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Free NREMT practice questionsFree Paramedic practice questions · EMS Operations

6 free Paramedic practice questions: Critical Care and Interfacility Transport

These are real questions from the same bank the app draws from. Each one is written to the NREMT Paramedic content specifications and kept inside the Paramedic scope of practice. Pick an answer and you get the full rationale, including why the other three options are wrong.

Work through all 6, then move on to the next topic. When you want the full picture, the free Paramedic diagnostic covers every topic in one sitting. No account needed for any of it.

Question 1 of 6

During transport, a 28-year-old patient who is severely agitated is secured face down on the stretcher with the wrists and ankles restrained behind the back. The patient continues to struggle against the restraints. The vital signs are BP 152/94, P 138, R 36, and SpO₂ 93% on room air. What should the paramedic do?

Show the answer and rationale

Correct answer · Reposition the patient supine on the stretcher

This patient is at risk of restraint asphyxia. Roll the patient supine. Face down with the wrists and ankles restrained behind the back, the patient cannot expand the chest wall or drop the diaphragm normally. The weight of the torso against the stretcher adds to the load on the chest. A struggling patient is making a large acid load. The body needs a high minute volume, which means moving a lot of air every minute, to make up for the acid. Limiting chest movement at that moment is how agitation turns into restraint asphyxia. The respiratory rate is 36 and the SpO₂ is 93% on room air in a 28-year-old. This patient is working against the restriction and losing. Prone restraint is not an accepted position to monitor a patient in any system. Move the patient supine or onto the side with the airway visible, and monitor continuously. Consider chemical sedation so the struggling stops adding to the acid load.

Why the others are wrong

Add a strap across the upper back and shoulders: A strap across the upper back and shoulders is standard for an agitated patient lying supine. On a supine patient, the strap keeps the patient from sitting up without limiting chest expansion. On a patient who is face down, the strap adds a second load right on top of a chest that already cannot expand. Pressure on a chest that cannot expand is the exact cause of restraint asphyxia.

Continue transport and monitor the patient closely: Close monitoring is right for a patient restrained supine with stable vital signs. In that patient, the risk is a change over time, and monitoring catches the change. Here monitoring only records a decline that monitoring cannot reverse. This young patient has a respiratory rate of 36 and a saturation of 93% on room air. The body is already failing to keep up. Watching does not change a mechanical restriction on the chest.

Loosen the wrist restraints and continue transport: Checking limb restraints is required care, because a restraint that is too tight cuts off circulation. Loosening the wrist restraints is right when the wrists are cool, cyanotic, or pulseless. Loosening the wrists while the patient stays face down leaves the chest just as compressed. Loosening the wrists also gives back the control that made the restraint necessary. The danger is the prone position and the weight on the torso, not the tension at the wrist.

Question 2 of 6

A paramedic requests a helicopter for a critically injured patient at a rural scene. The pilot declines the flight because of weather in the area. Ground transport to the trauma center will take 50 minutes. What should the paramedic do?

Show the answer and rationale

Correct answer · Begin ground transport to the trauma center

Start ground transport to the trauma center now. The pilot turned the flight down because of weather. A weather turndown is a safety call for the aircraft and the crew. The pilot makes that call without knowing how sick the patient is, so the injury cannot put pressure on the decision. This patient is critically injured, and the trauma center is 50 minutes away by ground. Waiting on scene does not get this patient any closer to the trauma center. Use the ground unit you have and go.

Why the others are wrong

Hold the patient on scene until the weather improves: Holding on scene for weather makes sense only when there is no ground option, or when nothing about the patient is time critical. An extrication that is still going is one example, because the patient cannot be moved yet. Ground transport is available here, and this patient is critically injured. Waiting spends time on a weather change that may never come.

Request a second service without stating the turndown: Calling a second service is allowed. A different service may fly a different aircraft from a different base with different weather. The problem is keeping the first turndown from the second service. A second service that is not told about the first turndown is making a safety call without all the facts. Calling one service after another until one says yes, without telling them about the turndown, is called helicopter shopping. Helicopter shopping can send a second crew into the same weather the first crew refused. If you do call a second service, tell them about the turndown, and get the ground unit moving anyway.

Ask the pilot to reconsider and attempt the flight: Asking the pilot to reconsider sounds like standing up for your patient. Pilots are kept from knowing the patient's condition on purpose, so no argument about the patient can change a weather call. Asking again puts that pressure right back on the pilot. A second request also does not move the patient any closer to the trauma center.

Question 3 of 6

A paramedic is preparing to transport an intubated patient from a critical access hospital to a receiving facility 2 hours away by ground. Which action should the paramedic take before departure?

Show the answer and rationale

Correct answer · Calculate the cylinder duration against the transport time

Oxygen gets used up on a long transport. The danger is the cylinder running dry before you reach the receiving facility, with no way to get more. How long a cylinder lasts depends on the gauge pressure, the cylinder constant, and the flow you are giving. Do the math against the expected transport time, and leave extra for delays, traffic, and a diversion. The oxygen math is a routine part of getting ready for any long or rural transfer. Confirm battery power, the medication supply, and a backup way to ventilate at the same time. You do the math before you leave because you cannot fix an empty cylinder two hours down the road with no resupply.

Why the others are wrong

Reduce the positive end-expiratory pressure setting: Positive end-expiratory pressure, or PEEP, gets lowered for specific reasons, like hypotension from poor blood return to the heart or a worry about barotrauma. Even then, lowering PEEP is a careful, titrated change on a patient who is having a problem with it. Nothing in this question says the current setting is causing harm. Lowering PEEP before every transport gives up the alveoli it is holding open on a patient whose settings are working. You would see worse hypoxemia an hour down the road. Checking the cylinder changes nothing about the patient's care and protects the one supply you cannot refill on the way.

Increase the delivered oxygen concentration to 100%: Turning the oxygen up to 100% is right for pre-oxygenation before a procedure or for a patient who is getting worse and needs the reserve. Doing it routinely on a two-hour transfer uses up oxygen much faster. More oxygen use makes the cylinder problem worse, not better. Oxygen is adjusted to the patient's saturation, not turned up just because you are leaving.

Ventilate the patient with a BVM device: A BVM is the required backup for a patient on a ventilator. Confirming one is on board is part of the check before you leave. Using the BVM for the whole trip is the problem. You give up the set rate, tidal volume, and PEEP the patient is already stable on. Bagging also ties up a provider's hands for two hours. The oxygen supply is what you cannot fix once the doors close.

Question 4 of 6

A paramedic responds for a patient who has a left ventricular assist device and is now weak and confused. No radial or carotid pulse can be palpated, and the pulse oximeter does not display a waveform. A continuous mechanical hum is heard over the chest, and the device controller shows no alarms and is connected to power. How should the paramedic assess this patient's perfusion?

Show the answer and rationale

Correct answer · Obtain a mean arterial pressure by Doppler

This patient has a left ventricular assist device (LVAD), and you check perfusion with a Doppler mean arterial pressure. An LVAD is a continuous-flow pump. The pump moves blood in a steady stream instead of in beats. That's why a patient with a working LVAD often has no radial or carotid pulse and no pulse oximeter waveform. Those findings are expected, and you cannot use them to call this patient pulseless. The continuous hum over the chest tells you the pump is running, and the controller has no alarms and is connected to power. Put a manual blood pressure cuff on the arm and a Doppler over the brachial artery. As the cuff deflates, the first sound you hear is the mean arterial pressure. In continuous flow, the mean arterial pressure is the number that means something. Judge perfusion by the mean arterial pressure along with mental status and skin findings. The weakness and confusion still need a cause. In LVAD patients, the cause is often dehydration, low blood volume, bleeding while on an anticoagulant, or a stroke.

Why the others are wrong

Begin chest compressions for pulselessness: Chest compressions are for a patient who is truly unresponsive with no signs of life and a pump that is not working. A pump that is not working means no hum and an alarming controller. This patient is awake enough to be described as weak and confused. Compressions on a running LVAD can also dislodge the outflow cannula. Find out whether the patient is perfusing before anyone starts compressions.

Obtain an automated blood pressure reading: An automated cuff reads the pulsing of blood through the artery. An LVAD moves blood without that pulsing, so the automated cuff usually fails to read or gives an unreliable number. The automated cuff is the routine tool on most calls. In an LVAD patient, a failed or falsely low reading points you to exactly the wrong conclusion. The Doppler does not need a pulse to work.

Disconnect and reconnect the device controller: Disconnecting and reconnecting the controller is a troubleshooting step for an LVAD that is alarming or has stopped. Even then, you do it with the patient's device coordinator, and you should call the coordinator early on any LVAD call. This controller shows no alarms, is on power, and the pump is audibly running. There is nothing to reset. Disconnecting a working pump can stop the circulation completely and cause the arrest you were trying to prevent.

Question 5 of 6

A paramedic is transporting a 2-day-old neonate from a rural hospital to a children's hospital. The transport isolette failed shortly after departure, and the neonate has been covered with a blanket. Thirty minutes later the neonate is jittery and feeding poorly, the skin is mottled, the T is 95.2°F, and the blood glucose level is 32 mg/dL. The P is 168 and the SpO₂ is 96% on room air. What should the paramedic administer?

Show the answer and rationale

Correct answer · Dextrose 10% at 2 milliliters per kilogram

This neonate has hypoglycemia from cold stress. The blood glucose is 32 mg/dL and the temperature is 95.2°F. A 2-day-old has almost no stored glycogen to start with. The isolette failed, so the neonate has been burning glucose to make heat. The small glycogen store ran out fast. That's why the neonate is jittery, feeding poorly, and mottled. Give dextrose 10% at 2 mL/kg. Neonates get the 10% concentration because the blood vessels in a neonate's brain are small and fragile. A more concentrated bolus can shift fluid and cause bleeding inside the brain, called intraventricular hemorrhage. Keep rewarming the neonate, but correct the glucose now.

Why the others are wrong

Dextrose 50% at 1 milliliter per kilogram: Dextrose 50% is the standard adult push for low blood sugar. This patient is 2 days old. D50 is five times more concentrated than the neonatal preparation. A bolus that concentrated can injure small veins and shift fluid across the immature blood vessels in the brain, raising the risk of intraventricular hemorrhage.

Dextrose 25% at 4 milliliters per kilogram: Dextrose 25% is used for older infants and children. A 2-day-old still needs the 10% concentration. At 4 mL/kg, D25 gives about five times the glucose of the correct dose and overcorrects a patient this small.

Glucagon at 0.5 milligrams intramuscularly: Glucagon raises the glucose by releasing glycogen stored in the liver. Glucagon works in an adult with normal glycogen stores and no IV access. This neonate had very little glycogen to start with and has spent 30 minutes burning through it to stay warm. Glucagon has almost nothing left to release.

Question 6 of 6

A paramedic is transporting a patient who has an arterial sheath in place in the right groin after a cardiac catheterization. Twenty minutes into the transport, bright red blood soaks the dressing over the site and a firm swelling is developing in the groin. The vital signs are BP 104/62 and P 108. What should the paramedic do first?

Show the answer and rationale

Correct answer · Apply firm manual pressure above the insertion site

Apply firm manual pressure just above the insertion site. The bleeding is not coming from where the sheath goes through the skin. The bleeding comes from the hole in the femoral artery. The artery is entered at an angle, so the hole in the artery sits above the skin entry. Pressing just above the skin site squeezes the artery against the femoral head. The bone behind the artery is what makes manual pressure work. Bright red blood soaking the dressing is arterial bleeding. The firm, growing groin swelling is a hematoma that is getting bigger. The pulse of 108 tells you the bleeding is already costing this patient volume. Leave the sheath in, because the sheath partly plugs the hole it made. Keep the leg straight and keep checking the swelling. The groin and the retroperitoneum can hold a lot of blood before the swelling looks bad from the outside.

Why the others are wrong

Remove the sheath and apply a pressure dressing: Removing the sheath and dressing the site is what the receiving hospital does, with staff, monitoring, and a plan for holding pressure. Pulling the sheath in a moving ambulance opens the hole in the artery all the way, because the sheath is partly plugging the hole. Sheath removal can also cause a vagal response. This patient already has a pulse of 108 and a pressure of 104/62 and cannot handle a vagal response.

Flex the hip to slow the flow of blood through the vessel: Flexing the hip makes this bleeding worse, not better. Patients with a femoral sheath are kept with the leg straight and the head of the bed low. Bending the hip kinks the sheath, disturbs the puncture site, and causes more bleeding. Bending the hip does nothing to slow blood flow through a hole in an artery the way direct pressure does.

Apply a tourniquet to the thigh above the swelling: A tourniquet is right for major bleeding from an arm or leg when you can put the tourniquet above the bleeding. A puncture in the common femoral artery in the groin is above any spot where a tourniquet fits. Bleeding there is junctional bleeding, which needs direct pressure or a junctional device. A tourniquet on the thigh sits below the bleeding point. The tourniquet cuts off blood to the leg and does nothing to the artery that is bleeding.

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