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The National Register Emergency Medical Technician (EMT) cognitive test is a computer adaptive test (CAT).This means that each candidate is evaluated based on the position of the responses on a spectrum. Once a candidate gets the correct answers, the computer will automatically enter more difficult questions to continue testing the candidate's skill level. The number of items a candidate can expect from the EMT exam will be between 70 and 120. Each exam will have between 60 and 110 “live” elements that will be counted towards the final score. The exam will also include 10 pilot questions that do not affect the final score. The maximum time allowed to complete the exam is 2 hours. To pass the exam, candidates must meet a standard skill level. The standard of success is defined by the ability to provide safe and effective entry-level emergency medical care.
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NEW QUESTION # 241
A 60-year-old has severe shortness of breath. Audible wheezing is present. The patient has a history of COPD, asthma, and diabetes with prescribed medications. The vital signs are BP 138/80, P 110, R 30, and SpO# 89% on room air. What actions should the EMT take? Select the two answer options that are correct.
Answer: D,E
Explanation:
The correct answers are B. Apply continuous positive airway pressure (CPAP) and D. Administer a beta-2 agonist.
This patient is in moderate to severe respiratory distress with:
Tachypnea (R 30)
Hypoxia (SpO# 89%)
Wheezing # indicates bronchoconstriction (asthma/COPD exacerbation)
Why B is correct (CPAP):
CPAP helps keep alveoli open, improves oxygenation, and reduces work of breathing.
It is indicated in patients who are awake, breathing, and in respiratory distress with hypoxia.
Especially beneficial in COPD exacerbations.
Why D is correct (Beta-2 agonist):
Beta-2 agonists (e.g., albuterol) relax bronchial smooth muscle, relieving wheezing and bronchospasm.
This directly treats the underlying problem in asthma/COPD exacerbation.
Why the other options are incorrect:
A). 3 LPM nasal cannula # Too low for significant hypoxia (SpO# 89%); patient needs more aggressive support C). Recovery position # Used for unconscious patients, not alert patients in respiratory distress E). Rescue breathing # Indicated for inadequate respirations, but this patient is breathing (though rapid) Exact Extracts:
"CPAP is indicated for patients with respiratory distress who are breathing spontaneously."
"Beta-agonists are used to relieve bronchospasm in asthma and COPD."
"Patients with wheezing benefit from bronchodilator therapy."
References:
NREMT EMT Education Standards - Airway, Respiration & Ventilation
National EMS Education Standards - Respiratory Emergencies
NREMT Candidate Handbook - Patient Management
NEW QUESTION # 242
A 10-year-old patient is in hypovolemic shock. Which of the following signs would be early indicators of shock for this patient? Select the three correct options.
Answer: B,D,E
Explanation:
Children compensate for shock through increased heart rate, respiratory rate, and vasoconstriction, which delays blood pressure drop. Therefore:
* Tachycardia is often the first sign
* Prolonged capillary refill ( > 2 seconds) is an early indicator
* Tachypnea supports perfusion
Blood pressure is a late sign in pediatric shock. SpO# is helpful but does not specifically indicate shock.
Blood glucose may be abnormal in other metabolic conditions but is not an early marker of volume loss.
References:
NREMT Pediatric Assessment Flowchart
PALS Guidelines - Recognition of Shock in Children
AAOS Emergency Care and Transportation (11th ed.), Chapter: Pediatric Shock
NEW QUESTION # 243
Following insertion of an oropharyngeal airway in an unresponsive 1-year-old male, he develops cyanosis and bradycardia. You should
Answer: B
Explanation:
The correct answer is A. Remove the airway and ventilate him.
In pediatric patients, improper placement or incorrect sizing of an oropharyngeal airway (OPA) can cause:
* Airway obstruction instead of opening
* Worsening hypoxia
* Leading to cyanosis and bradycardia
* The patient's cyanosis (low oxygen) and bradycardia (late hypoxia sign) indicate that the airway intervention has failed or worsened the situation.
* Immediate action is to:
* Remove the OPA
* Provide effective ventilations with BVM
* B. Continue ventilation with the airway in place # Incorrect because the airway is likely malpositioned or obstructing airflow
* C. Increase ventilation rate to 40-60 # Excessive and inappropriate; does not correct obstruction
* D. Start CPR if HR < 100 # In pediatrics, CPR begins if HR < 60 with poor perfusion, not < 100
* "If an airway adjunct worsens ventilation, it should be removed immediately."
* "Bradycardia in infants is a sign of hypoxia."
* "Ensure adequate ventilation before initiating compressions."
References:
NREMT EMT Education Standards - Airway, Respiration & Ventilation
National EMS Education Standards - Pediatric Airway Management
NREMT Candidate Handbook - Airway Management and Resuscitation
NEW QUESTION # 244
A 45-year-old patient has chest pain, shortness of breath, and skin that is cool and diaphoretic. The patient states they have a feeling of impending doom. Which of the following conditions should the EMT most strongly suspect?
Answer: B
Explanation:
The correct answer is C. Myocardial infarction.
This question describes classic signs and symptoms of acute coronary syndrome (ACS), specifically a myocardial infarction (heart attack). Key findings include:
* Chest pain
* Shortness of breath (dyspnea)
* Cool, pale, diaphoretic skin
* Feeling of impending doom
These are hallmark features emphasized in EMT education for recognizing cardiac emergencies.
According to standard NREMT-aligned EMT educational content, patients experiencing myocardial infarction often present with:
* "Chest discomfort or pain... may be described as pressure, squeezing, or heaviness"
* "Dyspnea (shortness of breath)"
* "Diaphoresis (cool, clammy skin)"
* "A feeling of impending doom"
These findings occur due to decreased cardiac output and sympathetic nervous system activation, which leads to sweating, anxiety, and vasoconstriction (cool skin).
Why the other options are incorrect:
* A. Aortic aneurysm: Typically presents with sudden tearing pain (often in the back), not the classic ACS presentation with diaphoresis and impending doom.
* B. Chronic bronchitis: A long-term respiratory condition characterized by cough and mucus production, not acute chest pain with diaphoresis.
* D. Congestive heart failure: Usually presents with fluid overload symptoms such as edema, crackles, and dyspnea, but not typically acute crushing chest pain with diaphoresis and impending doom.
Exact Extracts (NREMT-aligned EMT educational references):
* "Chest pain or discomfort... pressure, squeezing, or heaviness"
* "Shortness of breath (dyspnea)"
* "Skin may be pale, cool, and diaphoretic"
* "Patient may have a feeling of impending doom"
These combined findings strongly indicate acute myocardial infarction, making C the most appropriate answer.
References:
NREMT EMT Education Standards - Cardiology & Resuscitation
NREMT National Continued Competency Program (NCCP) - Cardiac Emergencies Standard EMT Textbook (AAOS Emergency Care and Transportation of the Sick and Injured, aligned with NREMT)
NEW QUESTION # 245
A 27-year-old patient reports trouble breathing after being struck by a car. Which of the following findings are indicative of a possible chest wall injury? Select the three answer options that are correct.
Answer: B,D,E
Explanation:
Clavicle deformity suggests potential rib or thoracic trauma. Unequal chest rise may indicate a flail segment, pneumothorax, or hemothorax. Subcutaneous emphysema, the presence of air under the skin, is a classic finding in pneumothorax or tracheobronchial injury.
Occipital depression is not chest related; epigastric distension is a GI symptom; and jugular vein distention would suggest tension pneumothorax or cardiac tamponade, which are more advanced complications.
References:
NREMT Trauma Assessment Guidelines
National EMS Education Standards - Chest Injuries
AAOS Emergency Care and Transportation (11th ed.), Chapter: Chest and Abdominal Trauma
NEW QUESTION # 246
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