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Free NREMT practice questionsFree AEMT practice questions · Cardiology & Resuscitation

10 free AEMT practice questions: Resuscitation and IV/IO Access

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

An AEMT places an intraosseous needle in the proximal tibia of a patient in shock. The needle stands upright without support. When the line is opened, no fluid flows. What should the AEMT do first?

Show the answer and rationale

Correct answer · Flush the catheter with a rapid syringe push of normal saline

The needle is in the right place, and the marrow needs a flush. The needle stands upright without support. A needle that stands on its own is seated in the bone. No flow points to the marrow, not to where you put the needle. Bone marrow is packed with fat and cell debris. The marrow tissue has to be pushed out of the way with a firm syringe push before fluid can move through it. Push about 5 to 10 mL of normal saline in an adult, or 2 to 5 mL in a child. The flush is the last step of placing an IO, not a fix for a problem. After the flush, plan on a pressure infuser or repeated pushes. An IO never runs fast enough by gravity alone.

Why the others are wrong

Remove the needle and place a new one in the other leg: Pulling the needle and starting over is right when a needle is misplaced. This needle stands upright on its own, so the placement is good. Pulling a working line to start again in the other leg throws away good access before you try the simple fix.

Raise the fluid bag higher to increase the gravity head: Raising the bag helps a slow IV drip, because bag height drives a gravity line. An IO never runs at a useful rate by gravity, no matter how high the bag is. The line needs a flush first.

Rotate the needle a quarter turn to open the marrow space: Turning the needle can sometimes free a blocked catheter. This needle is already seated. Turning a seated needle only widens the hole in the bone. Fluid then leaks into the tissue around the bone instead of the marrow. The marrow opens up with the pressure of the flush.

Question 2 of 10

An AEMT is starting an intravenous line on a stable patient with good veins in both the hand and the antecubital fossa. Why does the standard approach begin at the most distal suitable site?

Show the answer and rationale

Correct answer · A blown distal site still leaves the vein above it usable

You start distal so a failed stick still leaves the vein above it usable. This patient is stable, so saving future access matters more than speed. Blood in the veins flows from the hand up the arm toward the heart. If the hand stick blows, only that hand vein is damaged. The antecubital vein above the hand stays good. If you stick the antecubital vein first and blow it, fluid from any later hand IV has to pass the leak. A blown antecubital takes the whole arm out of play. On a stable patient, work from distal to proximal. Save the bigger proximal veins for a crashing patient who needs volume right away. In that patient, giving up the rest of that arm for later sticks is worth the speed.

Why the others are wrong

Distal veins are larger, so they accept a bigger catheter: Bigger veins do take bigger catheters. In this arm, the antecubital vein is the bigger vein, not the hand vein. Vein size tells you what catheter size to use, not which site to try first.

Distal sites are less painful, so the patient tolerates the stick better: A hand stick is usually more painful, not less. The hand has thinner skin and more nerves than the antecubital fossa. Pain is not why you start distal.

Distal sites reach the central circulation faster than proximal ones: Every peripheral vein drains to the central circulation. The hand is farther from the heart than the antecubital fossa. Fluid from the hand takes longer to reach the heart. Distance from the heart is not why you start distal.

Question 3 of 10

A 20 kg child with three days of severe gastroenteritis is tachycardic with capillary refill of four seconds and cool hands. Two 400 mL boluses of warmed isotonic crystalloid have produced only brief improvement. The child is still tachycardic with delayed refill, the lungs are clear, and there is no sign of bleeding. What should the AEMT do next?

Show the answer and rationale

Correct answer · Consider a third 400 mL bolus, since perfusion is still poor

This child is in hypovolemic shock from three days of severe gastroenteritis. After two boluses, the child is still tachycardic with a capillary refill of four seconds and cool hands. Each 400 mL bolus is 20 mL/kg for a 20 kg child, so this child has had the standard bolus twice. Give 20 mL/kg of warmed isotonic crystalloid and fully reassess. Give a second 20 mL/kg if there is no response, and consider a third after that. The time to hold the third bolus is uncontrolled bleeding, because that child needs a surgeon instead of another bag. This child lost fluid from vomiting and diarrhea. Keep giving fluid in the same steps until perfusion comes back. The lungs are still clear, so this child has room for more fluid. New crackles in the lungs are the finding that would make you stop.

Why the others are wrong

Hold further fluid, since two boluses is the pediatric maximum: Stopping after two boluses can feel like the careful choice in a small child. The third bolus is part of the normal steps. What holds it back is uncontrolled bleeding, not a set number of boluses. This child is still poorly perfused with clear lungs, and that is the situation a third bolus is for.

Give 800 mL this time, since the smaller boluses have not held: This child does need more fluid. Doubling the bolus to 800 mL skips the reassessment between boluses. That reassessment is how you catch too much fluid before it causes a problem. The bolus size stays the same, and what changes is whether you give another one.

Hold fluid and give oxygen alone, since the losses are not from bleeding: Oxygen belongs in the care of any child this sick. Giving oxygen does not replace the fluid this child lost. A child with a four second capillary refill after two boluses is still short on fluid. With no bleeding, more crystalloid is the right next step.

Question 4 of 10

An AEMT is with a 78-year-old patient who has had crushing chest pressure for an hour. The patient is pale, cool, and clammy, and will not tolerate lying flat. Vital signs are BP 82/60, P 116, R 26, SpO₂ 90% on room air. The patient's neck veins are distended and crackles are audible at both lung bases. Which finding most strongly argues against a rapid fluid bolus?

Show the answer and rationale

Correct answer · Distended neck veins together with crackles at both lung bases

This patient is in cardiogenic shock. The neck veins are distended, and there are crackles at both lung bases. Distended neck veins mean blood is backing up because it cannot get through the chest. You see distended neck veins in cardiogenic and obstructive shock. Flat neck veins would point to hypovolemic or distributive shock instead. The lungs tell you which of the two you have. Crackles mean the pump has failed and fluid has backed up into the lungs, and that is cardiogenic shock. Clear lungs would mean the pump is working and something outside the heart is in the way. That is obstructive shock. A heart that cannot move the blood it already has is not helped by more volume. A large bolus pushed into a failing left ventricle backs up into the lungs and makes the pulmonary edema worse. The same distended neck veins and crackles that name cardiogenic shock warn you against a rapid bolus. This patient will not tolerate lying flat, so sit the patient upright or semi-upright to help the breathing.

Why the others are wrong

A heart rate of 116/min with cool, clammy skin: A fast heart rate with cool, clammy skin shows up in almost every type of shock. These findings do not tell you which kind of shock this is. A patient who is simply low on volume has the same fast pulse and clammy skin, and that patient needs fluid.

A systolic pressure of 82 mmHg in a patient this age: A systolic pressure of 82 is the number that makes this patient look like they need fluid. Low blood pressure tells you perfusion has failed. The number does not tell you why. Here the pressure is low because the heart cannot pump out enough blood, and more volume does not fix a failing pump.

A saturation of 90 percent with a respiratory rate of 26: a real problem, and the patient does need treatment for those numbers. Those numbers are a result of the fluid already sitting in the lungs. The distended neck veins and the crackles are what tell you where that fluid came from.

Question 5 of 10

An AEMT gives naloxone to a 27-year-old patient found with pinpoint pupils and respirations of 6 per minute. The patient's breathing improves to 14 per minute and the color returns, but the patient remains sleepy and does not open the eyes. What should the AEMT do?

Show the answer and rationale

Correct answer · Stop dosing and keep watching the patient's respiratory rate during transport

This patient had respiratory depression from an opioid, and the naloxone has fixed the breathing. The pupils were pinpoint and the breathing was 6 a minute. After naloxone, the breathing is 14 a minute and the color is back. The goal of naloxone is adequate breathing, not a patient who is awake and talking. More naloxone past that point brings on agitation and acute withdrawal. Extra naloxone does nothing more for the breathing. An agitated patient in the back of the ambulance is harder to keep safe than a sleepy patient who is breathing well. Naloxone often wears off before the opioid does, and the breathing can slow down again. Keep watching the respiratory rate during transport. Repeat the naloxone per protocol if the rate drops.

Why the others are wrong

Give a repeat dose until the patient is awake and answering questions: A patient who is awake and answering questions is easier to assess. Waking this patient all the way up brings on withdrawal and agitation. The breathing is already fixed at 14 with good color, and more naloxone adds nothing to the breathing.

Give the rest of the dose so the effect lasts longer than the opioid: Naloxone wearing off before the opioid is a real risk. Giving more now does not make the naloxone last longer. More naloxone deepens the reversal and brings on withdrawal sooner. The answer to that risk is watching the breathing and repeating the dose per protocol if the breathing slows.

Stop dosing and support a refusal if the patient stays this stable on scene: Patients who wake up after naloxone often want to stay on scene, and this patient looks stable. Naloxone often wears off before the opioid does, and this patient could stop breathing after you leave. A refusal after naloxone is a high risk refusal. A refusal like this needs a careful capacity assessment and real documentation, and this patient should be transported.

Question 6 of 10

A 4-year-old patient in septic shock needs vascular access and peripheral attempts have failed. The parents say a hospital crew placed an intraosseous line in the patient's right proximal tibia yesterday afternoon during a transfer. Where should the AEMT place the line?

Show the answer and rationale

Correct answer · In the left proximal tibia, away from the bone used for the previous line

A bone that had an intraosseous needle in it within about the last twenty four to forty eight hours is off limits. The parents say the right proximal tibia was used yesterday afternoon. The old hole in that bone is still open. Fluid you push into the marrow leaks back out through the old tract instead of reaching the circulation. The fluid collects in the tissue around the bone. The rule is about the whole bone, not just the old puncture site. Moving a few centimeters down the same tibia does not get you around it. Go to a different bone, most often the opposite leg. That same fix works for every other reason a bone is off limits. Other reasons include a fracture in that bone or in the bone just above it. Infection, a burn, or an open wound over the site counts too. The same goes for a prosthetic joint or other hardware at the site, landmarks you cannot find, and a bone disease that weakens the bone.

Why the others are wrong

In the right proximal tibia again, since the old tract has already closed over: A day sounds like a long time, and a puncture that small sounds like it would seal over. Manufacturer guidance commonly keeps that bone off limits for about twenty four to forty eight hours. Yesterday afternoon is well inside that window.

In the right distal tibia, below the previous site in the same bone: The distal tibia is a real intraosseous site, and it puts some distance between the two punctures. The rule is about the bone, and the distal tibia is the same bone. The old tract is still open above your new needle.

Back to peripheral attempts, since a previous line rules out both legs: Going back to peripheral attempts avoids the bone you were warned about. Only the right tibia is off limits, and the left leg is open to use. Peripheral attempts have already failed, and a child in septic shock needs fluid, not more attempts at veins.

Question 7 of 10

An AEMT has seated an intraosseous needle in the proximal tibia of an adult in cardiac arrest. The needle stands upright without support and no marrow returns on aspiration. A pressure bag is attached and the fluid does not run. What should the AEMT do first?

Show the answer and rationale

Correct answer · Push a rapid 10 mL saline flush through the catheter

Push a rapid 10 mL saline flush through the catheter. The marrow is a network of tiny blood spaces packed in with fat and bone, not an open tube. Fluid will not flow into the marrow until a flush opens those spaces. The flush is required, not optional. You give five to ten milliliters in an adult and two to five in a child. Fluid that will not run before a flush tells you almost nothing about placement. The needle stands upright without support, and that is a good sign. No marrow on aspiration is not a bad sign, because plenty of correctly placed needles give you nothing back. The sign of a misplaced needle is tissue that swells when you flush. Flush the needle and watch the calf while you do.

Why the others are wrong

Remove the needle and place a second one in the opposite tibia: No flow and no marrow together can look like a failed placement. You have not done the flush yet, and the flush is the step that makes flow possible. Pulling the needle now could mean pulling one that is exactly where it belongs.

Confirm placement by aspirating again with a larger syringe: Getting marrow back on aspiration does confirm placement, and a bigger syringe sounds like it would pull harder. Having no marrow does not prove the needle is in the wrong place. More suction pulls marrow up against the catheter instead of opening the space.

Raise the pressure bag higher and wait sixty seconds for flow to start: Intraosseous lines do need pressure, because gravity alone will not push fluid into the marrow. Pressure against marrow that has not been flushed still meets a closed network of spaces. Waiting sixty seconds gets you nothing and costs a minute in a cardiac arrest.

Question 8 of 10

An AEMT is 25 minutes into a transport with a 79-year-old patient who has a history of heart failure and received fluid for dehydration. The patient is now short of breath and sitting forward, with crackles at both bases and distended neck veins. The intravenous site in the patient's hand looks and feels normal, and the line flows freely. What should the AEMT do?

Show the answer and rationale

Correct answer · Stop the infusion, sit the patient upright, and titrate oxygen to the patient's saturation

This patient has circulatory overload from the IV fluid. Fluid is going in faster than a weak heart can pump, and the extra fluid backs up into the lungs. The patient has a history of heart failure and is now short of breath and sitting forward. There are crackles at both bases and the neck veins are distended. The IV site looks and feels normal, and the line flows freely. A normal site tells you the problem is the fluid itself, not the line. Stop the infusion. Sit the patient upright so the fluid settles away from the upper lungs and the breathing muscles can work. Give oxygen titrated to the saturation, and watch the patient closely.

Why the others are wrong

Remove the catheter and place a new line in the other arm: A new line in a new site is the fix for a problem at the IV site, like infiltration. This site looks and feels normal, and the line flows freely. A new line only gives you another way to give the fluid that is hurting this patient.

Clamp the tubing and place the patient left side down with the head lowered: Clamping the tubing and putting the patient left side down with the head lowered is the treatment for an air embolism. An air embolism comes from a loose connection or a line that was never primed. This line is running steadily. The crackles and distended neck veins point to too much fluid. Lowering the head of a patient with fluid in the lungs floods the upper lungs.

Continue the fluid at a slower rate and reassess the patient's lungs in ten minutes: Slowing the fluid keeps a line open for a patient who came in dehydrated. The crackles and distended neck veins mean the fluid is already backing up into the lungs. The infusion has to stop. Option C also does not sit the patient upright or give oxygen to a patient who is short of breath. Waiting ten more minutes to recheck the lungs loses time on a patient who is getting worse now.

Question 9 of 10

Four minutes after return of spontaneous circulation, an adult has a pulse and a blood pressure of 104/62 mmHg with a supraglottic airway in place. The provider at the head is squeezing the bag about 20 times a minute, and the end tidal carbon dioxide reads 24 mmHg. What should the AEMT do?

Show the answer and rationale

Correct answer · Slow to one breath every 6 seconds, holding the end tidal value at 35 to 40 mmHg

This patient is being hyperventilated after return of spontaneous circulation. The provider is squeezing the bag about 20 times a minute, and the end tidal carbon dioxide reads 24 mmHg. The target for an adult is 10 breaths a minute, one every 6 seconds. Twenty a minute is double that target. Bagging at 20 a minute raises the pressure in the chest. Higher chest pressure cuts the blood returning to the heart, and this patient's circulation just came back. Bagging this fast also blows off carbon dioxide. Low carbon dioxide narrows the blood vessels in the brain, and this brain was just without blood flow. End tidal carbon dioxide only tracks blood flow when the ventilation stays steady. Bagging at 20 a minute pulls the value down by itself, so a reading of 24 cannot tell you how well blood is flowing. Slow to one breath every 6 seconds and hold the end tidal value at 35 to 40 mmHg. Titrate the oxygen separately.

Why the others are wrong

Continue at the current rate and titrate oxygen to the saturation target instead: Titrating oxygen is part of care after a cardiac arrest. Option A leaves the rate at 20 a minute, double what it should be. The fast rate is the problem the end tidal value of 24 is pointing at.

Slow to one breath every 10 seconds until the end tidal carbon dioxide hits 45 mmHg: Slowing the rate is the right direction. One breath every 10 seconds is only 6 a minute, which is below the target of 10. The goal is to hold the end tidal value at 35 to 40 mmHg, not to push it up to 45.

Increase the tidal volume so that each breath moves more air at the same rate: Bigger breaths move more air without speeding up the rate. This patient is already being bagged too fast. Larger breaths at that rate raise the pressure in the chest even more. Give each breath only until the chest starts to rise.

Question 10 of 10

An AEMT is running the resuscitation of a 63-year-old patient in cardiac arrest and is supervising rather than performing a task. Compressions stopped for 25 seconds while a partner started an intravenous line in the forearm, and stopped again for 20 seconds at the last rhythm check while two providers discussed the tracing. Which action is most appropriate?

Show the answer and rationale

Correct answer · Keep compressions going and hold every pause under 10 seconds

Every pause in compressions is time this patient has no blood flow. Compressions stopped for 25 seconds for the IV and for 20 seconds at the rhythm check. Together, those pauses are most of a minute with no circulation at all. Survival in a cardiac arrest depends on how much of the arrest someone is doing compressions. The pressure that pushes blood into the heart muscle is called the coronary perfusion pressure. Coronary perfusion pressure builds up over the first several compressions. Within seconds of stopping, that pressure is gone. When compressions start again, the pressure has to build back up from nothing. That's why every pause has to stay under 10 seconds. Start the IV or IO with compressions still going. Steady the arm or leg and work around the motion. A rhythm check is a quick look and a decision, with no discussion.

Why the others are wrong

Pause compressions for each task so it can be completed cleanly: Finishing each task cleanly sounds careful, but a clean IV is not what saves this patient. Compressions are what keep blood moving to the brain. That's why IV access and rhythm checks are done while compressions keep going.

Delay vascular access until return of spontaneous circulation: Vascular access is one of the things an AEMT adds in a cardiac arrest. Without a line, there is no route for the medications and fluids your protocol allows. Start the line without stopping compressions instead of skipping the line.

Lengthen the rhythm check so the tracing can be studied carefully: A longer rhythm check does not change the decision. The only question at a rhythm check is whether the rhythm is shockable. Studying the tracing longer only adds more seconds with no blood flow, and this patient cannot afford them.

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