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10 free EMT practice questions: Chest, Abdominal & Multi-System Trauma

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.

Work through all 10, then move on to the next topic. When you want the full picture, the free EMT diagnostic covers every topic in one sitting. No account needed for any of it.

Question 1 of 10

A 35-year-old fell approximately 15 feet from a ladder onto a concrete surface. On primary assessment, the patient responds only to painful stimuli, having been alert on the EMT's arrival minutes earlier. Airway is patent, breathing is rapid and shallow at 26/min, and radial pulses are weak and rapid. There is bruising over the flank and mild abdominal distension. Which finding is most important in establishing this patient as a load-and-go priority, and what should the EMT do?

Show the answer and rationale

Correct answer · Cite the declining mental status and ABC findings, then transport immediately

This patient is a load-and-go priority because the mental status is getting worse. The patient was alert when you arrived and now responds only to pain minutes later. A dropping level of consciousness means the brain is not getting enough blood flow or oxygen right now. The fall makes you suspect injury, and the findings in the primary assessment set the priority. Breathing and circulation are failing too. Breathing is rapid and shallow at 26, so each breath moves too little air. The radial pulses are weak and rapid. Weak, rapid radial pulses point to a narrowing pulse pressure and the body shutting down blood flow to the arms and legs. The flank bruising and abdominal distension point to the likely source, bleeding in the abdomen or in the retroperitoneal space behind it. The source does not change the plan. Treat the life threats, package the patient, and transport. Do the detailed exam on the way.

Why the others are wrong

Cite the fall mechanism alone, then complete a full secondary exam on scene: The fall is a real trauma triage criterion. A fall of about three times body height onto concrete is a good reason to go to a trauma center. The mechanism only makes you suspect injury, and plenty of patients survive a fall like this with minor injuries and normal vital signs. The bigger problem with option A is the full secondary exam on scene. This patient is getting worse, and every minute on scene is a minute the bleeding goes untreated.

Cite the flank and abdominal findings, then complete a full abdominal exam on scene: The flank bruising and abdominal distension are real findings, and they point to where the bleeding is coming from. A full abdominal exam on scene does not change anything you can do about that bleeding. The only EMT treatment for bleeding inside the abdomen is transport. The declining mental status is what tells you how fast to move.

Cite the patent airway as ruling out load-and-go, then complete a full exam on scene: A patent airway is good news, and checking the airway is the right first step of the primary assessment. The airway is only one part of that assessment. Breathing, circulation, and mental status are all abnormal in this patient. An open airway does not stop a patient from bleeding to death, so a patent airway cannot rule out load and go.

Question 2 of 10

A 26-year-old patient sustains a gunshot wound to the left chest. The EMT hears a sucking sound with each breath at the wound site. No commercial occlusive chest seal is available on the unit. What is the most appropriate EMT action?

Show the answer and rationale

Correct answer · Use any air-occlusive material, taped on three or four sides

This patient has an open pneumothorax, a sucking chest wound. The sucking sound is air moving in through the hole in the chest wall instead of through the trachea. When the hole is big enough, air takes that shortcut, and the lung on that side collapses as outside air fills the pleural space. You do not need a commercial chest seal to fix this. Anything air cannot pass through, taped down over the wound, closes the hole. Plastic wrap, the sealed wrapper the dressing came in, or the backing from a defibrillator pad all work. Taped on three sides, the dressing lets air out of the pleural space and blocks air from coming in. Taped on four sides, the dressing seals completely. Watch the patient closely and lift the dressing right away if signs of tension pneumothorax show up.

Why the others are wrong

Leave the wound uncovered until an occlusive dressing arrives: Leaving the wound open does avoid one real problem. A fully sealed dressing with no way for air to escape can turn an open pneumothorax into a tension pneumothorax. An uncovered hole keeps letting outside air in with every breath, and the lung stays collapsed for the whole transport. You also do not need a commercial seal, only material that air cannot pass through. Cover the wound now and lift the dressing if tension signs show up.

Cover the wound with a dry gauze dressing secured with tape: Dry gauze is right for a bleeding soft tissue wound, where you want a dressing that soaks up blood and holds pressure. Gauze is porous, so air passes straight through gauze and the pleural space keeps filling. Taping gauze down looks like a dressing and changes nothing for the patient. This wound needs material that blocks air.

Pack the wound tightly with gauze to stop air movement: Wound packing controls bleeding by pressing gauze down onto a bleeding vessel. Packing is right for bleeding wounds you can compress, like a groin, an armpit, or a thigh. Packing is contraindicated in the chest. Gauze pushed through a chest wound goes into the pleural space, can injure the lung, and is hard to get back out. Packing also does not stop air from moving in around the gauze.

Question 3 of 10

A 33-year-old patient is involved in a motorcycle collision and has an open fracture of the tibia with obvious bleeding, now controlled with direct pressure, and also reports increasing difficulty breathing. The EMT notes diminished breath sounds on the left and a respiratory rate of 26 breaths per minute with shallow effort. What should the EMT prioritize?

Show the answer and rationale

Correct answer · Support ventilation and manage the chest injury first

This patient has a chest injury with failing breathing. The breath sounds are diminished on the left, and the respirations are 26 a minute with shallow effort. The patient reports increasing difficulty breathing, so the breathing is getting worse. The bleeding from the open tibia fracture is already controlled with direct pressure. The primary assessment order sorts out which problem comes first. A breathing problem can kill in minutes, and a long bone fracture with the bleeding controlled does not. Support ventilation and manage the chest first, then finish splinting the tibia on the way. Supporting ventilation also lets you reassess whether the chest injury is getting worse.

Why the others are wrong

Splint the tibia fracture first to control bleeding: Splinting a long bone helps control bleeding and pain. Splinting would come first if the bleeding were still uncontrolled, because an open tibia fracture can bleed a lot. This question says the bleeding is now controlled with direct pressure. A controlled bleed is no longer the life threat, and failing breathing kills sooner.

Obtain a detailed pain assessment before addressing breathing: A detailed pain assessment belongs in the secondary assessment, after the life threats are handled. Asking pain questions while the tidal volume falls spends the most important minutes on information that will not change what you do next.

Elevate the injured leg before assessing the chest: Raising an injured leg is taught as an add on for bleeding control. The bleeding here is already controlled. Raising the leg does nothing for the chest. In the primary assessment, breathing comes before anything you do for the leg.

Question 4 of 10

A 28-year-old patient presents after blunt perineal trauma from a fall while hiking. The patient reports heavy vaginal bleeding. The primary assessment reveals an alert, oriented patient with a patent airway and adequate breathing. Vital signs: BP 118/72 mmHg, P 92/min, R 16/min. The patient is otherwise hemodynamically stable with no other injuries noted. What is the appropriate EMT management for the active vaginal bleeding?

Show the answer and rationale

Correct answer · Place an absorbent pad or sanitary dressing over the perineum and monitor vital signs

This patient has heavy vaginal bleeding after blunt trauma to the perineum, and the patient is stable. The blood pressure is 118/72, the pulse is 92, and the respirations are 16. Care for vaginal bleeding stays on the outside of the body. Place an absorbent pad or sanitary dressing over the perineum, and put nothing into the vagina. The pad soaks up the blood and lets you see how fast the patient is bleeding. Heavy bleeding can still lead to shock in a patient who looks stable now. Recheck the vital signs on the way to the hospital.

Why the others are wrong

Pack the vagina with sterile gauze to achieve hemostasis: Packing gauze into a wound is for a junctional site like the groin or armpit, where a tourniquet cannot reach. Vaginal bleeding is different. Packing the vagina means trying to control the bleeding from inside, and care for vaginal bleeding stays external, with pads and dressings only.

Irrigate the vaginal canal with sterile saline to flush clots: Irrigation flushes dirt and debris out of an open wound. Heavy bleeding needs the clots left alone. Saline pushed into the vaginal canal can wash out clots that are slowing the bleeding. Putting saline into the canal is also internal care, which vaginal bleeding does not get.

Apply direct pressure with a tourniquet above the groin to occlude blood flow: A tourniquet is for bleeding from an arm or a leg when direct pressure does not stop it. This bleeding is coming from the perineum, not from a limb. A band above the groin cannot close off the vessels that are bleeding here.

Question 5 of 10

A 17-year-old patient who is an athlete presents immediately after blunt trauma to the scrotum sustained during a contact sport. The patient reports severe localized pain and mild nausea but denies loss of consciousness or abdominal trauma. The primary assessment is unremarkable. Vital signs are normal: BP 132/78 mmHg, P 88/min, R 16/min. The scrotum is visibly swollen and ecchymotic. The patient is in obvious discomfort and guarding the area. What is the most appropriate prehospital management of this patient?

Show the answer and rationale

Correct answer · Position for comfort with scrotum elevated, apply cold pack, transport for evaluation

This patient has blunt trauma to the scrotum. The scrotum is swollen and bruised, and the patient is in severe pain and guarding the area. Let the patient get into the position that is most comfortable. Elevate the scrotum to bring down the swelling and the pain. Put a cold pack on the area to keep more swelling from building up. These steps are all supportive care. Finding out whether a testicle is damaged has to happen at the hospital, so transport the patient for that evaluation.

Why the others are wrong

Apply ice packs directly to the scrotum for 10 minutes, then transport supine: Cold on the scrotum is part of the right care. Forcing the patient to lie supine is the problem. The patient should stay in whatever position is most comfortable. A also leaves out elevating the scrotum, and elevation helps bring the swelling down.

Palpate both testes to assess for rupture before transport: Checking for a rupture is the hospital's job. Feeling the testes yourself adds pain and can cause more harm. What you find would not change how you treat this patient in the field.

Delay transport for 30 minutes to allow swelling to decrease before moving the patient: Waiting 30 minutes for the swelling to go down only delays care. The scrotum can hold a large amount of blood after a blunt injury. Only the hospital can tell how badly the testicles are hurt, so this patient needs timely evaluation there.

Question 6 of 10

A 35-year-old patient struck in the chest by an object has diminished breath sounds on the right side, with normal breath sounds on the left. Vital signs are stable: P 92/min, R 18/min, BP 132/88 mmHg. The patient's neck veins are normal, trachea is midline, and airway is patent. What is the most appropriate initial management by the EMT?

Show the answer and rationale

Correct answer · Give high-flow oxygen, position upright or semi-recumbent, and transport with monitoring

This patient has a simple pneumothorax. Breath sounds are diminished on the right and normal on the left. The blood pressure is 132/88, the pulse is 92, and the neck veins are normal. Those findings show no signs of a tension pneumothorax. There is air in the pleural space, but not enough pressure to shift the mediastinum or block blood returning to the heart. Breathing and circulation are holding up. Give high-flow oxygen and sit the patient upright or semi-recumbent to make breathing easier. Transport promptly and keep reassessing. Watch for distended neck veins, a falling blood pressure, or breath sounds that go from diminished to absent. Those signs mean the simple pneumothorax is turning into a tension pneumothorax.

Why the others are wrong

Administer high-flow oxygen and prepare equipment for needle decompression en route: Needle decompression is the treatment for a tension pneumothorax, and it is a paramedic skill. The signs of a tension pneumothorax are distended neck veins, tracheal deviation, and hypotension. This patient's vital signs, neck veins, and trachea are all normal, so there is nothing to get ready for. Needle decompression is also not something an EMT carries.

Assist ventilations with a BVM to help reexpand the collapsed portion of lung: Assisting ventilations with a BVM is for a patient who is breathing too slowly or too shallowly, or not at all. This patient has a respiratory rate of 18 and an open airway, which is adequate. Positive pressure can make a pneumothorax worse and speed up a tension pneumothorax.

Perform immediate needle decompression on the right side of the chest at the second intercostal space: Needle decompression at the second intercostal space treats a tension pneumothorax, the kind with distended neck veins, a deviated trachea, and hypotension. None of those are here, since the trachea is midline and the neck veins are normal. Needle decompression is a paramedic skill, so an EMT cannot perform it in any case.

Question 7 of 10

A 22-year-old cyclist struck by a motor vehicle across the anterior chest has high-impact blunt trauma. On assessment, the chest wall is intact with no flail segment, breath sounds are clear and equal bilaterally, but the patient coughs up blood-tinged sputum. Oxygen saturation is 88% on room air and declining. What is the most appropriate EMT action?

Show the answer and rationale

Correct answer · Give high-flow oxygen and monitor for progressive respiratory compromise during transport

This patient has a pulmonary contusion, which is a bruised lung. The chest wall is intact with no flail segment, so this is not a flail chest. The breath sounds are clear and equal, so a pneumothorax or hemothorax is unlikely. The patient is coughing up blood-tinged sputum, and the oxygen saturation is 88% and still dropping. Those two findings point to an injury inside the lung tissue itself. The blunt hit bruised the lung, and blood and fluid are leaking into the alveoli. Alveoli full of blood and fluid cannot move oxygen into the blood. That's why the saturation keeps drifting down instead of crashing all at once. You cannot fix the bruise in the field. Give high-flow oxygen so the alveoli that still work get as much oxygen as possible. Reassess often, because a contusion gets worse over time. This patient may need help breathing before you reach the hospital.

Why the others are wrong

Treat this as simple rib fractures and transport with routine monitoring of vital signs: Routine monitoring fits simple rib fractures with chest wall pain, normal oxygen levels, and no blood in the sputum. This patient is coughing up blood, and a rib fracture by itself does not do that. The saturation is 88% and falling, which means the lung tissue is failing. Calling this simple rib fractures leaves the patient without high-flow oxygen and without close watching.

Apply an occlusive dressing to the entire chest wall to seal air leaks from the injury: An occlusive dressing is the treatment for an open pneumothorax, where air moves through a hole in the chest wall. This chest wall is intact and the injury is blunt, so there is no hole to seal. Covering the whole chest also hides skin you need to keep checking. The dressing also limits how much the chest wall can move, and this patient is already struggling to oxygenate.

Begin positive-pressure ventilations immediately to forcefully reexpand the injured lung: Positive pressure ventilation is right when breathing effort is not adequate. This patient may need ventilations later as the contusion gets worse. Forcing air into bruised, bleeding lung tissue can make the injury bigger and make the bleeding worse. Start with high-flow oxygen while the patient is still breathing on their own, and assist only if that breathing fails.

Question 8 of 10

A trauma patient with a significant mechanism of injury has no visible external wounds but has cool, pale, clammy skin and a rapid heart rate. Which additional finding should increase suspicion for internal bleeding?

Show the answer and rationale

Correct answer · Restlessness and anxiety

Restlessness and anxiety should raise your suspicion for internal bleeding. This patient already has cool, pale, clammy skin and a rapid heart rate after a significant mechanism of injury. As the patient loses blood, less blood is circulating. The brain is one of the first organs to feel the drop in oxygen delivery. That's why the patient gets restless and anxious, and the change in mental status shows up before the blood pressure falls. In a trauma patient, restlessness and anxiety are an early sign of shock, not a behavior problem. Treat for shock and transport rapidly, before the vital signs get worse.

Why the others are wrong

Slow, deep respirations: Shock makes breathing fast and shallow as the body tries to make up for poor perfusion. Slow, deep breathing does not fit this patient.

Warm, flushed skin: goes with distributive shock, where the blood vessels lose their tone, like early sepsis or a spinal injury. This patient's skin is cool, pale, and clammy because the blood vessels have tightened.

Slow heart rate: A patient losing blood speeds up the heart to make up for the loss. This patient already has a rapid heart rate. A slow heart rate would argue against internal bleeding, not for it.

Question 9 of 10

A 36-year-old was struck by a vehicle during a crosswalk, sustaining blunt trauma to the abdomen and left rib cage. The patient is alert and speaking in full sentences. Airway is clear, breathing is adequate at 18/min. Vital signs are: BP 132/86 mmHg, P 108/min, skin cool and diaphoretic, capillary refill 2.5 seconds. The abdomen is soft with mild left-sided tenderness, and the patient reports deep-breathing pain over the ribs. What is the most appropriate management?

Show the answer and rationale

Correct answer · Initiate rapid transport with high-flow oxygen; monitor closely for signs of shock progression

This patient is in compensated shock, most likely from bleeding inside the abdomen. The pulse is 108, the skin is cool and diaphoretic, and capillary refill is 2.5 seconds. The blood pressure is still 132/86. The body is releasing stress hormones that tighten the blood vessels in the skin. The tight vessels move blood away from the skin and toward the core organs. The tight vessels also hold the blood pressure up, even though the tissues are already not getting enough blood. The hit to the abdomen and the left ribs puts the spleen at risk, and an injured spleen can bleed where you cannot see it. Compensation can fail suddenly. Transport rapidly, give high-flow oxygen, and keep reassessing. Watch for the blood pressure to drop, because a drop means the patient is decompensating.

Why the others are wrong

Transport routinely to the nearest hospital for abdominal imaging, as blood pressure is normal: A blood pressure of 132/86 looks reassuring. Routine transport is right when the vital signs really are stable. This patient's pulse of 108, cool and diaphoretic skin, and 2.5 second capillary refill show the body is already making up for blood loss. Waiting for the pressure to fall means you miss shock at the stage where you can still act early.

Delay transport to obtain a complete neurological examination and reassess vital signs in 10 minutes: Repeat vital signs and a neuro exam are standard parts of a trauma assessment. You do those checks on the way to the hospital. Those checks are not a reason to hold the ambulance. The fast pulse and poor perfusion already point to shock, and shock can decompensate during a 10-minute delay.

Apply a circumferential abdominal bandage to stabilize the rib cage and reduce pain: Wrapping or splinting has a place for rib pain. A tight bandage around the whole abdomen is a problem here. The left-sided tenderness points to a possible injury to a solid organ like the spleen. Squeezing the abdomen can raise the pressure inside it and make the bleeding worse. The bandage can also limit the breathing you are trying to protect.

Question 10 of 10

A 42-year-old restrained driver in a frontal motor vehicle collision complains of abdominal pain. Airway is clear, breathing is adequate. Vital signs are: BP 138/90 mmHg, P 96/min, R 16/min, skin warm, capillary refill less than 2 seconds. The abdomen is soft and non-distended with mild epigastric tenderness. There are no obvious external injuries to the abdomen. The patient states, "I think I'm okay; just some stomach pain." What is the most appropriate management?

Show the answer and rationale

Correct answer · Transport rapidly; blunt trauma can cause occult bleeding despite a soft, stable abdomen

This patient may be bleeding inside the abdomen, even with a soft abdomen and stable vital signs. Blunt trauma to the abdomen can injure solid organs like the spleen, liver, and kidneys. Blunt trauma can also injure hollow organs like the small bowel and duodenum. Those injuries can bleed inside without showing up on your exam. A soft, non-distended abdomen does not rule out a serious internal injury. A restrained driver in a frontal crash takes seat belt force across the epigastrium. That mechanism and the abdominal pain are red flags. Stable vital signs can get worse quickly as the bleeding continues. Transport rapidly, so the hospital can do imaging like a CT, ultrasound, or FAST exam and treat the injury before the patient decompensates.

Why the others are wrong

Transport routinely; the patient's vital signs are stable and the abdomen is soft: Routine transport fits a minor mechanism with a truly reassuring exam, like a low-speed bump with no pain and no tenderness. This patient was in a frontal crash and has abdominal pain. Stable vital signs and a soft abdomen can both stay normal while a solid organ bleeds into the abdomen. The abdomen often stays soft until enough blood builds up to irritate the lining of the abdomen.

Administer fluids intravenously to prevent shock during transport: IV fluid is a real treatment for hemorrhagic shock. Starting an IV and running fluid is above EMT scope and belongs to the AEMT and paramedic. IV fluid also does not stop the bleeding, even at a level that can give it. The one thing you control is how fast this patient gets to a surgeon.

Keep the patient NPO and reassess the abdomen for rigidity or distension: Keeping the patient NPO is correct, and you should do it. A patient who may need surgery should not eat or drink. Checking the abdomen again for rigidity or distension is good care too. D is only a monitoring plan and leaves out the transport decision. Do both on the way to the hospital instead of waiting on scene for a sign that may come too late.

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