1. You respond to a possible overdose. The patient is found with a needle nearby. What should you do FIRST?

2. Which mechanism of injury (MOI) automatically indicates the need for full spinal immobilization and trauma center transport?

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

4. A 54-year-old diabetic male is found confused and combative. Family states he took his usual insulin this morning but then “didn’t eat much breakfast.” His skin is cool and diaphoretic. What is the most likely cause of his altered mental status?

5. You are caring for a patient who becomes combative and refuses transport. Despite your efforts, he signs the refusal form. What should you document?

6. You are called to an industrial site for a worker who collapsed. Upon arrival, a supervisor reports the patient collapsed near a chemical storage area and there is a strong odor in the air. Several other workers are complaining of headache and nausea. What is your FIRST action?

7. An EMT arrives on scene to find a 22-year-old male who was involved in a motor vehicle collision. The patient is walking around the scene, talking on his cell phone, and states he feels “fine.” The vehicle has significant front-end damage, and the airbag deployed. What is the most appropriate initial action?

8. When obtaining the “E” component of a SAMPLE history, the EMT asks, “What were you doing when the symptoms started?” What additional information should also be gathered for the “E” component?

9. During assessment of a patient with difficulty breathing, the EMT notes that the patient is using accessory muscles to breathe, has intercostal retractions, and is sitting upright leaning forward on his hands. These findings indicate:

10. You respond to a call for an “unresponsive person” in a public park. You find a person lying on a bench. What should you do FIRST?

11. A 29-year-old male with type 1 diabetes calls for help because he feels “shaky and weak.” His blood glucose is 62 mg/dL. He is alert, oriented, and able to swallow. After administering one tube of oral glucose, his symptoms persist and repeat glucose is 58 mg/dL. What should you do NEXT?

12. You are assessing a 5-year-old child who fell from a playground structure. The child is crying loudly, reaching for a parent, and has a visible deformity to the left forearm. Based on your general impression, what is the most accurate statement about this child’s status?

13. A 32-year-old male fell 20 feet from a ladder and is now complaining of weakness in both legs and inability to move them. His vital signs are: BP 84/50 mmHg, HR 58/min, RR 18/min. His skin is warm and dry. Which type of shock should you suspect, and what is the underlying mechanism?

14. A 23-year-old female is brought to the emergency department by friends who state she was “acting strange” at a concert. On assessment, she does not respond to her name being called loudly. When you apply a painful stimulus to her trapezius, she pulls away and says “stop it.” Her pupils are equal and reactive. Blood glucose is 95 mg/dL. What is her AVPU status, and based on the presentation, what is the MOST likely cause of her altered mental status?

15. A 22-year-old female is found unconscious in her college dorm room. Her roommate states the patient is diabetic and has been “acting weird” for the past hour. Blood glucose is 38 mg/dL. The patient has a weak gag reflex but makes occasional groaning sounds. What is the MOST appropriate medication intervention?

16. A 6-month-old infant presents with increased work of breathing. You observe nasal flaring, intercostal retractions, and an expiratory wheeze. The infant’s respiratory rate is 52 breaths/min. What is the MOST appropriate initial intervention?

17. You respond to a vehicle collision on a highway. As you arrive, you notice an overturned tanker truck with a placard displaying the number 3072. Multiple patients are lying on the ground near the vehicle. What is your FIRST action?

18. You arrive at a two-vehicle collision on a rural highway. After initial scene size-up, you identify four patients: one critical (unresponsive, severe bleeding), two moderate (ambulatory with apparent fractures), and one minor (refusing care, minor scrapes). There are only two EMTs in your ambulance. What is your most appropriate resource utilization decision?

19. While treating a trauma patient with a deep laceration to the thigh, the EMT notices arterial bleeding that is spurting with each heartbeat. Which PPE should the EMT don before applying direct pressure?

20. A patient fell from a third-story window (approximately 30 feet) onto a grass lawn. Which statement best explains why this mechanism requires a comprehensive trauma assessment even though the patient is currently awake and talking?

21. A 68-year-old male has a weak radial pulse. What should you do to further assess his circulation?

22. A 28-year-old female was ejected from a vehicle during a rollover collision. On your arrival, she is alert but confused, speaking in short phrases with visible blood in her mouth. Her GCS is 12 (E3, V3, M6). Breath sounds are present bilaterally but you hear gurgling with each respiration. Her SpO2 is 90% on room air. After initiating spinal motion restriction, what is the MOST appropriate immediate intervention?

23. You arrive to find three patients. Patient A is screaming with a leg deformity. Patient B is unresponsive with snoring respirations. Patient C has a bleeding arm laceration. Which patient do you assess first?

24. A 35-year-old male is experiencing anaphylaxis after a bee sting. He is conscious but has severe respiratory distress with audible wheezing, facial swelling, and a blood pressure of 86/54 mmHg. He has his own epinephrine auto-injector but is too weak to use it. What is the correct dose and administration technique?

25. You respond to a residence for a “person not feeling well.” Upon entering, you observe a 58-year-old male slumped in a chair, appearing drowsy. His wife states he has been “acting strange” for the past hour. As you approach, you note his breathing appears labored with visible use of accessory muscles, his skin has a bluish tint around the lips, and he responds only to verbal stimulus with confused speech. Analyze this general impression and determine your immediate priority.

26. You respond to a “sick person” call at a residence. A 68-year-old female is lying in bed. She appears thin, pale, and diaphoretic. Her daughter states, “She’s been tired all week and said she felt dizzy this morning, then wouldn’t wake up from her nap.” The patient responds to painful stimuli with decorticate posturing. Her skin is cool and clammy. Based on the general impression and clinical presentation, which pattern BEST represents the likely underlying process?

27. You are called to assist a 44-year-old female experiencing an allergic reaction after eating shellfish. She is alert but anxious, with diffuse hives and mild facial swelling. She has a prescribed epinephrine auto-injector (0.3 mg). After contacting medical direction, you are authorized to assist. Which statement correctly describes the proper administration technique?

28. You respond to a nursing home for a 78-year-old female with altered mental status. Staff report she was found unresponsive in her room this morning. Her past medical history includes diabetes, hypertension, atrial fibrillation, and a previous stroke with right-sided weakness. During your assessment, you note the following: She does not respond to her name or loud verbal stimuli. When you apply a painful stimulus to her fingernail bed, she does not respond. Her respirations are irregular, with periods of apnea lasting 10-15 seconds. Her blood pressure is 190/110 mmHg. Her pupils are 4mm and sluggishly reactive. Blood glucose is 142 mg/dL. What does her presentation suggest, and what is your immediate concern?

29. EMS is dispatched to a 52-year-old male with chest pain. On arrival, the patient is sitting upright in a chair, clutching his chest, with pale, diaphoretic skin. He is able to speak in short sentences but appears anxious. His wife reports he took nitroglycerin 10 minutes ago with no relief. What is the most accurate general impression and immediate priority?

30. You are treating an unresponsive 72-year-old male found by family members at home. Family states he has a history of diabetes, hypertension, and “some kind of heart problem.” They do not know his medications. His blood glucose is 42 mg/dL. After administering oral glucose, his mental status improves, and he becomes oriented. When documenting this call, which information is MOST critical to include in your patient care report?

31. A 24-year-old male was stabbed in the left upper quadrant of the abdomen. During your primary assessment, he is alert but anxious. His skin is pale, cool, and diaphoretic. His heart rate is 124 beats per minute, and his blood pressure is 102/68 mmHg. What stage of shock is this patient most likely experiencing?

32. An EMT arrives on scene to find a 34-year-old male sitting on the curb after a bicycle accident. He is holding his arm, speaking clearly, and appears anxious but is tracking the EMT’s movements. How would the EMT classify this patient’s general impression?

33. A patient with chest pain has a blood pressure of 90/60, is diaphoretic, and has crushing pain radiating to the left arm. What is the appropriate transport decision?

34. A 28-year-old female is experiencing a panic attack with rapid breathing, chest tightness, and numbness in her hands. She is alert but extremely anxious. What should you do?

35. You respond to a construction site where a 42-year-old male fell 15 feet and landed on his left side on concrete. Bystanders state he initially complained of severe left abdominal pain but now says he “feels fine.” During your primary assessment, you note: he is alert and oriented, skin is pale but warm, heart rate 112, BP 118/76, respiratory rate 22. He has bruising over his left flank and reports mild left shoulder pain. He wants to refuse transport. What is your clinical interpretation and most appropriate action?

36. When obtaining a SAMPLE history from a patient who speaks limited English, which approach is MOST appropriate?

37. 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?

38. A 4-year-old child is brought to you by his frantic mother. The child is sitting upright, leaning slightly forward, drooling, and has a muffled voice. He appears anxious and is not crying. His skin is pale. What is your priority action?

39. A 22-year-old male was involved in a motor vehicle collision. When you arrive, he is unresponsive to your voice. You apply a painful sternal rub and he extends his arms and legs outward with his head arched back. What is his AVPU status, and what condition does this motor response suggest?

40. You respond to a residence for a patient with a severe nosebleed. Upon arrival, you find the patient actively bleeding with bright red blood dripping from both nostrils. The patient is leaning forward, and blood is pooling on the floor. Which PPE combination is MOST appropriate for this call?

41. You arrive at a motor vehicle collision involving a single vehicle that struck a utility pole. The driver, a 28-year-old female, is out of the vehicle and walking around. She appears alert and tells you she is “fine” and just wants to go home. You notice a small bruise on her forehead and torn clothing. What should your general impression tell you about this patient?

42. A 22-year-old male was stung by a wasp 10 minutes ago. He now has diffuse hives, swelling of his lips and tongue, difficulty breathing with wheezing, and a blood pressure of 84/52. What is the MOST appropriate intervention?

43. Under the Incident Command System (ICS), which position is responsible for overall management of the incident?

44. During a primary assessment, you palpate a weak, thready radial pulse in a 45-year-old trauma patient. The patient is alert but appears anxious. What does this finding indicate, and what is your immediate priority?

45. A 16-year-old female is in active labor. Her parents are not present. Can she legally consent to treatment?

46. Dispatch sends you to a reported structure fire with possible entrapment. As you approach, you see heavy smoke and flames coming from a two-story home. A neighbor reports two people may still be inside. Fire department has a 15-minute ETA. What is your BEST course of action?

47. You are treating a 40-year-old female who fell and has an obvious deformity to her right lower leg. The foot is pale, and she reports numbness and tingling in her toes. Capillary refill is greater than 3 seconds, and she has weak pulses distal to the injury. What is the PRIORITY intervention?

48. You are called to a residence for a 78-year-old woman with altered mental status. Her husband reports she has been confused and lethargic for the past day. She has a history of heart failure, diabetes, and chronic kidney disease. Her medications include furosemide, metformin, and lisinopril. On assessment, you note dry mucous membranes, poor skin turgor, and orthostatic hypotension. Her blood glucose is 58 mg/dL. Which of the following is the MOST critical underlying condition requiring immediate intervention?

49. A 19-year-old male was found unresponsive at a party. Friends report he was drinking alcohol and may have taken unknown pills. His eyes open when you apply a trapezius squeeze, he mutters incomprehensible sounds, and he pulls away from the painful stimulus. Using the Glasgow Coma Scale, what is his motor score?

50. You are dispatched to a multi-vehicle collision on the highway. Upon arrival, you identify the following patients: Patient A is a 35-year-old male walking around asking for help with his bleeding nose. Patient B is a 28-year-old female sitting on the ground, holding her chest and breathing rapidly. Patient C is a 40-year-old male lying motionless in the back seat of one vehicle. Which patient should be your highest priority?

51. You are completing care for a patient with profuse vomiting when you notice a small tear in your glove on your dominant hand. Your hand appears dry underneath with no visible contamination. What is your most appropriate immediate action?

52. 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?

53. You respond to a 28-year-old female at 36 weeks gestation who was involved in a motor vehicle collision. She was a restrained driver in a moderate-speed collision. During your primary assessment, she is alert and oriented, complaining of abdominal pain and mild vaginal bleeding. Her vital signs are: BP 92/60 mmHg, heart rate 108, respiratory rate 20. Her skin is warm and pink. She reports feeling the baby move normally. Based on these findings, what is your assessment of her circulatory status and priority level?

54. You respond to a two-vehicle collision on a four-lane highway. Both vehicles are in the left lane, and traffic is passing on the right at highway speeds. There are no apparent hazards such as fire or fluid leaks. What is your FIRST priority action?

55. You are called to a residence for a 4-year-old child who is choking. Upon arrival, the mother reports the child was eating grapes when she started coughing and gagging. The child is conscious, crying, and coughing forcefully. You hear stridor-like sounds between coughs. Her color is pink. What is the MOST appropriate immediate action?

56. A 62-year-old male presents with sudden-onset, severe chest pain that began 20 minutes ago while watching television. He describes it as “crushing pressure” and rates it 9/10. The pain radiates to his left arm and jaw. He took one nitroglycerin tablet five minutes ago with no relief. He has a history of hypertension and high cholesterol, takes aspirin daily, and smokes one pack of cigarettes per day. Based on the OPQRST and SAMPLE findings, which assessment finding is MOST concerning and suggests acute myocardial infarction rather than stable angina?

57. An EMT responds to a 55-year-old male with shortness of breath. Upon entering the room, the patient is sitting upright in bed, using accessory muscles to breathe, and appears anxious. His skin is pale and diaphoretic. What general impression should the EMT form, and what is the immediate priority?

58. A 4-year-old child is unresponsive. You need to assess circulation. Which pulse should you check?

59. A 45-year-old male was found unconscious at the bottom of a staircase. He has snoring respirations at 16 breaths per minute. What is the most appropriate initial airway intervention?

60. A 56-year-old male is unresponsive with sonorous respirations. What should you do FIRST?

61. During a winter response, you find a 79-year-old male in his unheated apartment. He is confused, shivering, and has cold, pale skin. His core temperature reads 90°F (32.2°C). His blood pressure is 102/64 mmHg, pulse is 56/min and irregular, and respirations are 12/min. Which intervention should you perform FIRST?

62. Which documentation principle states that if an intervention or assessment was not documented, it is legally considered not to have been performed?

63. You respond to a 45-year-old male with chest pain. Upon entering the room, you observe him clutching his chest, sitting upright, with ashen gray skin. He is diaphoretic and speaks only in two-word sentences. What is your general impression and immediate action?

64. You administered oxygen to a hypoxic patient. Which of the following is the MOST appropriate way to document this intervention?

65. What is the primary difference between an EMT and an AEMT (Advanced EMT) in terms of scope of practice?

66. A 4-year-old child is brought to you by a panicked parent. The child has had a fever for two days and today became lethargic. On your general impression, the child is lying on the parent’s shoulder, not resisting, with rapid breathing and mottled skin. The child briefly opens eyes when you speak but does not track you. What is your impression and immediate action?

67. While en route to the hospital with a 67-year-old male experiencing chest pain, you need to provide a radio report. The patient has a history of hypertension and diabetes, currently reports 8/10 substernal chest pain radiating to his left arm, and you’ve administered aspirin and nitroglycerin with mild improvement. Which of the following represents the MOST appropriate radio transmission?

68. During your rapid assessment of a patient, you form a general impression within the first few seconds. What is the PRIMARY purpose of this initial general impression?

69. You respond to a motor vehicle collision involving three patients. Patient A is ambulatory with minor lacerations and is coughing. Patient B is trapped in the vehicle with an open leg fracture and is screaming in pain. Patient C was ejected and is unresponsive with visible head trauma and labored breathing. You have limited initial PPE supplies in your jump bag. Analyze the situation and determine which PPE prioritization strategy best balances scene safety and patient care needs.

70. 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?

71. Which of the following is the correct technique for obtaining an accurate radial pulse in an adult patient?

72. A 76-year-old female presents with dizziness and a syncopal episode. She reports taking multiple medications for “her heart, blood pressure, and water retention.” Her vital signs are: BP 92/58 mmHg, HR 54/min, RR 16/min, SpO2 96%. She appears pale but is alert. Which medication combination is most likely contributing to her presentation?

73. You are dispatched to a fall at a construction site. A worker fell approximately 15 feet onto concrete. Based on this mechanism of injury, which injury pattern should you anticipate?

74. You respond to a call for a “man down” at a public park. As you approach, you see a middle-aged male lying on the grass near a park bench. Several bystanders are watching but keeping their distance. You notice a small crowd of people pointing and looking nervous. What is your FIRST action before approaching the patient?

75. When using the “MARCH” algorithm during primary assessment of a trauma patient, what does the “A” represent?

76. You are dispatched to a motor vehicle collision involving a car that struck a utility pole. The driver is unconscious, and the vehicle has a downed power line across the hood. What is your FIRST action?

77. A patient has a regular heart rate of 52 beats per minute. What is this called?

78. A 22-year-old male was ejected from a vehicle during a crash. On your arrival, he is unresponsive to voice but withdraws his right arm when you pinch his left shoulder. He does not open his eyes even to painful stimulus. His breathing is irregular, with a rate of 8 breaths/min. What is his GCS score and immediate priority?

79. During a secondary assessment of a patient who fell from a ladder, you palpate the cervical spine and note step-off deformity at the C5 level. The patient reports numbness in both arms but can move his legs. Which statement BEST describes the clinical significance of this finding?

80. You are staging near a reported explosion at an industrial warehouse. Fire department advises the scene is now safe to enter. Upon approach, you observe structural damage to the building, multiple patients in the parking lot, and one patient partially buried under debris. An approximately 30-year-old male patient was standing approximately 15 feet from the blast origin. He is conscious but confused, with bilateral tympanic membrane rupture, bilateral leg pain, and apparent chest wall bruising. He is unable to stand. Based on this MOI analysis, which injury pattern should you be MOST concerned about that is NOT immediately visible?

81. A 34-year-old male was found unresponsive after a heroin overdose. He has a respiratory rate of 6/min with shallow chest rise. His skin is cyanotic. What is the priority intervention?

82. A 55-year-old male has severe chest pain. He has a prescription for aspirin but no known allergies. His blood pressure is 140/90. After ensuring adequate oxygenation, what should you do?

83. A patient in cardiac arrest has return of spontaneous circulation (ROSC). What should you do?

84. Which of the following is the correct mechanism of action for glucagon in treating hypoglycemia?

85. You are treating a 24-year-old female having an acute asthma exacerbation. She has used her albuterol inhaler three times in the past hour without relief. She is sitting upright, using accessory muscles, and can only speak one or two words at a time. Her SpO2 is 89% on room air. Which finding indicates she is at greatest risk for respiratory failure?

86. A 34-year-old male was the unrestrained driver in a head-on collision. The vehicle has significant front-end deformity, the steering wheel is bent, and the windshield is starred. What does this mechanism suggest about potential injuries?

87. An EMT responds to a 24-year-old female with abdominal pain. She lives with her boyfriend, who answers most questions for her and won’t leave the room during assessment. The patient appears withdrawn and makes little eye contact. When asked about her last menstrual period, she says, “I’m not sure, maybe a couple months ago.” The boyfriend interrupts, “She’s just irregular.” Which aspect of this interaction should concern the EMT the MOST?

88. You are assessing a 28-year-old construction worker who fell 15 feet. He is sitting against a wall, pink and dry, talking to coworkers. He says his “leg hurts really bad.” What is your initial impression regarding priority?

89. When is it appropriate to use lights and sirens during patient transport?

90. You arrive at a two-vehicle collision on a busy highway. One vehicle is smoking, and fluid is leaking onto the roadway. Traffic is still moving around the crash scene. What should be your FIRST action after parking your ambulance?

91. A patient tells you that she is the victim of domestic violence and asks you not to tell anyone. What should you do?

92. 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?

93. A 45-year-old male was involved in a motor vehicle collision. During your primary assessment, you palpate a weak, thready radial pulse of 118 beats per minute. His skin is pale, cool, and diaphoretic. Based on these findings, what is the minimum estimated systolic blood pressure?

94. When performing rescue breathing for an adult patient with a pulse but no breathing, what is the correct rate and volume of ventilations?

95. You are called to a restaurant where a 34-year-old pregnant woman at 32 weeks gestation suddenly collapsed. Upon arrival, she is supine on the floor, diaphoretic, with a blood pressure of 88/54 mmHg and heart rate of 110 bpm. She is confused. Which of the following BEST explains her condition and the appropriate intervention?

96. A patient with an obvious emergency condition tells you she cannot afford to go to the hospital. What is the MOST appropriate response?

97. During primary assessment of an unresponsive adult patient, you observe that the patient has gurgling respirations. What is your immediate priority action?

98. A 68-year-old female with a history of congestive heart failure presents with difficulty breathing. She has pink, frothy sputum, distended neck veins, and crackles heard in both lung bases. Which condition is MOST likely causing her symptoms?

99. At a nursing home, you are called for an 82-year-old male with altered mental status. The staff reports he was normal at breakfast but is now unresponsive. His skin is pale, cool, and dry. Blood glucose is 180 mg/dL. He has a history of diabetes and atrial fibrillation. Which condition should be your PRIMARY concern for immediate intervention?

100. You are assessing a 55-year-old male who called 911 for chest pain. During your primary assessment, you note: blood pressure 88/52 mmHg, heart rate 118 bpm, respiratory rate 24, SpO2 92% on room air, and pale, diaphoretic skin. He reports the pain began 30 minutes ago and describes it as “crushing” pressure radiating to his left arm. What findings qualify this patient as a priority?