily fluids is anticipated. D) Proper disposal of sharps in puncture‑resistant containers. Answer: B Explanation: Standard Precautions require mask use when there is a risk of aerosol transmission, not only with known infections.
Question 4. The primary purpose of the “scene size‑up” is to: A) Begin patient assessment before ensuring responder safety. B) Determine the exact number of EMS units required. C) Identify hazards, assess safety, and decide on the need for additional resources. D) Perform a full secondary assessment on all patients. Answer: C Explanation: Scene size‑up focuses on safety, hazard identification, and resource needs before patient contact. Question 5. When using the AVPU scale, a patient who “responds to voice” is classified as: A) Alert B) Verbal C) Painful D) Unresponsive Answer: B Explanation: AVPU stands for Alert, Verbal, Pain, Unresponsive; “responds to voice” corresponds to Verbal. Question 6. Which of the following is the correct order of the primary assessment ABCs for a trauma patient? A) Airway, Circulation, Breathing B) Breathing, Airway, Circulation C) Airway, Breathing, Circulation D) Circulation, Airway, Breathing Answer: C Explanation: The standard primary assessment sequence is Airway, Breathing, Circulation. Question 7. The mnemonic DCAP‑BTLS used during secondary assessment stands for: A) Deformities, Contusions, Abrasions, Punctures – Bleeding, Temperature, Level of consciousness, Swelling
Answer: B Explanation: OPA size is measured from the incisors to the angle of the mandible; this ensures appropriate length. Question 11. A conscious adult who is choking and can cough effectively should be instructed to: A) Perform the Heimlich maneuver on themselves. B) Receive immediate abdominal thrusts from the responder. C) Continue coughing and monitor the airway. D) Have a nasopharyngeal airway placed. Answer: C Explanation: If the patient can cough, it indicates they are moving air; encourage coughing and observe. Question 12. For a child (age 1‑8) receiving rescue breaths, the recommended rate is: A) 10 breaths per minute B) 12 breaths per minute C) 20 breaths per minute D) 30 breaths per minute Answer: C Explanation: Pediatric rescue breathing is 20 breaths per minute (1 breath every 3 seconds). Question 13. When assisting a patient with a metered‑dose inhaler (MDI) during an asthma attack, the responder should: A) Instruct the patient to take three rapid puffs without a spacer. B) Place a spacer, have the patient exhale fully, then administer two puffs, waiting 30 seconds between puffs. C) Administer a single puff and immediately start CPR. D) Remove the inhaler and give the patient oral steroids. Answer: B Explanation: Using a spacer improves medication delivery; two puffs with a 30‑second interval is standard.
Question 14. The high‑performance CPR (CCR) compression depth for an adult is: A) 1‑1.5 in (2.5‑3.8 cm) B) 2‑2.4 in (5‑ 6 cm) C) 2.5‑ 3 in (6‑7.5 cm) D) 3‑ 4 in (7.5‑ 10 cm) Answer: C Explanation: CCR recommends a depth of 2.5‑ 3 in (6‑7.5 cm) for adult compressions. Question 15. According to AHA guidelines, the recommended compression‑to‑ventilation ratio for a single rescuer performing CPR on an adult is: A) 15: B) 30: C) 5: D) 10: Answer: B Explanation: The standard adult CPR ratio for one rescuer is 30 compressions to 2 breaths. Question 16. When applying an AED pad to a patient with a known pacemaker, the responder should: A) Place the pads directly over the pacemaker. B) Remove the pacemaker before applying pads. C) Position the pads at least 2 in (5 cm) away from the pacemaker. D) Avoid using an AED altogether. Answer: C Explanation: Pads must be placed away from implanted devices to prevent interference. Question 17. After a successful shock is delivered by an AED, the next immediate action is to: A) Resume CPR immediately for 2 minutes.
Answer: C Explanation: These are classic signs of an acute cerebrovascular accident (stroke). Question 21. The FAST assessment for stroke evaluates which of the following components? A) Face, Arms, Speech, Time B) Fever, Airway, Speed, Temperature C) Flaccidity, Ataxia, Sensation, Time D) Facial droop, Apathy, Speech, Tremor Answer: A Explanation: FAST = Face drooping, Arm weakness, Speech difficulty, Time to call emergency services. Question 22. During a diabetic emergency, the first‑line treatment for a conscious patient with hypoglycemia is: A) Intravenous insulin. B) Oral glucose (e.g., glucose tablets, juice). C) Intramuscular glucagon. D) Subcutaneous epinephrine. Answer: B Explanation: Oral glucose is the fastest, safest initial treatment for conscious hypoglycemia. Question 23. Which of the following is a hallmark sign of opioid overdose? A) Dilated pupils B) Hyperventilation C) Pinpoint pupils (miosis) D) Bradycardia with hypertension Answer: C Explanation: Opioid toxicity commonly produces constricted (pinpoint) pupils.
Question 24. Intranasal naloxone is administered in which dosage for an adult suspected of opioid overdose? A) 0.4 mg (one spray) B) 2 mg (one spray) C) 4 mg (two sprays) D) 8 mg (four sprays) Answer: B Explanation: The standard adult intranasal dose is 2 mg (one spray) per nostril, often 4 mg total if needed. Question 25. When assisting a patient with an epinephrine auto‑injector (EpiPen), the responder should: A) Remove the needle after injection and discard it in a sharps container. B) Keep the needle in the patient’s thigh for observation. C) Inject the device into the upper arm. D) Apply a tourniquet before injection. Answer: A Explanation: The needle should be removed after injection and placed in a sharps container to prevent injury. Question 26. Direct pressure is the first step in controlling external hemorrhage because: A) It permanently seals the wound. B) It reduces blood flow by compressing the vessel until clot formation. C) It eliminates the need for a tourniquet. D) It is only effective for arterial bleeding. Answer: B Explanation: Direct pressure promotes clot formation and temporarily stops bleeding. Question 27. A tourniquet should be applied: A) As soon as any bleeding is observed.
Explanation: The Rule of Nines assigns percentage values to body regions to estimate burned TBSA. Question 31. A patient with a suspected cervical spine injury should have their neck immobilized using: A) A rigid cervical collar and head blocks. B) A soft pillow and manual stabilization only. C) A cervical traction device. D) No immobilization until radiography is obtained. Answer: A Explanation: Rigid collars and head blocks provide proper immobilization pending definitive care. Question 32. When splinting a suspected forearm fracture in the field, the responder should: A) Apply a rigid splint that allows movement at the wrist. B) Use a bulky cast to immobilize the entire arm. C) Perform manual stabilization only; no splint is needed. D) Apply a splint that immobilizes the wrist, elbow, and forearm, then secure with bandages. Answer: D Explanation: A proper splint immobilizes the joints above and below the fracture to prevent motion. Question 33. During a mass casualty incident (MCI), the START triage system categorizes patients as: A) Immediate, Delayed, Minimal, Expectant. B) Red, Yellow, Green, Black. C) Critical, Serious, Minor, Deceased. D) Both A and B are correct. Answer: D Explanation: START uses both the color code (Red, Yellow, Green, Black) and the corresponding urgency descriptors. Question 34. The primary sign of heat‑stroke is:
A) Profuse sweating with normal temperature. B) Core body temperature > 104 °F (40 °C) with altered mental status. C) Shivering and cold extremities. D) Dry skin with mild headache only. Answer: B Explanation: Heat‑stroke presents with hyperthermia > 104 °F and CNS dysfunction. Question 35. In hypothermia, the most effective method to rewarm a mildly hypothermic adult is: A) Immersion in boiling water. B) Application of warm blankets and heated IV fluids (if IV access). C) Rapid vigorous massage. D) Administering epinephrine. Answer: B Explanation: Passive external rewarming with blankets and warmed IV fluids (if available) is safe for mild hypothermia. Question 36. When responding to a suspected chemical burn, the first step is to: A) Apply a dry dressing. B) Remove contaminated clothing and flush the area with copious water for at least 15 minutes. C) Neutralize the chemical with a base. D) Cover the burn with a tourniquet. Answer: B Explanation: Decontamination with water removes the chemical agent and prevents further tissue damage. Question 37. The appropriate initial management for a newborn with an Apgar score of 3 at 1 minute is: A) Observation only. B) Immediate positive‑pressure ventilation (PPV). C) Administration of epinephrine.
Question 41. When a patient refuses care after being informed of the risks, the responder should: A) Force treatment because of the duty to act. B) Document the refusal, including patient’s name, date, time, and stated reason. C) Call a supervisor and wait for instructions before leaving. D) Leave the scene without any documentation. Answer: B Explanation: Proper documentation of refusal protects both the patient’s autonomy and the responder legally. Question 42. Which of the following PPE is required when there is a risk of airborne pathogens? A) Gloves only. B) N95 respirator or higher, eye protection, gloves, and gown. C) Surgical mask and goggles. D) No PPE is needed if the patient is cooperative. Answer: B Explanation: Airborne precautions require a fit‑tested N95 respirator (or higher), eye protection, gloves, and a gown. Question 43. The “critical incident stress debriefing” (CISD) model is primarily used to: A. Diagnose PTSD in responders. B. Provide immediate emotional support and processing after a traumatic event. C. Conduct legal investigations of the incident. D. Train responders in tactical shooting. Answer: B Explanation: CISD offers structured debriefing to mitigate stress reactions following critical incidents. Question 44. Which of the following is the most accurate description of “implicit bias” in the context of first responder care? A) A conscious decision to treat patients differently based on appearance.
B) Unconscious attitudes that may affect assessment and treatment decisions. C) A legal requirement to treat all patients equally. D) A training method for cultural competence. Answer: B Explanation: Implicit bias refers to subconscious stereotypes influencing behavior. Question 45. In the context of hazardous materials (HazMat) awareness, the “hazard class” that denotes flammable gases is: A) Class 1 B) Class 2 C) Class 3 D) Class 8 Answer: A Explanation: Class 1 materials are explosives, but flammable gases are Class 2. (Correct answer: B) Explanation: Class 2 hazards cover gases, including flammable gases; therefore the correct answer is B. Question 46. When a responder encounters a patient with a suspected spinal injury in a vehicle extrication, the first step after ensuring scene safety is to: A) Pull the patient out quickly to prevent further injury. B) Apply a cervical collar and secure the head before any movement. C) Begin CPR immediately if the patient is unresponsive. D) Remove all clothing to assess injuries. Answer: B Explanation: Cervical immobilization precedes any extrication maneuvers to protect the spine. Question 47. The recommended oxygen flow rate for a pediatric patient (age 1‑8) receiving non‑rebreather mask in respiratory distress is: A) 2 L/min B) 4 L/min C) 6‑ 10 L/min
Question 51. Which of the following is the most reliable field indicator of a tension pneumothorax? A) Absent breath sounds on one side with tracheal deviation away from the affected side. B) Bilateral equal breath sounds with mild dyspnea. C) Crackles heard throughout both lung fields. D) Hyperresonance on the contralateral side. Answer: A Explanation: Tension pneumothorax presents with absent breath sounds, hyperresonance, and tracheal deviation opposite the injury. Question 52. The correct sequence for applying a tourniquet in the field is: A) Place as low as possible, tighten until bleeding stops, then note time of application. B) Place 2‑ 3 inches above the wound, tighten until bleeding stops, and record the time. C) Apply directly over the wound, then secure with a bandage. D) Use a rubber band and secure with tape. Answer: B Explanation: Tourniquets should be placed 2‑ 3 inches proximal to the wound, tightened enough to stop bleeding, and the time should be documented. Question 53. During a seizure, the responder’s priority is to: A) Restrain the patient to prevent injury. B) Insert an oral airway to protect the airway. C) Protect the patient from hazards and turn them onto their side after the seizure ends. D) Administer IV benzodiazepines immediately. Answer: C Explanation: Protecting from injury and post‑ictal positioning are the primary field interventions. Question 54. A patient with a known history of asthma presents with wheezing, shortness of breath, and use of accessory muscles. The first‑line intervention is: A) Immediate endotracheal intubation. B) Administration of high‑flow oxygen and assistance with a metered‑dose inhaler (MDI) using a spacer.
C) Intravenous epinephrine. D) Placement of a nasopharyngeal airway. Answer: B Explanation: Oxygen and bronchodilator therapy via MDI/spacer are first‑line for acute asthma exacerbations. Question 55. The “ABCDE” approach used in trauma assessment stands for: A) Airway, Breathing, Circulation, Disability, Exposure. B) Assessment, Breathing, Circulation, Disposition, Evaluation. C) Airway, Blood loss, Compression, Defibrillation, Electrolytes. D) Alertness, Breathing, Cardiac output, Disorientation, Environment. Answer: A Explanation: ABCDE is the standard systematic trauma assessment. Question 56. Which of the following statements about “implicit consent” is correct? A) It can be overridden by a family member’s refusal. B) It applies only when the patient is a minor. C) It allows treatment when the patient is unable to give express consent, such as in cardiac arrest. D) It requires a verbal acknowledgment from the patient. Answer: C Explanation: Implicit consent permits lifesaving interventions when the patient cannot consent. Question 57. In the context of a mass casualty incident, “tagging” a patient means: A) Applying a physical tag with the patient’s name and medical history. B) Assigning a color-coded tag indicating triage priority. C) Marking the patient’s skin with a permanent marker. D) Recording the patient’s vital signs on a tag. Answer: B Explanation: Tagging uses color‑coded tags (Red, Yellow, Green, Black) to indicate triage category.
Question 61. Which of the following vital sign changes is most indicative of early hypovolemic shock? A) Bradycardia with warm, flushed skin. B) Tachycardia with cool, clammy skin. C) Hypertension with normal skin temperature. D) Normal heart rate with cyanotic lips. Answer: B Explanation: Early hypovolemic shock presents with tachycardia and peripheral vasoconstriction (cool, clammy skin). Question 62. In a patient with a suspected allergic reaction, the first medication a responder should assist with is: A) Intravenous antihistamine. B) Oral corticosteroids. C) Epinephrine auto‑injector. D) Inhaled bronchodilator. Answer: C Explanation: Epinephrine is the first‑line treatment for anaphylaxis. Question 63. The “FAST” acronym for stroke assessment does NOT include which of the following components? A) Face droop B) Arm weakness C) Speech difficulty D) Temperature elevation Answer: D Explanation: FAST = Face, Arm, Speech, Time; temperature is not part of the assessment. Question 64. When performing a secondary assessment on a pediatric patient, the responder should prioritize which of the following?
A) Obtaining a complete medication list before any vital signs. B) Assessing the Pediatric Assessment Triangle (appearance, work of breathing, circulation). C) Performing a full neurological exam before airway management. D) Applying a cervical collar before checking breathing. Answer: B Explanation: The Pediatric Assessment Triangle provides a rapid visual assessment to guide further care. Question 65. A responder encounters a patient with a “locked‑in” facial expression, difficulty speaking, and drooping of one side of the face. The most likely diagnosis is: A) Bell’s palsy B) Stroke (CVA) C) Seizure post‑ictal state D) Migraine with aura Answer: B Explanation: These are classic signs of an acute cerebrovascular accident. Question 66. In the event of an electrical burn, the responder’s first action should be to: A) Remove the patient’s clothing to assess the burn depth. B) Apply a dry sterile dressing. C) Ensure the source of electricity is de‑energized before providing care. D) Immediately start IV fluids. Answer: C Explanation: Safety dictates that the electrical source be turned off to prevent ongoing injury. Question 67. Which of the following is the most accurate description of “critical incident stress syndrome” (CISS)? A) A chronic psychiatric disorder that develops months after exposure. B) An acute stress reaction that may develop within days after a traumatic event. C) A physical injury caused by stress hormones.
