NREMT Pocket Prep: Paramedic Exam Questions and Answers (2024-2025), Exams of Nursing

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NREMT POCKET PREP (2024-2025 NREMT

PARAMEDIC EXAM) QUESTIONS WITH COMPLETE

SOLUTIONS

What are the late signs of hemorrhagic shock? - CORRECT ANSWER-Rapid breathing, cool clammy skin, dull slightly dilated pupils Is carbon monoxide an internal factor or external factor for respiration? - CORRECT ANSWER-External Name 3 of the AHA reccomended managment principles for ROSC patients. - CORRECT ANSWER-Initiate Targeted Temperature Management if patient is comatose, Administer colloid/vasopressor to a goal blood pressure of <90 systolic or MAP <65mmHg, and obtain 12-lead. (THINK TAKE PT TO THE MOVIES) According to the NREMT, what is the dose of NARCAN for a patient with suspected opiod overdose? - CORRECT ANSWER-Narcan 2mg IN (1mg per nare) Name 3 WMD chemical agent exposures that a paramedic can see symptoms of on scene? - CORRECT ANSWER-Pulmonary agents, nerve agents, and vesicant agents. (Vesicant agents include mustard gas and primarily affect DNA to cause cellular damage) Why is an uncuffed ET tube appropriate for a 6 year old child? - CORRECT ANSWER-Pediatrics of this age range have a narrowing of the trachea at the level of the cricoid cartilage.

Name the major signs of hypothermia. - CORRECT ANSWER-Lack of coordination, confusion and memory loss, lack of shivering, weak pulses, slowed speech, drowsiness and very low energy, and slow shallow breathing. In dislocations and fractures, splinting is normally done in the position it is found. If circulation is comprimised, a paramedic may attempt to manipulate the injury one time to regain circulation. What is the one anatomical location that is the exception to this rule and therefore contraindicated in the prehospital setting? - CORRECT ANSWER-Elbow dislocations and fractures, due to the anatomical position of these injuries. Name 3 common SSRI medications. - CORRECT ANSWER-Zoloft (Sertaline), Prozac (Fluoxetine), and Paxil (Paroxetine) Define how to calculate the rate of an irregular rhythm and how and why it should be used. - CORRECT ANSWER-The range of an irregular heart rate can be determined by calculating the heart rate of the QRS complexes closest together and the QRS complexes furthest apart. The two rates can be calculated using the block or memory method. Regarding irregular heart rates, how do you perform the 6 second method? How do you perform the 10 second method? *NOTE, NREMT DOES NOT BELIEVE THIS METHOD EXISTS, BUT IT IS GOOD TO KNOW ANYWAY - CORRECT ANSWER- Viewing the rhythm strip, on a 6-second strip count the number of QRS complexes and multiply by 10. For a 10 second strip, count the number of QRS complexes and multiply by 6. Why is cystic fibrosis not considered a lower airway infection? - CORRECT ANSWER-Cystic fibrosis is caused by genetic factors, not an infection.

What three factors effect stroke volume? - CORRECT ANSWER-Contractility, afterload, and preload. What is cardiac elasticity? - CORRECT ANSWER-Elasticity is the factor that defines how "springy" the cardiac muscle is. It DOES NOT effect stroke volume. Name 3 factors that contraindicate endotracheal intubation. Name 2 things that do not effect indication of intubation. - CORRECT ANSWER-Inability to open the patient's mouth, inability to view the glottic opening, and intact gag reflex. Traumatic brain injury and respiratory compromise do not contraindicate intubation. Why should patients receiving hemodialysis receive sodium bicarb and calcium chloride during cardiac arrest? - CORRECT ANSWER-Patients in cardiac arrest who have received hemodialysis should be considered to have hyperkalemia, an excessively high potassium level in their blood. What are dysrhythmia of sinus origin? - CORRECT ANSWER-An ectopic rhythm is activity that occurs from a focus that is not the sinus node. Dyshythmias of sinus origin contain the same conduction path but are irregular, too fast, or too slow. Evaluation of ST segment elevation is not indicative of a myocardial infarction if there is ________ present. - CORRECT ANSWER-Left bundle branch blocks. A left bundle branch block may impair repolarization, making it look like an ST elevation myocardial infarction (STEMI). A patient is having an allergic reaction. Patient complains of itching with angioedema and shortness of breath, but denies swelling of the tongue or airway. What medication class (with example) is therefore indicated? - CORRECT

ANSWER-During an allergic reaction or anaphylaxis, it is appropriate to administer a beta-agonist, such as albuterol, in an attempt to reverse the bronchospasm and increase the patient's alveolar ventilation. What is the dose formula for morphine sulfate in a PEDIATRIC patient? - CORRECT ANSWER-0.1-0.2mg/kg IV Name the signs of heatstroke (7 answers) - CORRECT ANSWER-Core temperature of <104.0 degrees F, altered mental status, alteration in sweating, nausea/emesis, tachypnea, tachycardia, and headache. For a traumatic patient with significant blood loss, what is likely to be administered upon hospital arrival and why? - CORRECT ANSWER-Packed red blood cells are commonly used in the US emergency departments. They have a hemoglobin volume of two units in every single unit and do not contain plasma. This makes it less likely the patient will experience fluid overload or an infusion reaction from the infusion. O-negative packed red blood cells would quickly be administered to a hypovolemic female of childbearing age after three liters of lactated Ringer's solution fail to improve her blood pressure. Which of the following injury types is most likely to occur if your adult patient strikes his head on the bottom of a shallow pool while attempting to dive? - CORRECT ANSWER-Axial loading is often referred to as vertical compression of the spine when direct forces are sent down the length of the spinal column from the top of the head. The forces involved can produce compression fractures or crushed vertebral bodies without spinal cord injury and normally occurs from the area of T12-L2. Which of the following is most likely to present with unequal pupillary response, neck stiffness, and can be fatal in minutes? - CORRECT ANSWER-A subarachnoid

hematoma refers to intracranial bleeding that enters the cerebrospinal fluid, resulting in bloody cerebrospinal fluid and meningeal irritation. Bleeding results from trauma and other means. Patients with this type of hemorrhage often complain of the worst headache of their life with sudden-onset dizziness and blurred vision. Bleeding is often sudden and severe with this injury and can be deadly in minutes in some cases. Patients may also have unequal pupillary response and neck stiffness associated with meningeal irritation. Name the volume lost in each of the four classes of hemorrhage. - CORRECT ANSWER-Class I >15%, Class II 15-30%, Class III 30-40%, Class IV <40% Patients exposed to a housefire who have inhaled smoke may be exposed to what 3 gases? - CORRECT ANSWER-Carbon monoxide, hydrogen sulfate, and hydrogen cyanide. Periumbilical bruising indicates what type of injury? - CORRECT ANSWER- Retroperitoneal hemorrhage Which of the following incomplete spinal cord syndromes commonly occurs with hyperextension and/or flexion cervical spine injuries and presents with a greater loss of function in the upper extremities than in the lower extremities? - CORRECT ANSWER-Central spinal cord syndrome presents with some hyperextension and/or flexion injuries of the cervical spine. The syndrome is characterized by greater motor impairment in the upper than lower extremities. The signs and symptoms of central spinal cord syndrome include paralysis of both arms with sacral sparing. A patient is trapped in a vehicle in a seated position, and extrication is expected to take 20 minutes or more. Patient is unresponsive, a weak thready carotid pulse, and has no intact gag reflex. What kind of airway is indicated and why? -

CORRECT ANSWER-King LTD is indicated because it will maintain the airway, and c-spine manipulation must be kept to a minimum. What is Brown-Sequard syndrome? - CORRECT ANSWER-Damage to half of spinal cord Loss of pain and temperature sensation on contralateral side of body Loss of proprioception and discriminatory touch on ipsilateral side of body. What is central cord syndrome? - CORRECT ANSWER-A kind of incomplete spinal cord injury that limits a portion of the signals transmitted through that portion of the spinal cord, but allows some to pass through. A trauma patient presents with increased blood pressure, bradycardia, reactive pupils, and Cheynne-stokes respirations. What part of the brain is likely damaged?

• CORRECT ANSWER-Brain stem What medication will decrease cerebral edema and circulating blood volume after the injury? - CORRECT ANSWER-Mannitol, a diuretic In regards to increased ICP, what drug may be indicated when attempting to intubate? - CORRECT ANSWER-Lidocaine has been shown to control increases in intracranial pressure in closed-head injury patients that may occur during intubation. When extricating a stable patient from a vehicle seated in the drivers seat and the drivers side door is damaged too much to open, what is the safest way to extricate the patient? - CORRECT ANSWER-Open the passenger's side door and extricate the patient through the passenger's side.

Interference from other electrical devices will present as what kind of artifact on the EKG? - CORRECT ANSWER-60 cycle interference, appears as fibrillation-type waves between QRS complexes that is too rapid to be caused by a dysrhythmia. What EKG abnormalities are present with WPW syndrome? - CORRECT ANSWER- Delta waves (slurred upstroke in the QRS complex), widened QRS complex, and short PR interval (>120ms) How will hip dislocations present? - CORRECT ANSWER-Most dislocations at the hip will involve anterior rotation, and shortening of the affected leg with internal rotation. Mesentric ischemia is rare, but when it is present it is caused by what 3 things? - CORRECT ANSWER-Arterial thrombosis, arterial embolism, and vasospasm. Satolol is used for what condition, and what drug class is it considered? - CORRECT ANSWER-Class III, for wide complex tachycardia Define chronotropic - CORRECT ANSWER-rate of heartbeat Define dromotropic - CORRECT ANSWER-conductivity of heart Define inotropic - CORRECT ANSWER-The strength of the contractility Why is a patient in hypovolemic shock likely to develop increased dyspnea even after bleeding is controlled? - CORRECT ANSWER-Loss of erythrocytes decreases the bloods ability to carry oxygen, thus increasing respiratory rate.

According to the AHA, what kind of electrical shock is required when a patient presents with monomorphic VTACH? - CORRECT ANSWER-Synchronized cardioversion. Defibrillation is indicated when the VTACH is polymorphic, and in cases that one is unable to distinguish the two, treat as polymorphic. What would be the proper way to administer epinephrine to the patient without IV/IO access who is intubated while en route to the hospital? - CORRECT ANSWER- Through the patient's ET tube at 2.0-2.5 times the normal dose, diluted in 5-10 mL of sterile water What is true concerning J point elevation? - CORRECT ANSWER-The J point elevation is a type of ST segment elevation seen in normal hearts. It is seen in young, healthy adults and typically returns to baseline with exercise. It can be mistaken for a pathologic ST elevation; however, the key difference is a merging of the ST elevation with the T wave during an infarction. In J point elevation the T wave is an independent, normal wave. Your patient has bradycardia with shortness of breath and diaphoresis. Which intervention is considered a class IIa intervention after the maximum dose of atropine fails to improve the patient's condition and heart rate? - CORRECT ANSWER-The prehospital treatment for symptomatic bradycardia includes O2, atropine, dopamine, or epinephrine if the patient fails to improve after all other interventions. However, transcutaneous pacing (TCP) is the only class IIa intervention for the treatment of bradycardia after atropine (3 mg max) fails to improve the patient's condition and heart rate. According to AHA guidelines, unsynchronized high-energy shocks are recommended in which circumstances? - CORRECT ANSWER-Unsynchronized high-energy shocks are recommended:

For a patient with no pulse (VF/pVT) For clinical deterioration (in prearrest), such as those with severe shock or polymorphic VT, when you think a delay in converting the rhythm will result in cardiac arrest For patients who are unstable or deteriorating and synchronization cannot be immediately accomplished When you are unsure whether monomorphic or polymorphic VT is present in the unstable patient If the shock causes VF (occurring in only a very small minority of patients despite the theoretical risk), immediately attempt defibrillation According to research, approximately what percent of patients experiencing a STEMI do not receive pre-hospital ECGs because they do not present with chest pain? - CORRECT ANSWER-25% All of the following arrhythmias cause a decrease in cardiac output except: (a) atrial fibrillation (b) multifocal atrial tachycardia (c) wandering atrial pacemaker (d) premature atrial complexes - CORRECT ANSWER-(d) premature atrial complexes Which crainal nerves play a role in the act of swallowing? - CORRECT ANSWER-X, V, and VII (X controlling the vagus nerve, V controlling sensations in your face, cheeks, as well as taste and jaw movement, and VII controling facial expressions and sense of taste)

Which EKG waveform abnormality occurs when the right atrium pumps against a closed tricuspid valve sending waves of pressure through the jugular veins? - CORRECT ANSWER-Cannon A waves are waves of the pulse pressure visible in the jugular veins of a patient in Supra-Ventricular Tachycardia (SVT). They may also be seen in Ventricular Tachycardia (VTACH) with a pulse Which treatments are AHA recommendations for management of SVT in the adult patient? - CORRECT ANSWER-SVT is treated with vagal maneuvers, adenosine, β- blocker or calcium channel blocker. What are the "AHA 8 D's" of stroke care? - CORRECT ANSWER-Detection: rapid recognition of stroke signs and symptoms Dispatch: early activation and dispatch of EMS by phoning 9-1- Delivery: rapid EMS stroke identification, management, triage, transport, and prehospital notification Door: emergent ED/imaging suite triage and immediate assessment by the stroke team Data: rapid clinical evaluation, laboratory testing, and brain imaging Decision: establishing stroke diagnosis and determining optimal therapy selection Drug/Device: administration of fibrinolytic and/or EVT if eligible Disposition: rapid admission to the stroke unit or critical care unit, or emergent interfacility transfer for EVT What is Wolff-Parkinson-White syndrome? - CORRECT ANSWER-Congenital malformation resulting in incomplete separation of the atria from the ventricles during foetal maturation

This leads to the presence of an extra 'accessory' bundle connecting the ventricles and the atria Because in this accessory bundle there is no AV node to delay conduction a wave of depolarisation reaches the ventricle early pre-excitation occurs. Patients with WPWS present with paroxysmal supra ventricular tachycardia Paroxysmal Superventricular Tachycardia (PSVT) - CORRECT ANSWER-dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His. PSVT occurs because of a reentrant phenomenon (reexcitation of the atria when there is a one-way block). Usually a PAC triggers a run of repeated premature beats. Paroxysmal refers to an abrupt onset and ending. Termination is sometimes followed by a brief period of asystole (absence of all cardiac electrical activity). Some degree of AV block may be present. At what speed should the EKG machine be set? - CORRECT ANSWER-25mm/second Ventricular hypertrophy is caused by: - CORRECT ANSWER-Pressure overload You are preparing to perform fluid replacement on an adult trauma patient who lost a significant amount of his circulating blood volume, when you note a systolic change from 100mmHg to 86mmHg. There is no new bleeding, and his abdomen is distended with no signs of bruising, masses, or deformities. Which intravenous fluids would be most appropriate in this situation if the medical command physician recommends a fluid challenge?

a) 0.9% Saline b) 0.45% Saline c) D d) Lactated Ringers Solution - CORRECT ANSWER-d) Lactated Ringers Solution A patient is experiencing an anterior myocardial infarction. In which leads are you MOST LIKELY to see evidence of the infarction? - CORRECT ANSWER-V3 and V What is agnosia? - CORRECT ANSWER-An inability to recognize objects What is aphasia? - CORRECT ANSWER-An impairment of language What is dysarthria? - CORRECT ANSWER-Presence of slurred speech A patient with increased intercranial pressure to the midbrain will show what signs and symptoms? - CORRECT ANSWER-Patients with increased intracranial pressure at the level of the middle brainstem will likely present with a widened pulse pressure, bradycardia, and abnormal posturing (extension). A patient is found unconscious, tachycardia too fast to palpate accurately, and hypotension. EKG shows Torsades de Pointe, what is the most appropriate intervention for this patient? - CORRECT ANSWER-A high energy unsynchronized shock (Also acceptable: defibrillation) At what temperature range should a patient be kept if they are recieving Targeted Temperature Management and for how long? What kind of patients should

receive this treatment post cardiac arrest? - CORRECT ANSWER-32 degrees C to 36 degrees C for at least 24 hours if found to be comatose post cardiac arrest Active core rewarming procedures are considered invasive and reserved for the controlled environment of the hospital. However, some active core rewarming procedures are acceptable to initiate in the pre-hospital setting. Name one example of invasive active core rewarming that may be done in the prehospital setting? - CORRECT ANSWER-Administration of warm IV fluids and humidified O What measure of time on the EKG does the PR segment measure? - CORRECT ANSWER-The end of atrial depolarization to the start of ventricular depolarization Describe the procedure for orogastric tube placement in an unresponsive patient.

• CORRECT ANSWER-The steps for placing an orogastric tube in an unresponsive patient are:

1. Position the head in a slightly flexed position
2. Measure from mouth to ear to xiphoid process
3. Lubricate the tube with water-soluble gel and introduce the tube at the midline; advance it gently into the oropharynx, continuing into the stomach
4. Confirm placement
5. Apply suction to the tube
6. Secure the tube in place If you suspect that the ET tube has advanced too far and gone down the left bronchus, how far back should the ET tube be pulled after the cuff is deflated? - CORRECT ANSWER-2-3 cm

What is the benefit of inducing mild hypothermia to a post-arrest patient who has a return of spontaneous circulation? - CORRECT ANSWER-It reduces intracranial pressure, the cerebral metabolic rate, and the brain's demand for oxygen. What is the most common medication prescribed for epileptic seizures today? (this question was made in 2023) - CORRECT ANSWER-Common epileptic seizure medication is prescribed today mainly in the form of phenytoin. A patient is having severe chest discomfort that is not responsive to nitroglycerine. Morphine may be administered by a paramedic because (list at least two of the answers) - CORRECT ANSWER-Morphine may be used to manage ACS because it: Produces central nervous system analgesia, which reduces the adverse effects of neurohumoral activation, catecholamine release, and heightened myocardial oxygen demand Alleviates dyspnea Produces venodilation, which reduces LV preload and oxygen requirement Decreases systemic vascular resistance, which reduces LV afterload Helps redistribute blood volume in patients with acute pulmonary edema If a patient is experiencing hypocapnia, what signs and symptoms can the paramedic expect to occur? - CORRECT ANSWER-Hyperventilation causes excessive loss of exhaled carbon dioxide, which produces hypocapnia; this results in cerebral vascular constriction and reduced cerebral perfusion. If not quickly corrected and hyperventilation continues, paresthesia (tingling sensation), dizziness, and/or feelings of euphoria may be present.

What is a naturally occurring steroidal hormone produced by the adrenal cortex to help regulate the sodium/potassium balance in the blood? - CORRECT ANSWER-Aldosterone What treatment is indicated for a patient presenting with atrial fibrillation lasting less than 48 hours? - CORRECT ANSWER-Synchronized cardioversion What would a paramedic expect to see in a patient with a chronic adrenal dysfunction such as Addison's disease? - CORRECT ANSWER-Darkened skin, anorexia, hypoglycemia, nausea, and vomiting. Patients who present with unusually darkened skin patches, especially in areas such as the underarms and behind the knees, anorexia, hypoglycemia, nausea, and vomiting are most likely suffering from the long-term effects of Addison's disease due to corticosteroid deficiency. Where in the body has a patient been struck if you suspect they are experiencing commotio cordis? - CORRECT ANSWER-The chest by a fast moving object (most often in sports; such as a baseball or hockey puck) What is myasthenia gravis? - CORRECT ANSWER-It is an autoimmune neuromuscular disease that affects the motor cranial nerves. It is the GRAVE MUSCLE WEAKNESS. Exacerbation and remissions are parts of the disease which tend to be progressive over time.