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10 free EMT practice questions: Hematologic, Immunologic & Infectious Disorders

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

EMS is called to a nursing facility for an 81-year-old patient with a known urinary tract infection. The vital signs are BP 94/58 mmHg, P 118/min, R 24/min, and temperature 102.1°F, and staff report the patient is more confused than usual today. The skin is warm and flushed. Which of the following best describes this presentation?

Show the answer and rationale

Correct answer · Consistent with sepsis: infection with a systemic response, blood pressure not yet hypotensive

This patient has sepsis, and the blood pressure is not yet hypotensive. Sepsis is an infection plus a body-wide response to it. The infection is the known urinary tract infection. The body-wide response is the temperature of 102.1°F, the pulse of 118, the respirations of 24, and the new confusion. In an elderly patient, new confusion is often the first and most obvious sign. Staff saying the patient is more confused than usual today should make you think of sepsis. The blood pressure is what separates sepsis from septic shock. Adult hypotension starts below a systolic of 90. This patient's systolic is 94, so the pressure is still holding. The warm, flushed skin fits too, because the blood vessels are dilating in response to the infection. Transport and monitor this patient closely.

Why the others are wrong

Not an early sign of sepsis, since the blood pressure is within the normal range: A normal blood pressure does not rule out sepsis. Blood pressure is the last thing to fail. The body holds the number up with a faster heart rate and constricted blood vessels long before the pressure drops. Fever, a fast heart rate, fast breathing, and new confusion are the early findings to act on. Waiting for hypotension means waiting until the patient is already in septic shock.

Consistent with septic shock, since a systolic blood pressure of 94 mmHg is already hypotensive: Septic shock may be where this patient is heading. Septic shock applies once perfusion fails, with a systolic below 90 or signs of poor perfusion that fluids do not correct. This patient's systolic is 94. A systolic of 94 is close and calls for close monitoring, but the line is a number, and 94 is above 90.

Consistent with hypovolemic shock, given the patient's age and cool, pale skin: Hypovolemic shock fits a patient who lost volume through vomiting, diarrhea, bleeding, or poor intake. Those patients have pale, cool, clammy skin because the blood vessels clamp down to protect the core. This patient's skin is warm and flushed, not cool and pale like the option says. The question also names an active urinary tract infection. Warm, flushed skin means the vessels are dilating, the distributive pattern that infection causes.

Question 2 of 10

A 16-year-old patient with thalassemia major (who receives scheduled blood transfusions every 3-4 weeks) presents with severe fatigue, difficulty breathing, dizziness, and a notably pale appearance. According to the patient's mother, the patient is due for the next transfusion in 2 days and has been feeling progressively weaker over the past week. Vital signs are BP 108/64 mmHg, P 106/min, R 20/min, and SpO₂ 94%. The patient denies any recent bleeding or trauma. What is the most likely cause of this patient's acute symptoms?

Show the answer and rationale

Correct answer · Acute worsening of chronic hemolytic anemia from increased red blood cell destruction

This patient's thalassemia major is getting worse right before the next transfusion. Thalassemia major is a severe, long-term hemolytic anemia. Hemolytic means the red blood cells are being destroyed. These patients need regular transfusions to keep enough hemoglobin to carry oxygen. Between transfusions, the red cells keep breaking down and the hemoglobin keeps dropping. That's why the patient feels worst right before the next transfusion is due. This patient is due in 2 days and has been getting weaker for a week. The fatigue, trouble breathing, dizziness, and pale skin all come from too few red cells. The pulse of 106 and the SpO₂ of 94% are from the low red cell count too. The lungs are working fine. There is just not enough hemoglobin to carry the oxygen the lungs bring in. The heart speeds up to make up for the missing hemoglobin. The slow slide over a week, lined up with the transfusion schedule, is what points to the anemia.

Why the others are wrong

Acute hemolytic transfusion reaction from the blood products given at the last transfusion: An acute hemolytic transfusion reaction starts during a transfusion or shortly after one, within minutes to hours. The reaction shows up as fever, chills, back or flank pain, dark urine, and a sense of impending doom. This patient's last transfusion was weeks ago, and the next one is due in 2 days. The weakness built over a week instead of hitting all at once.

Acute heart failure from circulatory volume overload caused by repeated blood transfusions: Circulatory overload is a real risk in patients who get a lot of transfusions. Overload looks like fluid the heart cannot handle, with trouble breathing lying flat, crackles, and jugular venous distention. Overload follows a transfusion, and this patient is at the far end of the time between transfusions. Overload also does not make the skin pale. Pale skin points to too few red cells, not too much fluid.

Sepsis from an unrecognized bacterial infection causing the fatigue and rapid pulse: Sepsis is worth thinking about in any patient who gets a lot of transfusions, and fatigue with a pulse of 106 loosely fits sepsis. The signs of infection are missing. There is no reported fever, no source of infection, and the blood pressure of 108/64 is holding. Sepsis gets worse over hours to a day or two. Sepsis does not slide down over a week in step with a transfusion schedule.

Question 3 of 10

The EMT is treating a 4-year-old child in anaphylaxis following a bee sting. A pediatric epinephrine auto-injector is available. How should the EMT administer it?

Show the answer and rationale

Correct answer · Intramuscularly into the lateral thigh

The pediatric epinephrine auto-injector goes intramuscularly into the lateral thigh. This child is in anaphylaxis after a bee sting. In anaphylaxis, histamine widens the blood vessels and makes them leak. Fluid leaking out of those vessels swells the airway. Epinephrine does the opposite of histamine. Epinephrine tightens the blood vessels and relaxes the smooth muscle in the airway. At the EMT level, epinephrine goes in by auto-injector into the muscle of the anterolateral thigh. Give the epinephrine now. Do not wait on oxygen or vital signs first.

Why the others are wrong

Intravenously over 2 minutes: IV epinephrine, in a dilute concentration, is what paramedics give in cardiac arrest. This child is not in arrest. IV medications are AEMT and paramedic scope, not EMT scope. The auto-injector puts epinephrine into the muscle, not into a vein.

Subcutaneously into the upper arm: A subcutaneous injection goes into the fat under the skin. The subcutaneous route is AEMT and paramedic scope, not EMT scope. Intramuscular into the thigh is the route for epinephrine in anaphylaxis.

Intraosseously if venous access cannot be obtained: Intraosseous access is for a patient who needs vascular access when no vein can be found. Intraosseous access is an AEMT and paramedic skill, not an EMT skill. This child does not need vascular access to get epinephrine. Stopping to get vascular access only delays the epinephrine.

Question 4 of 10

A 48-year-old patient developed stridor and severe throat swelling 10 minutes after a medication injection. An epinephrine auto-injector was administered, but swelling and stridor persist. The patient is alert and anxious, breathing with difficulty, the oxygen saturation is 91% on room air, and the airway is patent but compromised by edema. How should the EMT position and oxygenate this patient during transport?

Show the answer and rationale

Correct answer · Position him upright or semi-upright, and provide high-flow oxygen

This patient has anaphylaxis with airway swelling, and the epinephrine has not fixed the swelling yet. The stridor and the throat swelling are still there, and the oxygen saturation is 91% on room air. Stridor means air is squeezing through a swollen, narrowed airway. When breathing is the main problem in anaphylaxis, the patient sits upright or semi-upright. Sitting up makes the work of breathing easier. High-flow oxygen treats the low saturation. Request ALS. Keep suction and a bag-valve mask ready, because this airway can keep swelling during transport. A repeat dose of epinephrine may be needed if the stridor does not get better.

Why the others are wrong

Place him supine with his head turned to the side: Lying on the back is for an anaphylaxis patient whose main problem is a low blood pressure. This patient's main problem is breathing. He has stridor, a swollen throat, and a saturation of 91%, so he needs to sit up.

Place him in the prone recovery position: The recovery position is for an unresponsive patient. The patient lies on the side so secretions drain out of the mouth. This patient is alert and working hard to breathe. A patient with difficulty breathing sits upright, not face down.

Allow him to remain in whatever position feels most comfortable: A position of comfort is part of the care for any patient with trouble breathing. Oxygen is the other part, and option D gives none. This patient has stridor and a saturation of 91%, so he needs high-flow oxygen. Option C is the only one that sits him up and gives him oxygen.

Question 5 of 10

The EMT is treating a 44-year-old patient who ate shellfish 30 minutes ago. The patient has widespread hives on the trunk and extremities but denies any difficulty breathing or throat tightness. However, the EMT notes the patient's baseline heart rate (which the patient reports is normally 68/min) is now 106/min, and the patient's baseline blood pressure (normally 132/82 mmHg) is now 98/60 mmHg. What is the most appropriate interpretation of these vital-sign changes?

Show the answer and rationale

Correct answer · The vital signs indicate systemic involvement and progression toward anaphylaxis

These vital signs show the reaction has gone systemic, and this patient is moving into anaphylaxis. The pulse went from a normal of 68 to 106. The blood pressure went from a normal of 132/82 to 98/60. A systolic of 98 alone would not be called hypotension in most adults. Compare the numbers to this patient's own normal. Within 30 minutes of eating shellfish, the pulse is up 38 beats and the systolic pressure is down 34 points. In an allergic reaction, mast cells and basophils release histamine all through the body. Histamine dilates the blood vessels and makes the capillaries leak plasma into the tissues. The vessels now hold more, and less fluid is left inside them. The blood pressure drops, and the heart speeds up to make up for the drop. Anaphylaxis is a type of distributive shock, and a rising pulse with a falling pressure is that shock starting. The lack of breathing trouble does not rule out anaphylaxis. Anaphylaxis means more than one body system is involved after an allergen exposure, and hypotension after a known allergen counts on its own. This patient has the skin and the circulation involved, which is two systems. The airway may never be the first system to fail, and waiting for the airway can let a treatable reaction turn into cardiac arrest. A reaction limited to the skin gets monitoring and transport. A systemic reaction gets epinephrine, and epinephrine works best before the body stops compensating. Lay the patient flat with the legs raised if tolerated, because sitting up can drop the preload further. Reassess constantly, since these reactions can get worse within minutes.

Why the others are wrong

These are normal anxiety responses to seeing hives; transport is not urgent: Anxiety can raise a pulse. A systolic pressure 34 points below the patient's normal does not come from anxiety. Calling this anxiety lowers the urgency and delays the epinephrine this patient needs now.

Tachycardia and mild hypotension are expected with urticaria and will resolve spontaneously: Hives alone leave the vital signs unchanged. Once the pulse climbs and the pressure falls, the reaction is no longer limited to the skin. Waiting for the reaction to clear up on its own means waiting for the patient to get worse.

These vital signs suggest a different condition unrelated to the allergic reaction: Vital signs that change with no exposure and no skin signs would send you looking for another cause. This patient ate shellfish 30 minutes ago and has widespread hives. Looking for an unrelated cause delays treatment for the anaphylaxis already in front of you.

Question 6 of 10

A 16-year-old patient is stung by a wasp and quickly develops urticaria (hives), facial flushing, and mild itching. The patient denies difficulty breathing or throat tightness and appears calm. Their vital signs are BP 118/74 mmHg, P 88/min, R 14/min, SpO₂ 99%. Which findings are present that would make this a localized allergic reaction rather than anaphylaxis requiring epinephrine?

Show the answer and rationale

Correct answer · Absence of respiratory involvement, normal vital signs, and lack of systemic symptoms

This is a localized allergic reaction, not anaphylaxis. The patient has hives, facial flushing, and mild itching, and denies trouble breathing or throat tightness. The blood pressure is 118/74, the pulse is 88, and the SpO2 is 99%. How bad the skin looks does not decide anaphylaxis. Anaphylaxis means the reaction has gone systemic, with two or more body systems involved or one system failing badly. A failing system looks like airway swelling or stridor, wheezing with low oxygen, hypotension, or vomiting and cramping. Everything this patient has is in the skin, and every other system checks out normal. Care is supportive. Transport for observation, because a reaction that starts in the skin can still get worse over the next hour.

Why the others are wrong

The presence of hives alone indicates anaphylaxis; epinephrine should be given: Hives plus a second body system is anaphylaxis, and most anaphylaxis cases do have skin findings. Epinephrine is for airway, breathing, or circulation problems, not for hives alone. This patient has a clear airway, no breathing complaint, and a normal blood pressure and pulse. Epinephrine for hives alone adds a fast heart rate, tremors, and anxiety, with no shock to reverse.

The insect sting as the trigger; anaphylaxis only occurs with food allergies: Insect stings are one of the most common causes of anaphylaxis in EMS. Any allergen can cause anaphylaxis, including foods, stings, medications, and latex. Anaphylaxis is the immune system's response, not something about the substance. How severe a reaction is depends on which body systems are involved, not on the trigger.

The patient's young age; teenagers rarely develop true anaphylaxis: Age does matter for some things in EMS, like how well children compensate and how differently elderly patients present. Age does not protect this patient. A 16-year-old releases the same chemicals as anyone else, and severe reactions in teenagers are common. This reaction is localized because no breathing or circulation problems are present.

Question 7 of 10

During patient care, an EMT sustains a splash of blood and saliva directly to the eye and mouth while controlling hemorrhage from a patient with unknown bloodborne pathogen status. What is the EMT's immediate priority after stopping direct patient care?

Show the answer and rationale

Correct answer · Immediately rinse the affected eye and mouth with copious water or saline for at least 15 minutes

You have a mucous membrane exposure to blood and saliva from a patient whose bloodborne pathogen status is unknown. The splash hit your eye and your mouth directly. The lining of the eye and the inside of the mouth do not have the tough outer layer that intact skin has. Germs can cross into your bloodstream within minutes. Rinse the eye and mouth with lots of water or saline for at least 15 minutes. The rinse dilutes the blood and washes it out before the germs get in. Rinsing is the only step here that lowers your risk of infection. Rinse before transport goes on, before you document, and before any cleanup back at the station.

Why the others are wrong

Complete the patient handoff at the hospital, then shower as soon as possible at the station: Finishing the handoff and showering at the station is good hygiene after a normal call. Your eye and mouth were already exposed on scene. Waiting lets the blood sit on your eye and mouth for the whole transport. By then you are well past the time when rinsing still limits how many germs get in.

Continue transport while wearing a protective face shield, and report the exposure after arrival at the ED: A face shield protects you from a second splash. Reporting the exposure at the ED is a real step you still have to do. Your eye and mouth are already contaminated, and a shield does nothing for blood that has already hit you. Waiting to report until arrival also pushes the rinse back past the point where rinsing still helps.

Apply antibiotic ointment to the eye and rinse the mouth with mouthwash: Antibiotic ointment is for minor wound care, and mouthwash is for bad breath. Neither one is meant for a bloodborne pathogen exposure. Ointment and mouthwash do not flush the eye or mouth like a large amount of water or saline. Most of the germs stay in place.

Question 8 of 10

A woman was stung by a wasp fifteen minutes ago. Which finding is the most significant sign that her allergic reaction has become anaphylaxis?

Show the answer and rationale

Correct answer · Stridor

Stridor tells you this allergic reaction has become anaphylaxis. The sound is harsh and high-pitched. Air is being forced through an upper airway that is swelling shut. The swelling is in the larynx or the pharynx, and the swelling can close the airway completely within minutes. Stridor is an airway threat, not a skin reaction. Of the four findings, stridor is also the least common. Give intramuscular epinephrine right away, manage the airway aggressively, and transport immediately.

Why the others are wrong

Hives: the classic allergic sign, and they can spread over a lot of the body. Hives stay in the skin, though. Histamine released into the skin causes the hives. Skin findings alone mean an allergic reaction, not anaphylaxis, no matter how widespread they get.

Itching: comes from the same histamine acting on the nerve endings in the skin. Itching tells you nothing about the airway, breathing, or circulation. On its own, itching never makes a reaction anaphylaxis.

Wheezing: a real sign of anaphylaxis, and wheezing does call for epinephrine. The wheeze is a musical sound from bronchospasm and swelling in the lower airways. The lower airways narrow, but they do not seal shut. Stridor comes from the upper airway at the larynx or pharynx, and the upper airway can close off completely. A closed upper airway kills faster.

Question 9 of 10

A 29-year-old patient develops audible wheezing, hives across both arms, and swelling of the lips within minutes of eating a granola bar containing peanuts. The patient is anxious, sitting upright, and speaking in short sentences. The patient's own prescribed epinephrine auto-injector and albuterol metered-dose inhaler are both within reach. The vital signs are BP 92/58 mmHg, P 118/min, and R 26/min, with SpO₂ 93% on room air. What should the EMT do first?

Show the answer and rationale

Correct answer · Assist the patient with the epinephrine auto-injector

This patient is in anaphylaxis. Within minutes of eating peanuts, the patient has hives, lip swelling, and audible wheezing. The blood pressure is 92/58. Hives, lip swelling, wheezing, and a low blood pressure together meet the criteria for anaphylaxis. Epinephrine is the definitive treatment for anaphylaxis. Help the patient use the epinephrine auto-injector first, and do not hold the epinephrine back for anything else.

Why the others are wrong

Assist the patient with the albuterol inhaler: Albuterol is the right drug for bronchospasm, and this patient is wheezing. The inhaler only opens up the lower airways. Albuterol does nothing for the low blood pressure or the lip swelling, and those show the reaction is affecting the whole body.

Contact medical control before giving any medication: Some medications do need an order from medical control first. Helping a patient use the patient's own prescribed epinephrine auto-injector does not need a call first. With a blood pressure of 92/58, waiting on that call is dangerous.

Apply a nonrebreathing mask and continue to reassess: Oxygen is a safe move for a patient with an oxygen saturation of 93%. Oxygen alone does not treat the low blood pressure or the lip swelling. Epinephrine is the definitive treatment, and the epinephrine should not wait while you put on a mask and reassess.

Question 10 of 10

A patient in a sickle cell crisis reports severe pain and appears fatigued. The vital signs are stable except for tachycardia. Which of the following is the most appropriate EMT management?

Show the answer and rationale

Correct answer · Supportive care, position of comfort, oxygen if hypoxic

This patient is in a sickle cell vaso-occlusive crisis. EMT care for a sickle cell crisis is supportive. Put the patient in a position of comfort, give emotional support, and limit any movement the patient does not need. Transport for evaluation and pain management. Give oxygen only if the patient is hypoxic or in respiratory distress. Routine oxygen for a patient who is not hypoxic is not clearly helpful. Pain medication and IV fluids beyond this are given at the hospital or by an AEMT or paramedic.

Why the others are wrong

Restrict oral fluids to reduce the risk of further vaso-occlusion: Fluids protect the patient in a sickle cell crisis. Dehydration concentrates the blood and causes more sickling. Restricting fluids makes the crisis worse.

Apply cold packs to the most painful joints for comfort: Cold packs feel like the natural fix for painful joints. Cold tightens the blood vessels and slows flow through vessels that are already blocked. Cold can make the crisis last longer. Warmth is the comfort measure for a sickle cell crisis.

Withhold pain management until the crisis is confirmed: A patient with known sickle cell disease can tell you what their usual crisis pain feels like. The crisis does not need to be confirmed in the field before the patient gets pain relief. Holding back pain control in sickle cell disease is a known gap in care, not caution.

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