1. What is the appropriate flow rate range for a nasal cannula when administering oxygen to a patient?

2. A 68-year-old female complains of mild shortness of breath after climbing stairs. Her SpO2 is 92% on room air, and she has clear lung sounds bilaterally. She has no history of COPD. Which oxygen delivery device is MOST appropriate for this patient?

3. A 72-year-old male with a history of severe COPD presents with increasing shortness of breath. His SpO2 is 88% on room air. He appears anxious and is using accessory muscles. Which of the following is the MOST appropriate oxygen administration strategy?

4. You are treating a 34-year-old male who was involved in a high-speed motor vehicle collision. He has an open femur fracture with significant bleeding, is pale and diaphoretic, and has a SpO2 of 94% on room air. His respiratory rate is 24 breaths per minute. What is the MOST appropriate oxygen intervention?

5. You are called to a residence for a 56-year-old male with difficulty breathing. Upon arrival, you find the patient sitting in a tripod position, audibly wheezing, with SpO2 of 86% on room air. He is alert but unable to speak in full sentences, answering with only one or two words. His respiratory rate is 32, and you note significant use of accessory muscles. After initiating high-flow oxygen via non-rebreather mask, his SpO2 increases to 90%, but his mental status begins to decline, and he appears increasingly fatigued. Which of the following represents the MOST appropriate next intervention?

6. A 28-year-old female was rescued from an apartment fire. She is conscious and coughing but has singed nasal hairs and carbonaceous sputum. Her SpO2 reads 92% on room air, and she has first-degree burns on her face and neck. Which oxygen delivery device should be applied FIRST?

7. When ventilating an apneic adult patient with a bag-valve mask, what is the appropriate ventilation rate?

8. A 45-year-old male complains of chest pain that started 20 minutes ago. He describes it as “pressure” in the center of his chest. His vital signs are: BP 148/92, pulse 98, respiratory rate 18, SpO2 96% on room air. He has no respiratory distress and clear lung sounds. What is the MOST appropriate oxygen administration for this patient?

9. You are treating a 62-year-old male who fell 15 feet from a ladder. He is unresponsive to painful stimuli. His breathing is labored with sonorous respirations at 8 breaths per minute. You note significant bruising to the right side of his head and deformity to his right arm. His SpO2 is 88% on room air. After opening his airway with a jaw-thrust maneuver, his breathing improves slightly but remains inadequate. What is the MOST appropriate sequence of interventions?

10. You are first on scene of a cardiac arrest. A 55-year-old male is pulseless and apneic. You begin CPR and your partner prepares the AED. Your service protocols allow for a supraglottic airway device. Your partner asks whether they should insert the supraglottic airway immediately or wait until after the first AED analysis. Which approach is CORRECT and why?

11. What is the correct dose and concentration of epinephrine for an adult patient (>30 kg) when administered via auto-injector for anaphylaxis?

12. Why is epinephrine administered intramuscularly (IM) rather than subcutaneously (SC) during anaphylaxis?

13. A 35-year-old male is experiencing anaphylaxis after a bee sting. He is conscious but has significant facial swelling, wheezing, and difficulty breathing. His BP is 88/54 mmHg. You have an adult epinephrine auto-injector available. After administering the medication, how long should you hold the auto-injector in place?

14. A 7-year-old child weighing 22 kg (48 lbs) is experiencing anaphylaxis after eating a peanut butter cookie. The parent hands you two epinephrine auto-injectors: one labeled “0.15 mg” and one labeled “0.3 mg.” Which auto-injector should you use?

15. You have just administered epinephrine to a 28-year-old woman experiencing anaphylaxis. Which of the following findings would indicate a POSITIVE response to the medication?

16. What is the primary mechanism of action of epinephrine that makes it the drug of choice for anaphylaxis?

17. A patient with anaphylaxis receives epinephrine from an auto-injector. After 8 minutes, his symptoms have not improved. What is the appropriate action regarding additional epinephrine administration?

18. You are called to a local park for a 42-year-old man who was stung by multiple wasps. On arrival, you find him sitting on a bench, appearing anxious. He has diffuse hives on his arms and trunk, his face appears swollen, and he states his “throat feels tight.” He has audible stridor when breathing. His blood pressure is 102/68 mmHg, pulse is 118 bpm, and respiratory rate is 28 breaths/min with labored effort. The patient’s wife states he has a history of severe allergic reactions and hands you an epinephrine auto-injector from his emergency kit. After administering the epinephrine, what should you do immediately?

19. A 55-year-old woman with known cardiac history develops anaphylaxis after receiving IV contrast during a CT scan at an outpatient imaging center. She is conscious but severely distressed with widespread hives, tongue swelling, wheezing, and a blood pressure of 76/42 mmHg. The imaging center nurse asks if she should administer the patient’s cardiac medication (a beta-blocker) for her racing heart. What is the most appropriate response?

20. You respond to a restaurant for a 16-year-old male who accidentally ate food containing peanuts. His friend states the patient is allergic to peanuts but didn’t have his epinephrine auto-injector with him. The patient is alert but anxious, with mild lip swelling and a few hives on his neck. His voice sounds normal, he denies throat tightness or difficulty breathing, his lungs are clear, and his vital signs are within normal limits. What is the most appropriate action regarding epinephrine administration?

21. What is the normal fasting blood glucose level range for an adult patient?

22. A 58-year-old male with a history of type 2 diabetes is found confused and diaphoretic in his home. His family states he skipped breakfast and took his insulin this morning. His blood glucose reads 45 mg/dL. Which condition is most likely causing his presentation?

23. You are assessing a 45-year-old female with diabetes who presents with altered mental status. Her blood glucose is 38 mg/dL, and she is able to follow simple commands but has difficulty speaking clearly. What is the MOST appropriate initial treatment?

24. A 22-year-old male with type 1 diabetes is unresponsive when you arrive. His blood glucose is 28 mg/dL. He has a gag reflex but cannot protect his airway. Which intervention is MOST appropriate?

25. You respond to a 67-year-old female with altered mental status. Family reports she has had flu-like symptoms for three days with decreased appetite. Vital signs reveal deep, rapid breathing and a fruity odor on her breath. Her blood glucose reads 485 mg/dL. Which condition should you suspect?

26. A 52-year-old male with a history of type 2 diabetes is found unresponsive in his vehicle. His wife reports he seemed confused and irritable earlier in the day but refused to eat. On assessment, you note pale, cool, diaphoretic skin; a rapid, weak pulse; and blood glucose of 32 mg/dL. Which pathophysiological process BEST explains his deterioration from confusion to unresponsiveness?

27. You are treating two diabetic patients simultaneously. Patient A has blood glucose of 52 mg/dL with cool, clammy skin and confusion that developed over 30 minutes. Patient B has blood glucose of 425 mg/dL with warm, dry skin, Kussmaul respirations, and confusion that developed over 2 days. Based on the pathophysiology of each condition, which statement BEST explains the difference in their skin presentations?

28. A 34-year-old female with diabetes is conscious but exhibits slurred speech and unsteady gait. Her roommate states the patient has been drinking alcohol at a party. Blood glucose is 55 mg/dL. What is the MOST appropriate action?

29. A 19-year-old female with type 1 diabetes called 911 for weakness and confusion. On arrival, she is alert but disoriented to time and place. Her roommate reports she has been studying for finals and hasn’t eaten in 8 hours. Blood glucose is 48 mg/dL. After administering oral glucose, her mental status improves within 10 minutes. What mechanism BEST explains her rapid improvement?

30. What is the correct dose and route for oral glucose administration in an adult patient with suspected hypoglycemia who can swallow safely?

31. Which of the following is an indication for spinal motion restriction (SMR) in a trauma patient with a significant mechanism of injury?

32. An EMT selects a cervical collar that is too large for a patient. What is the potential consequence of this error?

33. A 22-year-old football player is found unresponsive after a helmet-to-helmet collision during practice. He is not breathing and has no pulse. He is wearing a properly fitted football helmet with a face shield. What is the most appropriate action regarding his helmet?

34. A 45-year-old male was involved in a high-speed motor vehicle collision. He is alert and oriented, denies neck or back pain, and has no tenderness on palpation of the spine. However, he has an obvious deformity to his right femur. What is the most appropriate action regarding spinal motion restriction?

35. Which of the following is currently considered the preferred device for spinal motion restriction during transport of a patient with a suspected spinal injury?

36. A 30-year-old female fell from a second-story window. She is conscious but agitated and smells of alcohol. She has a 3-inch laceration on her forehead and complains of pain in her right ankle. She repeatedly states she is “fine” and wants to refuse transport. The EMT notes that the patient’s speech is slurred. Which finding is most concerning regarding the decision to implement spinal motion restriction?

37. A 55-year-old male was the unrestrained driver in a moderate-speed motor vehicle collision. The vehicle sustained significant front-end damage, and the steering column is bent. The patient is alert and oriented, complaining of mild neck pain and pain in his left wrist, which has an obvious deformity. He states he “hit the steering wheel hard.” His vital signs are stable. Which finding would most strongly indicate the need for spinal motion restriction?

38. An EMT responds to a patient who fell down a flight of stairs. The patient is complaining of back pain and has visible bruising along the spine. During initial assessment, the EMT notes the patient’s cervical collar has been removed by a well-meaning family member who stated, “It was hurting his neck.” The patient is now sitting up and moving his head. What is the most appropriate analysis of this situation?

39. An EMT is preparing to apply a cervical collar to a patient who was involved in a motor vehicle collision. When measuring for collar size, the EMT should measure from which anatomical landmarks?

40. A patient presents with a significant mechanism of injury but has no spinal pain, no tenderness on palpation, is alert and oriented, has no neurological deficits, and has no evidence of intoxication. Which additional finding would still indicate the need for spinal motion restriction?

41. Which of the following is the most common atypical presentation of acute myocardial infarction in geriatric patients?

42. A 78-year-old female fell in her bathroom and has a 3 cm laceration on her forehead. Her daughter states she takes warfarin for atrial fibrillation. Which pathophysiologic mechanism most significantly increases this patient’s risk of serious injury?

43. You are called to a skilled nursing facility for an 82-year-old male who fell while transferring from his wheelchair to his bed. He has a 5 cm hematoma on his left hip and reports pain with movement. Staff reports he takes apixaban (Eliquis) and metoprolol. Vital signs are: BP 138/84, HR 72, RR 18, SpO2 95% on room air. Which aspect of this presentation requires the most immediate consideration in your assessment and transport decision?

44. You respond to a private residence for a 76-year-old male with “weakness.” On arrival, you find the patient sitting in a recliner, appearing fatigued. His wife states he has been “not himself” for two days, sleeping more, refusing to eat, and seeming confused about what day it is. He has a history of diabetes, hypertension, and chronic kidney disease. Vital signs are: BP 102/58, HR 98, RR 22, SpO2 91% on room air, temperature 97.2°F (36.2°C). The patient denies any pain or discomfort. Based on this presentation, which interpretation best explains the clinical picture?

45. You are dispatched to a motor vehicle collision involving a 32-year-old female who is 34 weeks pregnant. She was a restrained driver in a moderate-speed collision. She is complaining of mild abdominal discomfort but has no visible injuries. Which assessment finding would be most concerning for placental abruption?

46. An 81-year-old woman is found by her daughter lying on the kitchen floor, unable to get up. She states she thinks she fell about 6 hours ago while getting a glass of water. She denies loss of consciousness but says she felt “dizzy” before falling. Her medication list includes: lisinopril, hydrochlorothiazide, metoprolol, warfarin, and oxybutynin. Vital signs are: BP 94/62, HR 58, RR 16, SpO2 94% on room air. Which combination of factors from this scenario most significantly increases her risk of recurrent falls?

47. You respond to an assisted living facility for a 79-year-old woman with “difficulty breathing.” Upon arrival, the facility director greets you at the door and seems unusually anxious to have you evaluate the patient quickly. The patient is in bed, appears thin and frail with multiple ecchymoses in various stages of healing on her arms and upper back. She has a small, healing laceration on her lip. When you ask what happened, she looks fearfully at the facility director before quietly saying, “I fell.” Her vital signs show mild tachycardia but are otherwise stable. She has no acute respiratory distress. Which action is most appropriate for this patient?

48. You are caring for an unresponsive 2-year-old male who was found by his mother after an unknown period of time. He has a pulse of 70/min and respiratory rate of 6/min with shallow, irregular breathing. His skin is pale and cool. What is the most appropriate initial airway management for this patient?

49. A 74-year-old male with a history of heart failure and COPD presents with increasing shortness of breath over the past 3 days. He lives alone in an apartment with minimal heating during winter. His oral temperature is 94.8°F (34.9°C), and his skin feels cool to touch. He denies feeling cold and reports he “just hasn’t been feeling right.” Which age-related change best explains why this patient may not recognize or respond appropriately to hypothermia?

50. Which of the following medication classes is most likely to mask the typical tachycardic response to hemorrhagic shock in an elderly trauma patient?