10 free EMT practice questions: Cardiovascular Emergencies & Cardiac Arrest

Deliver two ventilations with a BVM before making any change to the compressions: Adding ventilations is genuinely part of what the arriving crew brings: a bystander doing compression-only CPR needs the airway managed and breaths folded in at a 30:2 ratio. Ventilations are not the first correction on this scene, because the compressions themselves are not producing flow: hands over the manubrium move very little blood no matter how well the patient is oxygenated. Taking over with correct hand placement is the change that restores perfusion, and the ventilation cycle joins once effective compressions are running.

Allow the bystander to continue compressing in the same position until the automated external defibrillator (AED) is ready: Not interrupting compressions is the right instinct, and it is the reason the key's changeover is planned to cost only a couple of seconds, so half the reasoning here is sound. Ineffective compressions are not worth preserving, though: placement over the manubrium moves very little blood, so protecting them until the AED is ready means minutes of near-zero perfusion. The key protects both principles at once: correct compressions and a minimal pause.

Instruct the bystander to slide the hands lower on the sternum without taking over compressions: Coaching a bystander in place is standard when a lay rescuer is already delivering effective compressions and only needs a small adjustment, and it does avoid a pause. Once trained providers with equipment are on scene, they take over the highest-value task rather than delegating it, and a bystander who has been compressing will tire and drift from correct rate and depth. The key puts the best-trained hands on the chest during a changeover that is already brief.

Pulmonary embolism: does produce sudden pleuritic chest pain with tachycardia and tachypnea, so it belongs on this differential and is the closest competitor here. What it cannot do is take away breath sounds on one side, because the clot sits in the pulmonary vasculature rather than the pleural space, so air still moves in both lungs. PE also asks for a risk factor such as recent immobility, long travel, surgery, or a swollen tender calf, and this question gives you none; the unilateral decreased breath sounds settle it for the key.

Acute coronary syndrome: the reflex thought for any chest pain and is worth ruling out, especially in a patient who looks anxious. ACS presents as pressure or heaviness unaffected by breathing, in a patient with cardiac risk factors, and it does not change breath sounds on one side. A 19-year-old whose pain worsens on deep inspiration with one quiet lung field is describing a lung problem, and the key is the diagnosis that explains the breath sound finding.

Musculoskeletal chest wall pain: Chest wall pain is a strong answer whenever there is a mechanism such as a fall, heavy lifting, or a hard cough, along with tenderness reproduced on palpation. This question explicitly removes that, stating the pain started at rest without any injury, and no tenderness is described. Chest wall pain also never causes decreased breath sounds, which is the one finding the key has to explain and this option cannot.

Supine with the legs elevated: the classic move for hypovolemic or distributive shock, where returning pooled peripheral blood to the core genuinely helps because the problem is an underfilled or over-dilated vascular space. It fails here because the crackles tell you the lungs are already receiving more volume than the left ventricle can move forward. Shifting more blood centrally worsens the pulmonary edema while doing nothing at all for the pump failure underneath it.

Full Trendelenburg position: Full Trendelenburg is the same volume-shifting idea taken to its extreme, and it has largely been abandoned even in hypovolemia. On top of the increased venous return, tipping the patient head-down lets the abdominal organs press up on the diaphragm, which directly increases the work of breathing in someone already struggling. Both effects push the opposite direction from what a conscious patient with pulmonary edema needs.

Left lateral recumbent position: Left lateral recumbent is the airway-protection position, for the patient who is vomiting or cannot manage their own secretions, and it relieves vena cava compression in late pregnancy. This patient is conscious and breathing adequately, so they are protecting their own airway, and the fluid causing trouble is in the alveoli rather than the pharynx. Side-lying trades away the upright mechanical advantage without addressing the actual problem.

Relief after nitroglycerin shows the medication worked, so repeat vital signs can wait until arrival at the hospital: There is no scenario in which giving a medication reduces the need to reassess, and this option is wrong for a reason that has nothing to do with the diagnosis. Nitroglycerin dilates veins and arteries and can produce hypotension, so a patient who just received it needs vital signs rechecked because of the dose, not in spite of it. Deferring vital signs until arrival leaves exactly the window when hypotension would appear uncovered; the key keeps the assessment running.

Relief after nitroglycerin confirms the chest discomfort was cardiac in origin, since only cardiac pain responds to it: This is the trap the item is built around, and the inference behind it is reasonable, since nitroglycerin relieves angina by improving the supply-and-demand balance in the myocardium, so relief feels like proof. The flaw is that the same smooth-muscle relaxation relieves noncardiac chest pain, so a positive response does not isolate the heart as the source. The key is the more accurate statement precisely because it refuses to draw a conclusion the evidence cannot support.

Relief after nitroglycerin rules out a life-threatening cause and supports lowering the transport priority: Downgrading the transport priority on the basis of relief would make sense if pain were the disease and the amount of pain measured the amount of danger. In chest discomfort it does not: an evolving myocardial infarction can be intermittently pain-free while muscle continues to die, and this patient carries a prescription for nitroglycerin, which means known cardiac disease. Priority comes from the presentation and the risk, and the key leaves that judgment where it belongs.

Every 15 minutes, the standard interval used for all patients following a cardiac event: 15 minutes is a real interval and you will use it constantly. It is the standard for the stable patient. The error is in the justification attached to it: there is no rule that keys the interval to the type of event, such as a cardiac event, rather than to the patient's stability. The question hands you the discriminator outright by saying unresponsive with unstable vital signs, and stability, not diagnosis, sets the number.

Once at the start of transport and again immediately before arrival at the hospital: Two sets of vitals is roughly what a short, uneventful transfer of a stable patient might generate in practice, so it does not sound absurd. Ongoing assessment is defined as a repeating cycle: recheck mental status, airway, breathing, circulation, vital signs, and the effect of your interventions, not two isolated snapshots at the ends of the trip. On a patient who can re-arrest, a gap the length of the whole transport means a deterioration would be discovered at the emergency department doors.

Continuously, but only if the cardiac monitor shows visible changes in the electronic waveform: Continuous monitoring is correct and expected in this patient; the fatal word in this option is "only." A monitor reports rate and rhythm, and it will not tell you that the mental status changed, the skin went cool and clammy, the breathing became inadequate, or the pressure fell. Waiting for the screen to change means missing everything hands-on reassessment exists to catch, which is why the timed interval stands on its own.

Yes, because CPR must be started on any pulseless patient regardless of other findings: Starting CPR on every pulseless patient regardless of other findings ignores that dependent lividity and rigor mortis are recognized obvious signs of death, when these are present, the absence of a pulse does not change the fact that resuscitation is not attempted.

No, because resuscitation is rarely successful in patients of this advanced age: Reasoning from the patient's advanced age applies the wrong criterion: age is never the deciding factor; the presence of dependent lividity and rigor mortis is what makes CPR inappropriate, regardless of how old the patient is.

Yes, because only a physician at the hospital can legally pronounce the patient dead: Waiting for a physician at the hospital to pronounce death misapplies the rule, when obvious signs of death like these are already present, CPR is not started at all in the field; pronouncement procedures follow local protocol and do not require initiating futile resuscitation.

Reassure the patient this is unlikely to be cardiac since there is no chest pain: Absence of chest pain would carry real weight in a young patient with no risk factors, and that is where reassurance about a non-cardiac cause is reasonable. This patient is 68, diabetic, and diaphoretic, which describes the exact population that infarcts without chest pain. In this question the missing chest pain should raise suspicion of an atypical presentation rather than lower suspicion of a cardiac one.

Advise the patient to follow up with their primary doctor instead of transporting: Referral to a primary physician is appropriate for a genuinely low-acuity complaint, and even then the decision to leave a patient at home belongs to medical direction, not to a crew suggestion. A diabetic in this age range with unexplained diaphoresis is not that patient. The correct answer keeps the patient with the crew, where a sudden deterioration into arrest is survivable rather than discovered hours later.

Withhold any cardiac-related care since the presentation doesn't fit a classic pattern: This is the same reasoning error as the reassurance option, taken one step further, treating a presentation that does not match the textbook picture as a reason to do less. The supportive care in question carries essentially no risk: oxygen if hypoxic, monitoring, prompt transport. Notice the exam pattern too, because it repeats: three of these four options amount to doing nothing and differ only in how they justify it, and when three options point the same direction and one stands alone, the odd one out is usually the key.

Apply oxygen via nonrebreather mask before assisting with any medication: A student may think any chest-pain patient should receive high-flow oxygen, but the SpO₂ of 98% on room air shows adequate oxygenation, and oxygen is added only when a patient is hypoxic.

Assist with the nitroglycerin now and check the blood pressure afterward: A student may want to relieve the discomfort as quickly as possible and assist first, but nitroglycerin can drop the blood pressure quickly, so the reading must be confirmed before the dose, not after.

Administer a second dose of aspirin instead of the nitroglycerin: A student may think repeating the aspirin will help further, but the patient already received the one-time aspirin dose and a second dose does not address the patient's request for nitroglycerin.

It increases the heart rate to strengthen cardiac output: You might expect a vasodilator to work by speeding the heart up, but a faster heart rate raises oxygen demand rather than lowering it, which is the opposite of what relieves the discomfort.

It thins the blood to prevent new clots from forming: That is aspirin, the other drug you would give in this presentation, and it acts on clot formation. Nitroglycerin's relief comes from lowering the heart's oxygen demand, not from an antiplatelet effect.

It strengthens the heart muscle to increase contraction: Nitroglycerin does not make the heart contract harder. A stronger contraction would raise oxygen demand, and what relieves this patient is lowering it.

Situation: 54-year-old patient brought in with chest pain. Background: Nothing significant that I am aware of. Assessment: The patient could be cardiac and the vital signs have stayed stable. Recommendation: The patient should probably be watched closely: Incorrect. It uses the right headings but carries almost no information: no onset time, no vital signs, no interventions, and "nothing significant that I am aware of" is not a history. The receiving team cannot triage from this.

Situation: 54-year-old patient, 45 minutes of chest pain and diaphoresis. Background: No cardiac history, medications, or allergies. Assessment: This is an acute myocardial infarction with early cardiogenic changes. Recommendation: Draw troponins and activate the cath lab: Incorrect. "This is an acute myocardial infarction" states a diagnosis the EMT is not licensed to make, and ordering troponins and cath-lab activation is the receiving physician's decision, not an EMT recommendation. Report findings and a suspicion, not a diagnosis or orders.

Situation: 54-year-old patient, 45 minutes of chest pain and diaphoresis. Background: No cardiac history, medications, or allergies. Assessment: Alert and anxious, P 108/min, BP 116/72 mmHg, R 18/min, SpO₂ 94%. Recommendation: Suspected cardiac chest pain needing prompt evaluation: Incorrect, and this is the closest miss. It is complete except that it omits the oxygen already applied. Reporting "SpO₂ 94%" without "on high-flow oxygen" misleads the receiving team about how much respiratory support this patient needs: 94% on room air and 94% on 15 L/min are very different patients.