NREMT Bundled Exam Questions and Answers 2025, Exams of Nursing

Download NREMT Bundled Exam Questions and Answers 2025 and more Exams Nursing in PDF only on Docsity!

NREMT BUNDLED EXAM QUESTIONS AND ANSWERS 2025.

Obstructive shock - ASNWER-The type of shock that results when conditions that cause mechanical obstruction of the cardiac muscle also impact pump function ex. cardiac tamponade, tension pneumothorax Beck's triad - ASNWER-Signs of a cardiac tamponade. JVD, narrowing BP pressures, muffled heart sounds How do you treat for shock? - ASNWER-Keep the patient warm, control bleeding, put the patient in a position of comfort, and administer high-flow oxygen brain damage without oxygen - ASNWER--without enough oxygen, cardiac arrest or brain damage occurs within about 4 minutes -permanent brain damage within 6 minutes -death likely within 10 minutes

Distributive shock - ASNWER-The type of shock when there is widespread dilation of the small arterioles, venules, or both. Blood pools in the expanded vascular beds and tissue perfusion decreases Types of distributive shock - ASNWER-Septic shock caused by severe infections; neurogenic shock caused by damage to the spinal cord (bradycardia, low BP, warm skin); anaphylactic shock caused by allergic reaction; psychogenic shock Hypovolemic shock - ASNWER-The type of shock that results from an inadequate amount of fluid or volume in the system -15% of blood volume FBAO - ASNWER--signs of blockage include inability to cough or speak or inability to ventilate patient -bending patient forward at the waist, support chest with one hand, use heel of hand to give 5 back blows between shoulder blades -then 5 abdominal thrusts -alternate between the two until object is dislodged -if patient loses consciousness, give CPR starting with chest compressions -given even if patient has a pulse, so don't check -before giving breaths, look inside mouth for any visible objects FBAO in children - ASNWER--using thigh for support, lay facing down along forearm; ensure head is lower than the body -give 5 firm back blows between blades -5 chest thrusts; place 2 to 3 fingers in the middle of the chest just below the nipples. push down 1.5 inches.

-alternate, unless lose consciousness, then CPR cardiogenic shock - ASNWER--the type of shock caused by inadequate function of the heart. This develops when the heart cannot maintain sufficient output to meet the demands of the body -caused by any disease or event which prevents heart pumping -can occur directly after AMI up to 24 hours mouse to mouth/mouth to nose - ASNWER--mouth to mouth performed when patient does not have adequate breathing and artificial ventilation not available -open airway -place barrier device -pinch nose and form seal around patient's mouth -check for FBAO if you do not see chest rise and fall -give 1 breath every 5 to 6 seconds for adults and 1 every 3 for peds Steps of CPR - ASNWER-Determine unresponsiveness. Check for breathing for up to 10 seconds. Check carotid pulse for up to 10 seconds. Begin CPR until AED is available. Give 30 compressions at 100 beats/min and then 2 breaths over the course of 1 second. Once an advanced airway is inserted, ventilate at a rate of 8- 10 breaths/min and do not stop compressions. This is exactly the same for children, except two-rescuer CPR is 15:2. If patient experiences a return of spontaneous circulation, ventilate at a rate of 10- breaths/min. compression to breath ratios - ASNWER-under 8 years old: -2 provider: 15:

-1 provider: 30: -one third of chest diameter older: -30:2 always -2 inches AED procedure - ASNWER--if cardiac arrest was not seen by EMS, give 5 cycles of 30:2 before defibrillating -if cardiac arrest was seen, one EMT begins compressions and the other applies AED -if only one EMT available, apply AED immediately -check for pulse 2 minutes after defib -if no shockable rhythm, wait 2 minutes and re-analyze When to place left lateral - ASNWER-If patient has adequate breathing and is uninjured. To maintain a patent airway in an unresponsive patient. What to do if you fail to ventilate - ASNWER-If the breath doesn't go in successfully, reposition the patient and try again. If there is still nothing, assume there is a foreign body obstruction and begin CPR on an unresponsive apneic patient. Continue to attempt ventilations and open the mouth and look in every time. Pneumothorax signs - ASNWER--dyspnea, pleuritic chest pain that worsens during inspiration and expiration, absent or decreased breath sounds -rupture of visceral lining

Pulmonary embolism signs - ASNWER--dyspnea, acute chest pain, hemoptysis, cyanosis, tachypnea, hypoxia, tachycardia?** GCS Eye Opening - ASNWER-Spontaneous = 4 To voice = 3 To pain = 2 None = 1 GCS Verbal Response - ASNWER-Oriented = 5 Confused = 4 Inappropriate words = 3 Incomprehensible words = 2 None = 1 GCS Motor Response - ASNWER-Obeys commands = 6 Localizes pain = 5 Withdraws (pain) = 4 Flexion (pain) = 3 Extension (pain) = 2 None = 1 Rule of nines (adults) - ASNWER-Head = 9% Front = 18% Back = 18%

Each arm = 9% Groin = 1% Each leg = 18% Rule of nines (child) - ASNWER-Head = 18% Front = 18% Back = 18% Each arm = 9% Each leg = 14% Cushing's triad - ASNWER-Sign there might be an increase in intracranial pressure. Hypertension, bradycardia, and abnormal breathing. Signs of gonorrhea - ASNWER-No symptoms for a while, painful urination, discharge Blood volume during pregnancy - ASNWER-Can increase as much as 50% Umbilical cord - ASNWER-Contains two arteries and one vein. The vein carries oxygenated blood and arteries carry deoxygenated blood from the fetus to the woman. delivering a baby! - ASNWER--position mother with knees drawn up and spread apart; hips elevated and feet flat on the surface -apply gentle pressure to head avoiding fontanelle to prevent explosive deliver

-check for nuchal cord. remove it. if you can't and there isn't a chance of multiple deliveries, place two clamps 2-3 inches apart and cut between clamps

-as soon as head is delivered, suction mouth and then nose -dry and wrap in a blanket; place at level of vagina until umbilical cord is cut -cut when pulsations stop (first clamp 6 inches from infant's abdomen and second 9 inches) -up to 500 mL is normal Appendicitis pain - ASNWER--pain to the RLQ -rebounding pain -fever peritonitis - ASNWER--inflammation of peritoneum -abdominal pain, lack of appetite, markle test markle heel drop - ASNWER-markle test; used to assess a patient with abdominal pain, patient drops down onto heels, pain will be felt in region of pain source cholecystitis pain - ASNWER-RUQ pain, referred to the right shoulder gastrointestinal bleeding - ASNWER--hematemesis -hematochezia (blood in stool) -melena (dark, tarry stool) esophageal varices - ASNWER--weakening of blood vessels in esophagus -alcoholism -vomiting large amounts of bright red blood

Aortic aneurysm pain - ASNWER-Lower back and lower quadrants pain; tearing Mallory Weiss syndrome - ASNWER-When the junction between the esophagus and the stomach tears. Alcoholism and eating disorders can cause this Three P's of diabetes - ASNWER-Polyuria, polyphagia, and polydipsia. When the patient has hyperglycemia, glucose is excreted by the kidney and the process requires a large amount of water. DKA - ASNWER-Without glucose in the cells, the body will break down fat. When fat is used as an immediate energy source, chemicals called ketones and fatty acids are formed as waste products and are hard for the body to excrete signs: Kussmaul respirations, vomiting, abdominal pain, tachycardia Kussmaul respirations - ASNWER-Help the body blow off excess acids (CO2) which are deep, rapid breaths Signs of hyperglycemia - ASNWER-gradual onset, warm and dry skin, fruity breath, Kussmaul respirations (rapid and deep), restlessness, slurred speech, gradual response to treatment, diabetic coma Diabetic coma - ASNWER-Or hyperglycemic crisis. A state of unconsciousness resulting from ketoacidosis, hyperglycemia, and dehydration Signs of hypoglycemia - ASNWER-Rapid onset, pale, cool, moist skin, normal or rapid breathing, irritability, confusion, immediate response to treatment, insulin shock

Insulin shock - ASNWER-Hypoglycemic crisis Signs of opioids - ASNWER-Depressant, like heroin or oxycodone. Causes hypoventilation or respiratory arrest, pinpoint pupils, sedation or coma, hypotension. Everything "depresses" Sympathomimetics - ASNWER-Stimulants, like epinephrine or cocaine. Causes hypertension, tachycardia, dilated pupils, agitation, hyperthermia. Everything "stimulates" Sedative-hypnotics - ASNWER-Type of depressant, like alcohol. Slurred speech, sedation or coma, hypoventilation, hypotension. Induces sleep. Anticholinergics - ASNWER-Type of stimulant, like atropine. Tachycardia, hyperthermia, hypertension, dilated pupils. Same as sympathomimetics. Cholingergics - ASNWER-excess defecation or urination, pinpoint pupils, airway compromise, salivation, nausea/vomiting Signs of chlamydia - ASNWER-Lower abdominal pain, low back pain, nausea, fever 1st stage of labor - ASNWER-"dilation" Begins with the onset of contractions and ends when the cervix is fully dilated ( cm) can last about 18+ hours

2nd stage of labor - ASNWER-"expulsion" Begins when the fetus enters the birth canal and ends when the infant is born can last about an hour Preeclampsia - ASNWER-Pregnancy-induced hypertension. Headache, seeing spots, edema, anxiety, high BP -greater than 140/90 or increase in SBP of greater than 30 or increase in DBP of greater than 15 delivery is imminent if - ASNWER--there are signs of crowning -contractions are less than 2 minutes apart and last from 60-90 seconds -patient has strong urge to push -abdomen is very hard *before deciding to deliver on scene, contact medical direction for permission 3rd stage of labor - ASNWER-"placental" Begins with the birth of the infant and ends with the delivery of the placenta 5 to 20 minutes after delivery of baby para/gravida - ASNWER-para - number of births carried to term (includes stillbirths) gravida - number of times pregnant Eclampsia - ASNWER-Seizures that occur as a result of hypertension

Abruptio placenta - ASNWER-Usually results with trauma and causes massive bleeding and severe pain. When the placenta separates prematurely from the wall of the uterus Placenta previa - ASNWER-When the placenta develops over and covers the cervix -painless vaginal bleeding in third trimester ruptured uterus - ASNWER--can result in severe blood loss and death of fetus -tearing sensation in abdomen, constant and severe abdominal pain, ability to palpate fetus Emergency pregnancy situations - ASNWER-1. More than 30 minutes elapse and the placenta has not delivered

2. There is more than 500 mL of bleeding before delivery of the placenta
3. There is significant bleeding after the delivery of the placenta Prolapsed umbilical cord - ASNWER-A situation in which the umbilical cord comes out of the vagina before the infant. The infant's head will compress the cord, cutting off its own circulation. Place the woman with her hips elevated and insert your hand into the vagina to push the infant's head away from the cord Breech presentation - ASNWER-Can be delivered in the field - butt first. The only other time to insert your hand into the vagina is to push the walls of the vagina off the infant's airway as the head comes out. limb presentation - ASNWER--position mother so that hips are elevated -transport asap

APGAR Appearance - ASNWER-Pink = 2 Pink and blue = 1 Blue = 0 APGAR Pulse - ASNWER-100 beats/min = 2 Fewer than 100 = 1 Absent pulse = 0 APGAR Grimace - ASNWER-Infant cries and moves foot from stimulus; grimaces = 2 Weak cry (facial grimace) = 1 Does not cry or react = 0 APGAR Activity - ASNWER-Resists attempts to straighten knees or hips = 2 Infant makes weak attempts to resist straightening = 1 Infant is limp with no muscle tone = 0 APGAR Respiration - ASNWER-Rapid respirations = 2 Slow respirations = 1 Absent respirations = 0 When is blow-by oxygen indicated on a newborn? - ASNWER-Indicated for infants with cyanosis that is not dissipating heart rate between 100-

spontaneous breathing When is artificial ventilations indicated on a newborn? - ASNWER-Indicated for infants with cyanosis and a heart rate of less than 100 or if the infant is apneic breathing is shallow, slow, or absent When to begin resuscitation efforts on a newborn? - ASNWER-If the infant does not breathe after 10 to 15 seconds HR drops to less than 60 premature babies - ASNWER-born before 37 weeks Basket stretcher - ASNWER-Used for rough terrain National Incident Management System - ASNWER-Provides a consistent nationwide template to enable federal, state, and local governments to work together efficiently Incident Command System - ASNWER-To ensure responder and pubic safety, achieving incident management goals, and ensuring the efficient use of resources Red tagged (immediate) patients - ASNWER-Threat to ABCs, signs of shock, severe burns, open injuries Yellow tagged (delayed) patients - ASNWER-Burns without airway problems, major or multiple bone or join injuries, back injuries with/without spinal damage

Green tagged (walking wounded) patients - ASNWER-Minor fractures, minor soft- tissue injuries Back tagged (expectant) patients - ASNWER-Obvious death, respiratory arrest (if limited resources), cardiac arrest START triage - ASNWER-1. Identify walking-wounded

2. Approach non-green patients
3. If the patient is not breathing, open the airway using a simple maneuver. If the patient still does not breathe, label as expectant.
4. If the patient breaths after opening the airway, label red
5. If the patient is already breathing, check respiration rate. Label as red if >30 or <
6. If the patient has normal respirations, check radial pulses. Label is red if pulses are absent
7. Assess neurologic status and ask if they can follow simple commands. If they cannot, label as red. If they can, label as yellow agonal gasps - ASNWER--abnormal pattern of breathing and brainstem reflex characterized by gasping, labored breathing, accompanied by strange vocalizations and myoclonus -respiratory center in the brain continues to send signals to respiratory muscles -NOT effective breaths pulse oximetry - ASNWER--measures oxygen saturation of hemoglobin in the capillary beds

Cheyne-Stokes respiration - ASNWER--pattern of breathing characterized by a gradual increase of depth and sometimes rate to a maximum level, followed by a decrease, resulting in apnea -may be caused by damage to respiratory centers, congestive heart failure -heart failure, stroke ataxic respiration - ASNWER--abnormal pattern of breathing characterized by complete irregularity of breathing with irregular pauses and increasing periods of apnea JumpSTART triage - ASNWER-Intended for children younger than 8 or appear to weigh less than 100 lb

1. If they are not breathing, check pulse immediately. If there is no pulse, label as expectant.
2. If the patient is not breathing but has a pulse, open the airway. If the patient does not breathe, give give rescue breaths and check again. Label black if no response.
3. Respirations are <15 or >45 label red Otherwise the same as START Vesicants - ASNWER-Blister agents. Skin irritation, burning, reddening Immediate and intense skin pain Formation of large blisters Nerve agents - ASNWER-Cause cardiac arrest within seconds, symptoms are vomiting, tearing, diarrhea, etc. Types are organophosphates.

Metabolic agents - ASNWER-Shortness of breath, tachypnea, flushed skin, tachycardia, AMS, seizures, coma, apnea, arrest When to do a rapid trauma assessment - ASNWER-After major falls (greater than 15 feet) and for penetrating wounds, like stab wounds. larynx - ASNWER-upper airway ends and lower airway begins partial pressure of O2 and CO2 - ASNWER--pO2 in alveoli = 104 mm Hg -pCO2 in alveoli = 40 mm Hg tidal volume - ASNWER--500 mL is average differences in child and adult airways - ASNWER--child's upper and lower airways are smaller and more flexible than adult's -tongue is also proportionally larger and takes up more space signs of poor oxygenation - ASNWER--confusion -tachypnea -cyanosis respiration - ASNWER--gas exchange that occurs in the lungs -external respiration: process of respiration where gases are exchanged between lungs and external environment -internal: exchange of gases between the cells of the body and blood

chemoreceptors - ASNWER--in nervous system -monitor pH of spinal fluid and level of O2 and CO2 in the body -sends signals to respiratory centers in brain to change respiratory rate or depth of breathing intrapulmonary shunt - ASNWER--alveoli of the lungs are perfused with blood as normal, but ventilation fails to supply the perfused region -ventilation/perfusion ratio is zero -blood enters lungs, passes alveoli, returns to heart in unoxygenated state tension pneumothorax - ASNWER--build-up of air within pleural space -allows air to escape into pleural space but not to return -positive pressure ventilation may exacerbate this effect -can occur with chest trauma respiration assessment - ASNWER--work of breathing/labored breathing -depth of breathing -LOC -respiratory rate capnography - ASNWER--monitoring of the concentration or PP of carbon dioxide -usually presented as a graph of expiratory CO2 plotted against time end-tidal CO2 - ASNWER--normally 35-45 mm Hg -partial pressure of CO2 detected at the end of exhalation

-obtained via capnography airway opening maneuvers - ASNWER--place supine -head tilt chin lift - preferred; gently lift mandible while simultaneously pressing down on forehead, places patient in sniffing position -jaw thrust; should be used in patients who have suspected spine or neck injury. move jaw upward by placing fingers behind the angles of the jaw and gently lifting suction catheters - ASNWER--rigid tip catheter - Yankauer. for suctioning mouth. tonsil tips. no further than base of the tongue -soft tip flexible catheter - French. for suctioning nose or trachea hypopnea - ASNWER--shallow or inadequate tidal volume suctioning technique - ASNWER--turn on and set to 300 mm Hg -place tip only as far as you can see -apply as you are withdrawing catheter from mouth -limit time to 15 seconds in adults and 10 seconds in children and 5 seconds in infants oropharyngeal adjunct - ASNWER--inserted to prevent tongue from relaxing and blocking airway -can be used in patients who are breathing and those who require manual ventilation -only in patients who are unresponsive and do not have intact gag reflex

nasopharyngeal adjunct - ASNWER--better tolerated in patients who have intact gag reflex -also those who have ALOC but not able to protect airway position to maintain airway - ASNWER--recovery position -roll body onto one side, extend lower arm and place upper hand under cheek -prevents tongue from blocking airway and decreases risk of aspiration pressure regulator - ASNWER--decreases pressure of oxygen being released to safe level of 40 psi to 70 psi procedures of O2 administration - ASNWER--inspect cylinder and remove seal -cylinder needs to be cracked, which involves opening and closing valve with tank key -attach regulator and flowmeter to tank -attach mask/nasal cannula to nipple on flowmeter/regulator -turn flowmeter to desired LPM oxygen delivery equipment - ASNWER--nasal cannula -NRB -bag mask NRB - ASNWER--preferred -should be set to 10 to 15 LPM; two one-way valves -can deliver 95% O

-used in patient who are breathing on their own but hypoxic -prevent inhaling the exhaled gases -combination mask and reservoir bag system -should be used with oxygen flow rate high enough to inflate reservoir bag, which is a minimum of 10 LPM; if it collapses O2 flow not high enough nasal cannula - ASNWER--1 to 6 L/m -good for patients who do not tolerate a mask -24 to 44 percent oxygen bag mask - ASNWER--used to deliver O2 in patients who require ventilatory assistance -15 L/m -can deliver close to 100 percent O2 partial RB - ASNWER--Gives 60-75% -6-11 L -Will breathe out some O2 receiving → rebreathe 1/3 what is being exhaled; rest exhaled goes through vents; one two-way valve venturi mask - ASNWER--a face mask and reservoir bag device that delivers specific concentrations of oxygen by mixing oxygen with inhaled air; controlled oxygen therapy assisted ventilation - ASNWER--can be provided with bag mask device, CPAP, or mechanical ventilator

BiPAP - ASNWER--bilevel positive airway pressure -like CPAP -non-invasive form of therapy for sleep apnea -bipap has pressure for inhalation and lower pressure for exhalation -allows patient to get more air in and out of lungs -given to spontaneously breathing patients -typically used for COPD, asthma, CHF, pulmonary edema -only used on patients that are alert enough to obey commands, maintain their own airway, breath on their own stoma - ASNWER--if delivering O2 to patient with stoma, use tracheostomy mask -if you have to ventilate patient manually, attach bag-mask to trach tube to ventilate -if only stoma, child's mask can be connected to bag and placed over stoma to ventilate signs of airway obstruction (partial and complete) - ASNWER-partial - wheezing, stridor, weak cough complete - cyanosis, inability to speak, loss of consciousness wheezing - ASNWER--caused by narrowing or obstruction of lower airways -high-pitched whistling sound -can be heard without stethoscope

stridor - ASNWER--strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx or larynx (upper airway obstruction) -brassy, crowing sound -can be heard without stethoscope how often do you ventilate for adults and children? - ASNWER--every 5-6 seconds for adult -every 3-5 seconds for child albuterol side effects - ASNWER--tachycardia carbon dioxide retention and hypoxic drive - ASNWER--CO2 retention can occur due to COPD usually -COPD alter's drive to breathe -people with chronically high CO2, body gets used to high levels and instead begins to base drive to breathe on low oxygen levels dyspnea - ASNWER--shortness of breath -shallow, rapid breathing and anxiety croup - ASNWER-an acute respiratory syndrome in children and infants characterized by obstruction of the larynx, hoarseness, and a barking cough respiratory syncytial virus - ASNWER-A highly contagious virus that causes an infection of the upper and lower respiratory system.

pneumonia - ASNWER--inflammation of the lungs -sharp and localized chest pain that is made worse when breathing -crackles and rhonchi (low pitched rattling lung sounds) acute pulmonary edema - ASNWER--excess fluid on the lungs -can occur suddenly due to CHF -sx: SOB, pink, frothy sputum, cough, crackles/rales -o2 and lasix -orthopnea (difficulty breathing when lying down) school-age children vital signs - ASNWER-6-11 years old -70 to 110 bpm -15-20 breaths -SBP: 90-120 -98.6 adolescent vital signs - ASNWER--12 to 18 years -60-100 bpm -12-20 breaths -100 to 120 -98.6 COPD - ASNWER--damage to alveoli -often due to smoking -wheezing, SOB, coughing

asthma - ASNWER--a chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing -bronchodilators anaphylaxis - ASNWER--severe allergic reaction -sx: trouble breathing, stridor, hives -epinephrine and airway management pleural effusion - ASNWER--accumulation of fluid outside the lungs in pleural space -can occur due to infection, CHF, cancer -sx: SOB, decreased breath sounds over affected area cystic fibrosis - ASNWER--chonic inherited disease -affects digestive system and lungs -excessive mucus production, wheezing, dyspnea status asthmaticus - ASNWER-a severe, life-threatening asthma attack that is refractory to usual treatment and places the patient at risk for developing respiratory failure. metered dose inhaler - ASNWER--small spray canisters -used to deliver respiratory meds to the lungs -bronchodilators open airways and some steroids that decrease inflammation