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

Cite the fall mechanism alone, then complete a full secondary exam on scene: Mechanism is a legitimate trauma triage criterion, and a fall of roughly three times body height onto concrete is a genuine reason to transport to a trauma center, so citing it is not wrong. It is a reason to suspect injury rather than the finding that establishes priority, since plenty of patients survive a fall like this with minor injuries and normal vital signs. The second half is the real failure: this patient's status is actively deteriorating, so time spent on a full secondary exam on scene is time hemorrhage goes untreated. The key cites the findings that are already abnormal instead of the mechanism that predicted them.

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 do point at the source of the bleeding, so noticing them is good assessment. A full abdominal exam on scene changes nothing you can do about it, because there is no EMT-level treatment for intra-abdominal hemorrhage other than transport. Meanwhile the declining mental status changes everything about how fast you move. The key ranks the finding that drives the decision above the finding that merely names the diagnosis.

Cite the patent airway as ruling out load-and-go, then complete a full exam on scene: A patent airway is genuinely good news and confirming it is the correct first step of any primary assessment, so the observation itself is accurate. It is one component of that assessment rather than the whole of it, and the other three, breathing, circulation, and mental status, are all abnormal in this patient. A wide-open airway does not protect anyone from bleeding to death, so it cannot rule out load-and-go status. The key reads the entire primary assessment rather than stopping at the one reassuring part of it.

Leave the wound uncovered until an occlusive dressing arrives: Leaving the wound open avoids one real problem, since a fully sealed dressing with no escape path can convert an open pneumothorax into a tension pneumothorax, so the underlying worry is not baseless. An uncovered hole keeps admitting outside air with every breath and the lung stays collapsed for the whole transport. This option also treats a commercial seal as necessary when the only requirement is that air cannot get through the material. The key improvises right now and keeps the ability to lift the dressing if tension appears.

Cover the wound with a dry gauze dressing secured with tape: Dry gauze is right for a bleeding soft-tissue wound, where absorbency and pressure are exactly the properties you want. Those are the wrong properties for a chest seal: gauze is porous, so air passes straight through it and the pleural space keeps filling. Taping it down looks like a dressing and changes nothing about the physiology. The key requires air-occlusive material, which is the single specification gauze fails.

Pack the wound tightly with gauze to stop air movement: Wound packing controls bleeding by driving gauze down onto a vessel, and it is correct for compressible junctional or extremity wounds such as a groin, an axilla, or a thigh. It is contraindicated in the chest, where material pushed through the wound enters the pleural space, can injure the lung, is difficult to retrieve, and still does not stop air from moving in around it. This treats a bleeding problem when the problem in this question is an air problem.

Splint the tibia fracture first to control bleeding: Splinting a long bone is a genuine hemorrhage-control and pain measure, and it would be the priority if the bleeding were still uncontrolled, since an open tibia fracture can bleed significantly. The question specifically says the bleeding is now controlled with direct pressure, which moves the splint out of the life-threat category. Breathing failure kills sooner, so the key addresses it first and the splint happens on the way.

Obtain a detailed pain assessment before addressing breathing: A detailed pain assessment belongs in the secondary assessment and history, once the life threats have been managed. Working through the pain history while the tidal volume falls spends the only minutes that matter on information that will not change the immediate plan. Assessment that does not change what you do next never outranks an intervention that does.

Elevate the injured leg before assessing the chest: Elevating an injured extremity is a familiar adjunct in bleeding control teaching, but the bleeding here is already controlled and elevation does nothing for the chest. Any leg maneuver sits downstream of a breathing problem in the primary assessment sequence, so this both fails to help and delays what does.

Pack the vagina with sterile gauze to achieve hemostasis: Packing the vagina is beyond EMT scope and may trap infection, create clots that are difficult to remove, or obscure the extent of injury during hospital evaluation.

Irrigate the vaginal canal with sterile saline to flush clots: Irrigation of the vagina is not indicated and may disrupt clot formation or push clots deeper into the canal.

Apply direct pressure with a tourniquet above the groin to occlude blood flow: Tourniquets are not placed on the perineum; they are not effective for vaginal hemorrhage and would cause unnecessary tissue damage.

Apply ice packs directly to the scrotum for 10 minutes, then transport supine: Direct ice application is appropriate, but the patient should not be forced supine if he is more comfortable in another position; elevation is important for swelling reduction.

Palpate both testes to assess for rupture before transport: Palpation by the EMT is unnecessary and potentially harmful; it may increase pain and does not change prehospital management. Hospital ultrasound or imaging will assess for fracture or rupture.

Delay transport for 30 minutes to allow swelling to decrease before moving the patient: Delay of transport is not appropriate when testicular trauma is suspected; the patient requires timely hospital evaluation to rule out serious injury that could affect fertility.

Administer high-flow oxygen and prepare equipment for needle decompression en route: While supplemental oxygen is appropriate, preparing for needle decompression presumes deterioration that has not yet occurred and suggests a procedure outside EMT scope.

Assist ventilations with a BVM to help reexpand the collapsed portion of lung: Assisting ventilations with a BVM is not indicated for a patient breathing adequately at 18/min with a patent airway, and positive pressure can push more air through the pleural injury, enlarging the pneumothorax and risking progression to tension physiology.

Perform immediate needle decompression on the right side of the chest at the second intercostal space: Needle decompression is an advanced procedure (AEMT/Paramedic scope) and is indicated only if the patient develops signs of tension physiology, not on a stable patient with a simple pneumothorax.

Treat this as simple rib fractures and transport with routine monitoring of vital signs: Simple rib fractures with monitoring is a defensible plan for the patient with chest wall pain and tenderness, normal oxygenation, and no hemoptysis. Two findings take it off the table here: the patient is coughing up blood, which no isolated rib fracture produces, and the saturation is 88% and declining, which is lung tissue failing rather than a painful chest wall. Undercalling this means the patient rides in without high-flow oxygen and with nobody watching for the deterioration already underway.

Apply an occlusive dressing to the entire chest wall to seal air leaks from the injury: An occlusive dressing is the correct treatment for an open pneumothorax: a wound in the chest wall with air moving through it. This question states the chest wall is intact and the mechanism is blunt, not penetrating, so there is no hole to seal. Sealing an intact chest accomplishes nothing except covering skin you need to keep looking at, and dressing the entire chest restricts wall movement in a patient already struggling to oxygenate.

Begin positive-pressure ventilations immediately to forcefully reexpand the injured lung: Positive-pressure ventilation is right when respiratory effort is inadequate, and this patient may well need it later, since a worsening contusion is a classic path to assisted ventilation. Right intervention, wrong moment, and forcefully is the wrong adjective in any case. Driving pressure into bruised, bleeding lung tissue can extend the injury and worsen bleeding into alveoli. Start with high-flow oxygen while the patient is still breathing on their own, and escalate only if that effort fails.

Slow, deep respirations: Internal bleeding causes rapid, shallow breathing, not slow, deep respirations.

Warm, flushed skin: Skin becomes cool, pale, and clammy, not warm and flushed, as perfusion decreases.

Slow heart rate: Tachycardia, not a slow heart rate, is a sign of internal bleeding as the body compensates for blood loss.

Transport routinely to the nearest hospital for abdominal imaging, as blood pressure is normal: Incorrect. Despite a normal BP, the clinical constellation of tachycardia, altered perfusion (cool and diaphoretic skin, delayed cap refill), and traumatic mechanism mandates rapid transport. Waiting for BP to drop before recognizing shock is a common, dangerous error.

Delay transport to obtain a complete neurological examination and reassess vital signs in 10 minutes: Incorrect. Delaying transport when compensated shock is present risks rapid decompensation during the delay.

Apply a circumferential abdominal bandage to stabilize the rib cage and reduce pain: Incorrect. Circumferential abdominal bandaging is not an EMT intervention and could worsen internal bleeding by increasing intra-abdominal pressure.

Transport routinely; the patient's vital signs are stable and the abdomen is soft: Routine transport is the right call for a patient whose mechanism is minor and whose exam is genuinely reassuring, a low-speed bump with no complaint and no tenderness. It fails here because the two findings being leaned on, stable vitals and a soft abdomen, are exactly the ones blunt abdominal trauma is known to preserve while a solid organ bleeds into the peritoneum. A restrained driver in a frontal collision has the mechanism; the belt loads the epigastrium, and the abdomen often stays soft until enough blood has accumulated to irritate the peritoneum. The key wins because it acts on the mechanism rather than waiting for the exam to catch up.

Administer fluids intravenously to prevent shock during transport: Intravenous fluid is a real treatment for hemorrhagic shock, but it is above the EMT scope of practice, starting a line and running fluid belongs to AEMT and paramedic. Even at a level that could give it, fluid does not stop the bleeding; it buys time on the way to the surgeon. Choosing it here trades the one intervention an EMT actually controls, time to definitive care, for one they cannot perform.

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 go to surgery should not be eating or drinking, and serial reassessment for rigidity or distension is good care. It is wrong as the answer because it is a monitoring plan, not a transport decision, and it describes waiting on scene for a sign that may not appear until the patient has already lost significant volume. Do this en route; do not let it replace the decision to go.