EMT Primary Assessment Practice Test

25 practice questions

Choose an answer, then check it under Show answer.

1. Question 1 of 25Hard

   A 68-year-old female with severe septic shock is unresponsive. During the primary assessment, you note a patchy, purplish-blue, lace-like discoloration across her knees and lower extremities. What physiological process causes this finding?

   1. AA. Localized histamine release causing inflammatory edema and erythema
   2. BB. Rapid extravasation of red blood cells into subcutaneous adipose layers
   3. CC. Stagnant blood pooling in dilated venules from severe microvascular hypoperfusion
   4. DD. Rupture of superficial dermal capillaries due to sudden hypertension
   Show answer to question 1

   Answer: C. Stagnant blood pooling in dilated venules from severe microvascular hypoperfusion

   Mottling (cutis marmorata) is a reticulated, patchy discoloration caused by severe hypoperfusion, microcirculatory vasoconstriction, and stagnant pooling of deoxygenated blood in dilated superficial venules. It is an ominous indicator of poor tissue perfusion. Capillary rupture produces petechiae or ecchymosis, not the transient, reticular pattern characteristic of mottling.

2. Question 2 of 25Medium

   An EMT evaluates an 18-month-old toddler with a suspected respiratory illness. Which finding most strongly indicates that the child is progressing from respiratory distress to respiratory failure?

   1. AA. Intercostal and subcostal retractions
   2. BB. Lethargy accompanied by head bobbing
   3. CC. Persistent tachypnea of 36 breaths/min
   4. DD. Nasal flaring during inspiration
   Show answer to question 2

   Answer: B. Lethargy accompanied by head bobbing

   Lethargy combined with head bobbing indicates respiratory muscle exhaustion and worsening central nervous system hypoxia, which are late signs of impending respiratory failure in a child. While nasal flaring and retractions represent significant work of breathing, they are early compensatory signs of respiratory distress rather than decompensation.

3. Question 3 of 25Easy

   Why is pulse oximetry alone an insufficient assessment tool when determining the adequacy of a patient's ventilation?

   1. AA. It evaluates hemoglobin oxygen saturation rather than carbon dioxide elimination
   2. BB. It fails to detect hypoxia whenever a patient receives supplemental oxygen
   3. CC. It cannot produce accurate readings in patients with high respiratory rates
   4. DD. It reflects arterial blood pressure rather than respiratory gas exchange
   Show answer to question 3

   Answer: A. It evaluates hemoglobin oxygen saturation rather than carbon dioxide elimination

   Ventilation refers to the mechanical movement of air into and out of the lungs to clear carbon dioxide, whereas pulse oximetry specifically measures the percentage of hemoglobin bound to oxygen. A patient can have severe hypoventilation and carbon dioxide retention while maintaining an acceptable oxygen saturation, especially if receiving supplemental oxygen. Pulse oximetry does not reflect blood pressure, and it remains capable of measuring saturation during tachypnea.

4. Question 4 of 25Medium

   A 19-year-old male sustained a deep laceration to his lower leg. Bleeding has slowed to an intermittent trickle under light bystander pressure, but the patient is anxious, pale, and cool, with a rapid, weak radial pulse. What do these assessment findings indicate?

   1. AA. The patient is experiencing primary neurogenic shock from nerve injury.
   2. BB. The bleeding is fully controlled and requires no further intervention.
   3. CC. The patient has sustained life-threatening blood volume loss.
   4. DD. The injury was superficial and caused a transient vasovagal response.
   Show answer to question 4

   Answer: C. The patient has sustained life-threatening blood volume loss.

   Tachycardia, anxiety, pale and cool skin, and weak peripheral pulses are hallmark signs of systemic hypoperfusion resulting from severe hemorrhage. Even if current bleeding appears reduced due to temporary pressure or declining intravascular volume, the systemic presentation confirms significant, life-threatening blood loss that warrants definitive hemorrhage control and shock management.

5. Question 5 of 25Hard

   You are performing CPR on a 7-month-old boy in cardiac arrest, and your AED arrives. No manual defibrillator is available. How should the AED be used?

   1. AA. Use it with pediatric pads or a dose attenuator, if available.
   2. BB. Do not use any AED on an infant under any circumstances.
   3. CC. Use the AED only if the infant is more than 1 year old.
   4. DD. Delay the AED until ALS arrives with its manual defibrillator.
   Show answer to question 5

   Answer: A. Use it with pediatric pads or a dose attenuator, if available.

   For infants, a manual defibrillator is preferred, but when one is not available, use an AED with pediatric pads or a dose attenuator. If only adult pads are on hand, the AED may still be used.

   Why the other options are wrong

   • BAEDs may be used on infants when a manual defibrillator is not available.
   • CAED use is not restricted to children older than 1 year.
   • DDelaying defibrillation while waiting for ALS reduces the chance of survival.

6. Question 6 of 25Easy

   What is the normal resting heart rate range for a healthy, conscious adult?

   1. AA. 40 to 60 beats/min
   2. BB. 60 to 100 beats/min
   3. CC. 100 to 140 beats/min
   4. DD. 80 to 120 beats/min
   Show answer to question 6

   Answer: B. 60 to 100 beats/min

   The normal resting heart rate for an adult is between 60 and 100 beats per minute. A rate below 60 beats per minute represents bradycardia, while a resting rate above 100 beats per minute indicates tachycardia.

7. Question 7 of 25Medium

   An adult patient with altered mental status has a respiratory rate of 14 breaths/min, but the EMT observes very shallow chest rise and minimal air exchange. How should the EMT interpret and manage this finding?

   1. AA. Minute volume is adequate; place the patient in the recovery position.
   2. BB. Minute volume is adequate; apply oxygen via nonrebreather mask.
   3. CC. Minute volume is inadequate; immediately perform chest compressions.
   4. DD. Minute volume is inadequate; assist ventilations with a bag-valve mask.
   Show answer to question 7

   Answer: D. Minute volume is inadequate; assist ventilations with a bag-valve mask.

   Minute volume depends on both respiratory rate and tidal volume; extremely shallow chest rise indicates inadequate tidal volume, meaning minute ventilation is insufficient despite a normal rate, requiring assisted positive-pressure ventilation. Applying a nonrebreather mask is inappropriate because the patient cannot adequately draw oxygen into the alveoli with shallow breathing. Chest compressions are indicated only in cardiac arrest, which is not present here.

8. Question 8 of 25Medium

   An adult female was removed from a running vehicle inside a closed garage. She is conscious but confused, complaining of a throbbing headache and dizziness. Her pulse oximeter reads 98% on room air, and her respiratory rate is 18 breaths/min with adequate depth. Which action should the EMT take regarding oxygen therapy?

   1. AA. Initiate positive pressure ventilation using a bag-valve mask
   2. BB. Provide low-flow oxygen via a nasal cannula at 2 to 4 L/min
   3. CC. Withhold oxygen because her pulse oximetry reading is within normal limits
   4. DD. Administer high-flow oxygen via a nonrebreather mask at 15 L/min
   Show answer to question 8

   Answer: D. Administer high-flow oxygen via a nonrebreather mask at 15 L/min

   Standard pulse oximeters cannot distinguish between oxyhemoglobin and carboxyhemoglobin, yielding falsely normal or elevated saturation readings in carbon monoxide poisoning. High-flow oxygen via a nonrebreather mask should be applied immediately to hasten the elimination of carbon monoxide. Withholding oxygen based on a normal SpO2 reading is dangerous because the tissues are severely hypoxic.

9. Question 9 of 25Hard

   A 62-year-old male with severe chronic obstructive pulmonary disease was placed on a non-rebreather mask at 15 L/min for acute dyspnea. Ten minutes later, he becomes increasingly difficult to arouse, and his respiratory rate slows from 34 to 8 breaths/min with barely perceptible chest rise. What is the most appropriate action?

   1. AA. Remove the non-rebreather mask and switch to a nasal cannula at 2 L/min.
   2. BB. Place the patient in the Trendelenburg position to improve cerebral perfusion.
   3. CC. Initiate positive-pressure ventilation using a bag-valve mask with oxygen.
   4. DD. Insert an oral airway and perform vigorous endotracheal suctioning.
   Show answer to question 9

   Answer: C. Initiate positive-pressure ventilation using a bag-valve mask with oxygen.

   The patient has exhausted his compensatory efforts and progressed from respiratory distress into severe respiratory failure, evidenced by somnolence, bradypnea, and loss of tidal volume. The immediate priority is positive-pressure ventilation with a bag-valve mask. Reducing oxygen delivery by switching to a low-flow nasal cannula due to fear of the 'hypoxic drive' is a dangerous error when the patient is actively failing and hypoventilating.

10. Question 10 of 25Medium

    You are assessing a conscious 4-year-old child who suddenly developed respiratory difficulty while eating. You hear a high-pitched, harsh sound during inhalation. Which abnormal airway sound is this patient demonstrating?

    1. AA. Rhonchi
    2. BB. Crackles
    3. CC. Wheezing
    4. DD. Stridor
    Show answer to question 10

    Answer: D. Stridor

    Stridor is a harsh, high-pitched inspiratory sound indicating partial obstruction or narrowing of the upper airway, commonly seen in foreign body aspiration or croup. Wheezing is primarily an expiratory, musical sound caused by lower airway bronchoconstriction, as seen in asthma.

11. Question 11 of 25Medium

    A 61-year-old man who was choking becomes unresponsive and is lowered to the floor. He has no normal breathing. What should you do?

    1. AA. Give rescue breaths only and wait for him to resume breathing.
    2. BB. Straddle his thighs and give abdominal thrusts while he lies supine.
    3. CC. Begin CPR, looking in his mouth for the object before giving breaths.
    4. DD. Wait for the object to pass on its own while you give oxygen.
    Show answer to question 11

    Answer: C. Begin CPR, looking in his mouth for the object before giving breaths.

    When a choking patient becomes unresponsive, begin CPR. Chest compressions can dislodge the object, and each time you open the airway to give breaths, look in the mouth and remove an object only if you can see it.

    Why the other options are wrong

    • ABreaths alone will not clear the obstruction, and an unresponsive patient without normal breathing needs CPR.
    • BAbdominal thrusts are not used once the patient is unresponsive; chest compressions are performed instead.
    • DOxygen cannot pass a complete obstruction, and waiting allows cardiac arrest to develop.

12. Question 12 of 25Medium

    An 11-month-old infant with a 3-day history of fever and cough presents limp, responding only to painful stimuli. The infant's respiratory rate is 16 breaths/min with head bobbing, and the brachial pulse is 68 beats/min. Which assessment finding most strongly indicates decompensated respiratory failure rather than respiratory distress?

    1. AA. Elevated core body temperature
    2. BB. Sternal and subcostal retractions
    3. CC. Bradycardia and altered responsiveness
    4. DD. Active flaring of the nasal apertures
    Show answer to question 12

    Answer: C. Bradycardia and altered responsiveness

    In pediatric patients, bradycardia and altered mental status in the presence of respiratory compromise are late, ominous signs of impending arrest and respiratory failure. Nasal flaring and retractions represent compensatory efforts characteristic of respiratory distress before exhaustion and decompensation take place.

13. Question 13 of 25Easy

    Which structure folds over the glottic opening during swallowing to keep food and liquid out of the trachea?

    1. AA. Uvula
    2. BB. Epiglottis
    3. CC. Thyroid cartilage
    4. DD. Carina
    Show answer to question 13

    Answer: B. Epiglottis

    The epiglottis is a leaf-shaped flap of tissue that covers the glottic opening during swallowing, directing food and liquid into the esophagus.

    Why the other options are wrong

    • AThe uvula hangs from the soft palate and does not cover the entrance to the larynx.
    • CThe thyroid cartilage forms the front wall of the larynx and does not move to cover the airway.
    • DThe carina is the point where the trachea divides into the two main-stem bronchi.

14. Question 14 of 25Medium

    An 81-year-old male presents with severe dyspnea and exhaustion. You observe shallow, rapid respirations with minimal chest rise, and the patient is unable to speak more than one word at a time. What is the most appropriate initial management of this patient's breathing?

    1. AA. Apply oxygen at 2 L/min via a nasal cannula.
    2. BB. Assist ventilations using a bag-mask device with supplemental oxygen.
    3. CC. Position the patient supine and encourage slow, deep coughing.
    4. DD. Administer high-flow oxygen through a nonrebreather mask.
    Show answer to question 14

    Answer: B. Assist ventilations using a bag-mask device with supplemental oxygen.

    Geriatric patients have reduced respiratory muscle reserve and stiffened chest walls, making them tire quickly during respiratory distress. When a patient demonstrates inadequate tidal volume (shallow breathing) combined with exhaustion, they have entered respiratory failure and require immediate positive-pressure ventilation with a bag-mask device. Applying a nonrebreather mask is inappropriate because passive oxygen delivery cannot overcome severe hypoventilation and respiratory fatigue.

15. Question 15 of 25Easy

    Which patient presentation represents an appropriate indication for the insertion of an oropharyngeal airway?

    1. AA. A semi-conscious patient who moans and pushes the provider's hand away during assessment
    2. BB. A responsive patient with severe facial burns who presents with audible stridor
    3. CC. A confused patient with snoring respirations who coughs during oral suctioning
    4. DD. An unresponsive patient who has no gag reflex and requires assisted ventilation
    Show answer to question 15

    Answer: D. An unresponsive patient who has no gag reflex and requires assisted ventilation

    An oropharyngeal airway is indicated for an unresponsive patient who lacks an intact gag reflex to help maintain an open airway and facilitate positive-pressure ventilation. If a patient is semi-conscious, responsive, or exhibits an active cough or gag reflex, inserting an oropharyngeal airway can trigger severe vomiting, retching, or laryngospasm.

16. Question 16 of 25Medium

    During the primary assessment of an adult trauma patient, you observe abdominal muscle contraction during exhalation and prominent supraclavicular indrawing during inhalation. What is the primary significance of these observations?

    1. AA. The patient has experienced isolated bilateral phrenic nerve lacerations
    2. BB. The patient is using accessory muscles to meet increased ventilatory demands
    3. CC. The patient is demonstrating the normal mechanics of quiet tidal respiration
    4. DD. The patient is displaying psychogenic hyperventilation from emotional stress
    Show answer to question 16

    Answer: B. The patient is using accessory muscles to meet increased ventilatory demands

    Active contraction of the abdominal wall muscles during exhalation and indrawing of the supraclavicular fossa during inhalation are hallmark signs of accessory muscle use, signifying marked work of breathing. Normal quiet breathing primarily relies on the diaphragm and external intercostals without visible supraclavicular retractions or forceful abdominal contraction. While emotional stress can cause tachypnea, prominent physical retractions point toward significant respiratory compromise rather than pure psychogenic hyperventilation.

17. Question 17 of 25Easy

    A 45-year-old man at a restaurant is coughing forcefully and clutching his throat. He is red-faced and able to speak in short phrases between coughs. How should you classify and manage this patient's airway status?

    1. AA. Complete airway obstruction; deliver five back blows followed by chest thrusts.
    2. BB. Severe airway obstruction; immediately perform abdominal thrusts.
    3. CC. Anatomical airway obstruction; insert an oropharyngeal airway.
    4. DD. Mild airway obstruction; encourage him to continue coughing.
    Show answer to question 17

    Answer: D. Mild airway obstruction; encourage him to continue coughing.

    The patient has a mild foreign body airway obstruction with adequate air exchange, evidenced by forceful coughing and the ability to speak. For mild obstruction, the EMT should encourage spontaneous coughing and monitor closely rather than performing abdominal thrusts. Abdominal thrusts are indicated only for severe or complete airway obstructions where the patient cannot speak or cough effectively.

18. Question 18 of 25Medium

    During the primary assessment of an unresponsive patient found lying supine, you hear wet, bubbling sounds during each respiration. What does this sound specifically indicate?

    1. AA. Fluid or secretions present in the upper airway
    2. BB. Swelling of the tissues surrounding the vocal cords
    3. CC. Bronchospasm within the lower terminal airways
    4. DD. Partial obstruction of the larynx by the tongue
    Show answer to question 18

    Answer: A. Fluid or secretions present in the upper airway

    Gurgling is a distinct bubbling sound created when air moves through liquid, such as blood, vomitus, or saliva, in the pharynx. Partial obstruction caused by the tongue relaxing into the pharynx creates a snoring sound rather than gurgling.

19. Question 19 of 25Medium

    A 4-year-old child with a 3-day history of vomiting and diarrhea is lethargic, responds only to painful stimuli, and exhibits a capillary refill time of 4 seconds. The skin is mottled and cool to the touch. How should you prioritize this patient's care?

    1. AA. Classify as unstable; initiate immediate transport with supportive care en route
    2. BB. Classify as potentially stable; offer oral rehydration fluids prior to transport
    3. CC. Classify as stable; obtain a complete medical history before departure
    4. DD. Classify as stable; perform a detailed secondary assessment on scene
    Show answer to question 19

    Answer: A. Classify as unstable; initiate immediate transport with supportive care en route

    Lethargy, delayed capillary refill greater than 2 seconds, and cool, mottled skin in a pediatric patient indicate decompensated shock, representing an immediate life threat. This patient must be categorized as unstable, requiring high-flow oxygen, temperature management, and rapid transport to an appropriate facility. Providing oral fluids to a lethargic patient poses a severe aspiration risk, and lingering on scene for detailed history-taking delays critical resuscitation.

20. Question 20 of 25Hard

    A 74-year-old man who takes a beta-blocker for high blood pressure has lost a significant amount of blood. His heart rate is 68 beats/min, and his skin is pale and cool. Why might his heart rate be misleading?

    1. AA. Older adults always have a slower pulse when they are in shock.
    2. BB. Blood loss slows the heart rate in all patients.
    3. CC. A normal heart rate proves that he is not in shock.
    4. DD. His medication can prevent the expected rise in heart rate.
    Show answer to question 20

    Answer: D. His medication can prevent the expected rise in heart rate.

    Beta-blockers blunt the heart's response to stress, so a patient in shock may not become tachycardic. Rely on other signs, such as skin, mental status, and blood pressure, along with the history.

    Why the other options are wrong

    • AAge alone does not slow the pulse in shock; medications and disease can blunt the response.
    • BBlood loss usually causes a faster, not slower, heart rate.
    • CA normal heart rate does not rule out shock, especially in a patient taking a beta-blocker.

21. Question 21 of 25Easy

    You respond to an unresponsive patient who has loud, gurgling respirations. What is the primary indication of this abnormal breath sound?

    1. AA. Fluid, blood, or secretions collecting in the upper airway
    2. BB. Swelling and narrowing of the vocal cords and larynx
    3. CC. Bronchospasm and inflammation of the lower airways
    4. DD. Partial obstruction of the hypopharynx by the tongue
    Show answer to question 21

    Answer: A. Fluid, blood, or secretions collecting in the upper airway

    Gurgling indicates the presence of liquid, such as blood, vomitus, or secretions, in the upper airway and is an immediate indication for suctioning. Snoring respirations suggest airway occlusion by the tongue, whereas stridor indicates laryngeal edema and wheezing indicates lower airway narrowing.

22. Question 22 of 25Hard

    A full-term baby is born crying vigorously with good muscle tone. Which action is most appropriate next?

    1. AA. Suction the mouth and nose deeply first
    2. BB. Dry and warm the baby on the mother's chest
    3. CC. Hold the baby upside down and slap the back
    4. DD. Start ventilations with a bag-valve mask
    Show answer to question 22

    Answer: B. Dry and warm the baby on the mother's chest

    A vigorous term newborn needs routine care: dry and warm the baby, keep the airway clear, and place the baby skin-to-skin with the mother. Suction is used only if secretions block the airway or ventilation is needed.

    Why the other options are wrong

    • ARoutine deep suctioning can slow the heart rate and is not needed in a vigorous baby.
    • CHolding a newborn upside down and slapping can cause injury and is not recommended.
    • DVentilation is for a baby who is apneic or gasping or has a heart rate below 100/min.

23. Question 23 of 25Easy

    An EMT approaches a 68-year-old female who is lying in bed with her eyes closed. When the EMT asks, 'Ma'am, can you open your eyes?', the patient opens her eyes, answers a question slowly, and then drifts back to sleep. How should the EMT categorize this patient on the AVPU scale?

    1. AA. Responsive to verbal stimuli
    2. BB. Responsive to painful stimuli
    3. CC. Alert
    4. DD. Unresponsive
    Show answer to question 23

    Answer: A. Responsive to verbal stimuli

    A patient who does not open their eyes spontaneously but opens them and responds when spoken to is categorized as responsive to verbal stimuli. Alert is incorrect because an alert patient has spontaneous eye opening and interacts with the environment without requiring verbal prompting to awaken.

24. Question 24 of 25Hard

    Bystanders pulled a 9-year-old girl from a hotel pool after finding her floating face down. She is unresponsive, not breathing, and has a pulse. There is no history of diving or trauma. What is your first action?

    1. AA. Open the airway and start bag-valve mask ventilations
    2. BB. Apply a cervical collar and secure her to a long backboard
    3. CC. Perform abdominal thrusts to remove water from her lungs
    4. DD. Begin passive rewarming before any other care
    Show answer to question 24

    Answer: A. Open the airway and start bag-valve mask ventilations

    Drowning causes hypoxia, so the priority for a drowning patient who is not breathing but has a pulse is opening the airway and ventilating with oxygen. Spinal precautions are needed only with a mechanism such as diving or trauma.

    Why the other options are wrong

    • BWithout diving or trauma, routine spinal immobilization delays critical ventilation.
    • CAbdominal thrusts do not remove meaningful water and increase the risk of vomiting and aspiration.
    • DRewarming is secondary; ventilation must come first.

25. Question 25 of 25Hard

    A 28-year-old male was the unrestrained driver in a high-speed collision. He is fully alert and complains of left upper quadrant pain. His pulse is 114 beats/min, respirations are 20 breaths/min, skin is pale, cool, and clammy, and blood pressure is 122/80 mm Hg. How should the EMT determine transport urgency?

    1. AA. Low priority, because abdominal tenderness alone without rigidity does not indicate major bleeding
    2. BB. Low priority, because the patient is alert and the systolic blood pressure is over 100 mm Hg
    3. CC. High priority, because signs of early shock are present despite a normal blood pressure
    4. DD. High priority, solely because all motor vehicle collisions mandate rapid transport
    Show answer to question 25

    Answer: C. High priority, because signs of early shock are present despite a normal blood pressure

    Tachycardia and pale, cool, clammy skin following a high-energy mechanism indicate compensated shock from internal hemorrhage, making the patient a high priority for rapid transport even though blood pressure remains normal. Relying solely on normal blood pressure or intact alertness can lead to dangerously underestimating the severity of occult internal trauma.

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