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10 free AEMT practice questions: Sepsis and Systemic Infection

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

A 63-year-old patient with a fever and an indwelling urinary catheter is confused, warm to the touch, and tachycardic. The vital signs are BP 88/54, P 122, R 26, and SpO₂ 94% on room air. The AEMT establishes vascular access and begins isotonic crystalloid in measured boluses. Which finding would move the field impression from sepsis to septic shock?

Show the answer and rationale

Correct answer · Hypotension that persists after the protocol fluid volume

Septic shock is not a different disease from sepsis. It is a narrower label inside the same process, and one qualifier does all the work: hypotension that is still there after the fluid your protocol allows has gone in. Give the fluid and the pressure comes up, that is sepsis. Give the fluid and the pressure stays down, that is septic shock. Notice what this means for timing. You cannot call septic shock on arrival, however sick the patient looks, because the fluid has not been tried yet. Every other finding in this question is a real marker of a sick septic patient, but none of them is the qualifier the label turns on.

Why the others are wrong

A temperature that drops below 96.8°F during transport: A falling temperature is tempting because a low temperature in sepsis is genuinely a bad sign that carries a worse outlook than a fever. It is a severity marker, not the qualifier, and the label stays sepsis while the pressure is still responding.

A respiratory rate that climbs above 22 on reassessment: A rising respiratory rate is tempting because a rate of 22 or higher is one of the three qSOFA findings and it is often the earliest abnormal vital sign on the call. It predicts a bad outcome, but it does not change what the condition is called.

A mental status that stays altered after the second bolus: A persistently altered mental status is tempting because a change from baseline is one of the qSOFA findings and it tracks with how sick the patient is. Mental status is a severity marker here, and the fluid trial is what decides the label.

Question 2 of 10

A 3-year-old patient with a fever and a cough is quiet and slow to rouse. Capillary refill is 4 seconds and there has been no wet diaper since last night. The vital signs are BP 92/58, P 176, R 40, and SpO₂ 93% on room air. How should the AEMT read the normal blood pressure?

Show the answer and rationale

Correct answer · It is expected while a child is still compensating

Children compensate for shock better than adults and then decompensate faster, and that single fact should change how you read a pediatric cuff. A child raises cardiac output almost entirely by raising heart rate rather than stroke volume, so tachycardia is the earliest and most reliable warning you get. A normal blood pressure means very little until roughly a quarter to a third of blood volume is gone. Look at what this child is actually telling you. The refill is 4 seconds, the interaction is poor, and the diapers have been dry since last night. Capillary refill, mental status, and how the child engages with a caregiver are all more useful than the cuff, and every one of them is abnormal here.

Why the others are wrong

It suggests the fluid loss so far has been mild: A mild loss is tempting because the pressure is genuinely normal for this age and a normal number feels like reassurance. Perfusion findings are what move first in a child, and a 4 second refill with poor interaction says the loss is not mild.

It shows compensation has already failed: Failed compensation is tempting because this child is clearly sick and the phrase sounds like it fits a sick child. Compensation failing shows up as a falling pressure, and the pressure here is still being held, which is the definition of the compensated stage.

It means perfusion to the vital organs is still adequate: Reading a normal pressure as adequate perfusion is tempting because that is what the number seems to promise. Blood pressure is a late sign, and perfusion is what the refill, the mental status, and the dry diapers are telling you, all three of which are abnormal here.

Question 3 of 10

A 74-year-old patient with pneumonia and suspected septic shock is still hypotensive after the full isotonic crystalloid volume the protocol allows, given in measured boluses. The lungs remain clear. The vital signs are BP 80/48, P 128, R 28, and SpO₂ 94% on 6 liters per minute by nasal cannula. What should the AEMT arrange next?

Show the answer and rationale

Correct answer · A paramedic intercept while transport continues

Fluid has been given and the pressure did not follow, which by definition makes this septic shock. What that patient needs next is vasopressor support, and vasopressors are outside AEMT scope, so the move is a paramedic intercept while you keep closing the distance to the hospital. Notice that the intercept is not a way of handing off the call. Everything that belongs to you keeps running: oxygen titrated to target, a blood glucose checked and corrected, the patient actively warmed, and a notification that names septic shock along with the suspected source and the fluid already given. Request the intercept only when it genuinely gets the patient to that capability faster than driving does.

Why the others are wrong

An order from medical direction to start a vasopressor: Calling medical direction is tempting because a physician order feels like it unlocks whatever the patient needs. Online medical direction can direct care inside your scope, and it cannot expand that scope, so the order would not make the infusion something you may run.

A repeat of the full weight-based fluid volume: Repeating the volume is tempting because fluid is the tool you have and more of it feels like the natural next step. The protocol volume is already in, and repeating it past that point adds overload risk without addressing the vessel tone that is failing.

A switch to a larger bore catheter in the other arm: A larger catheter is tempting because flow rises steeply with the lumen and faster fluid sounds like a better answer. The problem is not how fast the fluid went in, since the full volume is already given and the pressure did not respond.

Question 4 of 10

A 77-year-old patient with a cough productive of thick sputum is lethargic and cool to the touch. The vital signs are BP 96/58, P 112, R 26, T 95.4°F, and SpO₂ 92% on room air. A crew member says the absence of a fever argues against sepsis. How should the AEMT weigh the temperature?

Show the answer and rationale

Correct answer · A low temperature meets the criterion and carries a worse outlook

The decisive finding is the temperature of 95.4°F, which falls below the 96.8°F threshold that marks the low end of the sepsis screening criterion, the same criterion whose high end is a temperature above 100.4°F. A body that cannot mount a fever while fighting infection has lost part of its thermoregulatory reserve, and that failure signals a more severe physiologic insult than a fever would. Paired with a pulse of 112, a respiratory rate of 26, and a pressure of 96/58, this patient meets criteria for sepsis and should be treated and transported as a time-critical sepsis alert rather than reassured by the missing fever.

Why the others are wrong

A temperature this low argues against an infectious cause: Ruling out infection because there's no fever is tempting, since fever is the sign most people associate with infection. The temperature of 95.4°F combined with the tachycardia and tachypnea shows a body overwhelmed by infection rather than free of it, so a low reading meets the criterion instead of excluding one.

The temperature is a late sign and adds little at this point: Calling the temperature a late sign is tempting because falling blood pressure genuinely is a late marker of decompensation. Temperature is captured on the first set of vitals and directly meets a screening criterion here, so it carries early diagnostic weight rather than arriving too late to matter.

The temperature matters only once it rises above 100.4°F: Waiting for a reading above 100.4°F is tempting because that number is the one most commonly memorized for fever. The criterion also includes anything below 96.8°F, and this patient's 95.4°F falls on that low side, meeting the standard without ever reaching the high threshold.

Question 5 of 10

A 55-year-old patient with a fever and left flank pain is oriented but says thinking feels slow today. The vital signs are BP 126/78, P 98, R 24, and SpO₂ 96% on room air. A crew member wants to wait for the pressure to change before calling this sepsis. Which action does this picture call for?

Show the answer and rationale

Correct answer · Beginning sepsis care now and continuing to reassess

Respiratory rate and mental status change before blood pressure does. That is the whole reason a septic patient can look stable on your first set of vitals and be far sicker than the numbers suggest. Blood pressure is the last vital sign to fall because the body compensates hardest to protect it, so waiting for the cuff to agree with you means waiting for the patient to run out of compensation. You already have what you need here. There is a plausible source in the flank pain and the fever, a respiratory rate of 24, and a change the patient reports about their own thinking. Start the care now and let the reassessment tell you how it is going.

Why the others are wrong

Rechecking the pressure in five minutes before deciding: Rechecking in five minutes is tempting because serial vitals are good practice and this pressure is genuinely normal. Waiting for the last finding to move turns the one vital sign that lags into the one you are relying on.

Treating the slowed thinking as an isolated neurologic problem: Calling it neurologic is tempting because slowed thinking really can be a stroke or a medication effect, and both belong on your differential. Pairing it with a fever and a likely source puts sepsis first until something rules it out.

Holding vascular access until the pressure drops below 100: Waiting on access is tempting because a systolic of 126 does not look like a patient who needs a line yet. Access is easiest before the vessels clamp down, and a patient who meets criteria now is the patient you want a line in.

Question 6 of 10

A 19-year-old college student has a fever, a severe headache, neck stiffness, and discomfort in bright light, with a purple rash on the trunk that does not fade under pressure. The vital signs are BP 104/62, P 124, R 26, and SpO₂ 96% on room air. Which precaution should the AEMT take before moving this patient?

Show the answer and rationale

Correct answer · Mask the patient and the crew and limit the exposure

Work the route, then pick the barrier. The findings here are the classic meningitis picture, and the rash that does not blanch pushes it toward the bacterial form, which can kill a healthy young adult in hours. That organism spreads by droplet, so the barrier goes on both faces. Mask the patient, mask yourself, keep the number of providers in the compartment small, and report it, because this is one of the exposures that gets provider prophylaxis. The same reasoning covers every infectious call you run. Airborne organisms get a mask that filters air, bloodborne organisms get a barrier at the skin, and anything that spreads by droplet gets the patient and the crew both masked.

Why the others are wrong

Apply a gown and gloves, leaving both faces uncovered: A gown and gloves are tempting because contact barriers feel like the thorough choice and the rash invites you to protect your skin. The rash is not what transmits this, and leaving both faces uncovered leaves the actual route wide open.

Apply an N95 respirator and skip masking the patient: An N95 is tempting because it is the heaviest respiratory protection on the truck and this is a frightening call. Airborne protection is built for organisms like tuberculosis, and masking only the crew skips the half of the barrier that controls droplets at the source.

Use standard precautions, which cover this presentation: Standard precautions are tempting because they are the default on every call and they are never wrong to start with. This presentation calls for an upgrade based on the suspected source, which is exactly what the treatment sequence tells you to do.

Question 7 of 10

A 74-year-old patient with suspected septic shock needs intraosseous access after peripheral attempts failed. The right knee was replaced with a prosthetic joint two years ago and the left leg is uninjured. Where should the AEMT place the needle?

Show the answer and rationale

Correct answer · The left proximal tibia, medial to the tuberosity

The right knee's two-year-old prosthetic joint is the finding that decides the site. Orthopedic hardware near an insertion point means the marrow cavity underneath may be replaced by metal or cement, so IO fluid and drugs would infuse into a closed space instead of the vascular sinusoids that carry them into central circulation. That takes the right tibia off the table entirely, not just the exact centimeter over it. The left tibia is uninjured with intact marrow, and the needle goes in medial to the tuberosity, onto the flat bone with a wide marrow cavity, not on the prominence itself.

Why the others are wrong

The right proximal tibia, medial to the tuberosity: This landmark, medial to the tuberosity, is the correct spot on either leg, but the prosthetic joint in that knee contraindicates the whole right tibia regardless of precision.

The left proximal tibia, directly over the tuberosity: The left leg is correct, since it's uninjured, so this looks right at first glance, but landing directly over the tibial tuberosity hits a bony prominence with a thin shell and little marrow beneath, instead of the flat surface two centimeters medial where the cavity is wide open. That placement risks a failed infusion.

The right proximal tibia, entered at a shallower angle: A shallower entry angle is a real technique adjustment for other situations, but it doesn't fix why the right tibia is contraindicated: the prosthetic joint rules out that bone entirely, no matter the angle used.

Question 8 of 10

A 6-year-old patient with a fever and a suspected abdominal infection is lethargic with mottled skin and a weak radial pulse. The vital signs are BP 74/40, P 168, R 36, and SpO₂ 92% on room air. How should the AEMT describe this perfusion?

Show the answer and rationale

Correct answer · Decompensated shock, since the pressure is below the threshold

Pediatric hypotension is age-specific, and the working figure for a child between one and ten years old is a systolic below 70 plus twice the age in years. For a 6-year-old that is 82, and this child is at 74. Measured hypotension in a child means the compensating mechanisms have failed, which is the definition of the decompensated stage. The rest of the picture agrees. Mottled skin, a weak radial pulse, and a lethargic child are all decompensated findings, where the compensated version would be a restless child with a radial pulse you can still feel. Watch the heart rate from here. Bradycardia in a child who was tachycardic is a pre-arrest finding rather than a sign of improvement.

Why the others are wrong

Compensated shock, since the heart rate is still climbing: Compensated is tempting because a rising heart rate really is the compensating mechanism at work and the child is clearly still fighting. Compensated means the pressure is still being held, and a systolic of 74 against a threshold of 82 says it no longer is.

Adequate perfusion, with the fever explaining the fast rate: Adequate perfusion is tempting because fever does raise the heart rate and 74 systolic sounds survivable read against an adult number. Mottled skin with a weak radial pulse is not adequate perfusion at any age.

Respiratory failure, with perfusion still intact for now: Respiratory failure is tempting because a rate of 36 with a saturation of 92 percent shows the respiratory system is working hard. That fast breathing is compensation for the acid load of poor perfusion, and the perfusion findings are the ones that are failing.

Question 9 of 10

A 68-year-old patient with a productive cough and reported fever has R 24, BP 118/72, and waveform capnography reading an EtCO₂ of 21 mmHg. Which statement about this capnography finding is most accurate?

Show the answer and rationale

Correct answer · The low EtCO2 is an objective early marker of severity that supports a sepsis impression, correlating with metabolic acidosis

A low EtCO2, roughly under 25 mmHg, in a patient with a suspected infection source correlates with metabolic acidosis and worse outcomes, so it functions as an objective early marker of sepsis severity even while the blood pressure is still normal. This patient's blood pressure has not yet dropped, which is exactly the scenario where capnography adds real information the vital signs alone do not show. The respiratory rate here (24, adequate rate and effort implied) is not itself a sign of inadequate ventilation, so the low number reflects the underlying metabolic picture rather than a ventilation failure.

Why the others are wrong

The low EtCO2 indicates inadequate ventilation and calls for immediate assisted ventilation with a BVM: The trigger for assisted ventilation is an abnormal rate paired with reduced tidal volume or effort, not a capnography number in isolation. Nothing in this presentation describes inadequate tidal volume or effort, so this low EtCO2 is being used as a severity marker, not a ventilation-failure alarm.

The low EtCO2 rules out sepsis, because septic patients typically show an elevated EtCO2 from a hypermetabolic state: This reverses the actual relationship. Sepsis produces a low EtCO2 tied to metabolic acidosis and worsening perfusion, not an elevated one, so a low reading supports rather than rules out a sepsis impression.

The EtCO2 value cannot be interpreted without also obtaining a blood glucose reading: Checking glucose is a separate treatment step in managing a septic patient, but it is not a precondition for interpreting a capnography value. The EtCO2 number stands on its own as an early severity marker.

Question 10 of 10

An AEMT has given a 20 mL/kg isotonic crystalloid bolus to a 74-year-old patient with a fever and a suspected pneumonia source. The initial vital signs were BP 84/52, P 122, R 24. On reassessment, the blood pressure is now 96/60 mmHg, but new bilateral crackles are heard at the lung bases, and the patient reports new difficulty breathing. What should the AEMT do next?

Show the answer and rationale

Correct answer · Hold further fluid boluses and reassess lung sounds and vital signs closely

The finding that decides this is bilateral crackles at the lung bases plus new difficulty breathing right after a 20 mL/kg bolus, in a 74-year-old with fever and suspected pneumonia. The bolus raised pulmonary capillary hydrostatic pressure faster than this patient's cardiac reserve and vascular compliance could handle, pushing fluid into the alveolar interstitium even though the blood pressure of 96/60 is still low. That changes the plan from continued fluid resuscitation to holding further crystalloid, watching lung sounds and vitals closely, and considering other pressure support if the AEMT's protocol allows it.

Why the others are wrong

Give a second 20 mL/kg isotonic crystalloid bolus: A second 20 mL/kg bolus is the move you'd make if the blood pressure alone still read 96/60 with no other complication, since sepsis often needs repeat fluid to restore perfusion. The new bilateral crackles and new dyspnea are the fluid-overload signal that breaks that logic here; repeating the same dose into lungs already backing up worsens the breathing problem instead of fixing perfusion.

Switch to dextrose 5% in water for the remaining resuscitation volume: Dextrose 5% in water is the right fluid when you need free water for a glucose or hydration deficit, because it distributes into total body water rather than staying in the vascular space. That property means it does nothing for this patient's blood pressure of 96/60 or the new crackles, so it answers a different problem than the one in front of you.

Disconnect the intravenous line entirely and transport without further intervention: Pulling the line entirely fits situations where access itself is causing harm or infiltrating badly, but nothing in this patient's presentation calls for losing IV access altogether. The correct response to fluid overload is holding the bolus and reassessing, not stripping away a line this patient may still need for monitoring or medication.

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