10 free EMT practice questions: Pediatric, Geriatric & Special Populations

This is not shock because the blood pressure is within the normal range for age: Low blood pressure is a fairly reliable warning sign in adults. In a child, blood pressure is the last thing to fall. By the time the pressure drops, cardiac arrest is close behind. This child's normal pressure is part of what compensated shock looks like.

This is decompensated shock because the heart rate is markedly elevated: Decompensated shock means compensation has failed. You see a low blood pressure, a child who is hard to wake, and often a heart rate that is falling or too slow. A fast heart rate is the body still compensating. This child is fussy but consolable, and the blood pressure is normal for age.

This is dehydration without shock, and only oral rehydration is indicated: Dehydration without shock is the same illness caught earlier. That child has dry lips and fewer wet diapers, but warm pink hands and feet, fast capillary refill, and a heart rate near normal. This child has cool, mottled skin and a capillary refill of 3 seconds. Those findings mean blood flow to the skin has already dropped. Cool, mottled skin is the line between dehydration and shock. This child needs shock care and transport, not just oral rehydration.

Continue ventilations alone and reassess in 2 minutes: Ventilations alone are right for the first 2 minutes. A slow heart rate from lack of oxygen often comes back up once oxygen reaches the lungs. You already gave those 2 minutes, and the heart rate is still 48 with poor perfusion. Two more minutes of ventilation alone only delays the blood flow this child needs.

Deliver abdominal thrusts for a possible obstruction: Abdominal thrusts are for a foreign body blocking the airway in a responsive patient. An unresponsive patient with a blocked airway gets compressions and a look in the mouth, not thrusts. Nothing here points to a blockage. The airway is open and the ventilations are effective, so air is going in. Drowning fills the lungs with water, and it does not plug the airway with an object.

Apply the automated external defibrillator first: An AED comes first for a sudden collapse in an older child or an adult, where a shockable rhythm is likely. A drowning arrest in a child comes from lack of oxygen, and those rhythms are almost never shockable. This child also still has a pulse of 48. There is no arrest rhythm for the AED to analyze yet.

Continue delivering abdominal thrusts with the child positioned supine: Abdominal thrusts are right for a responsive child. This child just lost consciousness. In an unresponsive patient, thrusts work less well, are harder to do right, and move no blood. This child's heart may be about to stop from the lack of oxygen.

Deliver alternating back blows and chest thrusts as used for an infant: Back blows and chest thrusts are for a responsive infant under one year old. An infant gets a different technique because abdominal thrusts can injure an infant's liver and spleen. This patient is 5 years old. More important, this child is now unresponsive, and an unresponsive patient of any age gets chest compressions.

Perform a blind finger sweep of the mouth before starting compressions: Blind finger sweeps are never done, at any level and at any age. A finger sweeping through a mouth you cannot see into can push the object deeper and wedge it tighter in a small airway. Look in the mouth, and take the object out only when you can see it.

The Glasgow Coma Scale: grades level of consciousness, not a general impression. The Glasgow Coma Scale scores eye opening, verbal response, and motor response. To score the motor response, you have to apply a stimulus and watch what the patient does. Applying a stimulus is a hands-on step. The question describes an assessment done without touching the child.

The SAMPLE history: for gathering a history. SAMPLE stands for signs and symptoms, allergies, medications, pertinent past history, last oral intake, and events leading up to the incident. The SAMPLE history is a verbal interview, not a general impression from sight and sound.

The rapid trauma assessment: a hands-on, head-to-toe check for injuries on a trauma patient. You have to touch the child to do a rapid trauma assessment. The question describes a tool that is done without touching.

Acute stroke causing the confusion and drowsiness: A stroke shows up with a focal deficit, like facial droop, arm drift, or slurred speech on the FAST screen. This patient has none of those. The drowsiness here affects the whole patient and came after a double dose, with a respiratory rate of 8.

Diabetic emergency producing the altered mental status: Hypoglycemia causes altered mental status, and it usually comes with a fast pulse and sweaty skin. Hypoglycemia does not explain a respiratory rate of 8. The empty pill bottle and the double dose point to the medication as the cause of the altered mental status.

Heart failure explaining the low oxygen saturation: Heart failure can drop the SpO2 too, because fluid in the lungs gets in the way of oxygen. Heart failure makes patients breathe fast, with crackles and jugular vein distension. This patient is breathing 8 times a minute. Breathing that slow comes from the medication slowing the brain's drive to breathe, so the low SpO2 traces back to the overdose.

Document the patient's current mental status as the baseline and assume any confusion is new: Writing down what you find as the baseline makes sense when nobody can tell you anything about the patient. Here the staff already told you this patient is not eating and seems "off" to them. The staff have a normal to compare against, and you have not asked for it yet. Calling today's confusion the baseline can hide a new medical problem behind the dementia.

Skip the mental status assessment entirely, as the patient cannot provide reliable information: This patient cannot give you a reliable history. The staff who see this patient every day can. Skipping the mental status assessment throws away information that is right there in the building.

Transport the patient immediately without establishing baseline, as this will be determined at the hospital: Fast transport is right once you suspect a new change. Finding out the baseline takes one quick question to the staff. The hospital will want that answer too, and asking costs you almost no time on scene.

Perform five back blows followed by five abdominal thrusts: Abdominal thrusts, the Heimlich maneuver, are the standard for a conscious patient over 1 year old. This infant is 7 months old. The liver and spleen are not protected by the rib cage, so abdominal thrusts can injure them instead of clearing the airway.

Perform five abdominal thrusts followed by blind finger sweeps: The abdominal thrusts here carry the same risk of organ injury in this 7-month-old. Blind finger sweeps used to be taught, and they are not anymore. A finger sweep done without seeing the object can push the object deeper and make the blockage worse.

Perform back blows only and proceed directly to CPR if the object is not expelled: Back blows are the right first step, but they are only half of the cycle. An infant gets five back blows and then five chest thrusts. Going straight to CPR skips the chest thrusts. CPR starts once the infant becomes unresponsive, and CPR does not replace the chest thrusts.

Hypotensive shock requiring immediate intravenous fluids and rapid transport: Hypotensive shock means the systolic pressure has dropped below the normal range for age. This child's pressure of 90/58 is still normal for a 4-year-old, so the shock has not reached that point yet.

Decompensated shock with altered mental status requiring airway intervention: Decompensated shock shares the fast pulse, the fast breathing, and the cool, pale skin you see here. Altered mental status with airway management would fit a child who has decompensated. This child is alert and crying, and the blood pressure is still 90/58. Both of those findings tell you the body is still compensating.

Normal vital signs for a 4-year-old in pain; no evidence of shock: Pain can raise a child's heart rate and breathing some. A pulse of 150, respirations of 32, and a 3 second capillary refill with cool, pale skin are more than pain can explain. Those are signs of poor perfusion, not simple anxiety.

Elderly patients have stronger pain tolerance and rarely experience true chest pain during a heart attack: Older patients often report less pain for the same amount of heart damage. The cause is changed pain signaling from autonomic neuropathy, not a higher pain tolerance. This patient's sweating and anxiety show the sympathetic response is still working. Calling the missing pain a stronger tolerance gives the wrong reason.

Nausea and fatigue are normal for any 81-year-old and do not warrant concern: Nausea and fatigue alone are common in older patients and can be harmless. This patient also has diaphoresis and anxiety, and the symptoms started suddenly this morning. Together those findings should raise your concern for ACS. Writing them off as normal aging skips looking for the cause.

The patient's medications, especially metoprolol and lisinopril, completely mask the symptoms: Beta blockers like metoprolol blunt a fast heart rate and the sympathetic surge, and a heart rate of only 88 fits that. Metoprolol and lisinopril control heart rate and afterload over time. They do not wipe out pain signals, and "completely mask" overstates what they do. The missing chest pain comes from age-related nerve changes, not from the medication list.

Two of three normal sides mean the child is stable: Two normal sides sound reassuring. The sides are not added up, and one abnormal side is enough to call a problem. This child's work of breathing is abnormal, so the child is not stable.

Normal appearance means the child is stable: A normal appearance is a good sign in a child. This child's flaring and retractions still show a breathing problem, so the child is not stable.

All three sides must be abnormal to signal a problem: Waiting for all three sides to turn abnormal sets the bar too high. A single abnormal side, like the flaring and retractions here, is enough by itself. Two abnormal sides already mean a seriously ill child.