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10 free AEMT practice questions: Acute Coronary Syndrome Recognition and Treatment

These are real questions from the same bank the app draws from. Each one is written to the NREMT AEMT content specifications and kept inside the AEMT scope of practice. Pick an answer and you get the full rationale, including why the other three options are wrong.

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Question 1 of 10

An AEMT is with a 90-year-old patient at an independent living apartment who has had 30 minutes of substernal chest pressure and nausea. There is no aspirin allergy, no bleeding history, and no aspirin taken today. The ambulance carries only 81 mg chewable tablets. The vital signs are BP 150/84, P 88, R 18, and SpO₂ 97% on room air. How much aspirin should the AEMT give?

Show the answer and rationale

Correct answer · Four 81 mg tablets, chewed rather than swallowed whole

Four 81 mg chewable tablets is 324 mg, and 324 mg is the adult target in suspected acute coronary syndrome. Chewing is part of the order, not a detail you can drop: the tablet has to dissolve in the mouth to get into the bloodstream quickly, and quickly is the entire point of an antiplatelet drug given to a patient whose coronary artery is closing right now. Count the tablets, hand them over, and tell the patient to chew.

Why the others are wrong

One 81 mg tablet, swallowed whole with a sip of water: One tablet is 81 mg, a quarter of the target. That is a daily preventive dose, not a treatment dose for an acute event, and swallowing it whole slows it down further.

Two 81 mg tablets, swallowed whole with a sip of water: Two tablets gets you to 162 mg, which is inside some protocol ranges, but swallowing them whole throws away the speed you were buying. If your protocol range starts at 162 mg, you still chew them.

Six 81 mg tablets, chewed rather than swallowed whole: Six tablets is 486 mg. More aspirin past the target does not block more platelets in the time frame that matters, and it raises the bleeding risk for nothing.

Question 2 of 10

An AEMT is treating a 92-year-old patient with an hour of substernal pressure and diaphoresis. The patient took one 81 mg aspirin tablet at breakfast four hours ago as a daily medication. There is no allergy and no bleeding history. The vital signs are BP 152/86, P 88, R 18, and SpO₂ 97% on room air. What should the AEMT do about aspirin?

Show the answer and rationale

Correct answer · Give enough chewable aspirin to bring the total up to the 324 mg target

A daily 81 mg tablet is a preventive dose, not a treatment dose, so this patient is 243 mg short of where an acute coronary syndrome needs to be. Count what is already on board, then give the rest. Three more 81 mg chewable tablets brings the total to 324 mg, which is exactly what the target asks for.

Why the others are wrong

Give a full 324 mg on top of the tablet the patient took this morning: Stacking a full second dose on top of the morning tablet takes the patient past the target for no added platelet effect. The rule is to reach 324 mg, not to give 324 mg again.

Withhold aspirin, since a dose was already taken in the last 24 hours: A morning dose is the reason to top up, not the reason to stop. Withholding here leaves the patient at a quarter of the dose that carries the mortality benefit.

Withhold aspirin until the receiving facility confirms the morning dose: A dose this time critical does not wait for a phone call. The history you already have is enough to do the arithmetic at the bedside.

Question 3 of 10

An AEMT is with an 87-year-old patient at a senior center who has 25 minutes of crushing substernal pressure, nausea, and cool damp skin. A family member states the patient came home two days ago from a hospital stay for a bleeding stomach ulcer and is still passing black stools. The vital signs are BP 128/76, P 96, R 18, and SpO₂ 96% on room air. What should the AEMT do about aspirin?

Show the answer and rationale

Correct answer · Withhold aspirin, since active gastrointestinal bleeding is a contraindication

The finding that decides this is the black stools continuing two days after a bleeding ulcer admission, which means the gastrointestinal bleed is still active, not resolved. Aspirin works by irreversibly blocking platelet aggregation through cyclooxygenase inhibition, and in a gut that is already losing blood, taking platelets out of service accelerates hemorrhage instead of just protecting a coronary vessel. Active gastrointestinal bleeding sits on the short list of true aspirin contraindications, so this patient runs the rest of the acute coronary syndrome plan, rest, oxygen if the saturation calls for it, a 12-lead, IV access, transport to a facility that can open an artery, but skips the aspirin step entirely.

Why the others are wrong

Give the full 324 mg, since the mortality benefit outweighs the bleeding: The mortality benefit of aspirin in acute coronary syndrome is real and is why it is standard practice, but that benefit assumes a patient who is not actively bleeding. The black stools here mean the bleed has not stopped, so pushing platelet inhibition into that patient trades one danger for another.

Give a single 81 mg tablet, since a low dose is safe with a bleeding ulcer: Dropping to a single 81 mg tablet still delivers an antiplatelet effect, since aspirin's block on platelet function does not scale down safely with a smaller dose. The active bleed makes any dose the wrong call, not just the full 324 mg.

Withhold aspirin, since a patient over 80 carries too much bleeding risk: Age alone never appears on the aspirin contraindication list, and plenty of patients in their eighties get it without issue for chest pain. What stops this patient is the active gastrointestinal bleed, not the number 87.

Question 4 of 10

An AEMT is caring for an 84-year-old patient with 20 minutes of substernal pressure and nausea, and the service's monitor can both acquire and transmit a 12-lead ECG. How soon should that first 12-lead be acquired?

Show the answer and rationale

Correct answer · Within 10 minutes of first contact with the patient

Twenty minutes of substernal pressure with nausea in an 84 year old is acute coronary syndrome until proven otherwise, and the 10 minute mark is the number the standard is built on. Getting the tracing that fast lets the ST segments and T waves speak before treatment or transport time changes the picture, and it lets a transmitted STEMI tracing activate the cath lab before the patient is at the door. Every minute of delay is myocardium at risk, so acquisition speed is the priority here, not medication order or transport readiness.

Why the others are wrong

Within 30 minutes of first contact with the patient: Thirty minutes still gets a tracing, but it is slow enough that a real ST elevation window can close, or the patient arrives before the hospital ever sees it, which erases the whole point of a prehospital 12-lead.

After the patient has been loaded into the ambulance: Loading first turns a still, controlled acquisition into one done inside a moving, vibrating box, and it burns scene minutes that this 20 minute presentation cannot afford to lose.

After both aspirin and nitroglycerin have been given: Aspirin and nitroglycerin both belong in this call, but nitroglycerin can blunt the ST changes the tracing is meant to catch, so giving them first hides the exact finding the 12-lead exists to record.

Question 5 of 10

An AEMT acquiring a 12-lead ECG on a patient with chest pressure has placed V1, V2, V4, and V3 and is positioning the last two precordial electrodes. Where do V5 and V6 belong?

Show the answer and rationale

Correct answer · V5 at the anterior axillary line and V6 at the midaxillary line, both level with V4

V4 sits at the midclavicular line in the fifth intercostal space, and that placement sets the horizontal plane for the rest of the precordial leads. V5 and V6 stay on that same plane rather than dropping a rib space with each electrode: V5 goes at the anterior axillary line, V6 at the midaxillary line, both level with V4. The precordial leads work by tracing a horizontal ring around the heart at one depth, so each electrode samples a different section of myocardium at that same level. Stepping V5 or V6 down a space breaks that ring and distorts your read of the lateral wall.

Why the others are wrong

V5 at the anterior axillary line and V6 at the midaxillary line, in the sixth space: If each precordial lead dropped a rib space as it moved laterally, V5 and V6 would go in the sixth space, but V4 has already fixed the plane at the fifth space, so dropping lower pulls the lateral leads off that reference and changes what they're sampling.

V5 and V6 both at the midaxillary line, one in the fifth and one in the sixth space: Putting both V5 and V6 on the midaxillary line looks tidy because they're both "lateral," but it leaves the anterior axillary line empty and gives you two views of nearly the same spot instead of a proper lateral sweep.

V5 at the midclavicular line and V6 at the anterior axillary line, both level with V4: V4 already occupies the midclavicular line, so placing V5 there again doubles up a view and shifts the whole lateral set one position too far medial, missing the anterior axillary line V5 is supposed to cover.

Question 6 of 10

An AEMT has acquired and transmitted a 12-lead ECG on a 73-year-old patient with 50 minutes of substernal pressure and diaphoresis. The receiving physician calls back and activates the catheterization laboratory at a hospital 24 minutes away. A community hospital 7 minutes away has an emergency department but no catheterization laboratory and would have to transfer the patient. The vital signs are BP 140/84, P 94, R 18, and SpO₂ 97% on room air. Where should this patient go?

Show the answer and rationale

Correct answer · The catheterization hospital, since a transfer costs more time than the drive

The finding that decides this is the physician's cath lab activation itself: this is a STEMI-equivalent presentation with 50 minutes of chest pressure and diaphoresis, and the receiving cardiologist has already confirmed the artery needs to be opened mechanically. Time to reperfusion is what determines how much myocardium survives, and a direct PCI transport is measured against a first-medical-contact-to-balloon target near 90 minutes, while a patient who lands at a non-PCI facility first restarts that clock closer to 120 minutes because a second ambulance, a second crew, and a second set of paperwork all have to happen before the balloon ever gets there. Seventeen extra minutes on the first ambulance ride is cheaper than any of that.

Why the others are wrong

The community hospital, since the closest appropriate facility rule governs: The closest appropriate facility rule is real, but appropriate means capable of doing the procedure this patient needs. The community hospital 7 minutes away has no catheterization laboratory, so it is close but not appropriate for this patient.

The community hospital, since the transfer can be arranged while care starts: Arranging a transfer is a real EMS practice, but it is not a background task that runs while treatment continues. It requires a second ambulance, a second crew, and a second handoff, and the myocardium keeps dying through all of it, so this trades a shorter first ride for a longer total time to PCI.

The catheterization hospital, unless the drive would run past 20 minutes: There is no fixed drive-time ceiling that governs this decision. The comparison that matters is total time to balloon by one trip versus two, and a 24 minute direct drive still beats a 7 minute drive followed by a transfer.

Question 7 of 10

An AEMT responds to an assisted living facility for an 88-year-old patient who became suddenly weak and developed difficulty breathing an hour ago. There is no chest pain, no fever, and no cough. The skin is pale and damp, the lungs are clear in all fields, and the patient has a cardiac history. The vital signs are BP 132/78, P 104, R 24, and SpO₂ 93% on room air. What should the AEMT do about supplemental oxygen?

Show the answer and rationale

Correct answer · Give oxygen titrated until the saturation reaches at least 94 percent

An older patient who suddenly gets weak and cannot breathe well, with pale damp skin and clear lungs, is a coronary presentation until something else explains it. The saturation sits below 94 percent, which is the line where oxygen stops being decoration and starts being treatment. Titrate it up to at least 94 percent and leave it there rather than opening an NRB by reflex.

Why the others are wrong

Give high flow oxygen by NRB and leave it at 15 L per minute: High flow is a starting point for a patient in real distress, but leaving it wide open pushes the saturation far past where it needs to be, and that extra oxygen narrows coronary vessels.

Withhold oxygen, since the saturation is still above 90 percent: Ninety is not the threshold. The number that decides oxygen in a suspected coronary event is 94 percent, and this patient is under it with a respiratory rate to match.

Give oxygen by nasal cannula and stop once the breathing feels easier: Feeling easier is not the endpoint. Comfort can arrive while the saturation is still sitting under 94 percent, and it can arrive from sitting the patient up rather than from the oxygen. The number is what tells you when you have given enough.

Question 8 of 10

A patient describes an hour of chest discomfort that is hard to pin down, and an AEMT notes that the skin is cool and clammy. What does that skin finding add to the picture?

Show the answer and rationale

Correct answer · It is one of the more specific field findings for a cardiac cause

Cool, clammy skin reflects a catecholamine-driven surge of peripheral vasoconstriction and sweat gland stimulation, the body's sympathetic response to falling cardiac output or the pain and fear of myocardial ischemia. Of the findings you can gather in the field, it is one of the more specific ones for a cardiac cause, more so than the discomfort itself, which can come from muscle, lung, or gut. That specificity is what pushes you to treat this as suspected acute coronary syndrome: oxygen if indicated, aspirin, a 12-lead, and a load-and-go transport rather than a wait-and-see approach.

Why the others are wrong

It confirms the patient has already reached decompensated shock: Decompensated shock is a perfusion diagnosis built on more than one system: a falling blood pressure, an altered mental status, and a weak or absent peripheral pulse all have to be weighed alongside the skin, and none of those are given here.

It rules out a musculoskeletal source for the discomfort entirely: A field finding can raise your suspicion for one cause without shutting the door on another; musculoskeletal pain can still produce diaphoresis through the sympathetic stress response, so cool clammy skin never closes out a source entirely.

It indicates the discomfort has been present for over an hour: The skin does not carry a clock. Diaphoresis can appear in the first minutes of an event or show up late, so it tells you nothing about the hour-long duration already given in the history.

Question 9 of 10

An AEMT transmits a 12-lead ECG to the receiving hospital eight minutes into a call for chest pressure. Why does sending the tracing that early change anything for the patient?

Show the answer and rationale

Correct answer · It starts the hospital's clock for activating the catheterization laboratory

The finding that matters is the timestamp, eight minutes into the call, on a tracing that shows ST-elevation. ST-elevation means a coronary artery is fully occluded and myocardium starts dying within minutes, so the hospital's door-to-balloon clock is built to start at first recognition of that pattern, not at wheels-in-the-door. Transmitting the ECG early lets the receiving facility start that clock while the patient is still in the truck, so the cardiology team, the catheterization lab staff, and the room are already moving before arrival. That head start is what shortens true ischemic time, not anything that happens on scene.

Why the others are wrong

It lets the AEMT begin a treatment that protocol otherwise withholds: Aspirin, oxygen, IV access, and nitroglycerin all run off the AEMT's own protocol based on the patient in front of them, not off a transmitted tracing being read at the hospital. Nothing in this call description ties a treatment order to the fax or transmission going through.

It shortens the ride by clearing a bed in the emergency department: Freeing a bed is a side effect of good notification, not the reason the tracing is time-critical. What actually takes time to assemble is the catheterization team, and that is the resource this early transmission gets moving.

It replaces the radio report the crew would otherwise have to give: The verbal radio report and the transmitted 12-lead do separate jobs: the crew still gives the notification call, and that call is half of what starts the hospital's response, so one does not stand in for the other.

Question 10 of 10

An AEMT is with a 95-year-old patient who has 30 minutes of substernal pressure and a long history of chronic obstructive pulmonary disease. A home saturation log kept by a caregiver runs around 90 percent on a good day. Right now the patient is working harder than usual to breathe. The vital signs are BP 138/82, P 104, R 24, and SpO₂ 84% on room air. What should the AEMT do about oxygen?

Show the answer and rationale

Correct answer · Give oxygen titrated toward the 90 percent the home log shows

The number that decides this is the 84 percent room-air reading against a home log that runs around 90 percent on this patient's good days. Chronic obstructive pulmonary disease can blunt the ventilatory response to carbon dioxide over years, so this patient runs and tolerates a lower baseline saturation than a healthy lung would. The acute coronary picture demands you correct hypoxia, but correcting it means bringing the number up toward that patient's own working range, roughly 88 to 92 percent, not chasing 100 percent and not leaving 84 percent uncorrected either way.

Why the others are wrong

Withhold oxygen, since raising it in this disease removes the drive to breathe: The old teaching that supplemental oxygen kills the hypoxic drive in COPD and causes apnea is not how AEMTs are taught to manage a hypoxic patient today; a reading of 84 percent is starving the myocardium you are already worried about, and withholding oxygen here treats a theoretical risk while ignoring the number in front of you.

Give oxygen by nasal cannula at 2 L and leave it there regardless of the reading: Two liters by nasal cannula is a real, reasonable starting point, but locking in a fixed flow and walking away skips the titration this patient needs; 2 L might land anywhere from the 80s into the mid-90s, and picking a number on the dial instead of a target on the monitor means you find out where you ended up by accident instead of by design.

Give oxygen only until the chest pressure itself begins to ease: Using chest pressure as the endpoint mixes up two separate problems: oxygen delivery is titrated to the saturation reading, not to whether the pain has eased, and tying the two together can leave you either stopping oxygen too soon or missing that the actual target, that 88 to 92 percent range, has already been reached or overshot.

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