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Nremt Cognitive Exam Sample Questions and
Answers
In trauma a low pulse pressure suggests? - Correct answer Significant blood loss Blood pressure has a direct effect on? - Correct answer The perfusion of the bodys tissues Cells that die during a stroke are called? - Correct answer Infarcted cells You are called to a home where a 91 year old man has had a syncopal episode and is vomiting. The caregiver who called 911 stated that the patient's bowel movements have been bright red since yesterday. The patient has not complained of any pain, but is nauseated. What is most likely wrong with this man and which choice includes appropriate treatment steps? Choices: A. He has an upper GI bleed and should be transported sitting up with high flow O2 administered via a non rebreather mask at 15 LPM. B. He has had a TIA and should be given high flow oxygen via NRB and transported on his effected side to the nearest hospital. C. He has pancreatitis and should be given high flow O2 via NRB at 15 LPM. Rapid transport in a left lateral recumbent position while keeping him warm will help avoid shock. D. He has a lower GI bleed and should be given O2 via nasal cannula at 4LPM and transported in a position of comfort while t - Correct answer D. He has a lower GI bleed and should be given O2 via nasal cannula at 4LPM and transported in a position of comfort while treating for shock Rationale: The bright red blood in the bowel movements is indicative of a lower GI bleed. Answer 1,2, and 3 all utilize an NRB to deliver high flow O2. Given that the patient is vomiting and nauseated, it would be advisable to use a nasal cannula, rather than an NRB, to help avoid potential airway compromise if the patient continues to vomit.
If a patient was feeling nauseated this would likely be a_______________response. If a person was tachycardic it would likely be a___________________ response. - Correct answer Parasympathetic/Sympathetic You are assessing an 84 year old man. Upon auscultation of the lungs you discover crackles or rale sounds. He is complaining of chest pain and congestion. These signs and symptoms can indicate? Choices: A. An embolism B. Collapse of the vena cava C. Left ventricular failure D. Right ventricular failure - Correct answer C. Left ventricle failure Rationale: These are signs and symptoms of a possible failure of the left ventricle. The pump portion of the heart is unable to pump efficiently and fluid begins to back up into the lungs. A child between 3-5 would have normal vitals if they were? Choices: A. 35 breaths a minute, pulse of 88, and Systolic BP of 100 B. 24 breaths a minute, pulse of 76, and Systolic BP of 98 C. 20 breaths a minute, pulse of 100, and Systolic BP of 110 D. 20 breaths a minute, pulse of 120, and Systolic BP of 120 - Correct answer 20 breaths a minute, pulse of 100, and Systolic BP of 110 Rationale: A child between 3 and 5 (preschool-age) should have respirations between 20-30, a pulse of 80-120, and a systolic BP of 80 -
(Toddler 12 to 36 months)
Rationale: Epiglottitis is known to strike children in this age group. Croup is usually in younger children. Transporting with airway support is the best answer. What is pulse pressure? - Correct answer The difference between the systolic and diastolic measurements of the blood pressure A 57 year old woman is complaining of chest pain. Her blood pressure is 109/88 and her respirations are at 22 per minute. What condition does the patient's blood pressure indicate? A. Paradoxical Pressure B. Low pulse pressure C.Systolic transcardiac eschemia D. Martiners Rule - Correct answer B. Low pulse pressure Rationale: A pulse pressure is considered abnormally low if it is less than 25% of the systolic value. In this question it is about 20% of the systolic value. The pulse pressure is the difference between the systolic and diastolic measurements of the blood pressure. 109 systolic - 88 diastolic = 21 mmHg. In trauma a low pulse pressure suggests significant blood loss. If the pulse pressure is extremely low, i.e. 25 mmHg or less, the cause may be low stroke volume, as in Congestive Heart Failure and/or shock. A low pulse pressure can also be caused by aortic valve stenosis and cardiac tamponade. Which of the following choices is a normal systolic blood pressure in a child? Choices: A.Greater than 120 mm Hg B. Greater than 70 mm Hg C. Less than 80 mm Hg D. 70 mm Hg - Correct answer B. Greater than 70 mm Hg Rationale: 80-110 mm Hg is considered a normal range for a child. A Transient Ischemic Attack (TIA) will usually stop after: Choices:
A. 30-60 minutes B. 1-2 days C. 10-15 minutes D. Proper intervention - Correct answer C. 10 to 15 minutes Rationale: Transient Ischemic Attack (TIA) is a blockage of vessels in the brain that usually subsides after a period of 10 to 15 minutes. However, if the patient's symptoms persist longer than 15 minutes, continue to treat the patient as if they are having a CVA (Cerebrovascular Accident). If resolution takes place within the 10-15 minutes, then chances are they have had a TIA. The final diagnosis of TIA is made if the symptoms resolve within 24 hours and is determined by a physician. If the pulse pressure is extremely low, i.e. 25 mmHg or less, the cause may be... - Correct answer Low stroke volume, as in Congestive Heart Failure and/or shock. A low pulse pressure can also be caused by aortic valve stenosis and cardiac tamponade. You are called to the scene of a man down. Dispatch reports the man is pulseless and bystanders are doing CPR. According to the NREMT Cardiac Arrest Management/AED skill sheet, which of the following sequences is appropriate? Choices: A. Question the bystanders, direct them to stop CPR , check for pulse and then attach the AED, Begin chest compressions B. Check for responsiveness, Assess for breathing, Check carotid pulse , put your gloves on C. Complete one cycle of CPR, Attach the AED, Have everyone stand clear during rhythm check D. Turn on power to AED, open the patient's airway, insert an adjunct and then analyze the rhythm - Correct answer C. Complete one cycle of CPR, Attach the AED, Have everyone stand clear during rhythm check
Rapid breathing is first seen in what stage of shock? Choices: A. Decompensated shock B. Compensated shock C. Irreversible - Correct answer B. Compensated Shock Rationale: A person may breath rapidly in compensated and decompensated shock, but it is FIRST seen in compensated shock. Which list includes only the "Five Rights" of medication administration? Choices: A. Medication, dose, time, route, and documentation. B. Patient, medication, dose, route, and time. C.Patient, medication, indication, dose, and time. D. Medication, dose, generic name, route, and documentation - Correct answer B. Patient, medication, dose, route, and time Rationale: The "Five Rights" of medication administration are: patient, medication, dose, route, and time. There is also generally an accepted "Sixth Right" which is 'Right Documentation,' or 'Write it Down,' however the NEMSES doesn't reference that "right." Cellular respiration and cellular metabolism are best described as: Choices: A. The exchange of respiratory gases between the systemic capillaries and the surrounding tissue beds B. The exchange of respiratory gases between the alveoli and the pulmonary capillary bed C. The use of oxygen and carbohydrates to produce energy and the creation of carbon dioxide and water by-products D. The use of oxygen to create hemoglobin in the blood stream - Correct answer C. The use of oxygen and carbohydrates to produce energy and the creation of carbon dioxide and water by products Rationale: Cellular respiration and cellular metabolism is the use of oxygen and carbohydrates to produce energy and the creation of carbon dioxide and water by-products.
All of the following are contraindications of oral glucose except: A. Vomiting B. Decreased level of consciousness C. Nausea D. Hypoglycemia - Correct answer D. Hypoglycemia Rationale: Nausea, vomiting, and decreased levels of consciousness are contraindicated for the use of oral glucose. Hypoglycemia, or low blood sugar, is an indication for the use of oral glucose. Upon making patient contact, you notice a large quantity of prescription bottles on the nightstand next to their bed. Which of the letters in the SAMPLE mnemonic is related to the observation? Choices: A. L B. P C. E D. A - Correct answer B. P (Past medical history) Rationale: This observation is going to tell you that the patient has some significant PAST medical history. It is associated with the P in the mnemonic. A 73 year old female was in her backyard gardening when she collapsed to the ground. Her husband told 911 that "she is breathing very fast and will not talk to me." You arrive to find the woman lying on her side in the grass. She is breathing at 7 breaths per minute and her pulse is irregular and very thready. Her lungs also present with crackles upon auscultation As you are taking a blood pressure (88/66) the husband tells you that the woman has been having jaw pain and some weakness for approximately 3 days. What is the most likely cause of this woman's condition and how would you treat her? Choices: A. Hypoperfusion B. Cardiac arrest, Treat for shock, and rapid transport
You have requested helicopter transportation of a critical burn patient. The remote nature of the accident will force the helicopter to land on an incline. From which direction should you approach the helicopter? - Correct answer The downhill side Rationale: Approaching from the downhill side of the helicopter is the safest route in this situation. NIMS is best explained as: Choices A) A National system of managing large emergencies based on having private and governmental organizations work independently at the scene of a mass casualty B) A template system for providing consistent, effective processes in preparing for, responding to, and recovering from an incident C) A systematic approach of assessment used during the triage of large groups of people during a mass casualty incident D) Governmental rescue organizations taking responsibility for controlling the parts of the scene that fall within their expertise - Correct answer B) A template system for providing consistent, effective, processes in preparing for, responding to, and recovering from an incident Rationale: The National Incident Management System is designed as a template system for providing consistent, effective processes in preparing for, responding to, and recovering from an incident. How air enters the lungs: - Correct answer 1. Air travels through mouth/nose
- Moves down the trachea 3.Left and right bronchi (the split is known as the carina)
- Stemming off the bronchi to the bronchioles
- From the bronchioles to the alveoli The alveoli is where gas exchange takes place
Using the following terms explain how oxygen enters the bloodstream and how carbon dioxide leaves the body: Alveoli, capillaries, oxygen-rich blood, oxygen-poor blood, and carbon dioxide. - Correct answer O2 RICH
- Within the ALVEOLI, O2 rich air is inhaled through the lungs and meets the capillaries
- In the CAPILLARIES, O2 rich air molecules attach to red blood cells 3.02 rich red blood cells then travel back to the HEART O2 POOR
- Carbon dioxide(within O2 POOR blood) comes from the HEART
- O2 poor blood crosses from the heart into the CAPILLARIES
- EXHALED from the body THESE PROCESSES OCCUR AT THE SAME TIME! Describe the process of breathing: - Correct answer INHALATION
- Diaphragm contracts (moves downward)
- Intercostal muscles contract (expanding rib cage)
- Causes thoracic cavity to expand creating a NEGATIVE pressure which air fills the space. EXHALATION
- Diaphragm/Intercostal muscles relax which creates a POSITIVE pressure in the thoracic cavity which results in air being pushed out Is exhalation an active or a passive process? - Correct answer Passive. Rationale: Unlike inhalation, there normally is no muscle contraction to exhale air. What drive is responsible for breathing control? What is the backup system? - Correct answer Carbon Dioxide Drive is our body's primary mechanism for breathing control. Increased CO2 levels will stimulate the body to increase the respiratory rate. As a backup, the Hypoxic Drive will stimulate breathing when O2 levels are sensed. What is the role of surfactant within the lungs? - Correct answer Think of surfactant as a lubricant in your lungs. Surfactant reduces surface tension inside of the alveoli. By doing this, gas exchange can take place because the presence of surfactant in the alveoli keeps them open.
Parietal pleura - Correct answer Membrane that lines the inside surface of the chest cavity Describe two methods for opening the airway of an unconscious patient. When would you use one over the other? - Correct answer Head tilt chin lift (best choice/preferred method). Tilt the forehead back while lifting the chin. Jaw thrust maneuver (use for suspected cervical spine injury/trauma patient) Physically push the angle of the lower jaw (mandible) up. How do you correctly size an OPA and NPA prior to use? - Correct answer OPA - measure from the corner of the mouth to the earlobe NPA - measure from the tip of the nose to the earlobe What are the steps to suctioning an adult patient? - Correct answer - Prepare equipment
- Test equipment
- Insert suction catheter into oropharynx only as far as you can see
- Apply suction while withdrawing the catheter
- Suction for no more than 10-15 seconds
- Rinse the suction catheter after use Match the following oxygen cylinder sizes with their capacity: D, E, M.
- 350-Liter
- 625-Liter
- 3,000-Liter - Correct answer Amount of oxygen when full D= 350 Liters E= 625 Liters M= 3,000 Liters What is the purpose of a regulator on an oxygen bottle? - Correct answer The pressure regulator on an oxygen bottle is responsible for taking the high pressure within the bottle down to a more manageable and controllable pressure. For example, for use with a nasal cannula.
When a patient has COPD and is having trouble breathing, what is going on in their body? - Correct answer When they take a breath, air is "trapped", preventing the patient from completely exhaling. What is COPD? - Correct answer COPD is a chronic inflammatory lung disease that causes obstructed airflow due to collapsed alveoli, mucous, or narrowed passages within the lungs Chronic bronchitis and emphysema are two chronic conditions that contribute to COPD. What is the difference between the two? - Correct answer Chronic bronchitis - inflammation of the lining of the bronchial tubes. The body responds by decreasing ventilation and increasing cardiac output. The patient is commonly known as a "blue bloater" due to cyanosis and edema. Emphysema - most often the cause of cigarette smoking, the alveoli at the end of the bronchioles are damaged. This results in less area for gas exchange to occur, which the body responds to by increasing ventilation and decreasing cardiac output. These patients are commonly referred to as "pink puffers". Blue bloater vs. Pink puffer - Correct answer Chronic bronchitis is blue bloater because they have insufficent oxygenation that leads to hypoxemia and causes them to be cyanotic Emphysema patients take in suffienent o2 but they are retaining C02 so they are pink, and they are using accessory muscles to breath which causes barrel chest or "puffer" look Pneumonia is an infection within the lungs. What causes shortness of breath in a patient with pneumonia and how is it different than emphysema? - Correct answer Pneumonia is most often caused by a bacterial or viral infection within the lungs. This produces an inflammatory response that causes fluid buildup in the alveoli, and prevents oxygen from efficiently diffusing to the blood. With emphysema, the alveoli are collapsed and damaged. This is a chronic condition while pneumonia can occur rapidly, but both have very similar signs and symptoms.
How can a patients position indicate respiratory distress? - Correct answer Patients in respiratory distress will likely change their position to allow for an easier work of breathing. One common position is the tripod position, in which the patient has their hands on their knees with their elbows out, leaning forward. Another common position is the sniffing position in which the patient will stick their head outward in an attempt to open the airway more. What is reffered to as an increased work of breathing? What can it lead to if not corrected? - Correct answer Increased work of breathing means that a patient is using an extra amount of energy to ventilate adequately. This can be seen as the use of accessory muscles, retractions or nasal flaring. A patient with an increased work of breathing is in respiratory distress and could eventually become so tired they fall into a respiratory arrest if they do not receive an intervention immediately. What is the equation for minute volume? - Correct answer Minute Volume = Respiratory Rate x Tidal Volume Why is minute volume important/better to use than just using the RR rate? - Correct answer A person's respiratory rate alone does not take into consideration the volume of each respiration. They could be breathing at a normal rate, but have little volume with each breath, which would not be adequate respiration. How are Cheyne-Stokes respirations categorized and what conditions can cause this breathing pattern? - Correct answer Cheyne-Stokes respirations are categorized by progressively increased respirations, followed by progressively decreased respirations, followed by a period of apnea. This respiratory pattern can be a result of stroke, brain injury, CO poisoning, or a brain tumor. You respond to the scene of a 55 year old male who is unconscious. He is breathing deep and rapid and has a blood sugar of 512. What type of respiratory pattern is this patient exhibiting and what is causing it? - Correct answer This patient's deep, rapid respirations are indicative of Kussmaul respirations, which is caused by diabetic ketoacidosis, or DKA.
What lung sounds would you likely hear from a person who is suffering from an asthma attack? What causes this sound? - Correct answer Wheezing is the common sound heard from someone with asthma. High-pitched whistle sound that is typically heard on expiration. Occurs when the air is forced through small, inflamed airways causing them to vibrate. What is stridor and why is it more common in children? - Correct answer Stridor is a high-pitched sound during inspiration that is caused by a partial airway obstruction in the upper airway. Stridor is more common in children because the diameter of their airway is smaller than adults. Causing the airway to swell resulting in the sound. What is cyanosis and how does it relate to the respiratory system? - Correct answer Cyanosis is the bluish or purple coloration of the skin or mucous membranes. Cyanosis occurs when the blood in the body does not carry enough oxygen. This lack of oxygen in the blood can be due to an airway obstruction, lung disease, or hypoventilation/apnea. Explain what pulse oximetry is? - Correct answer Measures the amount of oxygen that is bound to hemoglobin in the blood, also known as the oxygen saturation. How do bronchodilators help respiratory patients? Give an example of one you would use in the field. - Correct answer Dilate the bronchi and bronchioles which decreases resistance in the lower airway and increases airflow to the lungs. Albuterol What is the correct sequence of assessment for an unconscious/unresponsive patient and why? - Correct answer C-A-B. Circulation, Airway, Breathing. Circulation is emphasized as the first thing to assess because it poses the greatest life-threat. The goal is early intervention with compressions and
Which two heart rhythms are considered "shockable" rhythms? - Correct answer - Ventricular fibrillation
- Pulseless ventricular tachycardia Bystanders performed 5 minutes of CPR before you arrived. You took over compressions and defibrillation victim. What would be your next action to take? - Correct answer Perform 2 minutes of CPR and then a rhythm check Use the following terms, describe the flow of blood through the body: Atrium, ventricle, arteries, veins, aorta, pulmonary artery, pulmonary veins, capillaries, vena cava, arterioles. - Correct answer 1.Unoxygenated blood (this is the blood that has been "used up" by your body and needs to be resupplied with oxygen) enters the heart through the SUPERIOR AND INFERIOR VENA CAVA
- Blood enters into the RIGHT ATRUM
- Then it squeezed through the TRICUSPID VALVE
- Blood then enters into the RIGHT VENTRICLE
- Then it squeezed into the PULMONANIC VALVE
- Blood is then shot up through the PULMONARY ARTERY and then enters the LUNGS for some oxygen Since the goal of the right side is to get blood to the lungs always remember that the pulmonic valve and the pulmonary artery will be on the right side since it is associated with the lungs
- Blood enters from the lungs through the PULMONARY VEIN
- Blood then enters the LEFT ATRIUM
- Down the BISCUPID VALVE (also called MITRAL VALVE)
- Then blood is squeezed into the LEFT VENTRICLE
- After leaving the left ventricle blood is squeezed up the AORTIC VALVE
- Lastly up through the AORTA where blood is pumped throughout the body
- Arteries branch off into
- arterioles
- capillaries
- veins What is the difference between systolic and diastolic blood pressure? - Correct answer Systolic blood pressure - the pressure in the blood vessels while the heart is contracting. Represented as the top number of a blood pressure (i.e. 120/80 mmHg). Diastolic blood pressure - the pressure in the blood vessels while the heart is at rest. Represented as the bottom number of a blood pressure reading (i.e. 120/80 mmHg) What are two important roles of red blood cells? - Correct answer - Transport oxygen to the cells
- Transport carbon dioxide to the lungs What are 7 signs of cardiac compromise? - Correct answer 1) Abnormal blood pressure
- Pain, pressure or discomfort in the chest or abdomen
- Shortness of breath
- Palpitations
- Anxiety and/or irritability
- Abnormal pulse
- Sudden onset of nausea/vomiting Auscultation of the lungs reveal crackles and the patient is having difficulty breathing. Which side of the heart do you believe to be affected and why? - Correct answer Shortness of breath with crackles in the lungs is indicative of left-sided heart failure. The failure of the left ventricle to effectively pump blood to the body causes the blood to back up, or be congested, in the lungs.
