22 Cardiology & Resuscitation Practice Questions & Answers

1. 1. An AEMT finds an adult collapsed on a sidewalk. The patient does not respond to a shout or a shoulder squeeze, and over ten seconds the AEMT sees two irregular, snoring gasps and feels no carotid pulse. What should the AEMT conclude and do?

   • A.The gasps are agonal and not effective breathing, so this is cardiac arrest and compressions begin now✓ Answer
   • B.The gasps show a patent airway with residual respiratory drive, so ventilations are assisted and the pulse rechecked
   • C.The gasps indicate a partial airway obstruction, so the airway is cleared and repositioned before any pulse decision
   • D.The gasps suggest a perfusing but slow rhythm, so oxygen is applied and vital signs obtained before compressions

   Agonal gasps are a brainstem reflex seen early in arrest; they move almost no air and are not normal breathing. Arrest is recognized by unresponsiveness plus absent normal breathing plus no definite pulse felt within about ten seconds, and treating agonal gasps as breathing is a leading cause of delayed compressions.

   Source: AHA Guidelines for CPR and ECC, Part 7 Adult Basic Life Support — recognition of cardiac arrest (agonal gasps are not breathing)Report a problem with this question

2. 2. An AED has just delivered a shock to an adult in cardiac arrest. Two AEMTs are at the patient's side and the airway is being managed with a mask. What is the correct next action?

   • A.Check the carotid pulse for up to ten seconds and resume compressions only if no pulse is felt
   • B.Resume chest compressions immediately and continue for the full analysis interval before reassessing✓ Answer
   • C.Deliver two ventilations first so the shocked heart receives oxygenated blood on the next compression
   • D.Have the AED reanalyze at once so a second shock can be stacked while the myocardium is still primed

   Even when a shock terminates the abnormal rhythm, the myocardium is stunned and generates little or no forward flow for the first minutes, so a pulse is rarely present immediately after the shock. Compressions restore coronary and cerebral perfusion pressure that falls to zero the moment compressions stop, which is why the pulse check and reanalysis are deferred until the next scheduled rhythm check.

   Source: AHA Guidelines for CPR and ECC, Part 7 Adult BLS — defibrillation sequence: resume compressions immediately after shock deliveryReport a problem with this question

3. 3. A 58-year-old man has crushing substernal chest pressure radiating to the jaw. His skin is diaphoretic, his blood pressure is 138/84, and he tells the AEMT he took a phosphodiesterase-5 inhibitor for erectile dysfunction last night. What does this history change?

   • A.Aspirin is withheld because the drug interaction sharply increases the risk of gastric bleeding
   • B.Nitroglycerin is withheld because the combined vasodilation can cause profound hypotension✓ Answer
   • C.Transport is delayed until the drug clears because movement during the interaction provokes syncope
   • D.Oxygen is withheld because the combination raises the risk of coronary vasospasm during hyperoxia

   Phosphodiesterase-5 inhibitors and nitroglycerin both raise cyclic GMP in vascular smooth muscle, and together they produce additive vasodilation that can drop preload and blood pressure catastrophically. This is an absolute contraindication; aspirin, oxygen titrated to need, and prompt transport remain appropriate.

   Source: National EMS Education Standards 2021, AEMT Medicine/Cardiovascular — nitroglycerin absolute contraindication with PDE-5 inhibitorsReport a problem with this question

4. 4. A 72-year-old woman with an implanted cardiac device is in cardiac arrest. The AEMT sees a firm bulge under the skin below the left clavicle and a small square medication patch on the upper right chest. How should the AED pads be handled?

   • A.Place a pad directly over the device so current is delivered along the shortest path
   • B.Leave the medication patch in place and set the pad on top of it to keep the seal intact
   • C.Remove the patch, wipe the skin, and place the pads clear of the implanted device✓ Answer
   • D.Move both pads to the abdomen so neither the device nor the patch alters the shock

   A medication patch contains a metallic or conductive backing that can arc, burn the skin, and shunt current away from the myocardium, so it is removed and the skin wiped dry. Pads placed directly over a pulse generator divert current around the device and can damage it, so they are offset while keeping an anterolateral or anteroposterior vector through the heart.

   Source: AHA Guidelines for CPR and ECC — AED pad placement with implanted devices and transdermal medication patchesReport a problem with this question

5. 5. A 66-year-old man is severely short of breath sitting bolt upright at the edge of his bed. He has crackles to mid-chest bilaterally, pink frothy sputum, pitting ankle edema, and a blood pressure of 172/96. Which action is contraindicated in this presentation?

   • A.Running an intravenous fluid bolus to improve the perfusion suggested by his work of breathing✓ Answer
   • B.Keeping him upright with his legs dependent to ease the volume returning to the heart
   • C.Titrating supplemental oxygen upward while watching his saturation and mental status
   • D.Applying continuous positive airway pressure to reduce the fluid burden on the alveoli

   This is acute cardiogenic pulmonary edema: a failing left ventricle cannot move the volume it already receives, so plasma is forced into the alveoli. Adding intravascular volume raises preload and pulmonary capillary pressure and worsens the flooding, while positive airway pressure, an upright position, and titrated oxygen all reduce the work of breathing.

   Source: National EMS Education Standards 2021, AEMT — heart failure and acute pulmonary edema managementReport a problem with this question

6. 6. A trauma patient is anxious and restless with cool, pale, clammy skin, a rapid weak radial pulse, rapid breathing, and a blood pressure of 118/96 that was 124/78 ten minutes ago. What does the narrowing pulse pressure with a still-normal systolic reading indicate?

   • A.Adequate perfusion, as the systolic value remains within the accepted normal range
   • B.Isolated anxiety response, as catecholamine release alone accounts for all these findings
   • C.Compensated shock, as rising vascular resistance holds the pressure up while flow falls✓ Answer
   • D.A vagal reaction to pain, as parasympathetic tone narrows the gap between the pressures

   Falling stroke volume is met by sympathetic vasoconstriction, which raises the diastolic pressure toward the systolic one and narrows the pulse pressure while the systolic number still looks acceptable. Tachycardia, tachypnea, cool clammy skin, and restlessness with a normal blood pressure define compensated shock; hypotension is a late, decompensated sign.

   Source: National EMS Education Standards 2021, AEMT Shock and Resuscitation — compensated shock recognition (Complex depth)Report a problem with this question

7. 7. Two days after a myocardial infarction, a 70-year-old man is hypotensive with crackles in both lung bases, cool mottled skin, and altered mentation. He has a patent intravenous line. What management best fits this mechanism at the AEMT level?

   • A.Withhold all fluid and all oxygen, and transport quietly so cardiac workload is not increased
   • B.Sit the patient flat with legs elevated to autotransfuse volume and restore central pressure
   • C.Support oxygenation, give any fluid only in small challenges with reassessment, and transport rapidly✓ Answer
   • D.Infuse fluid wide open until the systolic pressure and mental status both return toward baseline

   In cardiogenic shock the pump, not the tank, has failed, and the crackles show the ventricle is already overwhelmed by the volume it has. Aggressive fluid worsens pulmonary edema, so volume is given only in small titrated challenges with lung sounds and vitals rechecked after each; the AEMT cannot give vasopressors, making oxygenation and rapid transport to definitive care the priorities.

   Source: National EMS Education Standards 2021, AEMT Shock and Resuscitation — cardiogenic shock; 2019 National EMS Scope of Practice Model (AEMT medication list)Report a problem with this question

8. 8. During an adult resuscitation, waveform capnography that had been reading steadily near 18 mmHg suddenly jumps and stays near 40 mmHg while compressions continue at the same quality. What should the team do?

   • A.Complete the cycle, then check for a pulse because the rise suggests return of circulation✓ Answer
   • B.Ventilate faster because the rise means carbon dioxide is accumulating from inadequate ventilation
   • C.Change compressors right away because the rise means the current compressor is fatiguing
   • D.Stop compressions at once and remove the airway because the rise means the tube has displaced

   Exhaled carbon dioxide during CPR reflects pulmonary blood flow, so a sudden sustained rise means far more blood is reaching the lungs than compressions alone can produce, which is an early marker of return of spontaneous circulation. Compressions are not stopped mid-cycle to chase it; the finding is confirmed at the next scheduled pulse check. A falling value, not a rising one, points to fatigue or poor compression quality.

   Source: AHA Guidelines for CPR and ECC — waveform capnography during CPR: abrupt sustained ETCO2 rise indicates ROSCReport a problem with this question

9. 9. An adult regains a palpable carotid pulse after a resuscitation. He remains unresponsive, and a bag-mask is in use. Which management change is most important at this moment?

   • A.Sit the patient fully upright immediately so that ventilation and chest expansion are optimized
   • B.Increase the ventilation rate deliberately, because the brain needs maximal washout after the arrest
   • C.Keep oxygen at the maximum available concentration throughout transport regardless of the saturation
   • D.Slow the ventilation rate deliberately, because excess breaths reduce venous return and cerebral flow✓ Answer

   Rescuers reflexively ventilate too fast after return of circulation. Every positive-pressure breath raises intrathoracic pressure and impedes venous return, lowering cardiac output, and the resulting drop in carbon dioxide constricts cerebral vessels, so hyperventilation directly reduces brain perfusion. Oxygen after return of circulation is titrated to a target saturation rather than left at maximum.

   Source: AHA Guidelines for CPR and ECC — post-cardiac arrest care: avoid hyperventilation and hyperoxiaReport a problem with this question

10. 10. A 6-month-old is limp and unresponsive after a prolonged respiratory illness. Ventilation is being delivered effectively, yet the brachial pulse remains very slow and the infant is mottled with poor central perfusion. What is the appropriate action?

    • A.Begin chest compressions, because a slow rate with poor perfusion behaves like arrest in an infant✓ Answer
    • B.Continue ventilating alone and recheck the pulse, because a present pulse rules out the need to compress
    • C.Apply the automated defibrillator and analyze, because a slow rate in an infant is a shockable finding
    • D.Give a rapid intravenous fluid bolus first, because a slow rate in an infant reflects volume depletion

    Infant cardiac output depends almost entirely on heart rate, so a profoundly slow rate with poor perfusion produces essentially no forward flow even though a pulse is felt. When oxygenation and ventilation have been corrected and perfusion remains poor at a very slow rate, compressions are started. Pediatric arrest is usually the end point of hypoxia, which is why the airway was addressed first.

    Source: AHA Guidelines for CPR and ECC, Pediatric Basic Life Support — bradycardia with poor perfusion despite oxygenation and ventilationReport a problem with this question

11. 11. An unresponsive adult is pulled from a lake and has no pulse and no breathing on a dock. What feature of this arrest should shape the AEMT's resuscitation?

    • A.The arrest is hypoxic in origin, so ventilations are integrated with compressions from the start✓ Answer
    • B.The rhythm is usually shockable, so repeated analyses take priority over delivering breaths
    • C.The spine is presumed injured, so full immobilization precedes any airway or circulatory care
    • D.The lungs are water-filled, so abdominal thrusts are used to clear them before any compressions

    Drowning causes arrest through progressive hypoxia rather than a primary electrical event, so oxygen delivery is the deficit that must be corrected and rescue breaths are given along with compressions rather than deferred. Attempts to drain water from the lungs waste time and risk aspiration, and spinal precautions are reserved for a mechanism that actually suggests injury.

    Source: AHA Guidelines for CPR and ECC — special circumstances: drowning-associated cardiac arrestReport a problem with this question

12. 12. An AEMT is called for an unresponsive adult found outdoors in freezing weather. The skin is cold and rigid, and no pulse is detected during a brief check. How should the assessment and care proceed?

    • A.Rub the extremities briskly and move the patient quickly to generate heat before assessing circulation
    • B.Repeat shocks continuously without limit, since a cold myocardium requires many attempts to convert
    • C.Declare death on scene at once, since rigidity and pulselessness in cold exposure confirm irreversible death
    • D.Extend the pulse check, handle the patient gently, insulate from the cold, and follow protocol limits✓ Answer

    Deep hypothermia slows metabolism so profoundly that a perfusing pulse may be very slow and hard to detect, and cold-stiffened tissue can mimic rigor mortis, so the pulse check is prolonged and death is not assumed. The cold myocardium is highly irritable, so rough handling can precipitate arrest, and repeated shocks and drugs are limited by protocol until rewarming occurs.

    Source: AHA Guidelines for CPR and ECC — special circumstances: accidental hypothermia and cardiac arrestReport a problem with this question

13. 13. A woman in the third trimester of pregnancy is in cardiac arrest on the floor of her home. Besides high-quality compressions and ventilations, what specific maneuver improves her chance of return of circulation?

    • A.Place a folded blanket beneath her shoulders to open the airway and improve chest expansion
    • B.Elevate both of the patient's legs on a rigid support to increase venous return from the periphery
    • C.Move the hands lower on the sternum so the compressions avoid the enlarged upper abdomen
    • D.Displace the uterus manually toward the patient's left to relieve compression of the vena cava✓ Answer

    In late pregnancy the gravid uterus compresses the inferior vena cava when the patient is supine, cutting venous return so severely that compressions cannot generate adequate output. Manual leftward displacement of the uterus relieves that obstruction while keeping the patient flat for effective compressions, so it is done throughout the resuscitation.

    Source: AHA Guidelines for CPR and ECC — special circumstances: cardiac arrest in pregnancy (manual left uterine displacement)Report a problem with this question

14. 14. A 61-year-old woman with diabetes reports two days of unusual fatigue, mild nausea, and breathlessness climbing stairs. She denies chest pain. Her skin is pale and slightly damp. Why should the AEMT still work this up as a possible acute coronary syndrome?

    • A.Symptoms lasting more than one day exclude ischemia, so the workup is done to document that fact
    • B.Diabetic neuropathy and sex-related differences often blunt or replace the classic chest pain✓ Answer
    • C.Chest pain is absent only when the infarct is small, so her symptoms indicate minimal muscle at risk
    • D.Fatigue with nausea in a diabetic patient is a recognized sign of insulin overdose rather than ischemia

    Autonomic neuropathy in diabetes and documented differences in how women present frequently produce anginal equivalents such as fatigue, dyspnea, nausea, epigastric discomfort, or syncope instead of crushing chest pain. Older adults show the same pattern, and failing to recognize these atypical presentations delays aspirin, the twelve-lead acquisition and transmission, and transport to definitive care.

    Source: National EMS Education Standards 2021, AEMT Medicine — acute coronary syndrome assessment (atypical presentation in women, older adults, and patients with diabetes)Report a problem with this question

15. 15. An AEMT acquires a twelve-lead tracing on a patient with chest pain and notices changes she believes represent an infarct. Under the national scope of practice for this level, what is the correct handling of that tracing?

    • A.Repeat it several times en route and act on whichever tracing shows the most pronounced changes
    • B.Withhold it until arrival so that an unconfirmed reading does not bias the emergency department team
    • C.Transmit it to the receiving facility and let physician interpretation guide destination decisions✓ Answer
    • D.Interpret it on scene and announce the findings so the receiving team can prepare the catheterization lab

    The national scope of practice places twelve-lead acquisition and transmission within the AEMT's skills but places interpretive reading at the paramedic level, so the tracing is sent to the physician who is qualified to read it. Early transmission still achieves the goal of shortening time to reperfusion because the destination decision can be made before arrival, and a provider acting on a self-made interpretation is practicing beyond the level.

    Source: National EMS Scope of Practice Model 2019 — AEMT cardiovascular skills: 12-lead acquisition and transmission, no interpretive readingReport a problem with this question

16. 16. A conscious adult in profound hypovolemic shock needs volume. Two attempts at peripheral intravenous access have failed and the veins are flat. What consideration guides the AEMT's next step for access?

    • A.Choose an implanted central access port, since it delivers volume faster than any peripheral route
    • B.Choose an intraosseous site with intact bone that has not been attempted and lacks overlying infection✓ Answer
    • C.Choose the limb that was already attempted, since the landmarks there are now clearly identified
    • D.Choose to defer access entirely and rely on positioning until the receiving facility can cannulate

    Intraosseous access reaches the noncollapsing marrow space and is indicated when peripheral access fails in a critically ill patient, but it is contraindicated in a fractured bone, at a site with infection or burn over it, near a joint prosthesis, where landmarks cannot be identified, or in a bone already attempted, because fluid extravasates through the earlier hole. Accessing an implanted central port is outside the AEMT scope.

    Source: National EMS Scope of Practice Model 2019 (AEMT IO initiation); National EMS Education Standards 2021 — vascular access contraindicationsReport a problem with this question

17. 17. An AEMT has given a fluid bolus through a large-bore intravenous line to an adult with hypovolemic shock. What reassessment set best determines whether more fluid should follow?

    • A.Total volume infused and bag count, compared against the weight-based figure calculated on scene
    • B.Mentation, skin findings, peripheral pulse quality, vital signs, and lung sounds after the bolus✓ Answer
    • C.Heart rate alone, with fluid continued until the rate settles fully into the expected resting range
    • D.Systolic blood pressure alone, repeated until the reading reaches the accepted normal range

    Fluid is titrated to perfusion, not to a number on a cuff. Improving mentation, warming skin, and a returning peripheral pulse show that oxygen delivery to tissue is recovering, while new crackles warn that the circulation has been overloaded. Chasing a normal blood pressure in uncontrolled internal bleeding can dislodge formed clot and dilute clotting factors, worsening hemorrhage.

    Source: National EMS Education Standards 2021, AEMT Shock and Resuscitation — fluid therapy titrated to perfusion endpointsReport a problem with this question

18. 18. A 68-year-old man has sudden severe pain between the shoulder blades that he describes as tearing. The pulse is markedly weaker in the left arm than the right and the blood pressures differ between arms. How should the AEMT proceed?

    • A.Load fluid aggressively to equalize the arm pressures before any movement of the patient
    • B.Handle him gently, avoid aggressive fluid loading, and transport promptly with continued monitoring✓ Answer
    • C.Position him head-down and encourage deep breathing to redistribute flow to the weaker arm
    • D.Treat it as coronary pain and follow the routine chest pain sequence including a nitrate

    Tearing pain radiating to the back with unequal pulses or pressures between the arms suggests aortic dissection, in which the intimal tear propagates along the vessel wall and can occlude branch arteries. Raising blood pressure and shear force with aggressive fluid, or vasodilating a patient whose problem is not coronary occlusion, can extend the dissection, so the field priorities are gentle handling, monitoring, and rapid transport.

    Source: National EMS Education Standards 2021, AEMT Medicine — aortic aneurysm and dissection (Fundamental depth)Report a problem with this question

19. 19. During a prolonged adult resuscitation with four responders present, compression quality begins to deteriorate as the same rescuer continues. Which factor most directly reduces the blood flow generated by the compressions?

    • A.Placing the heel of the hand on the sternum, which spreads force across too wide an area
    • B.Kneeling too close to the patient's side, which shifts hand position toward the sternal notch
    • C.Counting compressions aloud with the team, which paces the rescuer slower than intended
    • D.Leaning on the chest between compressions, which blocks refilling of the ventricles✓ Answer

    Blood is drawn back into the heart during the recoil phase, when intrathoracic pressure falls below venous pressure. Leaning keeps intrathoracic pressure elevated, so the ventricles never refill and the next compression ejects less blood, and coronary perfusion pressure falls. Fatigue produces this incomplete recoil within a couple of minutes, which is why compressors rotate and why the heel of the hand on the sternum is the correct technique.

    Source: AHA Guidelines for CPR and ECC, Part 7 Adult BLS — components of high-quality CPR: full chest recoil, avoid leaning, rotate compressorsReport a problem with this question

20. 20. Family members meet the crew at the door of a home where an elderly man is pulseless and apneic. They state he has a do-not-resuscitate order but cannot find the document, and one relative objects to withholding care. What should the AEMT do?

    • A.Provide comfort measures only, since a reported order always converts the call to end-of-life care
    • B.Wait outside the residence until the document is produced, since acting without it exposes the crew
    • C.Withhold resuscitation on the family's account, since a verbal report of the order is legally sufficient
    • D.Begin resuscitation and contact medical direction, since the directive is unverified and disputed✓ Answer

    A directive controls care only when it is valid, applies to this patient and this situation, and can be verified; when it is absent, questionable, or contested, resuscitation is started because the harm of not resuscitating a viable patient is irreversible while resuscitation can be stopped once the document is confirmed. Medical direction is contacted to resolve the conflict, and a do-not-resuscitate order never means withholding all care.

    Source: National EMS Education Standards 2021, AEMT — ethical issues in resuscitation; advance directives and DNR verificationReport a problem with this question

21. 21. An adult is found unresponsive and pulseless beside drug paraphernalia, with pinpoint pupils and a suspected opioid overdose. Two AEMTs are on scene. What is the correct priority?

    • A.Ventilate alone without compressions, since the pulselessness is entirely respiratory in origin
    • B.Withhold naloxone entirely, since it has no role once a patient has progressed to cardiac arrest
    • C.Start compressions with ventilations, adding naloxone only if it does not interrupt that care✓ Answer
    • D.Give naloxone first and hold compressions briefly, since reversing the opioid restores the pulse

    Opioid-associated arrest begins as respiratory depression and progresses to hypoxic arrest, so compressions with ventilations correct the actual deficit, oxygen delivery, and nothing may delay them. Naloxone reverses the receptor effect but does not circulate to the brain without perfusion, so it is given only alongside ongoing high-quality resuscitation, never as the first action in a pulseless patient.

    Source: AHA Guidelines for CPR and ECC — opioid-associated emergencies: CPR takes priority; naloxone must not delay resuscitationReport a problem with this question

22. 22. An AEMT reviews why a coronary artery narrowed by plaque can perfuse the heart at rest but fail during exertion. Which relationship explains the ischemia that develops?

    • A.Faster rates lengthen diastole, so blood pools in the coronary vessels and stagnates against the plaque
    • B.Faster rates shorten diastole, when coronary filling occurs, while oxygen demand simultaneously rises✓ Answer
    • C.Faster rates shift perfusion from systole to diastole, so the narrowed vessel is bypassed entirely
    • D.Faster rates raise the oxygen content of arterial blood, so the plaque absorbs more of the supply

    The left ventricular myocardium is perfused during diastole, because systolic contraction compresses the intramural coronary vessels. Tachycardia shortens diastole disproportionately, cutting supply at the same moment that rate and contractility raise myocardial oxygen demand, so a lesion adequate at rest becomes ischemic with exertion. This is also why controlling pain and anxiety helps the ischemic patient.

    Source: National EMS Education Standards 2021, AEMT Anatomy and Physiology — coronary perfusion during diastole and myocardial oxygen supply-demand balanceReport a problem with this question

Practice questions based on the National Registry Advanced EMT Examination Specifications and the National EMS Education Standards. This site is not affiliated with or endorsed by the National Registry of Emergency Medical Technicians, and nothing here is medical advice. AEMT scope of practice is set by your state and by your medical director, and drug doses, concentrations, infusion rates and clinical thresholds come from your protocols — never from a practice test. Resuscitation guidance is revised on a cycle; always follow the guidelines and protocols currently in effect where you practice. Confirm eligibility and current exam requirements with the National Registry before you test. About AEMT certification →