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10 free AEMT practice questions: Shock Recognition and Fluid Resuscitation

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 21-year-old college student has had three days of vomiting and diarrhea during a dormitory outbreak and is now too weak to stand. The neck veins are flat, the lung sounds are clear, and the skin is cool, pale, and moist. The vital signs are BP 98/76, P 122, R 22, and SpO₂ 97% on room air. Which shock category do these findings identify?

Show the answer and rationale

Correct answer · Hypovolemic shock, from the volume lost through vomiting and diarrhea

This is hypovolemic shock. Start at the neck. Flat neck veins mean the blood vessels are underfilled. Flat veins leave hypovolemic and distributive shock and take the other two off the list. Then look at the skin. Cool, pale, and moist skin means the blood vessels clamped down to protect the fluid that is left, and clamped vessels point to hypovolemic shock. Warm, red, and dry skin would have pointed you to distributive shock instead. Three days of vomiting and diarrhea is fluid leaving the body. Look at the blood pressure of 98/76 too. The systolic is drifting down while the diastolic climbs, because the blood vessels are clamped down.

Why the others are wrong

Obstructive shock, from a blockage sitting outside the heart itself: A blockage outside the heart backs blood up and distends the neck veins. This patient's neck veins are flat, so obstructive shock is ruled out before you even listen to the lungs.

Distributive shock, from the vasodilation that follows a viral illness: Distributive shock opens up the blood vessels and warms the skin. Cool, pale skin with clamped vessels is the opposite. A stomach and bowel illness like this one empties out the volume instead of widening the vessels.

Cardiogenic shock, from a pump too weak to move the volume it holds: A failing pump also distends the neck veins and usually adds crackles. Flat neck veins with clear lungs tell you the volume is low, not that the pump failed.

Question 2 of 10

A 10-year-old with three days of high fever and a severe pneumonia had a heart rate of 168 on arrival. Over the next ten minutes that rate drifts down to 52 while the child becomes harder to rouse. The vital signs are now BP 72/40, R 36, and SpO₂ 88% on an NRB. How should the falling heart rate be interpreted?

Show the answer and rationale

Correct answer · As a pre-arrest finding that calls for immediate oxygenation and ventilation

This falling heart rate is a pre-arrest finding. The heart rate went from 168 to 52 in ten minutes, and the child is getting harder to wake. Children keep their cardiac output up mostly by heart rate. A heart rate dropping like this does not mean the fever is breaking. The child is not getting better either. This child's compensation has run out, and cardiac arrest is close. This child needs oxygenation and ventilation right now. Hypoxia is the most common cause of cardiac arrest in children. The falling responsiveness, the systolic of 72, and the oxygen saturation of 88% on a nonrebreather all point the same way.

Why the others are wrong

As an expected rebound once fever driven tachycardia has run its course: Fever does raise the heart rate. A rate of 52 in a ten year old is far below normal for the age. The rate is not going back to a baseline.

As a normal response to the high oxygen concentration now being delivered: Oxygen does not slow a child in shock down to a heart rate in the fifties. Calling this a treatment effect wastes minutes this child does not have.

As evidence the compensation worked and the child is beginning to recover: A child who is recovering gets more alert, the skin warms up, and the capillary refill gets shorter. This child is getting harder to rouse while the rate falls.

Question 3 of 10

A 65-year-old patient with severe upper abdominal pain and repeated vomiting has been diagnosed with acute pancreatitis and is being transported from a clinic for admission. The skin is cool and the patient is restless. The vital signs are BP 104/82, P 116, R 22, and SpO₂ 95% on room air. Which reading of these numbers best describes the perfusion status?

Show the answer and rationale

Correct answer · Perfusion is failing, because the heart rate has climbed past the systolic

Perfusion is failing. The heart rate is 116 and the systolic is 104, so the heart rate is higher than the systolic. Two early signs of shock show up here, and the blood pressure is not one of them. The first is the pulse pressure, which is the systolic minus the diastolic. In an adult, the pulse pressure is normally around 30 to 40. This patient's pulse pressure is 22. The systolic drifted down as less blood went out with each beat, and the diastolic climbed as the blood vessels clamped down. The second is the shock index. Divide the heart rate by the systolic. Anything above about 0.9 to 1.0 means significant hypoperfusion. The quick check is that a heart rate higher than the systolic is a problem, and 116 against 104 is over that line. Pancreatitis pulls a large amount of fluid into the inflamed tissue, where the circulation cannot use it. That fluid is lost from the blood vessels even though it never leaves the body.

Why the others are wrong

Perfusion is adequate, because the diastolic of 82 shows relaxed vessels: A diastolic of 82 under a systolic of 104 means the blood vessels are clamped down, not relaxed. A narrow pulse pressure like that is a warning sign.

Perfusion is failing, because the pulse pressure has widened beyond 40 mmHg: The pulse pressure here is 22, which is narrow, not wide. In early shock the pulse pressure narrows, so waiting for it to widen is looking the wrong way.

Perfusion is adequate, because the systolic of 104 sits above the threshold: A systolic above 90 only tells you the blood pressure has not dropped yet. In compensated shock, the blood pressure stays normal. A normal pressure is what makes this stage easy to miss.

Question 4 of 10

An 87-year-old patient with a kidney infection is hypotensive and poorly perfused, and a student on the crew reaches for a bag of dextrose 5 percent in water to run the fluid bolus. Why is that fluid a poor choice for restoring circulating volume?

Show the answer and rationale

Correct answer · The dextrose is metabolized and the free water left behind spreads body wide

This patient is in septic shock from a kidney infection and needs circulating volume. Dextrose 5 percent in water does not give you that volume. In the bag, D5W is isotonic, so D5W looks like a fluid for shock. Once D5W is inside the patient, the body uses up the dextrose. What is left behind is free water. Free water spreads out across all the water in the body instead of staying in the vessels. Almost none of the D5W stays in the vessels, and the free water dilutes the electrolytes the patient still has. D5W is used as a carrier fluid or for a keep vein open line. When you need volume, give an isotonic crystalloid that stays in the extracellular space. At the AEMT level, that means normal saline or lactated Ringer's.

Why the others are wrong

It is hypertonic, so it pulls water out of the cells and into the vessels: Pulling water out of the cells and into the vessels is what a hypertonic fluid does. D5W is not hypertonic. The problem runs the other way, because the free water left behind spreads everywhere.

It carries no sodium, so the kidneys clear it before it reaches the vessels: The kidneys clearing the fluid is not the problem. The free water leaves the vessels by spreading across all the water in the body long before the kidneys matter.

It is hypotonic in the bag, so it drops the sodium before it expands volume: The D5W in the bag is isotonic, not hypotonic. The tonicity changes inside the patient once the dextrose is used up. The volume is lost at that point, after the fluid is already in the patient.

Question 5 of 10

An 8-year-old with severe dehydration from two days of vomiting is in compensated shock. No caregiver weight is available and the crew has no length based tape. Using the common field formula for this age range, what volume should the AEMT prepare for a 20 mL per kilogram bolus?

Show the answer and rationale

Correct answer · About 480 mL, from an estimated weight of 24 kilograms

Prepare about 480 mL. For children from one to ten years old, the common field formula estimates weight in kilograms as the age times 2, plus 8. This child is eight. Eight times 2 is 16, and 16 plus 8 is 24 kilograms. Multiply 24 kilograms by the ordered 20 mL per kilogram and you get 480 mL. The 480 mL is only a starting bolus. After you give the bolus, recheck the heart rate, capillary refill, mental status, skin signs, and lung sounds. Those findings tell you whether the child needs a second bolus or has slipped from compensated toward decompensated shock.

Why the others are wrong

About 320 mL, from an estimated weight of 16 kilograms: You get 16 kilograms if you double the age and forget to add the 8. Sixteen kilograms is also what the formula gives for a four year old. This child is eight, so a 320 mL bolus comes up 160 mL short.

About 560 mL, from an estimated weight of 28 kilograms: A 560 mL bolus comes from 28 kilograms, and 28 kilograms is what the formula gives for a ten year old. For this eight year old the formula gives 24 kilograms, not 28. The 560 mL bolus is more than this child should get.

About 360 mL, from an estimated weight of 18 kilograms: This patient is eight, not five. Eighteen kilograms is what the formula gives for a five year old. Using the younger child's weight leaves the bolus 120 mL short.

Question 6 of 10

A 43-year-old patient in decompensated shock from three days of vomiting is receiving a bolus of isotonic crystalloid during a long transport on a cold night. Why does the AEMT warm the fluid before it runs?

Show the answer and rationale

Correct answer · Room temperature fluid is well below body temperature and cools the patient

This patient is in decompensated hypovolemic shock from three days of vomiting. Room temperature fluid can feel warm in your hand, but the fluid is still well below body temperature. A liter or two of room temperature fluid will cool a patient who is already struggling to hold heat. Hypothermia, acidosis, and coagulopathy each make the other two worse. A cold patient's blood clots poorly, and the acidosis gets worse. Keeping a shock patient warm is real treatment, not just comfort care. Warm the fluid, warm the patient compartment, and cover the patient. All three are the same treatment, keeping this patient from cooling off.

Why the others are wrong

Warm fluid absorbs into the vessels faster than room temperature fluid does: The temperature of the fluid does not change how fast crystalloid moves into the vessels. You warm the fluid because cold fluid lowers the patient's own body temperature.

Warm fluid raises the tonicity of the bag so it holds volume in the vessels: Warming a bag does not change its tonicity. An isotonic fluid stays isotonic whether the bag is hot or cold. The volume the fluid holds in the vessels stays the same either way.

Warm fluid reduces the pain of the infusion, which lowers the heart rate: Comfort is a real benefit of warm fluid, but comfort is not the reason you warm the bag. Cold fluid pushes a shock patient toward hypothermia, acidosis, and coagulopathy, and that combination makes outcomes worse.

Question 7 of 10

A 50-year-old patient in decompensated shock is being ventilated with a BVM through a supraglottic airway. The EtCO₂ was 31 mmHg and now reads 17 mmHg. The AEMT notices the partner is delivering about 30 ventilations per minute. The blood pressure and heart rate are unchanged. What should the AEMT do first?

Show the answer and rationale

Correct answer · Slow the ventilation rate back to the correct number and recheck the value

Your partner is hyperventilating this patient. About 30 ventilations a minute is far too fast for an adult. Breathing for a patient that fast blows off carbon dioxide. Blowing off carbon dioxide drops the EtCO₂ reading even when blood flow has not changed. The EtCO₂ fell from 31 to 17, and the blood pressure and heart rate did not change. A falling EtCO₂ usually means falling perfusion. Here the fast rate alone can explain the drop, so you cannot read the number until the rate is fixed. Fast ventilation also hurts the patient directly. Each forced breath raises the pressure inside the chest. Higher pressure in the chest cuts the blood returning to the heart, and cardiac output falls. This patient is in decompensated shock and is already low on volume. Slow the rate back down, then recheck the EtCO₂. Slowing down fixes the falsely low reading and the real drop in cardiac output.

Why the others are wrong

Give another fluid increment, since the falling value shows lost perfusion: Fluid is the right move when a falling EtCO₂ really does mean lost perfusion. This patient may still need more fluid. Right now the fast rate can explain the whole drop, so the number cannot be trusted yet. Fix the ventilation rate first so the next reading means something.

Remove the supraglottic airway, since the falling value suggests displacement: Pulling the supraglottic airway makes sense when the device has moved. A displaced device changes the waveform and the chest rise. Nothing in this question describes a change in the waveform or the chest rise. The drop in EtCO₂ lines up with your partner's fast rate.

Increase the ventilation rate further to clear the carbon dioxide building up: Ventilating faster would be right for carbon dioxide that is building up, with a rising EtCO₂. This patient's EtCO₂ is falling because carbon dioxide is already being blown off too fast. Going faster drops the reading even lower. Faster ventilation also raises the chest pressure more and cuts even more blood return to the heart.

Question 8 of 10

An 85-year-old is found confused in a top floor apartment on the third day of a heat wave, after eating and drinking very little for three days. The skin is cool and mottled and the radial pulse is weak. The vital signs are BP 78/50, P 122, R 24, and SpO₂ 94% on room air. Two peripheral attempts spanning about ninety seconds have failed on collapsed veins. What is the appropriate next step for access?

Show the answer and rationale

Correct answer · Place an intraosseous line, since the decision rule for this patient is met

This patient is in decompensated shock and needs access now. The patient is confused, the skin is cool and mottled, the radial pulse is weak, and the blood pressure is 78/50. The rule for going to intraosseous access is two failed peripheral attempts or ninety seconds of trying, whichever comes first. This patient has had two failed attempts over about ninety seconds, so both parts of the rule are met. Collapsed veins are exactly what the intraosseous route is for. The marrow inside the bone is a network of veins that does not collapse. The marrow drains into the central circulation. Anything you would give through an IV can go through the intraosseous line at the same dose, including isotonic crystalloid. An intraosseous line will not run by gravity. Use a pressure bag or push the fluid with a syringe. Flush the line with 5 to 10 mL in an adult before anything will flow.

Why the others are wrong

Keep attempting peripheral access, since intraosseous access is a last resort: More peripheral attempts are reasonable while the rule has not been met. This patient already has two failed attempts on collapsed veins. Intraosseous access is not a last resort saved for a patient who is nearly dead. The intraosseous route is for the patient who needs access now.

Transport without access and let the hospital establish a line on arrival: A patient in decompensated shock needs fluid during the transport, not after arrival. Arriving at the hospital without access wastes the whole ride, when the fluid could already be running.

Attempt an external jugular line, the only remaining option at this level: The external jugular is a peripheral vein. An external jugular attempt is just another peripheral stick in a patient whose veins have already collapsed. The external jugular is not the only option left, and trying it delays the intraosseous line this patient needs now.

Question 9 of 10

A 23-year-old patient in compensated shock from two days of vomiting is being loaded for transport. A first responder asks whether the stretcher should be tilted head down and the patient's legs raised to move blood back toward the core. How should this patient be positioned?

Show the answer and rationale

Correct answer · Supine and kept warm, since routine head down positioning is not recommended

This patient is in compensated hypovolemic shock from two days of vomiting. Lay the patient supine and keep the patient warm. Routine head down positioning and passive leg raising are no longer recommended for shock. A shock patient goes supine unless something rules supine out. The exception is a patient in cardiogenic shock or pulmonary edema who cannot tolerate lying flat. That patient sits upright or semi upright so breathing stays possible. Keeping the patient warm is real treatment, not just comfort care. Hypothermia makes the blood clot poorly and makes acidosis worse. A blanket and a warm patient compartment help this patient more than a tilted stretcher.

Why the others are wrong

Head down at about thirty degrees, which returns blood from the legs to the core: The head down tilt is no longer recommended. A head down tilt does not improve outcomes. The tilt also makes it harder for the patient to breathe.

Legs raised without a head down tilt, which is the current recommended version: Raising the legs stopped being recommended at the same time as the head down tilt. Keeping half of the old position does not make the leg raise current.

Seated fully upright, which improves breathing and does not affect perfusion: Sitting upright is for the patient in cardiogenic shock or pulmonary edema who cannot tolerate lying flat. This patient is dry from two days of vomiting and has neither of those problems.

Question 10 of 10

A 20-year-old patient took a first dose of a new antibiotic twenty minutes ago and has hives, swelling of the lips, and wheezing. The AEMT gave intramuscular epinephrine three minutes ago and is managing the airway with oxygen, and the wheezing has eased considerably. The vital signs are now BP 84/48, P 128, R 24, and SpO₂ 95% on oxygen. What treats the remaining problem?

Show the answer and rationale

Correct answer · Isotonic crystalloid, since the vessels are dilated and leaking their volume

This patient is in anaphylactic shock, which is a type of distributive shock. The wheezing eased after the epinephrine, but the blood pressure is still 84/48 and the pulse is 128. Histamine makes the blood vessels dilate and leak within minutes. The fluid is still in the body, but it has leaked out of the vessels. The vessels are now too wide for the blood volume left inside them. The intramuscular epinephrine opened up the airway. That's why the wheezing eased. The low blood pressure is the problem that is left. When the pressure stays low after intramuscular epinephrine and airway management, the AEMT treatment is isotonic crystalloid. Start an IV and give a fluid bolus. The fluid fills the dilated vessels back up. Recheck the blood pressure after the bolus.

Why the others are wrong

An intravenous epinephrine push, which works faster than the muscular route: An intravenous epinephrine push is how a paramedic supports the blood pressure of a patient who still has a pulse. That push is Paramedic scope. For an AEMT, low blood pressure that lasts after the intramuscular dose gets treated with fluid.

Continue monitoring alone, since epinephrine lifts the pressure as it works: Monitoring alone fits a patient whose pressure has come back up after the epinephrine. This patient still has a systolic pressure of 84. Waiting does not replace the volume that leaked out of the vessels.

A second intramuscular epinephrine dose given immediately in the other thigh: A second intramuscular dose is right when symptoms persist 5 to 15 minutes after the first dose. The first dose went in three minutes ago. A dose given immediately comes before the shortest repeat interval. Give the fluid bolus now. If the symptoms persist once 5 minutes have passed, a second dose can follow.

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