1. You arrive at a nursing home for a reported fall. Staff report that a visitor became aggressive when told he couldn’t take a patient home, and is now threatening staff with a knife in the common area. The patient from the fall is in a different wing of the facility. What is the MOST appropriate sequence of actions?

2. You respond to a restaurant where a 55-year-old female is reported to be “acting strange.” As you approach, you notice she is slumped in her chair, pale, and diaphoretic. Her breathing appears labored, and she does not respond when you say her name. What is your immediate priority?

3. A 28-year-old female is found unconscious after a motor vehicle collision. She has a large hematoma on her forehead, unequal pupils, and is only responsive to painful stimuli with decerebrate posturing. Why is rapid transport critical for this patient?

4. You respond to a single-vehicle collision where the car struck a utility pole at an estimated 45 mph. The driver, an unrestrained 25-year-old male, has a laceration to his forehead and is complaining of abdominal pain. Based on the MOI, which injury pattern should you have a high index of suspicion for?

5. During a secondary assessment of a patient who fell from a roof, the EMT palpates the pelvis and notes instability and severe pain. The patient’s blood pressure is 88/54 mmHg, pulse is 124, and skin is pale and diaphoretic. What is the MOST appropriate action?

6. You are called to treat a 35-year-old male with significant facial trauma from an assault. There is active bleeding from his nose and mouth, and he is spitting blood. Which combination of PPE is most appropriate for this encounter?

7. How long should you check for a pulse in an unresponsive patient before starting CPR?

8. You are caring for an unresponsive 45-year-old male with inadequate breathing. You need to insert an oropharyngeal airway (OPA). How do you determine the correct size?

9. You are treating a 35-year-old male trauma patient involved in a high-speed motor vehicle collision. He has an obvious deformity to his right thigh and is in severe pain. He tells you, “I can’t afford an ambulance ride or hospital. Please just take me home – my wife can drive me later if I need to go.” He is alert and oriented with no signs of head injury. His wife arrives and begs him to go to the hospital. You explain the risks of refusing: possible internal bleeding, compartment syndrome, and permanent disability. He responds, “I understand – I just lost my job and we have no insurance. I’ll take my chances.” Which of the following BEST describes your obligation in this situation?

10. You respond to a motor vehicle collision involving a 30-year-old restrained driver who struck the steering wheel. During your primary assessment, you note the following: his airway is patent, he is breathing rapidly at 28 breaths per minute, and his radial pulse is weak and rapid at 120 beats per minute. His skin is pale, cool, and diaphoretic. You notice bruising across his chest from the seatbelt and a displaced segment of his lower ribs that moves paradoxically with breathing. His blood pressure is 88/64 mmHg. Based on these primary assessment findings, what is the MOST likely cause of his shock, and what is the immediate priority?

11. A 28-year-old female is found by her roommate after an unknown length of unconsciousness following a reported heroin overdose. She responds to painful stimuli by opening her eyes and withdrawing. She makes incomprehensible sounds but no words. Her roommate gave naloxone 5 minutes ago. How would you classify her current level of consciousness, and what change would you expect if the naloxone is effective?

12. A 72-year-old male patient with a history of hypertension and diabetes presents with confusion. His family states he has been ill with “the flu” for three days. Vital signs are: BP 94/62 mmHg, HR 112 bpm, RR 24 breaths/min, SpO2 91% on room air, temperature 102.2°F. Blood glucose is 68 mg/dL. Based on this comprehensive assessment, which of the following interpretations is MOST accurate?

13. A 45-year-old male patient presents with a blood pressure of 88/56 mmHg. Which of the following best describes this finding?

14. A 4-year-old child was eating popcorn when he suddenly began coughing and cannot speak. He is clutching his throat and appears panicked. His face is turning red. What is the MOST appropriate immediate intervention?

15. You respond to a residence for a “person not acting right.” The family states the 58-year-old male has diabetes and takes insulin. They found him this morning “staring at the wall and not making sense.” When you arrive, he opens his eyes when you speak, is mumbling words you cannot understand, and moves his arms around purposelessly when you try to examine him. His skin is pale, cool, and diaphoretic. Blood glucose is 42 mg/dL. What is his GCS and the most likely cause of his altered mental status?

16. When using the SBAR communication format, which element would include the patient’s vital signs?

17. An unresponsive 67-year-old female is found in her home by a neighbor who called 911. The patient has no identification and cannot provide consent. Which type of consent applies to this situation?

18. When assessing a patient’s pain using OPQRST, which component asks the patient to describe what the discomfort feels like?

19. A 19-year-old male was found unresponsive at a party. His friends report he was drinking alcohol and may have taken “some pills.” His skin is pale, cool, and diaphoretic. His respiratory rate is 8 breaths/min, and his pulse is weak and thready. What is the relationship between his level of consciousness and circulation status?

20. A 68-year-old male complains of chest pain and shortness of breath. His oxygen saturation reads 89% on room air. Which oxygen delivery device should you select, and at what flow rate?

21. When using the AVPU scale to assess a patient’s level of consciousness, what does the “V” indicate?

22. You are dispatched to a reported stabbing at a convenience store parking lot. Upon arrival, you observe a 22-year-old male with a single stab wound to the left upper quadrant of the abdomen. The patient is conscious and the wound is approximately 2 inches long. Based on this MOI, which statement best describes your assessment priorities?

23. While transporting a critical patient with lights and sirens, your ambulance is involved in a collision at an intersection. What should you do FIRST?

24. You respond to a motor vehicle collision on a rural two-lane road at night. Upon arrival, you observe a single vehicle that has struck a utility pole. The driver is slumped over the steering wheel. There is significant damage to the front of the vehicle, and a utility pole nearby shows damage with wires down in the road. A small fire has started in the engine compartment. A single police officer is on scene attempting to direct traffic with a flashlight. No fire department units have arrived. Which sequence of actions is most appropriate?

25. You respond to a call for an unresponsive 8-month-old infant. The mother reports finding the baby not breathing when she went to check on him after a nap. On your arrival, you find a pale, limp infant with no respiratory effort and no palpable pulse. The mother says the baby was “sleeping on his stomach” and had a “slight cold” yesterday. You begin CPR and request ALS backup. While performing your assessment and initiating resuscitation, what condition should you be MOST suspicious of as the underlying cause?

26. A patient has unequal pupils (anisocoria). When is this concerning?

27. At a HazMat incident, where should decontamination of patients occur?

28. When approaching a patient found unresponsive in a confined space, what should be the EMT’s FIRST priority before making patient contact?

29. Which of the following best describes the appearance of arterial bleeding?

30. You are assessing a 28-year-old male who was stabbed in the right side of the chest. He is alert but has significant respiratory distress. You note absent breath sounds on the right side, jugular venous distension, and a blood pressure of 84/58 mmHg. His trachea appears to be slightly deviated toward the left. Which condition should you suspect?

31. 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?

32. A patient who opens their eyes only when you pinch their shoulder and attempts to push your hand away would be classified as what on the AVPU scale?

33. During a primary assessment of a 3-year-old child with a fever, the EMT notes a capillary refill time of 4 seconds. What is the most appropriate interpretation of this finding?

34. A 34-year-old male is found sitting on a park bench. When you approach, he opens his eyes and looks at you but does not respond when you ask his name. You gently shake his shoulder and he mumbles something unintelligible. What is his AVPU score?

35. Which of the following patients should be identified as a priority patient requiring immediate transport?

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. You respond to a possible overdose. The 24-year-old patient is unresponsive with a respiratory rate of 6 breaths/min. You have naloxone (Narcan) available. What should you do?

38. A patient has a blood pressure of 80/50, heart rate of 120, and cool, pale, clammy skin. What do these findings indicate?

39. During the primary assessment of a patient with a gunshot wound to the thigh, the EMT notes brisk, dark red bleeding that is pooling rapidly. The patient is alert and oriented. What is the most appropriate initial intervention?

40. When assessing circulation during the primary assessment, at which location should you palpate for a pulse in an unresponsive infant?

41. You are assessing a 4-year-old child who has been coughing and has a high-pitched inspiratory sound when breathing. The child is sitting upright, drooling, and appears anxious. The parent reports the symptoms started suddenly about 20 minutes ago. The child has NO fever. Which condition should you MOST suspect?

42. A 4-year-old child is experiencing a seizure. The seizure has lasted approximately 3 minutes. The child is cyanotic around the lips and has noisy, labored breathing during the seizure activity. What is your PRIORITY intervention?

43. Which piece of personal protective equipment (PPE) is required for ALL patient contact, regardless of the chief complaint or suspected condition?

44. You are assessing a 68-year-old female with possible stroke. She is able to speak but has significant drooling and difficulty swallowing. Her voice sounds “wet” and gurgling. What does this indicate about her airway status?

45. Which of the following patients should be classified as high priority based solely on the general impression during the initial assessment?

46. A patient reports sudden onset of difficulty breathing and sharp chest pain that worsens with breathing. What should you suspect?

47. A 45-year-old female was involved in a motor vehicle collision. She is conscious and talking, but you note her radial pulse is absent. Her skin is pale and cool. What is the clinical significance of the absent radial pulse in this patient?

48. You are called to assist a 350-pound (159 kg) 58-year-old male experiencing respiratory distress. He was able to walk to the living room chair before becoming too short of breath to continue. He is sitting upright, using accessory muscles, with audible wheezing. His SpO2 is 86% on room air. Which intervention consideration is most critical for this patient?

49. During a primary assessment, an EMT notes that a patient has cool, pale, and diaphoretic skin. What physiological mechanism best explains these findings?

50. You are called to a residence for a 5-year-old child with fever. Upon arrival, the child is sitting on the parent’s lap, alert, crying appropriately, and has pink, warm skin. The parent reports the child has had fever for two days. What is your general impression?

51. You are called to assist a patient with a large, weeping wound on his leg. The wound is producing significant drainage. As you prepare to dress the wound, which PPE combination is most appropriate?

52. An EMT responds to a homeless shelter where a patient is reporting night sweats, weight loss, and a persistent cough lasting three weeks. After donning gloves and an N95 respirator, the EMT begins assessing the patient. Which statement best explains why this PPE selection is appropriate?

53. A 32-year-old woman is found lying comfortably on a couch after a minor motor vehicle collision. She has pink, warm, dry skin, is speaking in full sentences, and appears calm. She states she was rear-ended while stopped at a red light. What should the EMT do next?

54. A 67-year-old male with a history of hypertension and diabetes is found confused. His family reports he took his usual insulin dose this morning but then did not eat breakfast due to feeling nauseous. His skin is cool and clammy, and he is diaphoretic. His blood glucose reads 38 mg/dL. What is the MOST appropriate intervention?

55. A 34-year-old female complains of severe right lower quadrant abdominal pain with nausea and vomiting. When taking her history, she reports she had a similar episode six months ago that resolved on its own, but this episode is worse. She has an IUD for birth control. Which SAMPLE component raises the HIGHEST concern for ectopic pregnancy?

56. An EMT responds to a patient with a productive cough and fever who recently traveled internationally. The patient mentions family members have similar symptoms. Which PPE combination is MOST appropriate?

57. You are called to a nursing home for a 78-year-old female with difficulty breathing. Upon arrival, staff report she has a history of congestive heart failure and has been “getting worse all day.” Your primary assessment reveals: she is alert but very anxious, sitting upright in bed in a tripod position, using accessory muscles to breathe. Her respiratory rate is 32 breaths per minute with labored effort. You auscultate crackles (rales) in both lung bases. Her skin is pale and diaphoretic with SpO2 of 89% on room air. She speaks in three-word sentences. What is the MOST appropriate interpretation and initial management?

58. You are assessing a 35-year-old female with abdominal pain. During your primary assessment, you palpate her radial pulse and find it weak and thready at 112 beats per minute. Her skin is pale, cool, and slightly moist. What do these findings most likely indicate?

59. An EMT responds to a motor vehicle collision. The EMT provides the following radio report to the receiving trauma center: “This is Ambulance 7, we have a 10-50 with a 10-4 male, unconscious, 10-52 ETA 10 minutes, 10-17.” Which aspects of this communication are MOST problematic?

60. You respond to a two-story residential home for a “difficulty breathing” call. Upon arrival, a family member meets you at the door and says the patient is upstairs in the bedroom. You immediately notice a strong odor of natural gas. The family member insists, “It’s just a small leak, come in, she really needs you!” What is your most appropriate action?

61. A patient with a suspected cervical spine injury is unresponsive. How should you open the airway?

62. You respond to a motorcycle collision. The rider was not wearing a helmet and was thrown approximately 30 feet from the motorcycle, landing on pavement. Which injury pattern should you anticipate based on this mechanism?

63. You respond to a single-vehicle collision where the car struck a utility pole at approximately 35 mph. The driver, a 45-year-old male, was wearing a seatbelt and the airbag deployed. There is significant front-end damage and the windshield is starred but not penetrated. Based on this MOI, which potential injuries should you have a heightened index of suspicion for?

64. A 34-year-old female who is 36 weeks pregnant is complaining of severe, constant abdominal pain and dark red vaginal bleeding. She reports she has not felt the baby move in several hours. Her blood pressure is 80/50 mmHg, heart rate is 120 bpm, and she is pale and diaphoretic. What is the MOST likely condition, and what is the PRIORITY intervention?

65. What is the primary indication for using the jaw thrust maneuver instead of the head-tilt/chin-lift technique?

66. An EMT realizes after submitting a patient care report that she accidentally documented “nitroglycerin administered” when the patient actually received aspirin. What is the correct procedure for correcting this documentation error?

67. A 58-year-old female presents with sudden onset of severe chest pain radiating to her left arm and jaw. She is diaphoretic, anxious, and describes the pain as “crushing.” Her blood pressure is 148/92 mmHg, pulse 102, respirations 22. What is the MOST likely diagnosis?

68. A 58-year-old male with suspected cardiac arrest has agonal gasps at 4/min. Your partner begins chest compressions. Another EMT attempts to insert an oropharyngeal airway, but the patient gags and retches. What is the BEST course of action?

69. A 19-year-old female with severe asthma is in respiratory distress. Initially, she had loud wheezing, but now her breath sounds are diminished bilaterally with only faint wheezes. She is extremely anxious, has cyanosis around her lips, and can no longer speak. Her SpO2 is 82% on 15 L/min via non-rebreather mask. What does the change in breath sounds indicate, and what is the appropriate response?

70. Which finding is MOST concerning for imminent respiratory failure?

71. You respond to a motor vehicle collision on a two-lane highway at night. The vehicle is on its side, and a downed power line is lying across the hood. The driver is conscious and moving inside the vehicle. What is your FIRST action?

72. An 82-year-old male is found on the floor of his apartment by a neighbor. The patient is confused and unable to provide a history. His vital signs are: BP 90/60 mmHg, HR 102, RR 22, SpO2 91% on room air, Temp 101.8°F. His skin is warm and dry. The neighbor states the patient lives alone and has not been seen outside in two days. What is the MOST likely cause of his altered mental status and hypotension?

73. A 64-year-old male has chest pain that he describes as “crushing” and radiates to his jaw. He is diaphoretic and nauseated. What is your PRIMARY intervention priority?

74. During a cardiac arrest, you need to communicate with dispatch about resource needs. Which method of communication is MOST appropriate?

75. A 55-year-old woman fell from a ladder and has an obvious deformity to her left lower leg. The foot is pale, cool, and she reports numbness in her toes. There is no distal pulse. What should you do first?

76. A 24-year-old male was thrown from his motorcycle at highway speeds. He is alert and complaining of neck pain. He is lying supine on the ground. Which of the following is the MOST appropriate initial intervention?

77. You approach a 72-year-old female who appears to be sleeping in bed. She does not respond to your voice but withdraws from a sternal rub. Her skin is cool and pale, and her breathing appears shallow. What is your general impression?

78. Dispatch reports a “possible heart attack” at a local bar. Upon arrival, you observe a chaotic scene with patrons arguing, broken glass on the floor, and your patient lying near the entrance with bystanders standing around. What is your BEST course of action?

79. You respond to a residence for a 28-year-old female in respiratory distress. On arrival, you find her sitting upright in a tripod position, using accessory muscles, with audible stridor. She is drooling and unable to speak more than one word at a time. Her skin is hot to the touch, and her mother reports she has had a sore throat and fever for two days. During your primary assessment, her SpO2 is 88% on room air. What is your assessment, and what intervention is contraindicated?

80. A 22-year-old male was struck in the head during an assault. He was briefly unconscious but is now alert and oriented. He has a laceration on his scalp that is bleeding heavily. What is the MOST appropriate sequence of care for this patient?

81. A 22-year-old female is found unconscious after a witnessed seizure. She has snoring respirations at 8 breaths per minute. Her pulse is strong and regular. What is the MOST appropriate initial airway intervention?

82. You respond to a 56-year-old male with chest pain. Your assessment reveals: – Alert, oriented, pale, diaphoretic – Blood pressure: 158/94 mmHg – Heart rate: 92 bpm, irregular – Respiratory rate: 20 breaths/min – SpO2: 94% on room air – 12-lead ECG shows ST elevation in leads II, III, aVF – Patient reports 6/10 substernal chest pain radiating to jaw – Nitroglycerin 0.4 mg SL administered with improvement to 4/10 – Aspirin 325 mg chewed and swallowed During documentation, your partner suggests including that the patient “probably had a heart attack in the past based on the scars on his chest” and documenting the pain as “typical cardiac chest pain.” Which analysis of these suggestions is MOST accurate?

83. An EMT is assessing an unresponsive adult patient and notes that a radial pulse is palpable. Based on this finding alone, what is the minimum estimated systolic blood pressure (SBP)?

84. A 55-year-old male with crushing chest pain is being assessed. When asked about the events leading up to his symptoms, he says, “I was just watching TV when it started.” The pain has been present for 20 minutes and is 8/10 in severity. Which follow-up question about the “Events” component would be MOST clinically relevant?

85. You are called to a construction site for a worker who was crushed between two vehicles. Upon arrival, you find a 38-year-old male lying on the ground. He is alert but anxious. His airway is patent, breathing is rapid at 30 breaths per minute, and you note his skin is pale, cool, and diaphoretic. His radial pulse is absent, but you palpate a weak femoral pulse at 130 beats per minute. What is the MOST accurate interpretation of his circulatory status?

86. You have one ambulance and four patients from a collision. One is deceased, one has an open femur fracture, one is ambulatory with abrasions, and one is confused with abdominal pain. Who goes first?

87. What does the “L” in the SAMPLE history mnemonic stand for?

88. You are treating a 5-year-old unresponsive child in cardiac arrest. Using the age-based weight estimation formula, what is this child’s approximate weight for medication dosing calculations?

89. What is the minimum personal protective equipment (PPE) required for ALL patient contact situations?

90. You are the first arriving unit at a building collapse with approximately 50 victims. What is the correct sequence of actions?

91. A 6-month-old infant is found unresponsive in his crib. The mother states he was fine when she put him down for a nap 2 hours ago. The infant is pale, limp, and does not respond to touch or voice. What should guide your general impression of this patient?

92. You are treating a 65-year-old female from a cultural background where medical decisions are made by family elders, not the patient. She requires emergency transport for chest pain, but her husband states she cannot go to the hospital until he calls their son. The patient appears anxious but defers to her husband. What is your most appropriate action?

93. During the primary assessment, you assess circulation by checking the radial pulse. In an adult patient, what pulse rate range is considered within normal limits?

94. What is the correct sequence for initial scene size-up?

95. An alert and oriented 45-year-old man complains of chest pain. When you explain that you need to start an IV and give nitroglycerin, he clearly states, “I understand, and I want you to do it.” What type of consent has been obtained?

96. A 35-year-old male was involved in a bar fight 30 minutes ago. Police report he was punched in the abdomen multiple times and fell to the ground. When you arrive, the patient is standing, joking with officers, and has a small abrasion on his cheek. He refuses treatment, saying “I’m fine, I’ve been in worse fights.” His skin is slightly pale but he appears otherwise stable. What is your most appropriate response?

97. An EMT is caring for a prominent community member. What is the MOST appropriate action regarding patient confidentiality?

98. A 28-year-old construction worker has a deep laceration on his right forearm with bright red blood spurting rhythmically. You have applied direct pressure with gauze and elevated the arm, but bleeding continues heavily. What should you do next?

99. A 67-year-old male with a history of COPD is complaining of severe shortness of breath. During your primary assessment, you note he is using accessory muscles, has audible wheezing, and can only speak one or two words at a time. His SpO2 is 86% on room air. What is your IMMEDIATE priority?

100. You respond to a multi-patient incident at a construction site where scaffolding has collapsed. You are the first medical unit on scene. You identify three patients: Patient A is a 55-year-old male lying on the ground, unresponsive, with an obvious deformity to his left thigh and a large laceration on his forehead. His respirations are 6 per minute and shallow. Patient B is a 32-year-old male sitting against a wall, alert, holding his right arm which is bent at an abnormal angle. He is in obvious pain but speaking clearly. Patient C is a 28-year-old female walking around the scene with a bleeding scalp laceration. She is oriented and asking about her coworkers. Fire department personnel are on scene controlling hazards. Which patient should be your FIRST priority and what is your initial intervention?