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Free NREMT practice questionsFree EMT practice questions · Primary Assessment

10 free EMT practice questions: Breathing Assessment

These are real questions from the same bank the app draws from. Each one is written to the NREMT EMT content specifications and kept inside the EMT 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

The EMT is assessing a 34-year-old patient who was the restrained driver in a moderate-speed motor vehicle collision. The patient is alert and follows commands but speaks only one or two words at a time. Respirations are 24/min with minimal visible chest rise, and the skin is pale. What is the most appropriate action?

Show the answer and rationale

Correct answer · Assist ventilations with a BVM

Assist ventilations with a BVM. This patient has inadequate breathing. Adequate breathing needs two things: an acceptable rate and an adequate tidal volume. The rate here is 24, but there is minimal visible chest rise. Each breath is moving only a small volume of air. Speaking only one or two words at a time is the same finding, coming from the patient. A small tidal volume at any rate still adds up to too little air per minute. The pale skin is already showing the result. Assist with the BVM, and time your squeezes with the patient's own breaths so you do not fight them. The patient is alert and following commands, and that is reassuring. Mental status changes late in inadequate breathing. Rate and tidal volume change first, so judge the breathing on those.

Why the others are wrong

Apply an NRB at 15 L/min: A nonrebreather mask at 15 L/min raises the oxygen in each breath. The nonrebreather is the right treatment for a patient who is moving enough air but is low on oxygen. This patient's problem is the volume of air being moved. Adding oxygen to a breath that is too small does not make the breath any bigger. The BVM adds volume to each breath and can give high concentration oxygen at the same time.

Reassess the patient's breathing again in 5 minutes: Reassessing in 5 minutes fits a stable patient with a reassuring assessment, when you are watching for change. This assessment has already found inadequate breathing. Inadequate breathing gets treated now. A patient with a small tidal volume can get worse during those five minutes.

Apply a pulse oximeter to determine whether ventilatory support is needed: A pulse oximeter measures oxygen saturation, not ventilation. The reading can stay normal while the patient retains carbon dioxide and moves far too little air. That happens most often early on and in young patients. The decision to assist ventilations comes from the rate and tidal volume, and you have already assessed both. Waiting on a number delays care the physical exam has already called for.

Question 2 of 10

The EMT responds to an office for a 23-year-old patient who reports feeling unable to get a full breath after a heated argument with a coworker. The patient is alert and anxious, sitting upright, and breathing 32/min with deep, regular breaths and full, symmetric chest rise. There is no accessory muscle use, and the skin is warm, dry, and pink. What is the most appropriate action?

Show the answer and rationale

Correct answer · Administer oxygen and coach the patient to breathe more slowly

This patient is hyperventilating after a heated argument. The rate is 32/min, but the breaths are deep and regular with full, symmetric chest rise. There is no accessory muscle use, and the skin is warm, dry, and pink. This patient is moving a lot of air without working hard, so the breathing is adequate. Breathing this fast blows off too much carbon dioxide. The low carbon dioxide is what causes the tingling and the feeling of not getting a full breath. Give oxygen in case something medical is also going on. Coach the patient to slow the breathing down. Slower breathing lets the carbon dioxide climb back toward normal, and that is what makes the symptoms go away.

Why the others are wrong

Assist ventilations with a BVM to slow the breathing rate: Assisting ventilations with a BVM is for a patient whose breathing is not adequate. This patient is alert with full, symmetric chest rise, no accessory muscle use, and warm, dry, pink skin. The breathing is adequate even at 32/min. Bagging an awake patient fights the patient's own breaths and can push air into the stomach. Bagging also drives the carbon dioxide even lower and makes the symptoms worse.

Encourage the patient to take deeper and faster breaths until the symptoms resolve: Deeper, faster breaths sound like the fix for a patient who feels unable to get a full breath. The feeling comes from the low carbon dioxide that the fast breathing already caused. Breathing even deeper and faster drops the carbon dioxide more and makes the tingling and air hunger worse.

Have the patient breathe into a paper bag to control the rate: Breathing into a paper bag was the old treatment for hyperventilation syndrome. The bag was meant to raise the carbon dioxide, the same thing slow breathing does. The paper bag was dropped because you cannot be sure the cause is anxiety. The fast breathing could be the body making up for something like a pulmonary embolism or asthma. Limiting the oxygen would then make a sick patient sicker.

Question 3 of 10

An EMT finds an unresponsive 61-year-old patient on the kitchen floor. There is no chest rise consistent with normal breathing, but approximately every 20 to 30 seconds the patient makes a brief, gasping sound. A 10-second carotid pulse check reveals no pulse. What should the EMT do?

Show the answer and rationale

Correct answer · Begin chest compressions and start CPR

This patient is in cardiac arrest. The 10-second carotid pulse check found no pulse. The gasping sound every 20 to 30 seconds is agonal breathing. Agonal breathing is a brainstem reflex in a dying brain, and it moves almost no air. Agonal gasps are common early in cardiac arrest. Agonal gasps can make bystanders and new providers think the patient is still breathing. No pulse means the heart is not moving any blood. Start high-quality chest compressions right away, give ventilations with them, and put the AED on as soon as you have it.

Why the others are wrong

Deliver rescue breaths only, without chest compressions: Rescue breaths alone are right for respiratory arrest with a pulse. In respiratory arrest the heart is still moving blood, and breathing is the only thing missing. This patient had no pulse on a 10-second carotid check. Breaths without compressions put oxygen into blood that is not going anywhere. Compressions are what move the blood.

Insert an oropharyngeal airway and apply an NRB: An oropharyngeal airway and an NRB fit an unresponsive patient who has a pulse and is breathing adequately. An NRB only works when the patient pulls air in from the mask, and agonal gasps do not pull in enough air. With no pulse, there is also no blood flow to carry the oxygen.

Reassess for a pulse again in one minute before starting compressions: Pulse checks are not always reliable, and providers do miss weak pulses. That's why the pulse check stops at 10 seconds, and if you are not sure, you start compressions. Waiting a minute means a full minute with no blood moving. Compressions on a patient who turns out to have a pulse do far less harm than holding compressions from a patient who has none.

Question 4 of 10

An adult patient was found after an assault with a head injury. Respirations are 14/min, but chest rise is minimal with each breath, and the patient responds only to painful stimuli, having been alert when bystanders called 911. What is the most appropriate action?

Show the answer and rationale

Correct answer · Assist ventilations with a BVM

This patient has inadequate breathing after a head injury. The rate is 14 a minute, but the chest barely rises with each breath. Breathing has to be adequate in both rate and depth. Minimal chest rise means each breath is very small. Small breaths at 14 a minute move far less air than the body needs. Carbon dioxide builds up even though the rate looks normal. The change in mental status shows the breathing is failing. The patient was alert when bystanders called 911 and now responds only to painful stimuli. In a head injury, rising carbon dioxide widens the blood vessels in the brain. Wider vessels raise the pressure inside the skull. Higher pressure in the skull lowers the level of consciousness and weakens the breathing even more. Assist ventilations with a BVM. The BVM gives the patient the full breaths the patient cannot take alone, and those full breaths stop the cycle.

Why the others are wrong

Continue to monitor because the respiratory rate is within normal limits: Monitoring is right when the rate and the depth are both adequate and the mental status is stable. A rate of 14 does not prove the breathing is adequate. This patient's chest barely moves with each breath. Watching does nothing about the rising carbon dioxide.

Apply an NRB and reassess after immobilizing the spine: An NRB fits a patient who is breathing on their own with good volume but has low oxygen. The NRB raises the oxygen in each breath the patient takes. An NRB cannot make a breath bigger, so carbon dioxide keeps building. In a head injury, that carbon dioxide raises the pressure in the skull. Stopping to immobilize the spine before fixing the breathing also gets the order wrong.

Insert a nasopharyngeal airway and monitor breathing: A nasopharyngeal airway is the right tool for an unresponsive patient whose upper airway is blocked. Patients tolerate a nasal airway at a level of consciousness where an oral airway would make them gag. Nothing in this question describes a blocked airway. There is no snoring, gurgling, or stridor. A nasal airway also carries a caution in head injuries. The patient may have an injury to the middle of the face or the base of the skull. An airway adjunct holds the airway open, but an adjunct does not push air in. With an open airway, this patient's breaths are still too small.

Question 5 of 10

A worker at an industrial site was stabbed in the chest during an altercation. The patient is alert with difficulty breathing. When the EMT exposes the chest during the primary assessment, a wound on the right side bubbles and makes a sucking sound with each breath. What should the EMT do immediately?

Show the answer and rationale

Correct answer · Cover the wound with an occlusive dressing

This patient has an open pneumothorax from a sucking chest wound. The wound on the right side bubbles and makes a sucking sound with each breath. Air is getting pulled in through the hole in the chest wall instead of through the airway. Air in the pleural space collapses the lung on that side. That's why this patient is having trouble breathing. Cover the wound with a gloved hand right away. Then seal it with a vented chest seal, or an occlusive dressing taped on three sides. Do not tape all four sides. A seal taped on all four sides lets air in but not back out, and that's how you create a tension pneumothorax. Give high-concentration oxygen, reassess constantly, and transport fast.

Why the others are wrong

Auscultate the breath sounds on the right side: Listening to breath sounds is how you pick up a pneumothorax when there is no open wound to see. This patient already shows you the problem, because the wound bubbles and sucks air with each breath. Seal the wound first. Listen to the breath sounds after.

Begin positive pressure ventilations with a BVM: A bag-valve mask helps a patient who is not moving enough air on their own. Bagging does nothing to close the hole in the chest wall. The wound gets sealed first, and you assist ventilations after that only if this patient needs it.

Place a bulky gauze dressing over the wound: A bulky dressing is what you use to hold an impaled object in place. Gauze is not occlusive. Air keeps moving through gauze and into the chest, so this wound needs an airtight seal.

Question 6 of 10

The time of the call is 0300. A 2-month-old infant has had a cold for two days, and the caregiver states the infant now struggles to breathe during feedings. The EMT sees thick secretions blocking both nostrils, and the infant is working hard to breathe. The distress lessens noticeably whenever the infant cries. Which statement best explains why the breathing improves with crying?

Show the answer and rationale

Correct answer · Young infants breathe mainly through the nose

Young infants breathe mainly through the nose. Thick secretions are blocking both nostrils in this 2-month-old. A blocked nose by itself can cause real trouble breathing. Feedings are worse because the infant's mouth is busy with feeding. When the infant cries, the mouth opens and air moves in through the mouth. Breathing through the mouth gets around the blocked nose, and the distress eases. The problem here is the blocked nasal passages, not a disease of the lower airways.

Why the others are wrong

Crying increases the rate of the respirations: Crying does make an infant breathe faster. A faster rate does not explain why this infant's distress gets better. The relief comes from air moving through the open mouth.

The lower airways open more fully during crying: Opening the lower airways would help a problem down in the lungs. This infant's problem is in the upper airway, where thick secretions are blocking both nostrils.

Secretions drain from the lungs when the infant cries: Secretions draining out of the lungs would matter if the secretions were in the lungs. This infant's secretions are in the nose. Crying does not drain secretions out of the nose either.

Question 7 of 10

A 26-year-old patient was stabbed during an altercation outside a nightclub. The patient is anxious and reports difficulty breathing. During the primary assessment the EMT finds a wound on the left chest wall that makes a hissing sound as air moves through it with each breath. Which injury do these findings indicate?

Show the answer and rationale

Correct answer · Open pneumothorax

This patient has an open pneumothorax. The wound on the left chest wall makes a hissing sound as air moves through the wound with each breath. When the patient breathes in, air gets pulled through the hole in the chest wall into the pleural space. When the patient breathes out, the air gets pushed back out the hole. The pressure inside the chest should stay negative. With the hole open, the pressure in the pleural space evens out with the air outside. A closed chest injury does not move air in and out through the chest wall. Seal the wound with an occlusive dressing taped on three sides. Give high-concentration oxygen. If signs of tension develop, release the dressing to let the trapped air out. Transport rapidly.

Why the others are wrong

Tension pneumothorax: An open wound can turn into a tension pneumothorax as trapped air builds pressure in the chest. Tension shifts the trachea and drops the blood pressure. You would see absent breath sounds, low blood pressure, or jugular vein distention, and none of those are in this question. Tension is the complication you watch for after you seal this wound.

Flail chest: a section of the chest wall broken loose by several rib fractures. That section moves the opposite way from the rest of the chest during breathing. This patient has a hissing wound, not a chest wall moving the wrong way.

Hemothorax: A hemothorax is blood collecting in the pleural space. A hemothorax gives you diminished breath sounds and signs of shock. Blood in the chest does not make a hissing sound at a chest wall wound.

Question 8 of 10

At a transit station, an unresponsive 29-year-old patient with a suspected opioid overdose was found breathing 6 times per minute with shallow chest rise. The EMT provided positive pressure ventilations, and a crew member administered 4 mg of intranasal naloxone. Three minutes later the respirations are 14/min with adequate chest rise, the SpO₂ is 95%, and the patient is drowsy but responds to a loud voice. What should the EMT do next?

Show the answer and rationale

Correct answer · Monitor the breathing closely and continue oxygen en route

The naloxone worked, and this patient is breathing adequately again. The respirations are 14/min with adequate chest rise, the SpO₂ is 95%, and the patient responds to a loud voice. The naloxone pushed enough of the opioid off the receptors that control breathing. The goal of naloxone is adequate breathing, not a fully awake patient. Naloxone can wear off before many opioids do. When the naloxone wears off, the slow breathing can come back. Watch the breathing closely, keep the oxygen on, and be ready to ventilate again on the way to the hospital.

Why the others are wrong

Give additional naloxone until the patient is fully awake: More naloxone is for a patient who is still breathing too slowly or too shallowly after the first dose. This patient's respirations are already 14/min with adequate chest rise. Giving more to get the patient fully awake treats the drowsiness, and the drowsiness is not the problem.

Resume positive pressure ventilations with a BVM: You would go back to the BVM if the rate or depth drops again. Right now the patient is breathing 14 times a minute on their own with adequate chest rise. Bagging a patient who is moving enough air is the right skill at the wrong time.

Insert an oropharyngeal airway before moving the patient: An OPA is for a patient with no gag reflex. A patient who responds to a loud voice likely still has a gag reflex. Putting an OPA in this patient can cause gagging and vomiting.

Question 9 of 10

An EMT is assessing a 54-year-old patient at a community theater who reports difficulty breathing that began during the show. The patient is alert and sitting upright. The EMT prepares to auscultate the breath sounds. Which technique should the EMT use?

Show the answer and rationale

Correct answer · Listen at matching sites on both sides of the chest

This patient has difficulty breathing. Breath sounds tell you the most when you compare the two sides. Listen at matching spots on both sides, from top to bottom. A pneumothorax, a pleural effusion, pneumonia, or bronchospasm from asthma or COPD usually shows up as a difference between the two lungs. Listening at paired spots lets you catch that difference. The difference tells you whether this patient needs repositioning, oxygen, or rapid transport for a problem developing on one side. Listening at one spot would never show you a difference between the lungs.

Why the others are wrong

Listen over the center of the sternum in one location: One spot over the center of the sternum seems quick, and sound does travel. Heart sounds and noise from the large airways are loudest over the sternum. Those sounds cover up the lung fields. One spot also gives you nothing to compare against.

Listen through the clothing to save time: Listening through clothing saves time when you are trying to move fast on scene. Clothing rubs against the stethoscope and muffles the sound. Real crackles, wheezes, or decreased breath sounds can be hidden or changed. The stethoscope has to be on the skin for you to trust what you hear.

Listen only on the side where the discomfort is reported: The side with the discomfort seems like the side with the problem. A collapsed lung or fluid buildup can leave the painful side sounding normal while the other side is decreased. Skipping the other side misses the exact difference you are listening for.

Question 10 of 10

A 68-year-old patient with a history of heart failure has severe difficulty breathing. The patient is anxious, sitting upright, speaking in three-word phrases, and follows commands appropriately. Crackles are heard throughout both lung fields, P 118/min, R 32/min, BP 176/98 mmHg, SpO₂ 84% on an NRB. Which action is most appropriate?

Show the answer and rationale

Correct answer · Apply CPAP and monitor mental status

This patient has cardiogenic pulmonary edema, which is fluid in the lungs from a failing heart. Crackles are heard throughout both lung fields, and the SpO₂ is 84% even on a non-rebreather mask. The patient is still alert, sitting upright, following commands, and speaking in three-word phrases. Fluid floods the air sacs (alveoli) and the tissue around them. Less lung surface is left to move oxygen into the blood. CPAP gives continuous positive airway pressure. The pressure opens collapsed alveoli, pushes fluid back into the lung capillaries, and makes breathing less work. CPAP also lowers the blood returning to the heart and the pressure the failing left ventricle has to pump against. This patient can still protect the airway and is breathing on their own, so CPAP is the right step up from an NRB. Watch the mental status. If the breathing effort or mental status gets worse, switch to ventilating with a bag-valve mask (BVM).

Why the others are wrong

Assist the patient with a prescribed albuterol metered-dose inhaler: Albuterol is for wheezing from narrowed airways, like in asthma or COPD. This patient has crackles in both lung fields. The crackles come from fluid, not from narrowed airways. Albuterol does nothing for the fluid.

Continue high-flow oxygen by NRB and transport rapidly: High-flow oxygen by NRB is enough for a patient whose saturation comes up on it, or one who cannot tolerate a mask seal. This patient's SpO₂ is 84% on the NRB, so the NRB is not enough and CPAP is the next step. Transporting rapidly without stepping up the support leaves the patient at 84%.

Begin positive pressure ventilations at 12/min with a BVM at 15 L/min: Ventilating with a BVM is for a patient with poor breathing effort, no breathing, or a dropping mental status. This patient follows commands and is breathing on their own at 32. Starting a BVM skips over CPAP, the right tool at this stage.

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