10 free EMT practice questions: Circulation Assessment

An indication for positive pressure ventilations: Blueness limited to the hands and feet in a vigorously crying newborn with pink central color isn't an indication for positive pressure ventilations. This newborn is breathing and perfusing well centrally.

An indication for high-concentration oxygen: It isn't an indication for high-concentration oxygen either: central color is what matters for oxygenation status, and this newborn's trunk and lips are already pink.

A sign of inadequate circulation requiring rapid transport: It isn't a sign of inadequate circulation requiring rapid transport: the central color, strong pulse, and normal respirations show adequate circulation; the peripheral blueness alone is expected at this age.

The reading is accurate because 99% falls within the normal range: Calling the reading accurate because 99% falls within the normal range ignores that the signal itself is faint and repeatedly dropping out, which is a direct sign the device can't get a trustworthy reading.

The reading shows supplemental oxygen is unnecessary: The reading showing supplemental oxygen is unnecessary contradicts the clinical picture of shock this patient is displaying, regardless of what an unreliable number shows.

The reading rules out serious internal blood loss: The reading ruling out serious internal blood loss ignores that vomiting blood along with pale, cool, clammy skin and a weak rapid pulse are themselves strong evidence of ongoing blood loss.

Scalp wounds keep bleeding after pressure is released: Scalp wounds continuing to bleed after pressure is released doesn't explain why this specific amount of blood loss matters more in a child than an adult: the concern here is about total blood volume, not about how stubbornly a scalp wound bleeds.

A child's blood pressure drops before the pulse rises: A child's blood pressure dropping before the pulse rises has it backward: children compensate with a rising pulse first, and blood pressure is typically the last vital sign to fall, arriving late rather than early.

Blood clots more slowly in children than in adults: isn't accurate and isn't the reason a given volume of blood loss carries more weight in a small child.

As the normal rise expected in late pregnancy: A student picks this because they have learned that the heart rate climbs by roughly 20 beats/min by the third trimester. The prenatal card gives the patient's own pregnancy baseline of 92/min, and 116/min with R 24/min after a collision is a change on top of it, not the expected rise.

As a response to pain from the seat belt injury: A student picks this because pain genuinely raises the pulse. The question describes the soreness as mild, and the source directs the EMT not to assign these changes to any cause other than shock in an injured pregnant patient until that cause is established.

As an effect of the increased blood volume: A student picks this because they remember that blood volume rises substantially in pregnancy. The larger volume masks blood loss rather than producing tachycardia, which is why signs of shock appear late in this population and why the finding is treated as urgent rather than explained away.

Estimate the systolic pressure from the pulse sites still palpable: A student picks this because the folklore that a palpable radial pulse means a set systolic pressure is still passed around in the field. It is an estimate rather than a measurement, and the source teaches a cuff technique for this exact situation instead.

Record both a systolic and a diastolic pressure by palpation: A student picks this because they assume palpation is simply a quieter version of auscultation. The palpated method detects only the return of the pulse, so it produces a systolic value alone and no diastolic value.

Move the cuff to the opposite arm and listen again: A student picks this because switching arms is the standard fix for a bad cuff reading. The obstacle in this call is the road and siren noise and the patient's poor perfusion, neither of which changes when the cuff moves to the other arm.

Tighten it only until the bleeding slows while a distal pulse is still present: A tourniquet must be tightened until the bleeding stops. Stopping while a distal pulse remains means arterial flow continues, which can actually increase blood loss.

Place it directly over the wound to compress the injured vessel: The tourniquet is placed proximal to (above) the wound, not over it, so that it compresses the artery supplying the injury.

Plan to loosen it every few minutes to allow blood flow to return to the limb: Once a tourniquet controls bleeding it is not loosened in the field; loosening restarts the hemorrhage and can worsen shock. The time is noted and the device is left in place.

The blood pressure is unchanged and not clinically significant: The systolic reading is nearly unchanged, but the diastolic rise from 80 to 98 mmHg is a real and clinically significant narrowing of pulse pressure, not an insignificant fluctuation.

The diastolic reading must be an error, since it is unusually high: A diastolic pressure of 98 mmHg in this context reflects vasoconstriction from early compensated shock, not an equipment error, and should not be dismissed as a measurement mistake.

A widening pulse pressure, which rules out shock: This scenario shows pulse pressure narrowing, not widening, and a narrowing pulse pressure supports rather than rules out early compensated shock.

No shock: the normal blood pressure shows that perfusion remains adequate: A normal blood pressure never rules out shock; compensated shock is defined by signs of poor perfusion occurring while compensatory mechanisms are still maintaining the pressure, which is exactly what the skin signs, tachycardia, and narrowed pulse pressure show.

Decompensated shock: the pulse of 120/min shows compensation has failed: Tachycardia is a compensatory mechanism doing its job, not evidence that compensation has failed; decompensated shock is marked by a falling systolic blood pressure, and this patient's systolic pressure of 118 mmHg is still maintained, so the shock is compensated.

Stable: the rapid pulse reflects anxiety rather than a circulatory problem: Anxiety and restlessness after significant trauma are early signs of cerebral hypoperfusion and the catecholamine surge, not a simple emotional reaction; attributing a pulse of 120/min with pale, cool, clammy skin to nerves dismisses the compensated shock these findings define and would assign an unsafe low transport priority.

120/80: produces a pulse pressure of 40 mmHg, which is a textbook-normal value, not a narrowed one.

138/72: produces a pulse pressure of 66 mmHg, which is widened rather than narrowed; a widened pulse pressure is associated with conditions such as rising intracranial pressure, not compensated shock.

92/50: produces a pulse pressure of 42 mmHg, which is normal in width; although the systolic value is low, the gap between systolic and diastolic is not narrowed.

The patient is improving because the initially elevated blood pressure has come down: The first blood pressure was not hypertension that needed to settle. It was a pressure being maintained by compensation, with the narrowed pulse pressure as the clue; a fall to 86/64 accompanied by a climbing pulse, mottled skin, and new confusion is decompensation, not normalization, because every associated finding is worsening at the same moment.

The rising pulse is the only significant change between the two sets: The rising pulse is only one of several significant changes between the two sets; the drop in blood pressure, the mottled skin, and the new confusion are each independently ominous, and the falling pressure is the most critical finding of all.

The first set of vital signs already represented decompensated shock: The first set of vital signs showed a maintained blood pressure with signs of compensation, which defines compensated shock; decompensated shock is not present until the blood pressure falls, as it did in the second set.