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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 sepsis with a blood pressure that stays low after fluid. This patient has a fever, a urinary catheter, confusion, a pulse of 122, and a BP of 88/54. Those findings fit sepsis. The label moves to septic shock only when the hypotension is still there after the fluid your protocol allows has gone in. If the fluid brings the pressure up, the patient has sepsis. If the pressure stays down after the fluid, the patient has septic shock. You cannot call septic shock on arrival, no matter how sick the patient looks, because the fluid has not been tried yet. Finish the protocol fluid and recheck the pressure, because that reading decides the label.

Why the others are wrong

A temperature that drops below 96.8°F during transport: A temperature that falls below 96.8°F is a bad sign in sepsis, and it carries a worse outlook than a fever does. Low temperature still only marks how sick the patient is. The label stays sepsis while the pressure is still responding to fluid.

A respiratory rate that climbs above 22 on reassessment: A respiratory rate of 22 or higher is one of the three qSOFA findings. A fast rate is often the first vital sign to turn abnormal, and it predicts a bad outcome. A rising rate still does not change what the condition is called.

A mental status that stays altered after the second bolus: A change in mental status is another qSOFA finding, and it tracks with how sick the patient is. Confusion here is a sign of severity. A patient can stay confused after the second bolus while the pressure comes up, and that patient still has sepsis.

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

This child is in compensated shock, and a normal blood pressure is expected at this stage. Children compensate for shock better than adults, and then they decompensate faster. A child raises cardiac output mostly by raising the heart rate. That's why a fast heart rate is the earliest warning you get, and this child's pulse is 176. A child's blood pressure can stay normal until about a quarter to a third of the blood volume is gone. This child has a capillary refill of 4 seconds, is quiet and slow to rouse, and has had no wet diaper since last night. Capillary refill, mental status, and how the child acts with a caregiver tell you more than the blood pressure cuff. Every one of those is abnormal here.

Why the others are wrong

It suggests the fluid loss so far has been mild: A normal blood pressure for this age can look reassuring, as if the fluid loss has been mild. In a child, the perfusion findings change first. A capillary refill of 4 seconds and a child who is slow to rouse mean the loss is not mild.

It shows compensation has already failed: Compensation fails when the blood pressure starts to fall. This child is clearly sick, and the blood pressure is still normal. A normal pressure means the child is still compensating.

It means perfusion to the vital organs is still adequate: A normal blood pressure seems to promise that the organs are getting enough blood. Blood pressure is a late sign in children. The slow capillary refill, the poor mental status, and the dry diapers show poor perfusion right now.

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

This patient is in septic shock. The full crystalloid volume is in, and the blood pressure is still 80/48. A pressure that stays low after fluid is what makes this septic shock by definition. The next thing this patient needs is a vasopressor. Vasopressors are outside AEMT scope. Call for a paramedic intercept and keep driving toward the hospital. The intercept does not hand off your care, and everything that belongs to you keeps going. Titrate the oxygen to the target. Check the blood glucose and correct a low one. Actively warm the patient. Call the hospital and tell them it is septic shock, what the suspected source is, and how much fluid you gave. Request the intercept only when it gets the patient to a vasopressor faster than driving to the hospital does.

Why the others are wrong

An order from medical direction to start a vasopressor: Online medical direction can order care that is inside your scope. A physician order cannot make a vasopressor part of AEMT scope, so the order would not let you run the infusion.

A repeat of the full weight-based fluid volume: Fluid is the tool you have, and giving more seems like the next step. The protocol volume is already in. Repeating the full volume adds the risk of fluid overload and does nothing for the blood vessels that will not tighten.

A switch to a larger bore catheter in the other arm: A larger catheter does let fluid run in much faster. Speed is not the problem here. The full volume is already in, 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

A low temperature meets the sepsis criterion, and a low temperature carries a worse outlook. This patient's temperature is 95.4°F. The sepsis screen counts a temperature above 100.4°F, and the screen also counts a temperature below 96.8°F. A body that cannot make a fever while fighting an infection has lost some of its ability to control its own temperature. That failure points to a more severe illness than a fever would. This patient also has a pulse of 112, a respiratory rate of 26, and a blood pressure of 96/58. Those findings meet the criteria for sepsis. Call this a sepsis alert and transport without delay. Do not let the missing fever reassure you.

Why the others are wrong

A temperature this low argues against an infectious cause: Fever is the best-known sign of infection, so no fever can look like no infection. A temperature of 95.4°F with a fast pulse and fast breathing shows a body overwhelmed by infection. A low temperature meets the criterion and does not rule infection out.

The temperature is a late sign and adds little at this point: A falling blood pressure is a late sign of decompensation. Temperature is taken with the first set of vital signs. A low temperature meets a screening criterion right away, so the temperature matters early.

The temperature matters only once it rises above 100.4°F: 100.4°F is the best-known number for a fever. The criterion also includes anything below 96.8°F. This patient's 95.4°F is on the low side and meets the criterion without ever reaching 100.4°F.

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

Begin sepsis care now and keep reassessing. Respiratory rate and mental status change before blood pressure does. A septic patient can look stable on the first set of vital signs and be much sicker than the numbers show. Blood pressure is the last vital sign to fall, because the body works hardest to protect the blood pressure. Waiting for the blood pressure to change means waiting for the patient to run out of compensation. This patient's fever and left flank pain give you a likely source. The respiratory rate is 24, and the patient says thinking feels slow today. Slow thinking is a change in mental status. Start the care now, and let your reassessment tell you how the patient is doing.

Why the others are wrong

Rechecking the pressure in five minutes before deciding: Repeat vital signs are good practice, and a blood pressure of 126/78 is normal. Blood pressure is the vital sign that changes last. Waiting five minutes for the pressure means you are counting on the one sign that lags behind.

Treating the slowed thinking as an isolated neurologic problem: Slowed thinking can come from a stroke or a medication, and both belong on your list of possible causes. This patient also has a fever and a likely source. Slowed thinking with a fever and a source puts sepsis first until something rules sepsis out.

Holding vascular access until the pressure drops below 100: A systolic of 126 does not look like a patient who needs a line yet. An IV line is easiest to place before the blood vessels clamp down. This patient meets the criteria now, so get the line in now.

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

This patient most likely has bacterial meningitis. Fever, a severe headache, a stiff neck, and discomfort in bright light are the classic meningitis findings. The purple rash that does not fade under pressure points to the bacterial form. Bacterial meningitis can kill a healthy young adult in hours. The bacteria spread by droplets, so the barrier has to go on both faces. Put a mask on the patient and a mask on each member of the crew. Keep the number of providers in the back of the ambulance small. Report the exposure afterward, because this is one of the exposures where providers get medication to prevent the infection. On any infectious call, match the barrier to how the illness spreads. Airborne organisms get a respirator that filters the air. Bloodborne organisms get a barrier at the skin. Droplet organisms get a mask on the patient and on the crew.

Why the others are wrong

Apply a gown and gloves, leaving both faces uncovered: A gown and gloves protect your skin from contact spread, and a rash makes the skin look like the risk. The rash does not spread this infection. Droplets spread meningitis, and leaving both faces uncovered leaves that route wide open.

Apply an N95 respirator and skip masking the patient: An N95 respirator is built for airborne organisms like tuberculosis. This infection spreads by droplets. Masking only the crew skips the mask on the patient, and the patient's mask is what stops droplets at the source.

Use standard precautions, which cover this presentation: Standard precautions are where every call starts, and they are never wrong to start with. Standard precautions alone do not cover a droplet infection. A suspected droplet infection means you add a mask on the patient and on the crew.

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

This needle belongs in the left proximal tibia, medial to the tuberosity. The right knee was replaced with a prosthetic joint two years ago, and that joint decides the site. Hardware near the insertion site means the marrow underneath may be replaced by metal or cement. IO fluid and drugs would go into a closed space instead of the marrow, where they would normally be carried into the central circulation. The prosthetic joint rules out the whole right tibia, not just the spot over the joint. The left tibia is uninjured, and the marrow there is intact. Place the needle medial to the tuberosity, on the flat part of the bone where the marrow cavity is wide. Do not place the needle on the bump of the tuberosity itself.

Why the others are wrong

The right proximal tibia, medial to the tuberosity: Medial to the tuberosity is the correct landmark on either leg. The prosthetic joint in the right knee rules out the whole right tibia, no matter how exact the placement is.

The left proximal tibia, directly over the tuberosity: The left leg is the correct side, since the left leg is uninjured. Directly over the tibial tuberosity is a bump of bone with a thin shell and little marrow under it. The flat surface two centimeters medial has a wide marrow cavity. Placing the needle on the tuberosity risks an infusion that fails.

The right proximal tibia, entered at a shallower angle: A shallower angle is a real adjustment in other situations. A different angle does not change the reason the right tibia is ruled out. The prosthetic joint rules out that bone at any angle.

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

This child is in decompensated shock. The blood pressure is 74/40, the child is lethargic, the skin is mottled, and the radial pulse is weak. For a child between one and ten years old, low blood pressure is a systolic below 70 plus twice the age in years. For a 6-year-old, that number is 82, and this child is at 74. A low blood pressure in a child means the body can no longer make up for the shock. The stage where the pressure drops is decompensated shock. Mottled skin, a weak radial pulse, and lethargy all fit decompensated shock. A child who was still compensating would be restless, with a radial pulse you can still feel. Watch the heart rate from here. A tachycardic child who becomes bradycardic is close to cardiac arrest, not getting better.

Why the others are wrong

Compensated shock, since the heart rate is still climbing: A climbing heart rate is the body trying to compensate. Compensated shock means the blood pressure is still being held up. A systolic of 74 is below this child's cutoff of 82, so the pressure is no longer being held.

Adequate perfusion, with the fever explaining the fast rate: Fever does raise the heart rate, and a systolic of 74 sounds survivable next to 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: A respiratory rate of 36 with an SpO₂ of 92% shows the child is breathing hard. The fast breathing is the body making up for the acid built up from poor perfusion. The perfusion findings are the ones failing here.

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

This low EtCO2 supports sepsis, and it is an early sign of how sick the patient is. The patient has a productive cough, a reported fever, and an EtCO2 of 21 mmHg. With a likely infection, an EtCO2 under about 25 mmHg goes along with metabolic acidosis, which is acid building up in the blood. A low EtCO2 in sepsis also goes along with worse outcomes. The blood pressure is still normal at 118/72. Capnography shows you the problem before the blood pressure does. A respiratory rate of 24 is not a sign of poor breathing here. The low number comes from the acid in the blood, not from a ventilation problem.

Why the others are wrong

The low EtCO2 indicates inadequate ventilation and calls for immediate assisted ventilation with a BVM: Assisted ventilation with a BVM is for a patient with an abnormal rate plus shallow breaths or weak effort. A capnography number by itself does not call for a BVM. Nothing in this question describes shallow breaths or poor effort. Here the low EtCO2 is telling you how sick the patient is, and it is not a sign that ventilation is failing.

The low EtCO2 rules out sepsis, because septic patients typically show an elevated EtCO2 from a hypermetabolic state: Septic patients do not run a high EtCO2. Sepsis gives you a low EtCO2, from metabolic acidosis and worsening perfusion. A low reading supports a sepsis impression instead of ruling sepsis out.

The EtCO2 value cannot be interpreted without also obtaining a blood glucose reading: Checking a blood glucose is a separate step in caring for a septic patient. You do not need a glucose to read a capnography value. The EtCO2 number stands on its own as an early sign of how sick the patient is.

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

This patient is going into fluid overload after the bolus. After a 20 mL/kg bolus, the blood pressure came up from 84/52 to 96/60. The patient now has new crackles at both lung bases and new difficulty breathing. New crackles after a bolus are the clearest sign to stop giving fluid. The fluid went in faster than this 74-year-old's heart and blood vessels could handle. The extra fluid is now backing up into the lungs. The blood pressure of 96/60 is still low, but more fluid will only put more fluid in the lungs. Hold the boluses. Sit the patient up, give oxygen, and recheck the lung sounds and vital signs closely. Request an ALS intercept if the pressure stays low, because infusions of drugs that raise the blood pressure are paramedic scope.

Why the others are wrong

Give a second 20 mL/kg isotonic crystalloid bolus: A second 20 mL/kg bolus is what sepsis often needs when the blood pressure is still low and nothing else has changed. This patient now has new crackles at both bases and new trouble breathing. Those are signs of fluid overload. Another bolus puts more fluid into lungs that are already filling up.

Switch to dextrose 5% in water for the remaining resuscitation volume: Dextrose 5% in water is a carrier fluid or a keep vein open fluid. D5W is not a resuscitation fluid. D5W spreads out through all the water in the body and does not stay in the blood vessels. D5W does nothing for this patient's blood pressure of 96/60 or for the crackles.

Disconnect the intravenous line entirely and transport without further intervention: Pulling the IV fits a line that has infiltrated, where the fluid is going into the tissue instead of the vein. Nothing here points to a problem with the line itself. Fluid overload comes from the amount of fluid, not from the IV site. This patient may still need the line for medication. Fluid overload is handled by holding the boluses and reassessing.

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