Skip to content
Free NREMT practice questionsFree Paramedic practice questions · Cardiology & Resuscitation

8 free Paramedic practice questions: Shock States and Hemodynamic Support

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 8, 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 8

A paramedic gave epinephrine 0.3 mg intramuscularly to a 41-year-old patient with asthma who developed hives over the trunk, swollen lips, and wheezing 12 minutes after eating at a restaurant. Twenty minutes later the hives have faded, the lips are no longer swollen, and the wheezing has stopped. The vital signs are BP 122/78, P 92, R 16, and SpO₂ 98% on room air. The patient says, "That was just my asthma, and the shot fixed it. I feel fine now." Which plan is most appropriate?

Show the answer and rationale

Correct answer · Transport and monitor, because symptoms can return hours later without a new exposure

This patient had anaphylaxis, and the symptoms can come back. The hives over the trunk, swollen lips, and wheezing started 12 minutes after a restaurant meal. Hives and swollen lips with wheezing after a meal are anaphylaxis, not an asthma attack, no matter what the patient says. The patient looks completely well 20 minutes after epinephrine. Epinephrine also improves the bronchospasm of asthma. Getting better does not tell you which one the patient had. Anaphylaxis symptoms can go away and then return hours later without a new exposure. Transport this patient and keep monitoring, even though the patient feels fine.

Why the others are wrong

Treat as resolved asthma and release, because epinephrine reverses bronchospasm: Epinephrine does improve the bronchospasm of asthma, so a wheeze that stops after the shot looks like asthma that resolved. The hives and swollen lips before the shot were a second body system. This patient had anaphylaxis and got better from a drug that treats both conditions.

Observe on scene for 30 minutes, because a returning reaction would show up by that time: Watching the patient for 30 minutes sounds careful after a good response. A returning reaction can show up hours later. Thirty normal minutes on scene do not clear this patient.

Repeat the epinephrine now, because the first dose will wear off within minutes: A repeat dose of epinephrine is for symptoms that do not go away. This patient has no symptoms right now. A repeat dose now treats nothing and does not prevent a return hours later.

Question 2 of 8

A 29-year-old patient developed hives, swelling of the lips, and wheezing 8 minutes after a wasp sting. The paramedic gave epinephrine 0.3 mg intramuscularly into the thigh. Twenty minutes later the hives are fading, the lips are no longer swollen, the lungs are clear, and vital signs are BP 124/76, P 92, R 16, SpO₂ 99%. The patient has had hives after stings twice before, each cleared with an antihistamine at home, and wants to take diphenhydramine tablets and decline transport. The patient is alert and understands the risks of refusing. Which action should the paramedic take?

Show the answer and rationale

Correct answer · Advise transport and explain that symptoms can return hours later without another sting

This was anaphylaxis, and the reaction can come back hours later without another sting. A reaction that comes back like that is called a biphasic reaction. The patient had hives, lip swelling, and wheezing 8 minutes after the sting. Skin plus airway is more than one body system. Twenty minutes after the epinephrine, the patient looks completely better, with a blood pressure of 124/76 and clear lungs. A full response to epinephrine does not end the risk. The two earlier episodes were hives alone, and they cleared at home. This reaction involved the airway too. Advise transport and explain why. The patient is alert and understands the risks, so the patient still has the right to refuse after hearing the reason.

Why the others are wrong

Accept the refusal after 30 more minutes of normal vitals, as epinephrine reversed the reaction: Waiting for 30 more minutes of normal vital signs sounds careful, and epinephrine did reverse the symptoms. Feeling fine is the reason the patient wants to leave, not proof the reaction is over. A reaction that returns hours later will not show up in 30 minutes.

Give a second epinephrine dose now to prevent the symptoms from returning: A second epinephrine dose is for symptoms that persist after the first one. This patient's lips are no longer swollen, the lungs are clear, and the hives are fading. A repeat dose now has nothing to treat.

Accept the refusal after oral diphenhydramine, which prevents symptoms from returning: Diphenhydramine is what cleared the earlier episodes, and those were hives alone. This time the skin and the airway were both involved, so it was anaphylaxis. Diphenhydramine is only an add-on to epinephrine. Taking diphenhydramine does not remove the reason for transport, because the reaction can still come back hours later.

Question 3 of 8

A 44-year-old patient has hives, wheezing, and BP 78/42 minutes after a bee sting. The skin is warm and flushed, the neck veins are flat, and the lungs have no crackles. There has been no vomiting, diarrhea, or bleeding. After a 1,000 mL crystalloid bolus the BP is 80/44, and within 6 minutes of intramuscular epinephrine it is 104/66. Which mechanism best explains why the fluid alone failed and epinephrine worked?

Show the answer and rationale

Correct answer · Vessels dilated and leaked, so fluid escaped, and epinephrine constricts them

This is distributive shock from anaphylaxis. The vessels opened and leaked, and epinephrine constricts them. The patient has hives, wheezing, warm flushed skin, flat neck veins, and no crackles. There was no vomiting, diarrhea, or bleeding. The fluid is still in the body, but it has leaked out of the vessels. A bolus goes into vessels that keep leaking, so the pressure only moved from 78/42 to 80/44. Epinephrine is a vasoconstrictor, so it reverses the opened vessels directly. Within 6 minutes of the epinephrine, the pressure was 104/66. In anaphylaxis, intramuscular epinephrine comes first. Fluid is for a pressure that stays low after the epinephrine, never a substitute for it.

Why the others are wrong

Plasma was lost from the body, and epinephrine restored the missing volume: Replacing lost volume is how you fix a pressure that is low from vomiting, diarrhea, or bleeding. This patient had none of those. Epinephrine is a vasoconstrictor, not volume, so it cannot replace anything.

Fluid overloaded a failing left ventricle, and epinephrine cleared the lungs: A failing left ventricle backs fluid up, and you would hear crackles. These neck veins are flat and the lungs have no crackles, so the pump is not backing up. The wheezing is bronchospasm, not fluid in the lungs.

A vagal surge dilated the vessels briefly, and lying flat restored the pressure: A vagal surge does open the vessels for a short time, and lying flat corrects it. This patient has hives and wheezing, and the pressure stayed low after 1,000 mL of fluid. A vagal surge does not explain any of those findings.

Question 4 of 8

A 42-year-old patient develops hives across the chest and abdomen, swelling of the lips, and audible wheezing within minutes of eating a meal containing peanuts at a restaurant. The paramedic obtains vital signs of BP 78/46, P 130, R 28, and SpO₂ 90% on room air. What should the paramedic do next?

Show the answer and rationale

Correct answer · Administer epinephrine intramuscularly in the outer thigh

This patient is in anaphylaxis. The hives, the lip swelling, and the wheezing started within minutes of eating peanuts. The blood pressure is 78/46. Epinephrine IM in the outer thigh is the definitive treatment for anaphylaxis. Epinephrine reverses the vasodilation that is dropping the blood pressure. At the same time, epinephrine opens up the tight airway. Give the epinephrine first. Fluids and more airway support come after this dose, not before it.

Why the others are wrong

Administer broad-spectrum antibiotics intravenously: Broad-spectrum antibiotics are for an infection, like the one behind septic shock. Septic shock builds over hours to days, with a fever and a source of infection. This patient reacted within minutes of eating peanuts.

Administer a norepinephrine infusion for persistent hypotension: A norepinephrine infusion is for low blood pressure that has not responded to first-line treatment. In septic shock, norepinephrine comes in after fluids fail. In anaphylaxis, epinephrine is the first treatment and the definitive one. This patient has not had epinephrine yet, so a vasopressor infusion is not the next step.

Administer a 1-liter normal saline bolus and reassess: A normal saline bolus is good supportive care for the low blood pressure in either septic shock or anaphylaxis. A fluid bolus does nothing for the airway swelling and the bronchoconstriction. Epinephrine treats both of those directly. Give the fluid after the epinephrine, not instead of it.

Question 5 of 8

A 36-year-old patient is found at the bottom of a swimming pool after a diving accident, awake and reporting numbness and an inability to move both legs. The paramedic notes the patient's skin below the nipple line is warm, pink, and dry, while the skin above is unaffected. The vital signs are BP 82/50, P 58, R 20, and SpO₂ 98% on room air. Spinal motion restriction is applied, and the paramedic auscultates clear, equal breath sounds bilaterally with no evidence of external bleeding. Which condition is most likely causing this presentation?

Show the answer and rationale

Correct answer · Neurogenic shock

This patient is in neurogenic shock from a spinal cord injury in the diving accident. The blood pressure is 82/50, and the pulse is only 58. A pressure that low should make the heart speed up to compensate. The dive disrupted the sympathetic pathways that run down the spinal cord below the injury. The vessels below the injury dilate and stay open. That is why the skin below the nipple line is warm, pink, and dry, and the heart rate stays low instead of climbing. Volume replacement alone will not fix this shock. Care also has to treat the dilated vessels and the slow heart rate. Warm this patient aggressively, because heat escapes fast through dilated vessels.

Why the others are wrong

Septic shock: The pulse is 58, and sepsis gives you a fast heart rate. In septic shock the vessels dilate early, so the skin is warm, but the heart speeds up to compensate. This patient also has no fever and no infection source.

Anaphylactic shock: Anaphylaxis needs an allergen exposure, and this patient has no exposure history, no hives, and no wheezing. Histamine dilates the vessels all over the body and the heart rate goes up fast, and this pulse is 58.

Hypovolemic shock: No source of bleeding was found, the skin below the nipple line is warm, pink, and dry, and the pulse stays at 58 instead of climbing. Losing blood or fluid makes the vessels constrict to protect perfusion, so the skin turns pale, cool, and clammy and the pulse runs fast.

Question 6 of 8

A 54-year-old patient reports vomiting a large amount of dark red blood over the past hour and appears anxious. The patient's skin is pale, cool, and diaphoretic, and the paramedic notes weak, rapid radial pulses. The vital signs are BP 84/52, P 128, R 26, and SpO₂ 94% on room air. The patient denies any recent trauma and has no midline back pain or motor deficit on exam. Which condition is most likely causing this presentation?

Show the answer and rationale

Correct answer · Hypovolemic shock

This patient is in hypovolemic shock from bleeding in the gastrointestinal tract. The patient has vomited a large amount of dark red blood over the past hour. The skin is pale, cool, and diaphoretic, and the pulse is 128. Those findings mean the sympathetic nervous system is working and firing hard to make up for the lost blood. The body tightens the vessels in the arms and legs and speeds up the heart to protect the brain and core organs. With a spinal injury, the sympathetic pathways are cut, so the skin stays warm and the heart rate does not climb. You cannot stop bleeding inside the gastrointestinal tract in the field. Protect the airway, because this patient can vomit more blood and aspirate it. Replace fluid per protocol and transport to a hospital that can stop the bleeding.

Why the others are wrong

Cardiogenic shock: can give you the same pale, cool, clammy skin and fast heart rate. You would usually also see crackles, jugular venous distention, or a history of heart disease. None of those are described here, and this patient has an obvious source of blood loss.

Neurogenic shock: follows a spinal cord injury. The skin below the injury stays warm, pink, and dry, and the heart rate does not rise even with a low pressure. This patient has no back pain, no motor deficit, and a pulse of 128.

Septic shock: comes from an infection, usually with a fever. The vessels dilate, so the skin is warm, and the heart speeds up to compensate. No fever or infection is described for this patient, and the skin is pale and cool instead of warm.

Question 7 of 8

A 22-year-old patient sustains a diving injury and is found with paralysis of both legs and diminished sensation to the level of the nipples. The patient's skin below the injury is warm, pink, and dry, and the paramedic notes no external bleeding or signs of other trauma. The vital signs are BP 76/40, P 54, R 14, SpO₂ 97% on room air, and T 95.6°F. The paramedic determines the patient is in neurogenic shock caused by the spinal cord injury. What should the paramedic do next?

Show the answer and rationale

Correct answer · Give a cautious crystalloid bolus and add blankets for hypothermia

This patient needs a cautious crystalloid bolus and blankets. The temperature is 95.6°F, so the patient is already becoming hypothermic. In neurogenic shock, the vessels are dilated because the signals that tighten them are gone. Wide open vessels lose heat through the skin much faster than vessels that are normally constricted. The vessels are wide open, not empty. A cautious bolus supports the pressure without overfilling the vessels. Blankets and active warming treat the temperature drop directly. Hypothermia left untreated can make the blood clot poorly and make the heart irritable.

Why the others are wrong

Give a rapid two liter crystalloid bolus to normalize the blood pressure: The vessels here are dilated, not empty, and this patient has no bleeding source. Pouring in two liters fast risks fluid overload and pulmonary edema without fixing the real problem.

Apply a pelvic binder and prepare for blood product transfusion: Lost vessel tone explains this whole shock, and there is no external bleeding and no sign of other trauma. A pelvic binder and blood products treat a pelvic fracture with internal bleeding, so here there is nothing to bind or transfuse for.

Withhold intravenous fluids to maintain permissive hypotension: This low pressure comes from dilated vessels, not from bleeding, so there is no clot to protect. Permissive hypotension keeps the pressure low so too much fluid does not break up a forming clot in a bleeding trauma patient. Here a low pressure only makes organ perfusion and the heat loss worse.

Question 8 of 8

A 29-year-old develops hives, stridor, and a systolic pressure of 74 within five minutes of a bee sting. Vascular access has not been established. Which action comes first?

Show the answer and rationale

Correct answer · Epinephrine 0.3 mg intramuscularly into the anterolateral thigh

This patient is in anaphylaxis. Hives, stridor, and a systolic pressure of 74 came on within five minutes of a bee sting. The systolic pressure of 74 is what makes this an emergency and not just a rash. Mast cells and basophils are dumping histamine, tryptase, and leukotrienes. Those chemicals open up the blood vessels, make the capillaries leak, and swell the larynx. Epinephrine tightens the blood vessels through its alpha-1 effect, and that raises the pressure. Epinephrine opens the airway through its beta-2 effect. An intramuscular injection into the anterolateral thigh works without an IV. That is why epinephrine comes before fluid, before a vasopressor, before CPAP, and before anyone tries to get vascular access.

Why the others are wrong

Isotonic crystalloid in increments through a large-bore line: Fluid comes after epinephrine, and there is no vascular access yet to give it through. Starting a large-bore line first delays the intramuscular injection that stops the histamine release.

A vasopressor infusion titrated to a mean arterial pressure target: There is no vascular access to run an infusion, and this patient has anaphylaxis, not septic shock. A vasopressor infusion also skips epinephrine, the drug that turns off the chemical release causing this reaction.

CPAP to support the work of breathing: The stridor here comes from swelling of the larynx in the upper airway, and positive pressure at the mouth does not open that swelling. CPAP does nothing for a systolic pressure of 74 either.

Find out which Paramedic topics are costing you points

Ten questions on one topic tell you about that topic. The free diagnostic covers every Paramedic topic and breaks your results down by topic, so you know what to drill next. No card, no signup to try it.

Take the free Paramedic diagnostic

More free Paramedic practice questions by topic