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

Apply an NRB at 15 liters per minute: A nonrebreather at 15 liters is for a patient who is hypoxic or in obvious respiratory distress. This patient is at 97% and breathing easily at 16. There is no low oxygen to fix.

Apply a nasal cannula at 4 liters per minute: A nasal cannula at 4 liters fits a stroke patient whose SpO₂ is in the low 90s. Stroke care calls for oxygen only once the SpO₂ is below 94%. This patient is at 97% on room air. A cannula here gives oxygen for the diagnosis, not for a low reading.

Begin assisted ventilation with a BVM: A bag-valve mask is for breathing that is too slow, too shallow, or stopped. This patient breathes on their own at 16 with no effort. The breathing is adequate, so there is nothing to assist.

A simple febrile seizure: a seizure in a young child with a fever, and it is usually brief and stops on its own. Nothing in this question says the child has a fever. This seizure has gone 8 minutes without stopping, and that duration is what names it.

A postictal state: The postictal state is the confused, sleepy recovery period after a seizure stops. This child is still seizing at 8 minutes. There is no postictal state yet.

A focal seizure: starts in one part of the brain, so the movement is often on one side of the body. Nothing here says the movement is limited to one side. The 8 minutes of nonstop seizing is what names this presentation, not where the seizure started.

Stage on scene and wait for the paramedic unit to arrive: Waiting on scene for ALS makes sense when ALS can reach you sooner than you can reach the hospital. Here the paramedic unit needs 14 minutes, and the emergency department is only 7 away. Waiting just lets the seizure go on longer.

Request an order from medical direction to give a sedative: A benzodiazepine is the right drug to stop this seizure. Diazepam, midazolam, and lorazepam are all outside the national AEMT scope. Medical direction cannot give you permission to use a drug your scope does not include.

Meet the paramedic unit and transfer care at that point: Meeting the paramedic unit helps when the meeting point is faster than the hospital. The intercept takes 14 minutes, twice as long as the 7 minute drive to the emergency department. Meeting them only adds time before the patient gets the drug.

Hold the arms and legs still to prevent injury: Holding the arms and legs still comes from wanting to prevent injury. A generalized seizure makes more force than a joint or long bone can safely resist. Restraining a seizing 6-year-old can break a bone or tear a muscle. Holding the limbs also does not 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. Swallowing the tongue cannot happen. The jaw muscles clamp down hard enough to crack teeth on the block or push the block into the airway.

Lift the patient onto the cot and secure the straps: Moving the patient onto the cot is right once the convulsions stop. This 6-year-old is still seizing on the tile floor. Moving a seizing child adds injury risk and does nothing until the seizure ends.

Supine positioning, oxygen by NRB, and routine transport: Lying flat on the back is the wrong position for this patient. At 34 weeks, the uterus presses on the vena cava when the patient lies flat. After a seizure, a patient goes on the side so secretions and vomit drain. A seizure with a blood pressure of 178/112 at 34 weeks also needs rapid transport, not routine transport.

Seated positioning, a fluid bolus, and transport to the nearest clinic: Sitting a patient up and giving a fluid bolus fits a patient whose blood pressure is low, like in shock. This patient's blood pressure is high at 178/112. Sitting up does not take the uterus off the vena cava. A clinic cannot deliver the baby, and delivery is the only treatment that ends eclampsia.

Left lateral positioning, bright lighting, and a repeat blood pressure: Left lateral positioning is right for this patient. Bright lights add stimulation that can trigger another seizure. A repeat blood pressure does not replace rapid transport to obstetrics for a patient who already has eclampsia.

Release the patient to a family member after a normal exam: Releasing a patient after a normal exam can work for a simple faint that has fully resolved. This patient collapsed during exercise, which is the pattern for cardiac syncope. A normal exam only means the rhythm fixed itself for now. Sending this patient home is not safe.

Give a fluid bolus and recheck a standing blood pressure: Standing blood pressures and a fluid bolus fit orthostatic hypotension or dehydration. Those patients get lightheaded when they stand up. This patient collapsed in the middle of a jog, with no change in position. Nothing points to low volume.

Treat the event as vasovagal and transport without a monitor: A vasovagal faint has warning signs first, like lightheadedness, nausea, or dimming vision. Vasovagal faints usually happen while the patient is upright and still. This patient collapsed with no warning in the middle of a jog. A vasovagal faint does not explain that collapse, and skipping the monitor misses the cardiac cause.

They confirm adequate oxygen delivery to the tissues: A normal SpO₂ would usually suggest the blood is carrying enough oxygen. Here the pulse oximeter is counting carbon monoxide as if it were oxygen. The 98% tells you nothing about how much oxygen reaches the tissues.

They are inaccurate because both patients are confused: Pulse oximeters can misread because of poor perfusion, motion, or nail polish. Confusion does not affect the probe. The bad reading here comes from what carbon monoxide does to hemoglobin.

They indicate the symptoms come from a shared illness: Two people sick at the same time does raise the idea of an infection or a shared exposure. The running generator points straight to carbon monoxide. Carbon monoxide is a more specific and more urgent cause than a generic shared illness.

An acute ischemic stroke from a blocked cerebral vessel: An acute ischemic stroke fits a sudden change, often with weakness on one side. This patient has no focal weakness. The confusion built slowly over four days instead of starting suddenly.

A structural bleed producing rising intracranial pressure: A slow bleed in the brain, like a subdural, is common in older patients. A subdural can take hours or even days to show itself. A slow course alone does not separate a bleed from an infection. Here the temperature of 100.8 degrees Fahrenheit and the pulse of 108 point to an infection instead.

A postictal state following an unwitnessed seizure: Postictal confusion follows a seizure and clears within minutes to tens of minutes as the brain recovers. This patient has been declining for four days, and nobody saw a seizure. Four days is far longer than a postictal state lasts.

09:15, the time the patient was found on the floor with symptoms present: The patient was found on the floor at 09:15 with the symptoms already there. Nobody observed the patient acting normally at 09:15. Using the time the patient was found makes the patient look normal more recently than anyone actually confirmed.

An averaged time halfway between the phone call at 06:30 and the discovery at 09:15: Last known well has to be a time someone actually observed. An average between two times is a made-up time that nobody witnessed.

The time EMS personnel first confirmed the deficits during their assessment on scene: The time EMS confirmed the deficits is when the symptoms were checked, not when the patient was last observed at a normal baseline. The EMS assessment time plays no part in the last known well time.

Return the patient home since the symptoms resolved: Taking the patient home treats the cleared symptoms as proof that nothing serious happened. Symptoms that go away are still a warning that a stroke may be coming. Transport this patient for a hospital evaluation.

Cancel the response and clear the scene: Clearing the scene fits a false alarm. A TIA is not a false alarm, and the patient still needs a hospital evaluation even with no deficit right now.

Downgrade to non-emergency transport: Symptoms that are gone sound like a lower priority. A TIA is a warning that a real stroke may follow, so this patient is not a lower priority. Keep the transport going to a stroke-capable hospital, with early notification.