10 free EMT practice questions: Baseline Vital Signs & Diagnostics

The radial pulse should be counted a second time for accuracy: You already counted the radial pulse. Your fingers stay on the wrist to hide the respiratory count, not to count the pulse a second time.

Respiratory movement is easier to feel at the wrist than to see: Your fingers are not on the wrist to feel the breathing. Your fingers stay there so the patient does not know you are counting breaths.

Counting both vital signs together shortens time on scene: Counting both at once is not about saving time on scene. The technique is there to get a respiratory rate the patient has not changed.

A basilar skull fracture: shows up as Battle's sign, which is bruising behind the ears. You also see raccoon eyes and clear fluid draining from the ears or nose. A basilar skull fracture does not change the pupils. This patient has no bruising behind the ears and no fluid leaking.

Increased intracranial pressure: squeezes the oculomotor nerve. The pupil on that side turns sluggish, or fixed and dilated. A slow pulse and irregular breathing often come with it, as part of Cushing's triad. Here both pupils are quick and equal, so the nerve is not being squeezed and the brain is not herniating.

Unilateral oculomotor nerve damage: Damage to one oculomotor nerve gives you one blown pupil, dilated and not reacting to light. The eyelid on that side can droop, or the eye can point down and out. Both of this patient's pupils got smaller equally, so neither side has that nerve damage.

Enough oxygen is reaching the tissues to meet demand: Enough oxygen reaching the tissues takes enough hemoglobin to carry it. Saturation is only a percentage of whatever hemoglobin is there. This patient has severe anemia, so there is less hemoglobin to carry oxygen.

The number of red blood cells is within normal limits: A normal red blood cell count fits a patient without anemia. The pulse oximeter does not count red blood cells. This patient has severe anemia with pale skin and pale inner eyelids, which points to a low count.

The saturation is falsely raised by the pale skin: Problems at the sensor site can throw off a reading, and pale skin can look like one of those problems. The question says the reading matches the radial pulse you felt. That match tells you the device is picking up real blood flow.

It confirms that early shock is developing: A refill longer than 2 seconds can be a sign of shock. Every other perfusion finding here argues against shock. The central skin is warm, pink, and dry, the radial pulse is strong and regular, and the vital signs are normal.

It indicates the patient is becoming hypothermic: Hypothermia is a real risk for a patient left out in the cold. This patient is calm and alert with warm skin on the trunk, and was outside only about 20 minutes. None of that fits a body temperature that is dropping.

It shows the ankle injury has compromised circulation: Poor circulation from an injury shows up in the injured limb. The refill was checked at the fingertips, and the only injury is a closed ankle injury. An ankle injury cannot explain a finding in the hand.

Attempt the blood pressure again with the child held still: A full set of vital signs normally includes a blood pressure. Holding a poorly perfused 2-year-old still for a third try costs time. The number you get still tells you little at this age.

Apply an adult cuff to the thigh to obtain a reading: An adult cuff on the thigh is a different way to get a number. An adult cuff is far too large for a 2-year-old's thigh. A cuff that is too big gives a falsely low reading, and the child would look worse than the other findings show.

Record the blood pressure as unobtainable and recheck in 15 minutes: Writing the blood pressure down as unobtainable is fine. The 15 minute recheck is the problem. A child with a decreased level of consciousness, mottled skin, and delayed capillary refill is unstable. An unstable child gets reassessed about every 5 minutes.

The most recent set, which is still within adult ranges: Checking each number against the adult range is how you read a single set. Every value in the latest set passes that check. Reading only the latest set leaves out the change over time, and the change over time is what serial vital signs are for.

The first set, which is the recorded baseline: You do need the first set as a starting point. On its own, the first set only tells you where the patient started. The first set becomes useful when you compare it with the later sets, and B never makes that comparison.

The report of only mild abdominal soreness: Mild soreness sounds reassuring, and what the patient tells you does count. Soreness is a symptom the patient reports, while vital signs are signs you measure. Here the measured signs are moving steadily in one direction after a blow to the abdomen.

60 to 100 beats per minute: A rate of 60 to 100 is the normal resting range for an adult. An infant at 60 to 100 would be dangerously bradycardic.

80 to 110 beats per minute: A rate of 80 to 110 is faster than the adult range, but the rate is still too slow for a healthy infant. A normal infant checked against this range would look too fast.

40 to 60 beats per minute: A rate of 40 to 60 in an infant is significant bradycardia. At that rate you worry about poor perfusion and think about starting chest compressions.

A 12-lead ECG interpretation: EMTs can acquire and transmit a 12-lead ECG. Interpreting the 12-lead is outside EMT scope. Reading the tracing is not an EMT step in working up altered mental status.

A blood culture: needs a sterile blood draw from a vein, lab processing, and time for the culture to grow. None of those steps are in EMT scope, and none can be done in the field.

A chest X-ray: needs imaging equipment and radiology training. Both are outside EMT scope, and neither one is available before the hospital.

Normal; no further action needed: No further action would fit a reading between 94 and 99%, the normal adult range. A reading of 91% is below that range, so this patient is not normal.

Only meaningful if the patient also reports difficulty breathing: The patient's own report of trouble breathing is useful, but you do not need to wait for it. SpO₂ is an objective measurement. A low reading counts on its own, even before the patient says anything about their breathing.

Falsely low and should be disregarded: A pulse oximeter can read falsely low with a poor waveform, cold hands, nail polish, or motion. Nothing like that is described in this question. With no sign of a bad reading, you trust the 91%.

Clearly abnormal and requires immediate intervention: An infant with a fast heart rate who is lethargic, poorly perfused, or febrile does need immediate intervention. A rate above about 220/min points to SVT. This infant is alert, feeding, and has no fever, with a rate well below 220/min.

Impossible to interpret without an ECG: You can judge a heart rate by counting the pulse and comparing it to the normal range for age. An ECG is for rhythm problems, like an irregular beat. An ECG is not needed to confirm a rate of 165/min with no other red flags.

Bradycardic for an infant this age: Bradycardia in an infant means a rate below about 100/min. A slow rate like that often signals hypoxia or a coming arrest. This infant is at 165/min, well above 100/min and in the opposite direction.