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NREMT STUDY GUIDE EXAM WITH COMPLETE
SOLUTION (PASS ASSURED)
1. Where does gas exchange of oxygen and carbon dioxide occur?
a. larynx
b. bronchioles
c. alveoli
d. main stem bronchi: Alveoli
The alveoli are where the lungs and the blood exchange oxygen and carbon dioxide during the process of breathing in and breathing out. Oxygen breathed in from the air passes through the alveoli and into the blood and travels to the tissues throughout the body.
2. What is the primary role of the epiglottis?
a. bringing oxygen into circulation
b. aids in food digestion
c. assist air flow to the larynx
d. prevent aspiration while eating: Prevent aspiration while eating
The main job of the epiglottis is to close over the trachea while you're eating to prevent food entering your airway.
3. What is the PRIMARY role of the mediastinum?
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a. Protects vital structures of the chest
b. Protects your diaphragm from collapse
c. Protects your lungs from collapse
d. Surrounds the heart's four chambers: protects vital structures of the chest
The mediastinum protects many vital structures including the heart, large vessels, the trachea, and critical nerves.
4. You respond to a 8 year old male who states he is having trouble breathing. His respiratory rate is 44
breaths/min and you notice accessory muscle use on exam. You can hear an audible wheeze present. What should your initial step be?
a. Start BVM ventilations
b. Attempt a head tilt-chin lift
c. Obtain his oxygen saturation
d. Gather a SAMPLE history: Obtain his oxygen saturation
This patient is able to speak so the airway is patent, we don't have any oxygen data so we need that before we can go ahead with oxygen administration. This will give the final piece of info to start assessing his current status.
5. You are called to the home of a 4 year old female patient. The patient has a persistent "barking cough" and
has stridor on exam. The mother tells you that this has gotten worse over the last few nights, until tonight she had a "hard time" breathing. What do you suspect?
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b. A patient with ecchymosis behind one ear
c. An unconscious patient with an intact gag reflex
d. An semiconscious adult who cannot maintain their own airway: a patient with ecchymosis behind one ear
Bruising behind one ear is known as the "Battle sign" and an indication of a basilar skull fracture, which is a severe head injury. Use of a nasopharyngeal airway with severe head injuries is contraindicated.
8. You are transporting a 53 year-old male who complains of shortness of breath, dizziness, numbness in his
hands, and a dry mouth. His vital signs are: blood pressure 118/80 mmHg, HR 120, RR of 32, SpO2 99%, and ETCO2 of 26 mmHg. What do you suspect?
a. Hypokalemia
b. Hypoventilation syndrome
c. Pneumothorax
d. Hyperventilation syndrome: Hyperventilation syndrome
This patient is hyperventilating as demonstrated by his increased respiratory rate and low end-tidal reading levels. A high respiratory rate increases the amount of carbon dioxide exhaled, accounting for the low end-tidal reading. His heart rate is also a little elevated, possibly due to anxiety.
9. A 78 year old female is found lying on her bathroom floor unconscious. Her caregiver reports finding her
like this upon arrival and is unsure what happened. You hear gurgling sounds on inspiration. What is the next best step?
a. Suction her airway
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b. Begin ventilations with a bag-valve mask
c. Insert an oropharyngeal airway
d. Provide nasal cannula at 2 L/min: suction her airway
The gurgling sounds on inspiration suggest her airway needs to be cleared. You want to make sure you suction and clear her airway before proceeding with treatment.
10. You assess a 23 year-old male who was struck in the right chest wall with an airbag after a motor
vehicle accident. The patient complains of pain on in-spiration and shortness of breath. You gather the following from your physical assessment: unequal chest wall rise and absent lungs sounds on the right side. What do you suspect?
a. Flail chest
b. Cardiac tamponade
c. Tension pneumothorax
d. Right chest contusion: Tension pneumothorax
Tension pneumothorax is where one of the lungs collapses, and can commonly happen with traumatic events like a motor vehicle crash. Its hallmark signs and symptoms are absent lung sounds on attected side and unequal rise and fall of the chest.
11. You arrive on scene to a 4 year-old girl choking on her food. She is unrespon-sive and not breathing.
What is the next best step in the management of this patient?
a. Start chest compressions
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d. Posterior, below the scapula: Posterior, below the scapula
Below our scapula is a large area of the lungs to auscultate breath sounds.
14. A 10 year-old boy complains of sore throat and pain when swallowing. He presents in the tripod
position and has a fever of 101 degrees F. His parents state he went to bed fine and woke up suddenly with symptoms. You suspect:
a. Croup
b. Epiglottitis
c. Bacterial Tracheitis
d. Bronchiolitis: Epiglottitis
The patient presents with the hallmark symptoms of epiglottitis, sudden sore throat and pain when swallowing. It is also common for children to wake up the next day suddenly with these symptoms. He is also demonstrating signs of respiratory distress as he presents in the tripod position.
15. You arrive on scene to a patient with a history of COPD having an exacerba-tion. He requires rapid
transport to the emergency department. What is the best position for the patient to be transported on the stretcher?
a. Trendelenburg position
b. Supine position
c. Prone position
d. Fowler's position: Fowler's position
8 / 224 This position is where the head of the stretcher is elevated 45-60 degrees, so the patient is sitting upright. This position is typically the most comfortable for patients with diflculty breathing.
16. You and your partner arrive on scene to a 7 year-old male who has tripped and fell into a pool,
hitting his head. You find he has no respirations and no pulse. What is the next best step in the management of this patient?
a. Provide manual stabilization of cervical spine and gather additional rescuers to perform 2-rescuer CPR at a
15:2 ratio.
b. Apply cervical collar and deliver 2-rescuer CPR at 30:2 ratio.
c.Insert nasopharyngeal airway and begin bag-valve mask ventilations at 12-20 breaths/min
d. Apply cervical collar, insert nasopharyngeal airway, and gather additional rescuers to perform 2-rescuer CPR at 15:
ratio.: Provide manual stabilization of cervical spine and gather additional rescuers to perform 2-rescuer CPR at a 15:2 ratio. AHA guidelines suggest 2-rescuer CPR for a child is performed at a 15:2 ratio and that manual stabilization of C-spine is preferred when performing CPR.
17. When a person inhales, the diaphragm moves...
a. Up
b. Down
c. Anterior
d. Posterior: Down
10 / 224 position would increase his breathing diflculty. CPR is not needed as this patient has a pulse and is breathing.
20. What is the most common cause of an airway blockage?
a. Food obstruction
b. The tongue
c. Vomit
d. Throat swelling: The tongue
When a patient becomes unconscious, their throat muscles relax which can cause the tongue to fall back and block the airway.
21. What is the physical process of moving air into and out of the lungs?
a. Inspiration
b. Oxygenation
c. Ventilation
d. Diffusion: Ventilation
The process of ventilation is the physical act of moving air into and out of the lungs.
22. A 38 year-old female presents restless on her couch with shortness of breath and accessory muscle use.
From your assessment you find an open and clear airway. What is the next best step?
a. Assess skin color and mental status
b. Obtain oxygen saturation
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c. Assess respiratory rate, quality, and effort
d. Take her radial pulse: Assess respiratory rate, quality, and ettort
The order of operations is ABCs. Airway, breathing, then circulation. We made sure the airway was patent, so the next step is assessing the patient's breathing quality.
23. You arrive on scene to a patient that has a high-pitched, whistling breath sound on inspiration.
What abnormal breath sound does this represent?
a. Wheezing
b. Stridor
c. Rales
d. Rhonchi: Stridor
This is an abnormal breath sound that is commonly heard with children when they have conditions such as croup. It is a high-pitched sound like wheezing, but it is more common to be heard on inspiration.
24. Typically an abdominal thrust maneuver is given when a patient is choking. In some cases, a chest
thrust should be provided. Select ALL of the following scenarios that would indicate the use of chest thrusts in a choking victim: (Choose 3)
a. 48 year-old male weighing 375 pounds
b. 78 year-old male with a history of previous myocardial infarction
c. 6-month old infant
13 / 224 breaths. He is unable to lift his head upright. His vital signs are as follows: BP 102/76, HR 100, RR 28 and shallow, SpO2 74% on oxygen by nasal cannula at 3L/min. What is the next best step?
a. Titrate home oxygen to 6L/min by nasal cannula
b. Administer oxygen with non-rebreather mask
c. Intubate with ET tube
d. Begin ventilations with bag-valve mask: Begin ventilations with bag-valve mask
This patient is entering respiratory failure and requires ventilatory assistance to breath. His respiratory rate is high, his oxygen saturation is low, he cannot speak and has labored breathing. Providing higher concentration oxygen will not work as his ventilations is the underlying problem in this situation.
27. What are Cheyne-Stokes respirations?
a. Rapid, deep breaths commonly seen in patients with severe metabolic aci-dosis
b. Periods of rapid and slow breathing followed by periods of apnea, commonly seen in patients with head
injuries
c. Irregular, rapid breathing followed by periods of apnea, can be seen in patients with stroke
d. A gasping, involuntary reflex to breath and is an indicator of cardiac arrest-
: Periods of rapid and slow breathing followed by periods of apnea, commonly seen in patients with head injuries This describes Cheyne-Stokes breathing pattern. It is a crescendo-decrescendo breathing pattern with periods of no breathing.
28. You arrive on scene to a 85 year-old female who complains her home oxygen unit is not working. The
device shows an oxygen flow rate of 3L/min. Upon ex-amination you see she has signs of cyanosis around her lips and her fingertips. Her vital signs are as follows: BP 120/78, HR 88, RR of 24, and SpO2 80% on oxygen by nasal
14 / 224 cannula at 3L/min. What is the next best step?
a. Check home oxygen unit for any leaks
b. Increase oxygen flow rate to 6L/min
c. Administer oxygen by non-rebreather mask
d. Check for a kink in nasal cannula hose: Administer oxygen by nonrebreather mask
The home oxygen unit is not working, and the patient's SpO2 levels are low. The first course of action is to administer supplemental oxygen to increase her SpO2 levels.
29. A 22 year-old male complains of shortness of breath after football practice. He states he started getting
more tired as practice went on. His chest wall expansion is normal and he does not complain of chest pain. Upon auscultation you heard diminished breath sounds in the upper left chest. His vital signs are as follows: BP 118/78, HR of 112 beats, RR of 16, and SpO2 90% on room air. What condition do you suspect?
a. Pulmonary embolism
b. Spontaneous pneumothorax
c. Tension pneumothorax
d. Pleuritis: Spontaneous pneumothorax
Spontaneous pneumothorax is common in young, thin, tall males who exercise. The diminished breath sounds on one side of the lungs is another clue of this condition.
30. Which structure is considered the divide between the upper and lower res-piratory tracts?
a. Trachea
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c. Switch to a nasal cannula on 6L/min
d. Increase oxygen flow rate so reservoir bag remains at least 2/3 full when patient breathes in: Increase oxygen flow rate so
reservoir bag remains at least 2/3 full when patient breathes in The non-rebreather mask should also be inflated, even when the patient inhales. If it is not at least 2/3 full, adjust oxygen flow rate.
32. A 48 year-old male reports sudden onset shortness of breath. He complains of left-sided chest pain as
well. He states it might be pneumonia as he just flew home from Australia yesterday and thinks he got something there. His vital signs are as follows: BP 104/82, HR 114, RR of 20, SpO2 82% room air. What do you suspect?
a. Pneumonia
b. Myocardial infarction
c. Pulmonary embolism
d. Asthma attack: Pulmonary embolism
The patient displays signs of a PE as he has acute onset shortness of breath and chest pain. He also just flew home on a long flight, which is a risk factor for PE. His oxygen saturation is also very low.
33. What flow rate and oxygen delivery percent does the nonrebreather mask provide?
a. 10-15 L/min and up to 100%
b. 10-15 L/min and 80-95%
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c. 4-8L/min and 24-50%
d. 1-6L/min and 24-44%: 10-15 L/min and 80-95%
34. You arrive on scene to a man that is lying on the floor unresponsive and not breathing. You begin bag-
valve mask ventilations, but do not see chest rise or fall. You should...
a. Reposition the head
b. Call ALS for advanced airway placement
c. Suction the oropharynx for 20 seconds
d. Place an oropharyngeal airway: Reposition the head
The next best step would be to reposition the head to make sure the tongue is not blocking the airway and try again with the BVM. If there is still no chest rise or fall, then placing an NPA or OPA would be the next step.
35. You arrive on scene to a 29 year-old female having an asthma attack. You determine she requires
ventilatory assistance. At the EMT level, how can you promote bronchodilation with ventilations?
a. Ventilate patient in Fowler's position on stretcher
b. Administer ventilations with bag valve mask and albuterol with a nebulizer device
c. Administer patient's inhaler after 20 breaths from the bag-valve mask
d. Administer oral Benadryl then provide BVM ventilations: Administer ventilations with bag valve mask and albuterol with a nebulizer device
An EMT can administer albuterol through a nebulizer mask to help with bronchodilation.
36. What chemical does the body produce to prevent atelectasis?
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d. Do NOT suction the stoma. Ventilate patient's nose/mouth with bag-valve mask.: Suction secretions in stoma then ventilate
stoma with a pediatric bag-valve mask Suction the secretions in the stoma to clear it. Then ventilate stoma with a pediatric BVM. If this does not work, try ventilating the patient's nose/mouth.
39. You and your partner are performing CPR on a 70 year-old patient. You are tasked to ventilate with
the bag-valve mask. You should...
a. Ventilate with bag-valve mask every 15 seconds
b. Ventilate twice when CPR stops after 15 compressions
c. Ventilate twice when CPR stops after 30 compressions
d. Ventilate with bag-valve mask every 30 seconds: entilate twice when CPR stops after 30 compressions
Ventilations are delivered at a 30:2 compression to ventilation ratio for adult CPR.
40. How does emphysema affect the lungs?
a. Excess fluid buildup in space between lungs and chest
b. Increased mucous secretions in the bronchioles
c. Damage to alveoli reducing surface area for gas exchange
d. Partial collapse of the lung: Damage to alveoli reducing surface area for gas exchange
Emphysema damages the inner wall of the alveoli, leaving them abnormally inflated and eventually prone to rupture. This creates a larger space in the alveoli instead of many small ones, decreasing the surface area for gas exchange.
41. You arrive on scene to a patient you determine has an adequate airway. Which of the following
20 / 224 signs would confirm this?
a. The patient is alert and oriented
b. The patient presents relaxed in their chair
c. The patient is able to speak in full sentences
d. The patient follows your commands: The patient is able to speak in full sentences
If the patient is able to speak in complete sentences, this means they have an adequate airway. If they were only able to speak in a few words, then airway compromise could be present. The other answers do not provide any information on the patient's airway, so they could possibly have an inadequate airway.
42. At what point does irreversible damage to the brain begin to occur when the brain is deprived of
oxygen?
a. 2 minutes
b. 5 minutes
c. 10 minutes
d. 15 minutes: 10 minutes
After 1-2 minutes, brain damage begins to occur. At 5 minutes, brain damage becomes severe. At 10 minutes, brain damage becomes irreversible. At 15 minutes, there is little chance of survival.
43. Select ALL of the following structures/cavities that consist of the upper airway: (Choose 5)
a. Trachea
