10 free AEMT practice questions: Neurologic Emergencies: Stroke, Seizure, and Altered Mental Status

Apply an NRB at 15 liters per minute: An NRB at 15 liters is for a patient who is hypoxic or in obvious respiratory distress, not this one, whose SpO₂ sits at 97% with an unlabored rate of 16, so there's no deficit to correct.

Apply a nasal cannula at 4 liters per minute: A nasal cannula at 4 liters seems reasonable for a stroke patient sitting in the low 90s, borderline hypoxic. This patient's SpO₂ reads 97% on room air with an unlabored rate of 16, so no oxygen deficit exists. Stroke protocols call for supplemental oxygen only once saturation drops below 94%, so this treats the diagnosis, not the number.

Begin assisted ventilation with a BVM: A BVM is for inadequate breathing, too slow, shallow, or apneic; this patient is breathing unlabored at 16 with a 97% saturation, already adequate, so there's nothing to assist.

A simple febrile seizure: the brief, self-limiting, generalized seizure you see in a feverish child, usually stopping well under five minutes on its own. Eight continuous minutes with no break blows past that definition regardless of whether fever is present.

A postictal state: The postictal state is the depressed, confused recovery period that follows once the seizure activity has stopped, with the patient still but not responsive. This child is still actively seizing at the eight-minute mark, so there is no postictal phase to describe yet.

A focal seizure: involves abnormal firing limited to one region of the cortex, often producing movement in a single limb or side while the patient stays aware. Nothing here narrows the activity to one body part, and the eight-minute duration is what defines this presentation, not seizure location.

Stage on scene and wait for the paramedic unit to arrive: Staging on scene appeals when ALS truly is closer than the hospital and can shorten time to definitive treatment. Here the paramedic unit is 14 minutes out, twice the 7-minute run to the ED, so waiting only lets the seizure continue longer for no benefit.

Request an order from medical direction to give a sedative: A benzodiazepine is exactly what this seizure needs, and that instinct is correct, but diazepam, midazolam, and lorazepam sit outside the national AEMT formulary, so no order from medical direction can grant a drug that scope of practice does not include.

Meet the paramedic unit and transfer care at that point: Meeting the paramedic unit only helps when the intercept beats the hospital's arrival time. At 14 minutes out, the rendezvous takes twice as long as the 7-minute transport to the ED, so it answers a slower version of the same question transport already solves.

Hold the arms and legs still to prevent injury: Holding the limbs still comes from the same worry about injury, but the contractions in a generalized seizure generate more force than a joint or long bone can safely resist. Restraining a seizing 6-year-old risks fracturing a bone or tearing muscle instead of preventing that injury, and it does nothing to shorten the seizure.

Place a bite block between the teeth to protect the tongue: A bite block comes from the old myth that a seizing patient can swallow the tongue; that cannot happen. The masseter muscles clamp down hard enough during the seizure to crack teeth on the block or push it into the airway.

Lift the patient onto the cot and secure the straps: Lifting the patient onto the cot is correct once the convulsions stop, not while this patient is still actively seizing on the tile floor. Moving a seizing body adds injury risk and accomplishes nothing until the seizure has ended.

Supine positioning, oxygen by NRB, and routine transport: Supine positioning and oxygen fit a routine post-ictal patient with no pregnancy concern, but at 34 weeks the vena cava is compressed by the uterus when flat on the back, and this patient's BP of 178/112 makes routine transport the wrong urgency call.

Seated positioning, a fluid bolus, and transport to the nearest clinic: A fluid bolus and seated positioning belong to a hypotensive or shock patient, but this patient is hypertensive at 178/112, sitting upright does nothing to relieve uterine compression of the vena cava, and a clinic cannot deliver magnesium sulfate or manage delivery.

Left lateral positioning, bright lighting, and a repeat blood pressure: Left lateral positioning is the correct piece here, which is what makes this the closest option, but bright lighting increases the sensory stimulation that can provoke another seizure, and rechecking a blood pressure does not substitute for initiating rapid obstetric transport on a patient who already meets eclampsia criteria.

Release the patient to a family member after a normal exam: A normal neurologic exam and a calm patient look like grounds to release, and that logic holds for a simple faint that's fully resolved. It fails here because the collapse happened during exertion, the pattern for cardiac syncope, where a normal exam only means the rhythm corrected itself, not that it's safe to send this patient home.

Give a fluid bolus and recheck a standing blood pressure: Standing blood pressures and a fluid bolus fit orthostatic hypotension or dehydration, conditions that cause lightheadedness on standing after prolonged upright rest. This patient collapsed mid-jog with no positional trigger, so nothing points to volume depletion, and orthostatic testing answers a question this history never asked.

Treat the event as vasovagal and transport without a monitor: This looks like a classic vasovagal faint: quick return to baseline and a normal exam. Vasovagal syncope needs a prodrome, lightheadedness, nausea, dimming vision, and it happens while upright and still. Collapsing without warning mid-jog is the one detail that pattern can't explain, so calling it vasovagal and skipping the monitor misses the cardiac cause.

They confirm adequate oxygen delivery to the tissues: A normal SpO₂ reading is the number every option here has to explain, and taken alone it looks reassuring, but that is exactly backward: the device is counting the molecule blocking oxygen delivery as though it were oxygen, so 98% here confirms nothing about tissue oxygenation.

They are inaccurate because both patients are confused: Pulse oximeters can misread from poor perfusion, motion, or nail polish, but altered mental status itself does not distort the probe. The inaccuracy here comes from what carbon monoxide does to hemoglobin, not from the patients being confused.

They indicate the symptoms come from a shared illness: Two people sick together does raise infectious or environmental illness as a thought, but the running generator points specifically to carbon monoxide exposure, a sharper and more urgent explanation than a generic shared illness.

An acute ischemic stroke from a blocked cerebral vessel: A stroke comes on suddenly, with vertigo, ataxia, visual loss, or a focal deficit appearing over minutes from an abrupt blockage. This patient has no focal weakness and a four-day gradual decline instead of the sudden onset that defines a stroke.

A structural bleed producing rising intracranial pressure: A structural bleed raising intracranial pressure produces worsening headache, vomiting, and falling responsiveness over hours as the mass effect grows, a much faster and more severe course than this slow four-day confusion with stable vital signs otherwise.

A postictal state following an unwitnessed seizure: A postictal state follows a seizure with confusion that clears within minutes to tens of minutes as the brain recovers from the ictal event; a four-day decline with no witnessed convulsive activity falls far outside that recovery window.

09:15, the time the patient was found on the floor with symptoms present: 09:15 is when the patient was found with symptoms already present, not the last time the patient was observed acting normally; using it as the last known well overstates how recently the patient was confirmed normal.

An averaged time halfway between the phone call at 06:30 and the discovery at 09:15: Last known well is an actual observed time, not an estimate or an average between two other times; averaging invents a data point nobody witnessed.

The time EMS personnel first confirmed the deficits during their assessment on scene: The time EMS confirmed the deficits on scene marks when the symptoms were verified, not when the patient was last observed at neurologic baseline, and it plays no role in the last known well determination.

Return the patient home as requested: Taking the resolved deficit as proof nothing serious happened leads to agreeing to take the patient home, missing that a resolved deficit is still a warning sign of a stroke risk soon after.

Cancel the response and clear the scene: Resolved weakness reads as a false alarm worth clearing the scene over, but a transient ischemic attack still requires hospital evaluation even without an ongoing deficit.

Downgrade to non-emergency transport: A resolved deficit sounds like lower urgency, which is how the transport priority gets downgraded, but the elevated risk of a stroke following a transient ischemic attack keeps this a time-critical transport.