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NREMT practice questions

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Question 1Airway, Respiration, and Ventilation

An adult patient is unresponsive, apneic, and pulseless. After the first cycle of compressions and ventilations with a bag-mask device, you note the chest does not visibly rise. Which action should you take first?

  1. Continue compressions without interruption and ignore chest rise
  2. Switch to mouth-to-mask ventilation without changing hand position
  3. Reposition the head and reopen the airway, then reassess the mask seal Correct answer.
  4. Increase the ventilation rate to compensate for poor air movement

Explanation

When the chest does not rise during bag-mask ventilation, the immediate priorities are opening the airway and correcting the mask seal. Repositioning the head with a chin lift or jaw thrust and reseating the mask addresses the most common causes of ineffective ventilation. Rate increases do not fix an obstructed or leaking airway and may promote gastric inflation.

Question 2Airway, Respiration, and Ventilation

Which finding best indicates that a patient's airway is patent and ventilation is adequate?

  1. Paradoxical inward movement of the abdomen during inhalation
  2. A respiratory rate of 6 breaths per minute with shallow effort
  3. Audible gurgling with each exhalation
  4. Chest rise with ventilation and clear speech in a responsive patient Correct answer.

Explanation

A patent airway permits air movement, and adequate ventilation produces visible chest rise. In a responsive patient, clear speech confirms air is moving past the vocal cords and the airway is open. Gurgling, very slow shallow breathing, and paradoxical abdominal movement all signal compromise.

Question 3Airway, Respiration, and Ventilation

You are assessing a responsive adult with a suspected spinal injury who is speaking in full sentences. Which airway maneuver is most appropriate?

  1. Hyperextension of the neck with a towel roll
  2. Insertion of an oropharyngeal airway without measuring
  3. Head tilt–chin lift
  4. Jaw thrust without head extension Correct answer.

Explanation

In a patient with suspected spinal trauma, the jaw thrust opens the airway while minimizing movement of the cervical spine. The head tilt–chin lift and neck hyperextension can displace an injured spine. An oropharyngeal airway requires proper measurement and is not the first step for a patient who is speaking.

Question 4Airway, Respiration, and Ventilation

An adult with a severe asthma exacerbation is alert, speaking in short phrases, with audible wheezing and a pulse oximetry reading of 91% on room air. Which intervention is most appropriate initially?

  1. High-flow oxygen and nebulized albuterol Correct answer.
  2. Immediate endotracheal intubation
  3. Encouraging the patient to breathe slowly without supplemental oxygen
  4. Assisted ventilation with a bag-mask device at a fast rate

Explanation

Severe asthma with hypoxemia and increased work of breathing is treated with supplemental oxygen and inhaled bronchodilators. These measures relieve bronchospasm and improve oxygenation. Bag-mask ventilation is reserved for patients with inadequate spontaneous breathing, and intubation is a later step if treatment fails.

Question 5Airway, Respiration, and Ventilation

Which statement correctly describes the purpose of the Sellick maneuver during bag-mask ventilation?

  1. It measures the depth of chest compressions
  2. It confirms placement of an oropharyngeal airway
  3. It opens the airway by lifting the jaw forward
  4. It reduces the risk of gastric inflation by applying cricoid pressure Correct answer.

Explanation

The Sellick maneuver applies pressure to the cricoid cartilage to compress the esophagus against the cervical spine. This is intended to reduce the likelihood of regurgitation and gastric inflation during positive-pressure ventilation. It does not open the airway or assess device placement.

Question 6Airway, Respiration, and Ventilation

Which device is most appropriate for delivering a precise oxygen concentration to a spontaneously breathing patient who requires high FiO2?

  1. Venturi mask at a set liter flow
  2. Nonrebreather mask at 15 L/min Correct answer.
  3. Simple face mask at 6 L/min
  4. Nasal cannula at 2 L/min

Explanation

A nonrebreather mask with a reservoir delivers the highest oxygen concentration to a spontaneously breathing patient. It is used when severe hypoxemia requires near-maximal FiO2. Nasal cannula and simple masks provide lower, less reliable concentrations.

Question 7Airway, Respiration, and Ventilation

During ventilation with a bag-mask device, you observe the epigastrium rising while the chest rises only minimally. What is the most likely cause?

  1. Inadequate mask seal on the face
  2. The oxygen reservoir is not attached
  3. The patient is breathing spontaneously
  4. Excessive ventilation volume entering the esophagus and stomach Correct answer.

Explanation

Epigastric rise with minimal chest rise suggests air is entering the stomach rather than the lungs. This typically results from excessive volume or pressure during ventilation or from an improperly positioned airway. Reducing volume and ensuring correct airway positioning helps resolve it.

Question 8Airway, Respiration, and Ventilation

Which finding is most consistent with adequate oxygenation during supplemental oxygen therapy?

  1. Cyanosis of the lips and nail beds
  2. Respiratory rate of 4 breaths per minute
  3. Pulse oximetry of 94% to 99% with improved work of breathing Correct answer.
  4. Accessory muscle use with nasal flaring

Explanation

Adequate oxygenation is reflected by a pulse oximetry reading in the normal range and a reduction in respiratory effort. Cyanosis and accessory muscle use indicate inadequate oxygenation or increased work of breathing. A very slow rate signals respiratory failure.

Question 9Airway, Respiration, and Ventilation

An adult patient is in respiratory arrest with a palpable pulse. Which ventilation rate should be provided with a bag-mask device?

  1. One breath every 5 to 6 seconds Correct answer.
  2. One breath every 10 seconds
  3. One breath every 15 seconds
  4. One breath every 2 seconds

Explanation

For an adult in respiratory arrest with a pulse, provide one breath every 5 to 6 seconds, which is about 10 to 12 breaths per minute. This rate supports oxygenation without excessive intrathoracic pressure. Faster rates can impair venous return and cause gastric inflation.

Question 10Airway, Respiration, and Ventilation

Which patient is the best candidate for an oropharyngeal airway?

  1. An unresponsive patient without a gag reflex Correct answer.
  2. A patient who is speaking but has noisy breathing
  3. A patient with suspected basilar skull fracture
  4. A responsive patient with a gag reflex

Explanation

An oropharyngeal airway is indicated for an unresponsive patient who lacks a gag reflex and needs airway support. It holds the tongue away from the posterior pharynx. It should not be used in a patient with an intact gag reflex because it can trigger vomiting or laryngospasm.

Question 11Airway, Respiration, and Ventilation

You are preparing to insert a nasopharyngeal airway in a patient with facial trauma. Which assessment is most important before insertion?

  1. Presence of a gag reflex
  2. Ability to speak in full sentences
  3. Pulse oximetry reading
  4. Signs of basilar skull fracture or severe midface instability Correct answer.

Explanation

A nasopharyngeal airway should be avoided when basilar skull fracture or severe midface instability is suspected because of the risk of intracranial placement or further injury. Gag reflex status determines OPA use, not NPA use. Oxygenation and speech do not contraindicate NPA placement.

Question 12Airway, Respiration, and Ventilation

Which physical finding most strongly suggests upper airway obstruction in an unresponsive patient?

  1. A regular pulse with warm extremities
  2. A pulse oximetry reading of 98%
  3. Bilateral breath sounds with a soft abdomen
  4. Paradoxical chest and abdominal movement with no air movement at the mouth Correct answer.

Explanation

Paradoxical chest and abdominal movement with no air movement at the mouth indicates the airway is obstructed and the patient is making ineffective respiratory effort. Bilateral breath sounds and normal oximetry suggest the airway is open. This finding requires immediate airway opening maneuvers.

Question 13Airway, Respiration, and Ventilation

Which action best prevents gastric inflation during bag-mask ventilation of an adult?

  1. Ventilating with just enough volume to produce visible chest rise Correct answer.
  2. Delivering each breath over one second at maximal squeeze
  3. Using the largest available mask regardless of fit
  4. Increasing the ventilation rate to 20 breaths per minute

Explanation

Gastric inflation is minimized by delivering only enough volume to make the chest rise and by avoiding excessive pressure. Overly forceful or rapid ventilation drives air into the esophagus and stomach. A properly sized mask and a controlled rate further support effective ventilation.

Question 14Airway, Respiration, and Ventilation

A patient with a tracheostomy tube is in respiratory distress with decreased breath sounds and no air movement at the nose or mouth. What should you assess first?

  1. The oxygen reservoir on the bag-mask device
  2. The patient's ability to speak
  3. The tracheostomy tube for obstruction or dislodgement Correct answer.
  4. The presence of a gag reflex

Explanation

In a patient with a tracheostomy, the tracheostomy tube is the primary airway and should be assessed first for obstruction, mucus plugging, or dislodgement. Ventilation should be provided through the tracheostomy if it is patent. Assessing speech, reservoir, or gag reflex does not address the immediate airway problem.

Question 15Airway, Respiration, and Ventilation

Which statement about pulse oximetry is correct?

  1. It reliably detects hypoventilation in all patients
  2. It estimates oxygen saturation and can be affected by poor perfusion Correct answer.
  3. It directly measures arterial oxygen tension
  4. It replaces the need for clinical assessment of breathing

Explanation

Pulse oximetry estimates the percentage of hemoglobin saturated with oxygen and depends on adequate peripheral perfusion for accurate readings. Cold extremities, hypotension, and motion can produce inaccurate values. It does not measure arterial oxygen tension or replace clinical assessment.

Question 16Airway, Respiration, and Ventilation

An adult patient has a respiratory rate of 28, shallow depth, and oxygen saturation of 88% despite a nonrebreather mask. What is the most appropriate next step?

  1. Apply a nasal cannula at 4 L/min
  2. Continue the nonrebreather mask and reassess in 10 minutes
  3. Assist ventilations with a bag-mask device Correct answer.
  4. Encourage the patient to take deeper breaths

Explanation

Inadequate ventilation with hypoxemia despite high-flow oxygen indicates the patient needs assisted ventilation. Bag-mask ventilation supports both oxygenation and ventilation. Continuing the same therapy or adding a low-flow device will not correct the underlying hypoventilation.

Question 17Airway, Respiration, and Ventilation

Which finding indicates that an oropharyngeal airway is the correct size for an adult patient?

  1. The tip extends past the uvula when the flange is at the teeth
  2. The device reaches the carina
  3. The flange sits at the chin when the tip is at the earlobe
  4. The flange rests at the lips when the tip reaches the angle of the jaw Correct answer.

Explanation

An oropharyngeal airway is correctly sized when the flange rests at the lips and the tip reaches the angle of the mandible. This places the tip behind the tongue without advancing too far. An airway that is too long can obstruct the airway or stimulate the larynx.

Question 18Airway, Respiration, and Ventilation

Which statement best describes the relationship between ventilation and oxygenation?

  1. Ventilation and oxygenation are identical processes
  2. Oxygenation occurs only in the upper airway
  3. Ventilation is the movement of air; oxygenation is the transfer of oxygen to the blood Correct answer.
  4. Ventilation occurs only in the alveoli

Explanation

Ventilation refers to the movement of air into and out of the lungs, while oxygenation is the process by which oxygen enters the blood. They are related but distinct, and a patient can have adequate ventilation with poor oxygenation. Understanding the difference guides oxygen and ventilation therapy.

Question 19Airway, Respiration, and Ventilation

A patient with a suspected opioid overdose is unresponsive with slow, shallow breathing and a pulse. Which intervention is most appropriate?

  1. Apply a nasal cannula and monitor
  2. Assist ventilations and administer naloxone per protocol Correct answer.
  3. Begin chest compressions immediately
  4. Insert an oropharyngeal airway and wait for improvement

Explanation

Opioid overdose with inadequate ventilation requires assisted ventilation and naloxone to reverse respiratory depression. Supporting ventilation is essential because naloxone may take time to act. Chest compressions are indicated only when there is no pulse.

Question 20Airway, Respiration, and Ventilation

Which assessment finding most strongly suggests inadequate minute ventilation?

  1. A respiratory rate of 8 with shallow depth and confusion Correct answer.
  2. Warm, dry skin with a regular pulse
  3. A respiratory rate of 22 with normal depth and clear speech
  4. A pulse oximetry reading of 97% with normal effort

Explanation

Minute ventilation is the product of respiratory rate and tidal volume. A rate of 8 with shallow depth produces low minute ventilation, and confusion suggests inadequate gas exchange. Normal rate, depth, and oxygen saturation argue against inadequate ventilation.

Question 21Airway, Respiration, and Ventilation

Which technique best confirms correct placement of a supraglottic airway device?

  1. Presence of a gag reflex
  2. Insertion depth measured from the chin
  3. Auscultation of the epigastrium and lungs with chest rise Correct answer.
  4. Palpation of the device cuff

Explanation

Correct placement of a supraglottic airway is confirmed by chest rise and by auscultating the lungs while checking the epigastrium for absent sounds. Epigastric sounds suggest esophageal placement or gastric inflation. Device depth and gag reflex do not confirm ventilation.

Question 22Airway, Respiration, and Ventilation

Which patient condition most increases the risk of aspiration during bag-mask ventilation?

  1. Full stomach with decreased level of consciousness Correct answer.
  2. Normal oxygen saturation
  3. An empty stomach after fasting
  4. A patent airway with a strong cough

Explanation

Aspiration risk rises when the stomach is full and protective airway reflexes are impaired, as with decreased consciousness. Positive-pressure ventilation can force gastric contents into the airway. Fasting, a strong cough, and normal saturation reduce rather than increase this risk.

Question 23Airway, Respiration, and Ventilation

A patient with a severe foreign body airway obstruction is conscious but cannot speak or cough effectively. Which action is most appropriate?

  1. Perform a blind finger sweep
  2. Deliver abdominal thrusts Correct answer.
  3. Apply a nasal cannula
  4. Encourage forceful coughing

Explanation

A conscious patient with severe obstruction who cannot speak or cough effectively requires abdominal thrusts to expel the object. Blind finger sweeps can push the object deeper and are not recommended. Encouraging coughing is appropriate only when the patient can cough forcefully.

Question 24Airway, Respiration, and Ventilation

Which statement about respiratory rates in older adults is most accurate?

  1. Baseline respiratory rate is always higher than in younger adults
  2. A normal resting rate may mask serious illness because of reduced respiratory reserve Correct answer.
  3. Respiratory rate is the least useful vital sign in older adults
  4. Older adults rarely experience hypoxemia

Explanation

Older adults may have reduced respiratory reserve, so a normal resting rate does not guarantee adequate ventilation during illness. Deterioration can occur with subtle changes in rate and effort. Respiratory rate remains a valuable and sensitive indicator of worsening condition.

Question 25Airway, Respiration, and Ventilation

Which device delivers a fixed, precise oxygen concentration regardless of the patient's inspiratory effort?

  1. Nonrebreather mask
  2. Nasal cannula
  3. Venturi mask Correct answer.
  4. Simple face mask

Explanation

A Venturi mask uses a specific air-entrainment ratio to deliver a fixed oxygen concentration. This makes it useful when precise FiO2 control is needed. Nasal cannula, simple masks, and nonrebreather masks deliver variable concentrations that depend on the patient's breathing pattern.

Question 26Airway, Respiration, and Ventilation

A conscious adult is breathing spontaneously but has an oxygen saturation of 84% and is unable to maintain a patent airway. Which device is most appropriate to support both airway patency and oxygenation in this patient?

  1. Nonrebreather mask
  2. Nasal cannula
  3. Bag-mask device with an oropharyngeal airway Correct answer.
  4. Simple face mask

Explanation

When a patient cannot maintain a patent airway and is hypoxic, ventilation support with a bag-mask device and an airway adjunct is needed because passive oxygen devices do not protect or open the airway. A bag-mask device delivers both ventilation and high-concentration oxygen while an oropharyngeal airway keeps the tongue from obstructing the pharynx.

Question 27Airway, Respiration, and Ventilation

During positive pressure ventilation, air is heard entering the stomach and the chest does not rise adequately. Which adjustment most directly addresses this problem?

  1. Increasing the ventilation rate
  2. Repositioning the head and delivering slower, smaller breaths Correct answer.
  3. Applying firmer pressure on the mask
  4. Increasing the oxygen flow rate

Explanation

Air entering the stomach usually indicates the airway is not properly aligned or that breaths are delivered too forcefully or too quickly. Repositioning the head and giving slower, smaller breaths that just produce visible chest rise reduces esophageal opening pressure and limits gastric inflation.

Question 28Airway, Respiration, and Ventilation

Which assessment finding best confirms that alveolar ventilation is adequate in a patient receiving assisted breaths?

  1. A strong radial pulse
  2. Warm and dry skin
  3. Clear and equal breath sounds with visible chest rise Correct answer.
  4. A rising oxygen saturation trend

Explanation

Ventilation is assessed by evidence that air is moving into and out of the lungs, which is confirmed by visible chest rise and bilateral breath sounds. Oxygen saturation reflects oxygenation and may lag behind changes in ventilation, so it is not the primary confirmation of adequate ventilation.

Question 29Airway, Respiration, and Ventilation

An adult who is apneic but has a palpable carotid pulse requires rescue breathing with a bag-mask device. Which delivery pattern is appropriate?

  1. One breath every 2 seconds
  2. One breath every 3 seconds
  3. Two breaths every 30 seconds
  4. One breath every 10 seconds Correct answer.

Explanation

For an adult in respiratory arrest with a pulse, ventilations are delivered at roughly one breath every 5 to 6 seconds, which is about 10 to 12 breaths per minute. This rate maintains oxygenation without the hypocapnia and gastric inflation that excessively fast ventilation can cause.

Question 30Airway, Respiration, and Ventilation

Which patient is the most appropriate candidate for an oropharyngeal airway?

  1. A patient with an intact gag reflex who is drowsy
  2. A patient who is alert but has noisy breathing
  3. A conscious patient with a gag reflex
  4. An unresponsive patient without a gag reflex Correct answer.

Explanation

An oropharyngeal airway is indicated for unresponsive patients who lack a gag reflex, because the device can provoke gagging, vomiting, and aspiration if protective reflexes are present. It is used to hold the tongue away from the posterior pharynx in patients who cannot maintain their own airway.

Question 31Airway, Respiration, and Ventilation

A patient has sustained blunt facial trauma with suspected midface instability. Which consideration most affects the decision to use a nasopharyngeal airway?

  1. The presence of basilar skull fracture signs Correct answer.
  2. The patient's level of consciousness
  3. The patient's oxygen saturation
  4. The patient's gag reflex

Explanation

Nasopharyngeal airways are avoided when there are signs of basilar skull fracture or severe midface instability, because the tube could pass into the cranial vault or disrupt tissue. Facial trauma alone does not prohibit the device, but evidence of skull fracture and midface instability changes the risk substantially.

Question 32Airway, Respiration, and Ventilation

Which finding in an unresponsive patient most suggests obstruction of the upper airway?

  1. Absent breath sounds over one hemithorax
  2. Inspiratory stridor with suprasternal retractions Correct answer.
  3. Bilateral crackles at the bases
  4. A prolonged expiratory phase with wheezing

Explanation

Upper airway obstruction produces turbulent airflow at the larynx or above, heard as inspiratory stridor, often with retractions as the patient works to pull air past the obstruction. Crackles, expiratory wheezing, and unilateral absent sounds point to lower airway or pleural problems rather than obstruction above the trachea.

Question 33Airway, Respiration, and Ventilation

Which action most effectively limits gastric inflation during bag-mask ventilation of an adult?

  1. Using the largest available mask
  2. Squeezing the bag fully with each breath
  3. Ventilating as rapidly as possible
  4. Delivering each breath over about one second until the chest just rises Correct answer.

Explanation

Gastric inflation occurs when airway pressure exceeds the esophageal opening pressure, which happens with large, fast, or forceful breaths. Delivering each breath over about one second and stopping when the chest begins to rise keeps peak pressure low and reduces air entry into the stomach.

Question 34Airway, Respiration, and Ventilation

A patient with a tracheostomy tube is in respiratory distress with no air movement at the stoma and no air escaping from the tube. Which action should be taken first?

  1. Force a suction catheter through the tube
  2. Increase humidification of the oxygen supply
  3. Attach a nonrebreather mask over the stoma
  4. Remove the tracheostomy tube and ventilate the stoma Correct answer.

Explanation

Absent air movement at the stoma and no flow through the tube suggest an obstruction that cannot be relieved with suctioning, so the tube must be removed and ventilation provided through the stoma or upper airway. Delaying removal risks fatal hypoxia while less definitive measures are attempted.

Question 35Airway, Respiration, and Ventilation

Which statement about pulse oximetry is most accurate?

  1. It measures the adequacy of ventilation directly.
  2. It replaces assessment of respiratory rate and depth.
  3. It is reliable in all patients regardless of perfusion.
  4. It reflects oxygen saturation and may be normal despite poor ventilation. Correct answer.

Explanation

Pulse oximetry estimates the percentage of hemoglobin saturated with oxygen, but it does not measure ventilation or carbon dioxide elimination. A patient can have a normal saturation while hypoventilating, and readings become unreliable with poor perfusion, motion, or certain dyshemoglobinemias.

Question 36Airway, Respiration, and Ventilation

An adult has a respiratory rate of 30, shallow depth, and a saturation of 86% despite a nonrebreather mask. Which interpretation best guides management?

  1. The patient is hyperventilating and should be coached to slow down
  2. The mask should be replaced with a nasal cannula
  3. Minute ventilation is inadequate and assisted ventilation is required Correct answer.
  4. Oxygenation is adequate and only reassurance is needed

Explanation

A rapid, shallow pattern with persistent hypoxemia despite high-flow oxygen indicates that the patient is failing to move adequate air volumes, so minute ventilation is insufficient. Positive pressure assistance with a bag-mask device is needed to support ventilation while the underlying cause is treated.

Question 37Cardiology and Resuscitation

An adult in cardiac arrest is being ventilated with a bag-valve mask and high-flow oxygen. Which finding best indicates that chest compressions are generating adequate perfusion?

  1. End-tidal CO2 waveform reading of 8 mmHg
  2. Pupils that remain fixed and dilated
  3. End-tidal CO2 waveform reading of 22 mmHg Correct answer.
  4. Palpable carotid pulse during the recoil phase

Explanation

End-tidal CO2 during CPR reflects pulmonary blood flow, so a value of roughly 10 mmHg or higher, and especially a rising trend, suggests effective compressions and return of circulation when it rises abruptly. A persistently low value signals poor compression quality or a nonperfusing rhythm.

Question 38Cardiology and Resuscitation

Which structure normally initiates the electrical impulse of the cardiac cycle?

  1. Purkinje fibers
  2. Bundle of His
  3. Sinoatrial node Correct answer.
  4. Atrioventricular node

Explanation

The sinoatrial node in the upper right atrium has the fastest intrinsic rate of automaticity and therefore normally serves as the heart's pacemaker, firing at 60 to 100 times per minute in a resting adult.

Question 39Cardiology and Resuscitation

A 62-year-old man is pale, diaphoretic, and nauseated with a blood pressure of 78/44 mmHg and a heart rate of 44 per minute. He has a history of inferior myocardial infarction. Which rhythm does this presentation most suggest?

  1. Third-degree atrioventricular block Correct answer.
  2. Sinus tachycardia with premature atrial complexes
  3. Ventricular tachycardia
  4. Atrial fibrillation with rapid ventricular response

Explanation

Third-degree block produces complete dissociation between atria and ventricles, so the ventricular rate is slow and the patient becomes hypotensive and symptomatic. Inferior infarction can injure the atrioventricular node and produce this pattern.

Question 40Cardiology and Resuscitation

During a cardiac arrest resuscitation, which action most directly improves the likelihood of successful defibrillation?

  1. Increasing the compression rate above 140 per minute
  2. Administering sodium bicarbonate early
  3. Minimizing interruptions in chest compressions Correct answer.
  4. Ventilating with larger tidal volumes

Explanation

Coronary perfusion pressure falls rapidly when compressions stop, so minimizing pauses before and after shocks preserves myocardial blood flow and improves the chance that a shock will restore an organized rhythm.

Question 41Cardiology and Resuscitation

A 58-year-old woman reports crushing substernal chest pressure that radiates to her left jaw and began 40 minutes ago. She is alert, has a blood pressure of 132/84 mmHg, and has no aspirin allergy. Which medication is most appropriate to give first?

  1. Chewed aspirin Correct answer.
  2. Nebulized albuterol
  3. Sublingual nitroglycerin
  4. Intramuscular epinephrine

Explanation

Chewed aspirin is given early in suspected acute coronary syndrome because platelet inhibition limits thrombus growth and reduces mortality. It is appropriate for an alert patient with no allergy and no active bleeding.

Question 42Cardiology and Resuscitation

A patient in cardiac arrest is in ventricular fibrillation. After the first shock, which intervention should immediately follow?

  1. Insert an advanced airway before compressions
  2. Resume chest compressions for two minutes Correct answer.
  3. Deliver a second shock right away
  4. Check a pulse for 10 seconds

Explanation

After a shock, compressions resume immediately for a full two-minute cycle before the rhythm is reanalyzed, because the myocardium needs time to respond and pauses reduce coronary perfusion.

Question 43Cardiology and Resuscitation

A 70-year-old man has a heart rate of 190 per minute, a narrow-complex regular rhythm, and a blood pressure of 128/76 mmHg. He is alert and denies chest pain or shortness of breath. Which intervention is most appropriate?

  1. Unsynchronized defibrillation
  2. Intravenous amiodarone infusion
  3. Immediate synchronized cardioversion
  4. Adenosine by rapid intravenous push Correct answer.

Explanation

A stable patient with a regular narrow-complex tachycardia is treated with vagal maneuvers followed by adenosine, which briefly blocks atrioventricular conduction and can terminate a reentrant supraventricular tachycardia.

Question 44Cardiology and Resuscitation

Which finding is most consistent with atrial fibrillation on a cardiac monitor?

  1. Wide-complex rhythm at 180 per minute
  2. Progressively lengthening PR intervals
  3. Regular rhythm with sawtooth flutter waves
  4. Irregularly irregular rhythm with no distinct P waves Correct answer.

Explanation

Atrial fibrillation produces chaotic atrial activity, so no organized P waves are seen and the ventricular response is irregularly irregular. The QRS complexes remain narrow unless conduction is aberrant.

Question 45Cardiology and Resuscitation

A 24-year-old athlete collapses during a game and is unresponsive with no normal breathing. An automated external defibrillator is attached and advises a shock. Which action should be taken before pressing the shock button?

  1. Start positive pressure ventilations
  2. Place an oral airway
  3. Ensure no one is touching the patient Correct answer.
  4. Recheck the carotid pulse

Explanation

Everyone must be clear of the patient before a shock is delivered to prevent injury to rescuers from the electrical discharge. The device analyzes the rhythm, and the shock is delivered only after the scene is safe.

Question 46Cardiology and Resuscitation

A 66-year-old woman has a blood pressure of 74/40 mmHg, a heart rate of 168 per minute, and a wide-complex regular rhythm. She is confused and has cool skin. Which treatment is indicated?

  1. Transcutaneous pacing
  2. Oral aspirin and nitroglycerin
  3. Synchronized cardioversion Correct answer.
  4. Adenosine 6 mg rapid IV push

Explanation

An unstable patient with a tachyarrhythmia and a pulse requires immediate synchronized cardioversion to restore perfusion. Instability is shown by hypotension, altered mental status, and poor peripheral perfusion.

Question 47Cardiology and Resuscitation

Which statement about high-quality chest compressions in an adult is correct?

  1. Compress at a rate of 140 per minute to a depth of 3 inches
  2. Compress at a rate of 100 to 120 per minute to a depth of at least 2 inches Correct answer.
  3. Compress at a rate of 80 per minute to a depth of 1 inch
  4. Compress at a rate of 100 per minute with full recoil but allow the chest to remain depressed

Explanation

Current adult CPR guidance calls for compressions at 100 to 120 per minute with a depth of at least 2 inches (5 cm) while avoiding excessive depth, and full chest recoil between compressions to permit venous return.

Question 48Cardiology and Resuscitation

A 55-year-old man in cardiac arrest is found to have pulseless electrical activity on the monitor. Which cause should be sought and corrected first?

  1. Drug overdose
  2. Hyperkalemia
  3. Tension pneumothorax Correct answer.
  4. Hypothermia

Explanation

Pulseless electrical activity requires a search for reversible causes, and tension pneumothorax is one that can be corrected immediately in the field with needle decompression. Obstructive causes such as tension pneumothorax, tamponade, and massive pulmonary embolism are prioritized because rapid correction can restore output.

Question 49Cardiology and Resuscitation

Which finding most strongly suggests that a patient is experiencing an acute myocardial infarction rather than angina?

  1. Chest discomfort relieved by sublingual nitroglycerin
  2. Chest discomfort that persists despite rest and nitroglycerin Correct answer.
  3. Chest discomfort that lasts less than two minutes
  4. Chest discomfort that resolves with rest

Explanation

Ischemic discomfort that continues despite rest and nitroglycerin suggests ongoing myocardial injury rather than stable angina, which typically resolves with rest or nitroglycerin within minutes. Persistent symptoms warrant urgent transport and activation of hospital resources.

Question 50Cardiology and Resuscitation

A patient has a heart rate of 38 per minute, a blood pressure of 82/50 mmHg, and is dizzy and diaphoretic. Intravenous access is established. Which intervention is most appropriate next?

  1. Adenosine 6 mg rapid intravenous push
  2. Synchronized cardioversion at 100 joules
  3. Atropine 1 mg intravenous push Correct answer.
  4. Amiodarone 150 mg intravenous infusion

Explanation

Symptomatic bradycardia with hypotension and poor perfusion is treated with atropine, which blocks vagal tone and can increase the sinus rate. If atropine is ineffective, pacing or a catecholamine infusion is considered.