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Free NREMT practice questionsFree AEMT practice questions · Medical/Obstetrics/Gynecology

10 free AEMT practice questions: Respiratory Emergencies and Nebulized Medications

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.

Work through all 10, then move on to the next topic. When you want the full picture, the free AEMT diagnostic covers every topic in one sitting. No account needed for any of it.

Question 1 of 10

A 33-year-old patient with asthma has difficulty breathing. The AEMT applies waveform capnography through a nasal sampling cannula. The waveform shows a slow rising upstroke with no flat plateau, and EtCO₂ reads 48 mmHg. What does the shape of this waveform indicate?

Show the answer and rationale

Correct answer · Obstructed airflow in the lower airways

A normal capnogram has a sharp upstroke and a flat plateau, because the alveoli empty together. When the lower airways are narrowed, different parts of the lung empty at different speeds, the plateau never flattens, and the tracing climbs the whole way across. That sloping shape is the shark fin, and it means bronchospasm. Read the shape as well as the number, because the fin can show up before the reading moves and it flattens back out as the airways open.

Why the others are wrong

A leak in the capnography sampling line: A sampling cannula sits loose in the nose, so suspecting the equipment when a tracing looks odd is a fair first thought. A leak in the sampling line makes the waveform small or ragged and drags the reading down, rather than tilting the upstroke. What is described is a steady slow climb, which is an airflow problem and not a sampling problem.

A fall in the patient's cardiac output: Capnography reports circulation as well as ventilation, so a perfusion problem belongs on the list of things an abnormal tracing could mean. Falling cardiac output lowers the height of the waveform, because less blood carries carbon dioxide to the lungs. That changes the size of the tracing, not the slope of the upstroke.

Ventilations being delivered too quickly: A patient in respiratory distress is usually breathing fast, and a rate problem is the first thing many students reach for with an abnormal capnogram. Ventilating too fast blows carbon dioxide off and lowers the reading, and this patient is breathing on their own with a reading of 48 mmHg. Rate errors move the number, while narrowed airways change the shape.

Question 2 of 10

A 6-year-old patient with asthma has been struggling to breathe for an hour. On arrival the patient is limp, the breathing effort has faded, P 150, R 8, and SpO₂ 84% on room air. The AEMT begins positive pressure ventilations with a BVM. At what rate should the ventilations be delivered?

Show the answer and rationale

Correct answer · One breath every 2 to 3 seconds

A child who has a pulse but is not breathing adequately is ventilated at one breath every 2 to 3 seconds, which comes out to roughly 20 to 30 breaths a minute. Children burn through oxygen faster and hold less reserve than adults, which is why their assisted rate is quicker than the adult rate. Aim for gentle chest rise with each breath instead of squeezing the bag hard, since extra volume pushes air into the stomach and makes ventilation harder. Count out loud, because the easiest mistake with a sick child is drifting faster than you meant to.

Why the others are wrong

One breath every 6 seconds: the adult rate for a patient with a pulse, and using it on a child underventilates them. The higher oxygen demand of a child is exactly why the pediatric rate is faster.

One breath every 10 seconds: Slowing down is the drilled correction for the most common error at the bag, so the slowest rate on the list can look like the careful answer. One breath every 10 seconds is 6 breaths a minute, slower than the assisted rate for a patient of any age. A child ventilated that slowly keeps falling rather than recovering.

Two breaths after every 30 compressions: This is the compression to ventilation ratio for CPR, and this child has a pulse of 150. Ventilation rates and CPR ratios are separate numbers, and confusing them leads to compressions on a patient who is still perfusing.

Question 3 of 10

A 66-year-old patient with chronic obstructive pulmonary disease has been on oxygen for 10 minutes and has finished a nebulized bronchodilator treatment. The SpO₂ has come up to 90%, but the patient is now harder to rouse, with R 8 and shallow and very little chest movement. What should the AEMT do next?

Show the answer and rationale

Correct answer · Begin positive pressure ventilations with a BVM

The saturation looks acceptable, and that is the trap in this patient. A saturation number tells you about oxygen, while a falling level of consciousness with R 8 and shallow breathing tells you carbon dioxide is climbing and ventilation is failing. A chronic lung patient in respiratory failure gets assisted ventilation, delivered slowly with a long time to exhale so the trapped air can escape. Never take oxygen away from a patient as a treatment for sleepiness, because the fix for failing ventilation is ventilation.

Why the others are wrong

Remove the oxygen and watch the breathing: This choice rests on the belief that the oxygen suppressed the breathing, which is not real physiology. Pulling oxygen off a patient who was hypoxic ten minutes ago makes them hypoxic again and leaves the failing ventilation untouched.

Sit the patient up and reassess in 5 minutes: Sitting a patient up supports a patient who is still moving air and doing the work of breathing. A patient at R 8 who is hard to rouse has run out of the effort that position is meant to help, and 5 minutes is far too long to wait.

Repeat the nebulized bronchodilator treatment: A nebulized treatment only works if the patient can pull the mist deep into the lungs, and this patient is barely moving air. Medication cannot reach airways that air is not reaching.

Question 4 of 10

A 34-year-old patient with a history of asthma is sitting upright with audible expiratory wheezing in both lung fields after running out of a rescue inhaler. The patient is alert, speaking in short sentences, with BP 128/78, P 104, R 26, and SpO₂ 92% on room air. Which nebulized dose of albuterol should the AEMT prepare?

Show the answer and rationale

Correct answer · 2.5 mg mixed with saline and driven by oxygen flow

Lock 2.5 mg in as the number you reach for. That is the standard adult nebulizer dose, mixed with saline and driven by oxygen flow, and protocols that go higher for severe bronchospasm top out around 5 mg rather than four times the standard dose. If you remember one albuterol number for the exam, make it this one, because almost every respiratory scenario you see will start with it.

Why the others are wrong

1 mg mixed with saline and driven by oxygen: 1 mg is under the standard dose. Nebulized albuterol is not titrated down for an adult with active bronchospasm, and a smaller dose simply treats the patient less.

0.3 mg mixed with saline and driven by oxygen: 0.3 mg is the adult epinephrine auto-injector dose, not an albuterol dose. Mixing those two numbers up is common, so tie 0.3 mg to anaphylaxis and 2.5 mg to the nebulizer.

10 mg mixed with saline and driven by oxygen: 10 mg is double even the highest documented range. Protocols that allow more than the standard dose reach about 5 mg for severe bronchospasm, not 10 mg.

Question 5 of 10

A 66-year-old patient has had a fever and a productive cough for three days and now has difficulty breathing. Auscultation finds coarse, low-pitched sounds over the right lower lobe that change after the patient coughs, with clear sounds elsewhere. BP 118/72, P 104, R 24, T 101.8°F, SpO₂ 91% on room air. Which condition do these findings best support?

Show the answer and rationale

Correct answer · Pneumonia, because secretions sit in the larger airways

The sound tells you where the problem is, and where the problem is tells you what it is. Coarse, low-pitched sounds that clear or change with a cough are rhonchi, and rhonchi come from secretions and sputum sitting in the larger airways. Pair that with fever, a productive cough, and findings focused over one lobe, and you have pneumonia. Hold the pairing steady in your head: fluid down in the alveoli gives crackles, secretions up in the bigger tubes give rhonchi, and the two are never swapped.

Why the others are wrong

Acute pulmonary edema, because fluid has filled the alveoli: Pulmonary edema puts fluid in the alveoli, and the sound that makes is crackles at the bases spreading upward, heard on both sides rather than over one lobe.

An acute asthma attack, because the lower airways have narrowed: An asthma attack narrows the small airways and gives you wheezing across both lung fields with a long exhale, not focal coarse sounds that change after a cough.

A spontaneous pneumothorax, because air has entered the pleural space: A pneumothorax gives decreased or absent sounds over the affected side with sudden onset, not coarse sounds that clear with a cough after three days of fever.

Question 6 of 10

A 31-year-old patient with severe asthma has had two back to back nebulized albuterol treatments and continues to worsen, with faint wheezing, single-word speech, and SpO₂ falling from 91% to 87% on oxygen. There are no hives and no swelling, and BP 118/70. Which additional treatment has a recognized role here where protocol authorizes it?

Show the answer and rationale

Correct answer · Epinephrine given by the intramuscular route

Epinephrine is not only an anaphylaxis drug. In severe asthma that is not responding to nebulized treatment, intramuscular epinephrine has a recognized role at the same dose you would use for anaphylaxis, where your protocol authorizes it. The absence of hives and swelling does not take it off the table, because the indication here is failure of the nebulized treatment rather than an allergic picture. Read the trend: faint wheezing, single-word speech, and a saturation moving the wrong way on oxygen all say this patient is not responding, so repeating the same treatment a third time is not the escalation this call needs.

Why the others are wrong

Nebulized epinephrine at the same dose as albuterol: Nebulized epinephrine has a role in croup, where it shrinks swollen tissue below the cords. It is not the recognized route for a severe asthma patient failing nebulized bronchodilators.

Intravenous magnesium given over twenty minutes: Magnesium given by the intravenous route for severe asthma sits above the AEMT level, so it is not a treatment you would be reaching for on this call.

A third nebulized albuterol treatment run continuously: Two treatments have already failed and the patient is worse. Running a third continuously is more of the therapy that is not working, and the lesson is explicit that a failing patient needs escalation instead.

Question 7 of 10

A 70-year-old patient with chronic obstructive pulmonary disease reports that breathing has been worse for two days, that the cough has increased, and that the sputum has changed color and thickness. Auscultation finds diminished sounds with wheezing plus coarse, low-pitched sounds. Which explanation accounts for the coarse, low-pitched sounds?

Show the answer and rationale

Correct answer · Large volumes of sputum sitting in the larger airways

Rhonchi are a large airway sound, and patients with this disease make a lot of sputum, so hearing them here is ordinary rather than alarming. An exacerbation usually shows up as three things together: breathing that has gotten worse, more coughing, and a change in the sputum, which is exactly the history given. Diminished sounds with wheezing is the chronic background, and the coarse low-pitched layer on top of it is the secretions. Keep the pairing straight in your head: crackles come from fluid down in the alveoli, and rhonchi come from secretions up in the bigger tubes.

Why the others are wrong

Fluid filling the alveoli behind a failing left ventricle: Fluid in the alveoli produces crackles, described as fine popping. It is a different sound produced at a different level of the lung.

Air trapped behind small airways that cannot empty fully: Air trapping is real in this disease and it is why exhalation drags out, but trapped air does not make a coarse low-pitched sound. It shows up as diminished sounds and wheezing.

Narrowing of the upper airway above the level of the vocal cords: Narrowing above the vocal cords produces stridor, which is heard on inspiration and is not a coarse sound rising from the chest.

Question 8 of 10

An AEMT is comparing an asthma exacerbation with a chronic obstructive pulmonary disease exacerbation. Both narrow the lower airways through smooth muscle tightening. Which feature is characteristic of the chronic obstructive pulmonary disease patient rather than the asthma patient?

Show the answer and rationale

Correct answer · Daily breathlessness between flares

Start with what the two share, because that is why the same drug helps both: the ring of muscle around the small airways tightens, and a bronchodilator relaxes it. What separates them is what happens after the treatment. Asthma is reversible, so the airways open back up and the patient breathes normally between attacks. Chronic obstructive pulmonary disease is mostly irreversible, so these patients live short of breath every day and call you when they drop below their own baseline rather than when they first get sick.

Why the others are wrong

Wheezing heard through both lung fields: Wheezing across both lung fields shows up in both conditions, since both narrow the same small airways. It does not separate them.

Breathing that returns to normal between flares: This is the same fact read backwards, which is what makes it worth sitting with. Returning to normal between attacks is exactly what asthma does and exactly what chronic obstructive pulmonary disease does not, so this describes the other patient in the comparison. Reversibility is the discriminator; the question is asking which side of it you are on.

A prolonged expiratory phase during the attack: A prolonged expiratory phase is a feature of any obstructed lower airway, and it is listed as part of the asthma picture as well.

Question 9 of 10

A 6-year-old patient weighing 20 kg is having an asthma exacerbation with wheezing throughout both lung fields, retractions, and SpO₂ 91% on room air. The patient is alert and speaking in short phrases. Which nebulized albuterol dose should the AEMT give?

Show the answer and rationale

Correct answer · 2.5 mg, which is the same dose used for an adult patient

This is one of the few places where the pediatric number is the easy one, because it is the same number you use for an adult. Nebulized albuterol is given at 2.5 mg for a wheezing child with suspected asthma, and it is not scaled down by weight. The reason is that a nebulizer delivers a mist the child breathes in, and a smaller child simply takes in less of it. Do not let the weight in the scenario pull you into a calculation, because that weight is there to test whether you know this dose is flat.

Why the others are wrong

0.5 mg, which is one fifth of the usual adult dose: Cutting the dose to a fifth undertreats a child in active bronchospasm. The nebulized dose is not scaled by body size the way an injected or intravenous drug is.

1.25 mg, calculated at half of the adult dose: Halving the adult dose looks like careful pediatric practice, but it is the wrong instinct for a nebulized bronchodilator, where the standard dose is the same as for an adult.

0.1 mg per kilogram, which comes to 2 mg here: A per-kilogram calculation is right for many pediatric drugs and wrong for this one. The presence of a weight in the scenario does not make the dose weight-based.

Question 10 of 10

A 74-year-old patient with cardiogenic pulmonary edema is placed on continuous positive airway pressure (CPAP). Within several minutes, the SpO₂ rises and the patient's breathing becomes visibly less labored. What explains this improvement?

Show the answer and rationale

Correct answer · It reopens collapsed alveoli and pushes fluid back into the pulmonary circulation

CPAP increases pressure in the lungs, opens collapsed alveoli and prevents further alveolar collapse, pushes more oxygen across the alveolar membrane, and forces interstitial fluid back into the pulmonary circulation, which is why it improves oxygenation in cardiogenic pulmonary edema.

Why the others are wrong

It provides a much higher oxygen concentration than a nonrebreather mask delivers: CPAP's benefit comes from the positive pressure it generates, not simply from delivering a richer oxygen mixture than a nonrebreather mask already provides.

It relaxes bronchial smooth muscle to reverse the airway constriction causing this: Relaxing bronchial smooth muscle is the mechanism of a bronchodilator such as albuterol, not of CPAP, which works through pressure rather than a pharmacologic effect on the airway.

It actively suctions the accumulated fluid out of the alveoli through the mask: CPAP works by pushing pressure into the airway and forcing fluid back into the pulmonary circulation, not by suctioning fluid out through the mask.

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