1. When using the OPQRST mnemonic to assess a patient’s pain, what does the “Q” represent?

2. Which of the following correctly describes the primary purpose of Standard Precautions in EMS?

3. You respond to an industrial warehouse for a reported chemical spill with multiple symptomatic workers. On approach, you observe a hazmat placard with the number “3” and workers coughing near the entrance. What is your FIRST priority action?

4. You respond to a restaurant where a 52-year-old male has collapsed. Bystanders report he was eating dinner when he suddenly stood up, clutched his chest, and fell to the ground. When you arrive, you find him unresponsive with no respirations and no pulse. You begin CPR and apply the AED. The AED analyzes and advises “no shock advised.” You resume CPR. After 2 minutes, you reassess and find the patient has a weak carotid pulse but remains unresponsive with agonal gasps. His skin is pale and cool. What is the MOST appropriate interpretation and next action?

5. A 67-year-old male was found lying on the floor at his residence. He opens his eyes when you say his name but is confused and cannot follow simple commands. His skin is pale, cool, and diaphoretic. How should you categorize his level of consciousness?

6. You are called to a residence for a “sick person.” As you approach the front door, you notice a strong chemical odor and see an empty container with a “flammable liquid” label on the porch. The patient is visible through the window, lying on the floor. What should you do first?

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

8. A rural county’s EMS system has experienced significant challenges: average response times exceed 15 minutes, volunteer EMT availability is inconsistent, the nearest hospital is 30 minutes away, and the county lacks a dedicated medical director, relying instead on a neighboring county’s physician who is rarely available for online consultation. The county commissioners ask you to recommend the single MOST critical improvement to address multiple system weaknesses. Which recommendation would have the broadest positive impact?

9. A 3-year-old child is brought to you by his panicked mother. She states he was eating grapes when he suddenly started coughing and gagging, then became quiet and turned blue. The child is now silent, clutching his throat, and unable to cough or cry. What is the significance of the child being silent rather than coughing?

10. An EMT is assessing an unconscious 68-year-old male who fell from a ladder. The patient is unresponsive with sonorous respirations. Manual opening of the airway does not improve breathing quality. What is the most appropriate next step?

11. A 5-year-old child presents with severe respiratory distress. The parent reports the child has had a barking cough and fever for two days. You observe suprasternal and intercostal retractions, nasal flaring, and stridor. The child is sitting upright and appears anxious. SpO2 is 91% on room air. What is your priority action?

12. You are called to a home for a 2-year-old child with difficulty breathing. The mother reports the child has had a barking cough and fever for the past 12 hours. Upon assessment, you note inspiratory stridor, a seal-like barking cough, and hoarse voice. The child is sitting on the mother’s lap and appears anxious but is consolable. SpO2 is 94% on room air. What is the MOST likely diagnosis, and what is the MOST appropriate intervention?

13. A 45-year-old male was found lying in an alley by bystanders. His radial pulse is absent, but you can palpate a carotid pulse. His skin is cool, pale, and diaphoretic. What do these findings indicate about his circulatory status?

14. You are called to a high school football game where a 17-year-old player collapsed after making a tackle. Bystanders report he “got hit hard and didn’t get up.” The patient is supine on the field, conscious but complaining of neck pain and tingling in both arms. He cannot move his legs. You observe he was wearing a helmet but no shoulder pads. What is your priority action after establishing scene safety?

15. What is the normal respiratory rate range for an adult?

16. Which of the following situations is an example of abandonment?

17. According to the START triage system, a patient who is not breathing after a simple airway maneuver should be tagged as which category?

18. You are transporting a 48-year-old male with hypoglycemia after administering oral glucose. His blood glucose improved from 45 mg/dL to 92 mg/dL, and his mental status has returned to normal. He states he feels fine and wants to refuse further transport. What is the MOST appropriate action?

19. You respond to a residence for a 72-year-old female with difficulty breathing. Upon entering the room, you observe the patient sitting upright in a tripod position, using accessory muscles, with audible wheezing. Her skin is pale and diaphoretic. What does your general impression tell you about this patient’s status?

20. You respond to an industrial accident at a manufacturing plant. Your general impression reveals three injured workers. Worker 1 is standing and holding a bloody towel to his hand, requesting help loudly. Worker 2 is sitting on the ground, holding his abdomen, and appears pale with rapid breathing. Worker 3 is lying on the ground, unresponsive, with a chemical spill near his body and no obvious movement. You are the only EMS provider on scene with no additional resources for 10 minutes. Which patient should you assess and treat first?

21. A 22-year-old male was stabbed in the right upper quadrant of the abdomen during a bar fight. He ran two blocks before collapsing. Your primary assessment reveals: he is responsive to painful stimuli only, his respirations are rapid at 32 breaths per minute and shallow, you cannot palpate a radial pulse but feel a weak thready femoral pulse at 130 beats per minute. His skin is pale, cold, and clammy. You note a 3-inch laceration to the RUQ with minimal external bleeding. What is the MOST accurate interpretation of his circulatory status?

22. You respond to a nursing home for a “fall.” Upon arrival, staff reports a 78-year-old female fell out of bed approximately 2 hours ago. She was found on the floor and has not moved since. During your primary assessment, you note: she does not respond to voice or painful stimuli, her respirations are irregular at 8 breaths per minute with sonorous respirations, her radial pulse is bounding but irregular at 52 beats per minute, and her blood pressure is 210/120 mmHg. Her pupils are unequal (left 6mm, right 3mm). What is the MOST likely cause and appropriate priority determination?

23. A patient has an SpO2 of 82% on room air. What does this indicate?

24. A 24-year-old female is found unresponsive at a party. Friends say she was drinking alcohol and may have taken an unknown substance. When you pinch her trapezius muscle, she extends her arms and legs rigidly. How would you document her AVPU status, and what does this response indicate?

25. When using OPQRST to assess a patient’s pain, what does the “P” represent?

26. When is it appropriate to exceed the posted speed limit while operating an emergency vehicle?

27. A 22-year-old male was thrown from his motorcycle and struck his head on the pavement. Bystanders report he was unconscious for approximately 2 minutes, then “woke up” and seemed fine. When you arrive 15 minutes after the incident, he is confused, cannot tell you where he is, and does not remember the accident. He has a superficial abrasion on his forehead. His vital signs are BP 148/92, P 58, R 12. What condition should you suspect, and what is your priority intervention?

28. A patient makes incomprehensible sounds but does not speak words. What is the verbal component of GCS?

29. Which breathing pattern is most characteristic of a patient in diabetic ketoacidosis (DKA)?

30. Which element of a patient care report (PCR) serves as the primary legal protection for an EMT when a patient later claims inadequate care was provided?

31. A 22-year-old male was struck in the chest with a baseball bat during an altercation. He is sitting against a wall, appears anxious, and has rapid, shallow breathing. You note bruising to the right side of his chest. He states his pain is “8 out of 10.” What finding during your general impression would most strongly indicate this is a high-priority patient?

32. What does a placard with a skull and crossbones indicate?

33. You are caring for a 72-year-old female with a history of COPD who called for worsening shortness of breath. Her family reports she has been ill with a cold for three days. On primary assessment, you find her sitting in a tripod position, using accessory muscles to breathe. She is alert but cannot speak more than one or two words at a time. Her respirations are 32 per minute with visible intercostal retractions. Her skin is cool and diaphoretic. Breath sounds reveal diffuse wheezing in all lung fields. Her oxygen saturation is 88% on room air. What is the MOST appropriate initial management for this patient?

34. A 68-year-old woman with chest pain is alert, oriented, and refusing transport. She speaks clearly and says, “I know it could be a heart attack, but I’m not going.” What is the MOST appropriate action?

35. You approach a patient who is pale, diaphoretic, and clutching his chest. What is your immediate priority?

36. A 22-year-old male presents after being found unresponsive at a party. Vital signs are: blood pressure 100/70 mmHg, pulse 52 and regular, respirations 10 and shallow, SpO2 92% on room air. His skin is pale, cool, and diaphoretic. Which interpretation of these vital signs is MOST accurate?

37. A 38-year-old female was involved in a high-speed motor vehicle collision. She was the unrestrained driver. During the rapid secondary assessment, the EMT notes: bruising across the lower abdomen and hips (seatbelt sign), absent bowel sounds in all four quadrants, and hypotension with a blood pressure of 86/54 mmHg. The patient is alert but anxious. Based on these findings, the EMT should suspect:

38. You arrive on scene to find a 19-year-old male actively seizing. Bystanders report he has a history of epilepsy and has been seizing for approximately 3 minutes. What should you do FIRST?

39. A 70-year-old male presents with sudden onset of right-sided facial drooping, inability to speak clearly (slurred speech), and weakness in his right arm. Using the Cincinnati Prehospital Stroke Scale, what do these findings indicate?

40. What is the primary purpose of a quality improvement (QI) program in EMS?

41. Which of the following MOI findings would require immediate fire department notification for extrication?

42. 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?

43. 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?

44. You respond to a multi-vehicle collision on an interstate highway involving a passenger car, a semi-truck, and a motorcycle. Scene size-up reveals: the passenger car rear-ended the semi-truck at highway speed, the motorcyclist was ejected and struck the guardrail, and there is a fuel leak from the semi-truck with no fire currently. The semi-truck driver is walking and talking, the car driver is unresponsive in the vehicle, and the motorcyclist is approximately 30 feet from the motorcycle, not moving. Traffic is backed up in both directions. Which of the following represents the most appropriate sequence of actions?

45. You need to insert a nasopharyngeal airway in an adult male patient. Which of the following correctly describes the proper sizing and insertion technique?

46. A 28-year-old male was stabbed in the left upper quadrant of the abdomen. He is alert but anxious. His skin is cool, pale, and diaphoretic. His heart rate is 118 beats per minute, and his blood pressure is 100/74 mmHg. Which statement BEST describes this patient’s condition?

47. You are dispatched to a residential address for a “person not feeling well.” En route, dispatch updates: 72-year-old female, sudden onset right-sided weakness and facial droop, last seen normal 90 minutes ago. Your ALS unit is 10 minutes out; the nearest stroke center is 35 minutes by ground; air transport is available with 15-minute ETA to scene. Analyze the resource and transport decisions for this scenario.

48. Which of the following mechanisms of injury is MOST likely to cause significant internal bleeding that may not be immediately apparent?

49. Which cardiac rhythm is characterized by chaotic, disorganized electrical activity with no identifiable QRS complexes on the ECG, and is associated with no pulse?

50. 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?

51. 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?

52. A patient has a respiratory rate of 6 breaths per minute with minimal chest rise. What should you do?

53. A patient with epiglottitis has a muffled voice and is drooling. What should you avoid?

54. During a primary assessment, you check for a radial pulse. If the radial pulse is palpable, what minimum systolic blood pressure (SBP) can you estimate?

55. You are performing CPR on a 65-year-old male in cardiac arrest. After 2 minutes of compressions, the AED analyzes the rhythm and advises “No shock advised.” What should you do next?

56. A 58-year-old female complains of chest pain that started 20 minutes ago. During your primary assessment, you note she is alert but anxious. Her skin is warm and dry. You palpate a radial pulse of 88 that is regular and strong. What is your NEXT immediate action in the primary assessment?

57. A trauma patient is unresponsive to verbal and painful stimuli, has mottled and cold skin, and no palpable peripheral pulses. You can barely detect a faint carotid pulse. Based on these findings, which stage of shock is this patient in, and what does this indicate about their prognosis?

58. A patient is experiencing an acute myocardial infarction (MI). Which medication should be administered FIRST if the patient has no allergies and no contraindications?

59. An EMT responds to a 52-year-old male with sudden onset severe chest pain. During the secondary assessment, the EMT notes: blood pressure 168/94 mmHg, pulse 112 and regular, respirations 24 with crackles heard bilaterally in the lower lung fields, and jugular venous distension (JVD) visible when the patient is at a 45-degree angle. The EMT should recognize this cluster of findings as MOST suggestive of:

60. An EMT is caring for a patient with a condition that requires medication administration not covered in the standard protocols. The EMT contacts the base station physician via radio, explains the situation, and receives a verbal order to administer the medication. This is an example of:

61. A patient was the unrestrained driver in a head-on collision at 35 mph. The vehicle has moderate front-end damage, the windshield is starred, and the steering wheel is bent. Which aspect of this MOI is most concerning for internal injuries?

62. A 16-year-old male with a history of asthma is experiencing severe respiratory distress. He is sitting in a tripod position, using accessory muscles, and can only speak one or two words between breaths. He has a prescribed albuterol inhaler. What is the MOST appropriate action?

63. A trauma patient has a GCS of 8. What is the appropriate transport decision?

64. You arrive at a private residence for a “difficulty breathing” call. As you approach the front door, you hear loud shouting inside and what sounds like glass breaking. A woman runs out the front door crying and yells, “He has a gun!” What is your most appropriate action?

65. A 7-year-old child is brought to you by his mother. She states he has had a cough and fever for two days. The child is sitting upright, leaning forward with his hands on his knees, drooling and unable to speak. He appears anxious and is making a high-pitched sound when breathing. What is the MOST likely diagnosis, and what is the appropriate management?

66. A 68-year-old male with COPD is in respiratory distress with labored breathing, an SpO2 of 86%, and appears exhausted. He is using accessory muscles and can only speak in short phrases. What is the MOST appropriate oxygen delivery?

67. A patient with difficulty breathing has an SpO2 of 88% on room air. After applying oxygen via non-rebreather at 15 L/min, the SpO2 is still 91%. What should you do?

68. A 45-year-old male with severe chest pain refuses transport despite your explanation of the risks. He is alert, oriented to person, place, and time, and understands your concerns. What is the MOST appropriate action?

69. You are ventilating an unconscious patient with a bag-valve mask when you notice secretions accumulating in the posterior pharynx. The patient has an oropharyngeal airway in place. What is the appropriate sequence for suctioning?

70. A 45-year-old male with a history of schizophrenia is found wandering in traffic. When you approach, he appears disheveled, is talking to himself, and does not respond to your questions. He becomes agitated when you attempt to assess him and shouts, “They’re coming to get me!” What is the MOST appropriate approach to managing this patient?

71. You respond to a motor vehicle collision involving a minivan and a tanker truck. The tanker displays a placard with the number 1993. The driver of the tanker is ambulatory and states the tank is about half full. The minivan has three passengers, one of whom is complaining of back pain. There is no visible leak or spill. What resources should you request?

72. You respond to a call for a 55-year-old male with “weakness.” On arrival, you find him sitting in a chair, speaking clearly but with a slight facial droop. He states he felt “funny” this morning and has had trouble holding his coffee cup with his right hand. Vital signs are stable. He lives alone and wants to stay home. What is your assessment and action?

73. A patient has a blood pressure of 180/110 with severe headache and blurred vision. What should you suspect?

74. A patient responds only by withdrawing from painful stimuli. What is the Glasgow Coma Scale (GCS) motor response score?

75. 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?

76. A 68-year-old female with diabetes is found confused by her family. When you assess her, she looks at you when you speak but cannot tell you her name, where she is, or what day it is. She does not respond to questions appropriately but does not require any stimulus to keep her eyes open. What is her AVPU status and orientation level?

77. 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?

78. Which set of findings BEST describes a patient with a “sick” general impression requiring immediate intervention?

79. Which of the following findings would be MOST concerning for a cervical spinal cord injury in a trauma patient?

80. You arrive at a house fire with three victims. Patient A is walking and coughing. Patient B is sitting, alert, with burns to both arms. Patient C is unconscious with soot around the nose and mouth and singed nasal hairs. Which patient should be your highest priority?

81. You respond to a two-story residential home for a fall. Dispatch reports a 68-year-old male fell from a ladder while cleaning gutters. What resources should you consider requesting based on this MOI?

82. Which action is the FIRST priority when arriving at the scene of a motor vehicle collision?

83. Your ambulance is the first emergency vehicle to arrive at a motor vehicle collision on a two-lane rural road. There are two vehicles involved with moderate damage and no obvious hazards. What should you do FIRST?

84. A 52-year-old male is found lying on a park bench. When you approach and call his name, he slowly opens his eyes but does not speak. He closes his eyes again when you stop talking. What is his AVPU classification?

85. You respond to a two-vehicle collision on a rural highway at night. As you approach, you see both vehicles have moderate damage and there appear to be three patients walking around. You smell diesel fuel and notice one vehicle is leaking fluid. The nearest hospital is 25 minutes away, and ALS is 15 minutes out. Analyze this scene and determine the BEST initial action.

86. You arrive at a residence for a 45-year-old male with chest pain. As you approach, you note he is clutching his chest, pale, sweating profusely, and breathing rapidly. What is your IMMEDIATE priority?

87. A 23-year-old male is actively seizing when you arrive. The seizure has lasted approximately 4 minutes. He has a history of epilepsy. His airway is patent, and he is cyanotic around the lips. What is the PRIORITY intervention for this patient?

88. A 45-year-old male was involved in a motor vehicle collision. He has a bruise across his abdomen from the seatbelt. His vital signs are: BP 88/54 mmHg, HR 122/min, RR 26/min, SpO2 94% on room air. His skin is pale, cool, and diaphoretic. He is alert but anxious. Based on these findings, approximately how much blood volume has he likely lost?

89. An EMT assesses vital signs on a 68-year-old female complaining of dizziness. The blood pressure reading is 92/58 mmHg, pulse is 104 and weak, respirations are 22, and skin is pale and diaphoretic. Which statement BEST interprets these findings?

90. You arrive on scene to find a 68-year-old male who was involved in a low-speed motor vehicle collision. He is walking around the scene, talking to bystanders, and states he feels “fine.” He has a small bruise on his forehead. What is the most appropriate determination regarding this patient’s priority status?

91. A 55-year-old patient with pneumonia presents with fever, productive cough, and crackles in the right lower lobe. Her SpO2 is 91% on room air. She is alert but appears fatigued. Which intervention is MOST appropriate for this patient?

92. You respond to a motor vehicle collision. There are three patients. Patient A is walking around and complaining of neck pain. Patient B is sitting on the curb, alert, with a deformed right thigh. Patient C is unconscious, not responding to voice, and has unequal pupils. Which patient is your highest priority?

93. You are dispatched to a residence for a “sick person.” As you approach the house, you see broken glass on the front porch and hear loud arguing inside. A police unit is staging one block away. What should you do FIRST?

94. A 30-year-old male was involved in a motor vehicle collision. He is conscious but complaining of neck pain. His airway is patent, and he is speaking clearly. You note that he was the unrestrained driver. What is the MOST appropriate method to open his airway if it becomes compromised?

95. You are assessing a 68-year-old female with a suspected stroke. She is breathing at 8 breaths per minute with shallow chest rise. Her SpO2 reads 91% on room air. During your primary assessment, you note that her airway is patent but she is unable to protect her airway due to decreased gag reflex. What should be your immediate priority intervention?

96. In ICS, what is the term for the location where the Incident Commander manages the incident?

97. During a secondary assessment, the EMT uses the mnemonic DCAP-BTLS to systematically evaluate for signs of injury. What does the “T” in this mnemonic represent?

98. You respond to a call for a “psychiatric emergency” at a private residence. Dispatch reports the patient is a 35-year-old male with a history of schizophrenia who has been off his medications for two weeks. Family reports he is “acting paranoid and has a knife.” As you approach the scene, you see the patient standing on the front lawn holding a large kitchen knife. He is shouting at passing cars. What is your most appropriate immediate action?

99. An EMT responds to a patient with a productive cough and fever. The patient mentions recent international travel. Which PPE combination is MOST appropriate for initial contact?

100. A 45-year-old male is involved in a motor vehicle collision. He is extricated from the vehicle and placed on a backboard. When you approach, you note that he is speaking clearly and states, “My neck really hurts.” During your primary assessment, you ask him to squeeze your fingers and wiggle his toes. He follows all commands appropriately. What does this indicate about his neurological status?