29 Primary Assessment Practice Questions & Answers

1. 1. A patient is breathing 22 times per minute but each breath moves very little air, with cyanosis and altered mental status. This patient is BEST described as being in:

   • A.Respiratory failure needing a BVM✓ Answer
   • B.Adequate breathing, monitor only
   • C.Mild distress needing a nasal cannula
   • D.Normal breathing for a man his age

   A fast rate alone does not mean adequate breathing. Very shallow breaths with cyanosis and altered mental status indicate inadequate tidal volume and failing gas exchange, which is respiratory failure. This requires positive-pressure ventilation with a BVM, not just supplemental oxygen.

   Source: National EMS Education Standards — inadequate breathing: shallow tidal volume despite rate needs PPVReport a problem with this question

2. 2. Which statement about the difference between ventilation and respiration is correct?

   • A.Ventilation means oxygen binding to hemoglobin
   • B.Respiration happens only in the nose and mouth
   • C.Ventilation and respiration describe the same thing
   • D.Ventilation moves air; respiration exchanges gas✓ Answer

   Ventilation is the mechanical movement of air into and out of the lungs, while respiration is the exchange of oxygen and carbon dioxide at the alveoli and cells. A patient can ventilate (move air) yet fail to oxygenate, such as in carbon monoxide poisoning, which is why the terms are distinct.

   Source: National EMS Education Standards — Respiratory physiology: ventilation vs respirationReport a problem with this question

3. 3. You are assessing an unresponsive 4-month-old infant. Where should you check for a pulse?

   • A.Radial artery at the wrist
   • B.Femoral artery in the groin
   • C.Carotid artery in the neck
   • D.Brachial artery in the arm✓ Answer

   For infants the brachial artery on the inner upper arm is used because a short, chubby neck makes the carotid hard to locate; the pulse check should take no more than 10 seconds.

   Source: AHA BLS Guidelines — Infant pulse check: brachial artery (≤10 s)Report a problem with this question

4. 4. A patient with a suspected heart attack now has a weak, thready pulse; cool, clammy skin; low blood pressure; and altered mental status. This presentation is most consistent with:

   • A.Vasovagal syncope
   • B.Acute panic attack
   • C.Cardiogenic shock✓ Answer
   • D.Severe dehydration

   When the heart's pumping function fails after an MI, cardiac output drops, producing hypotension, a weak pulse, cool clammy skin, and altered mental status — the hallmarks of cardiogenic shock, which requires rapid transport.

   Source: Cardiogenic shock — pump failure causing hypotension and poor perfusionReport a problem with this question

5. 5. Compared with adults, cardiac arrest in children is most often caused by:

   • A.A congenital pacemaker defect
   • B.A sudden coronary artery clot
   • C.A respiratory or hypoxic problem✓ Answer
   • D.Ventricular fibrillation (VF)

   Pediatric arrests are usually the end result of respiratory failure or hypoxia, so oxygenation and ventilation are emphasized, whereas adult arrests are commonly primary cardiac events (VF).

   Source: Pediatric resuscitation — arrest is most often respiratory/hypoxic in originReport a problem with this question

6. 6. A trauma patient is anxious and restless with a heart rate of 122, respirations of 26, and pale, cool, clammy skin, but a blood pressure of 118/76. This presentation is BEST described as:

   • A.No shock; blood pressure is still normal
   • B.Compensated (early) hypovolemic shock✓ Answer
   • C.Decompensated (late) hypovolemic shock
   • D.Neurogenic shock from spinal injury

   Tachycardia, tachypnea, anxiety, and pale/cool/clammy skin with a still-normal blood pressure define compensated (early) shock: the body maintains BP through vasoconstriction and increased heart rate. A falling BP marks the later decompensated stage, so a normal BP does not rule out shock.

   Source: National EMS Education Standards — Shock and Resuscitation; AAOS Emergency Care 12eReport a problem with this question

7. 7. A 6-year-old fell from a second-story window. He has a heart rate of 140 and is quiet but responsive, with a normal blood pressure. Which statement should MOST guide your management?

   • A.A heart rate of 140 is worrying only in adults
   • B.The normal blood pressure confirms he is stable
   • C.Shock is ruled out because the child still responds
   • D.Children compensate, then crash; treat for shock✓ Answer

   Pediatric patients maintain blood pressure through strong compensatory mechanisms and can appear stable until they abruptly decompensate; tachycardia after a significant fall signals early shock, so you must treat aggressively and transport rapidly rather than be reassured by a normal BP.

   Source: National EMS Education Standards — Pediatric trauma / shock; PALS compensated shockReport a problem with this question

8. 8. A patient pulled from a house fire has singed nasal hairs, soot around the mouth, hoarseness, and facial burns. What is the PRIMARY concern?

   • A.Airway compromise from inhalation injury✓ Answer
   • B.Calculating the exact percentage burned
   • C.Cooling the facial burns with water
   • D.Controlling pain before anything else

   Singed nasal hair, soot, hoarseness, and facial burns signal inhalation injury with impending airway swelling; the airway is the priority because progressive edema can occlude it, so early aggressive airway management and oxygen come first.

   Source: National EMS Education Standards — Burns / inhalation injury airway priorityReport a problem with this question

9. 9. During the primary assessment of an unresponsive medical patient you hear snoring respirations. What should you do FIRST?

   • A.Open and reposition the airway✓ Answer
   • B.Begin chest compressions now
   • C.Obtain a blood glucose reading
   • D.Apply a nonrebreather at 15 L/min

   Snoring respirations indicate partial airway obstruction by the tongue; opening and repositioning the airway — head-tilt/chin-lift, or jaw-thrust if trauma is suspected — is always the first correction, because oxygen and other interventions are ineffective through an obstructed airway.

   Source: National EMS Education Standards — Airway management (primary assessment, airway first)Report a problem with this question

10. 10. You are called for a 2-year-old with a fever. Before touching the child, you form a general impression from the doorway using the Pediatric Assessment Triangle (PAT). Which three elements make up the PAT?

    • A.Alertness, verbal response, and response to pain
    • B.Airway patency, pulse quality, and pupillary response
    • C.Appearance, work of breathing, and circulation to skin✓ Answer
    • D.Activity level, skin temperature, and blood pressure

    The PAT is a hands-off assessment done from across the room before touching the child, and its three arms are appearance, work of breathing, and circulation to the skin. Together they answer the 'sick or not sick' question; hands-on checks such as pulses, pupils, and blood pressure come afterward.

    Source: NREMT EMT Test Plan, Domain 2 job task 'form a general impression'; AAOS Emergency Care 12th ed. / PALS Pediatric Assessment TriangleReport a problem with this question

11. 11. You enter a home and find a 68-year-old man sitting upright, leaning forward on his outstretched arms with his neck extended, working hard to breathe. As part of your general impression, this position most suggests:

    • A.dizziness from a sudden drop in BP
    • B.significant respiratory distress✓ Answer
    • C.severe abdominal pain with guarding
    • D.a stroke causing one-sided weakness

    The tripod position — upright, leaning forward on the arms with the neck extended — maximizes the mechanical advantage of the accessory breathing muscles, so patients adopt it instinctively when they are struggling to breathe. Recognizing such distress positions from the doorway is a core part of forming the general impression.

    Source: AAOS Emergency Care 12th ed., Patient Assessment — general impression and positions of respiratory distress (tripod position)Report a problem with this question

12. 12. A 50-year-old woman lies with her eyes closed. When you loudly call her name she moans and turns her head toward you, but she does not open her eyes or follow commands. On the AVPU scale she is:

    • A.alert, because she moved her head
    • B.unresponsive, as her eyes stay closed
    • C.responsive only to painful stimulus
    • D.responsive to a verbal stimulus✓ Answer

    In AVPU, any purposeful reaction to your voice — moaning, turning toward the sound, moving on command — classifies the patient as V (responds to Verbal). 'Alert' requires spontaneous eye opening and awareness before any stimulus, and P is reserved for patients who react only after a painful stimulus.

    Source: NREMT EMT Test Plan, Domain 2 job task 'assess level of consciousness'; AAOS Emergency Care 12th ed., AVPU scaleReport a problem with this question

13. 13. While assessing a patient with a head injury, you calculate a Glasgow Coma Scale (GCS) score. Which statement about the GCS is correct?

    • A.A score of 8 or lower means severely decreased LOC✓ Answer
    • B.The lowest total score a patient can receive is 0
    • C.The verbal component is scored from a low of 1 to 6
    • D.A score of 12 or lower means severely decreased LOC

    The GCS sums eye opening (1–4), verbal response (1–5), and motor response (1–6), so the minimum is 3 and the maximum 15; each component's floor is 1, never 0. A total of 8 or less indicates a severely decreased level of consciousness in which the patient typically cannot protect the airway.

    Source: AAOS Emergency Care 12th ed., Glasgow Coma Scale (eye 4, verbal 5, motor 6; range 3–15; GCS ≤8 = severe)Report a problem with this question

14. 14. A motorcyclist is unresponsive after a crash and is breathing shallowly. To open his airway, you should use:

    • A.a tongue-jaw lift with a finger sweep of the mouth
    • B.a head-tilt/chin-lift with the neck gently extended
    • C.the recovery position with his head turned to the side
    • D.a jaw-thrust maneuver with manual in-line stabilization✓ Answer

    A significant trauma mechanism with unresponsiveness means a possible spinal injury, so the airway is opened with a jaw-thrust while another rescuer holds manual in-line stabilization — the jaw-thrust lifts the tongue without extending the neck. Only if the jaw-thrust fails to open the airway may you fall back on head-tilt/chin-lift, because a patent airway outranks spinal precautions.

    Source: AAOS Emergency Care 12th ed., Airway — jaw-thrust for suspected spinal injury; AHA guidelines (airway priority over spinal motion restriction)Report a problem with this question

15. 15. During the primary assessment of an unresponsive overdose patient, you hear gurgling sounds with each breath. What should you do first?

    • A.Begin bag-valve-mask ventilations with oxygen
    • B.Apply a high-concentration nonrebreather mask
    • C.Suction the oropharynx before giving any oxygen✓ Answer
    • D.Insert an oropharyngeal airway to lift the tongue

    Gurgling means liquid — secretions, blood, or vomitus — is in the airway, and giving oxygen or positive-pressure ventilation first would push that fluid into the lungs and cause aspiration. The rule is suction immediately when you hear gurgling, then oxygenate or ventilate once the airway is clear; snoring, by contrast, signals the tongue and calls for repositioning.

    Source: AAOS Emergency Care 12th ed., Airway management — gurgling indicates fluid: suction before oxygenation/ventilationReport a problem with this question

16. 16. You are managing the airway of an unresponsive medical patient. Before inserting an oropharyngeal airway (OPA), you must confirm that the patient:

    • A.is breathing 12 or more times per minute
    • B.has no signs of basilar skull fracture
    • C.responds at least to painful stimulus
    • D.has no gag reflex when it is checked✓ Answer

    An OPA sits against the posterior pharynx, so if any gag reflex is present it will trigger vomiting and possible aspiration — the absence of a gag reflex is the mandatory precondition. A patient who responds to pain almost certainly still has a gag reflex, and basilar skull fracture is the classic contraindication for the nasopharyngeal airway, not the OPA.

    Source: AAOS Emergency Care 12th ed., Airway adjuncts — OPA indicated only in patients without a gag reflexReport a problem with this question

17. 17. An unresponsive trauma patient has an intact gag reflex, so you prepare a nasopharyngeal airway (NPA). Which finding would make the NPA inappropriate?

    • A.A suspected fracture of the lower jaw
    • B.A gag reflex present during assessment
    • C.Snoring respirations caused by the tongue
    • D.Bruising behind the ears over the mastoid✓ Answer

    Bruising over the mastoid (Battle sign), raccoon eyes, or blood/CSF from the nose or ears indicates a possible basilar skull fracture, and an NPA could pass through the fractured cribriform plate into the cranial vault — so it is contraindicated. An intact gag reflex and snoring are actually reasons to choose an NPA, and a mandible fracture does not block the nasal route.

    Source: AAOS Emergency Care 12th ed., Airway adjuncts — NPA contraindicated with suspected basilar skull fracture (Battle sign, raccoon eyes, CSF drainage)Report a problem with this question

18. 18. You are suctioning secretions from an adult patient's airway with a rigid catheter. Suction should be applied:

    • A.continuously until the airway appears fully clear
    • B.only during withdrawal, for no more than 5 seconds
    • C.only during withdrawal, for no more than 15 seconds✓ Answer
    • D.while inserting the catheter, for up to 15 seconds

    Suction removes oxygen along with secretions, so it is applied only while withdrawing the catheter and is limited to about 15 seconds per attempt in an adult to avoid hypoxia. The shorter limits — about 10 seconds for a child and 5 seconds for an infant — reflect their smaller oxygen reserves; suctioning during insertion or continuously deprives the patient of oxygen.

    Source: AAOS Emergency Care 12th ed., Suctioning technique — suction on withdrawal only; limits ~15 s adult, 10 s child, 5 s infantReport a problem with this question

19. 19. A 30-year-old found near drug paraphernalia responds only to painful stimulus and is breathing 6 times per minute with minimal chest rise. The most appropriate immediate support is:

    • A.the recovery position with continued observation
    • B.a nasal cannula at 6 L/min and rapid transport
    • C.bag-valve-mask ventilation with high-flow oxygen✓ Answer
    • D.a nonrebreather mask at 15 L/min with monitoring

    A rate of 6 with minimal chest rise is inadequate breathing: both rate and tidal volume are too low to sustain gas exchange. Passive oxygen devices like a nonrebreather or cannula only enrich air the patient must draw in himself, so this patient needs positive-pressure BVM ventilation (about one breath every 6 seconds for an adult) with supplemental oxygen.

    Source: AAOS Emergency Care 12th ed., adequate vs inadequate breathing; AHA 2020 guidelines — adult rescue breathing 1 breath every 6 secondsReport a problem with this question

20. 20. An alert 72-year-old with fever and a productive cough is breathing 24 times per minute with full, adequate chest rise. Her SpO2 is 88% on room air. The best oxygen decision is to:

    • A.withhold oxygen until the SpO2 drops below 85%
    • B.apply a nonrebreather mask at 15 L/min of oxygen✓ Answer
    • C.apply a nasal cannula set at 1 L/min of oxygen
    • D.assist her breathing with a BVM and high-flow O2

    Her breathing is adequate — good rate and full tidal volume — so she does not need positive-pressure ventilation; but an SpO2 of 88% is significant hypoxia (below the ~94% threshold), so she needs high-concentration oxygen by nonrebreather. BVM is reserved for inadequate breathing, and 1 L/min by cannula is too little for this degree of hypoxia.

    Source: AAOS Emergency Care 12th ed., oxygen therapy — NRB 15 L/min for significant hypoxia/distress with adequate breathing; SpO2 target ≥94%Report a problem with this question

21. 21. An elderly man collapses in front of you. He is unresponsive and takes an occasional slow, gasping breath every 10 to 15 seconds. You should interpret these gasps as:

    • A.hyperventilation caused by acute anxiety
    • B.an airway partly blocked by the tongue
    • C.absent breathing that requires ventilation✓ Answer
    • D.adequate breathing that needs only oxygen

    Occasional gasping breaths are agonal respirations — brainstem reflexes seen in the first minutes of cardiac arrest — and they do not move meaningful air, so the patient is treated as not breathing. The correct response is to check the pulse and begin ventilations or CPR with an AED, not to give passive oxygen.

    Source: AHA 2020 CPR/ECC guidelines — agonal gasps are not effective breathing; treat as respiratory/cardiac arrestReport a problem with this question

22. 22. During the primary assessment of an unresponsive 60-year-old man, where should you first palpate for a pulse?

    • A.At the radial artery at the wrist
    • B.At the brachial artery in the arm
    • C.At the femoral artery in the groin
    • D.At the carotid artery in the neck✓ Answer

    In an unresponsive adult you go straight to the carotid because it is a central pulse that remains palpable even when blood pressure is too low to produce a radial pulse. The radial site is for responsive adults, and the brachial artery is the standard site for infants under one year.

    Source: AAOS Emergency Care 12th ed. / AHA guidelines — carotid pulse for unresponsive adults, radial for responsive, brachial for infantsReport a problem with this question

23. 23. A chainsaw operator has bright red blood spurting from a deep thigh wound and his skin is growing pale. As you begin the primary assessment, your first action should be to:

    • A.open the airway and evaluate his breathing
    • B.control the hemorrhage with direct pressure✓ Answer
    • C.apply high-flow oxygen for the blood loss
    • D.obtain a complete set of baseline vital signs

    Life-threatening external hemorrhage is the one problem addressed even before airway — the X in X-ABC — because a patient can exsanguinate from an arterial bleed in minutes. Apply direct pressure at once and escalate to a tourniquet placed high and tight if the extremity bleeding is not controlled, noting the application time.

    Source: AAOS Emergency Care 12th ed. / NREMT primary assessment sequence — X-ABC: control exsanguinating hemorrhage before airwayReport a problem with this question

24. 24. You are reassessing a trauma patient who has shown signs of compensated shock. Which new finding most clearly indicates progression to decompensated shock?

    • A.A heart rate that stays above 100 per minute
    • B.Skin that remains pale, cool, and diaphoretic
    • C.Growing anxiety and complaints of thirst
    • D.A systolic blood pressure that begins to fall✓ Answer

    In compensated shock, tachycardia, vasoconstriction (pale, cool, clammy skin), anxiety, and thirst maintain a normal blood pressure; those findings define the compensated stage rather than ending it. Decompensation begins when those mechanisms fail and the systolic pressure falls — hypotension with declining mental status is the hallmark of decompensated shock.

    Source: AAOS Emergency Care 12th ed., Shock — compensated (normal BP with tachycardia) vs decompensated (falling systolic BP); NREMT sample TEI topicReport a problem with this question

25. 25. You are assessing circulation and perfusion in a 4-year-old who may be in shock. Which principle should guide your interpretation of the findings?

    • A.Blood pressure can stay normal until shock is advanced✓ Answer
    • B.Tachycardia can be blamed on crying and disregarded
    • C.Capillary refill is unreliable in children under age 6
    • D.Hypotension appears early, so a normal BP is reassuring

    Children compensate powerfully with tachycardia and vasoconstriction, so their blood pressure often remains normal until shock is far advanced — hypotension in a child is a late and ominous sign. That is why capillary refill (most reliable in children under about 6) and skin signs matter so much, and why persistent tachycardia must never be dismissed as mere crying.

    Source: AAOS Emergency Care 12th ed., Pediatric assessment — hypotension is a late sign of shock in children; cap refill most reliable under age 6Report a problem with this question

26. 26. During the primary assessment you find both vomitus pooling in the airway and slow, shallow breathing. How should you manage these life threats?

    • A.Load the patient and manage both during transport
    • B.Treat each one immediately, in the order it is found✓ Answer
    • C.Note them and intervene after the secondary assessment
    • D.Support breathing first because oxygen matters most

    The primary assessment is a treat-as-you-go survey: each life threat is corrected the moment it is discovered, in assessment order, before moving on. Here the airway problem was found first and must be fixed first — suctioning the vomitus — because ventilating over an obstructed airway is ineffective and forces the material into the lungs; deferring life threats to later phases is never acceptable.

    Source: NREMT EMT Test Plan, Domain 2 — identify and treat life threats during the primary assessment, in the order found (ABC sequence)Report a problem with this question

27. 27. You are transporting a patient whose primary assessment revealed signs of shock. How often should you reassess vital signs during transport?

    • A.Every 15 minutes, the standard for all patients
    • B.At least every 5 minutes, as the patient is unstable✓ Answer
    • C.Once at departure and once on arrival at the hospital
    • D.Only when the patient's condition visibly changes

    A patient with signs of shock is unstable, and unstable patients are reassessed at least every 5 minutes so that deterioration — such as a falling blood pressure — is caught while there is still time to act. The every-15-minute interval applies only to stable patients, and waiting for a visible change means the trend is discovered too late.

    Source: AAOS Emergency Care 12th ed., Reassessment — every 5 minutes for unstable patients, every 15 minutes for stable patientsReport a problem with this question

28. 28. You are 25 minutes from the hospital with a patient whose shock is worsening. An ALS unit is available a few minutes away. Your best decision is to:

    • A.begin transport and arrange an ALS intercept en route✓ Answer
    • B.finish a full secondary assessment before moving him
    • C.cancel the ALS unit since you can reach the hospital
    • D.remain on scene and wait for the ALS unit to arrive

    A patient in worsening shock needs definitive hospital care, so the rule is that requesting ALS must never delay transport: begin moving toward the hospital and have the ALS unit intercept you en route, gaining advanced interventions without losing time. Waiting on scene or finishing a secondary assessment burns minutes of the patient's limited 'golden period.'

    Source: NREMT EMT Test Plan, Domain 2 — identify need for rapid transport/additional resources; AAOS Emergency Care 12th ed., ALS intercept without delaying transportReport a problem with this question

29. 29. You find an unresponsive woman in a shopping mall with no obvious injuries. Your best source for the chief complaint and the events before the collapse is:

    • A.her own responses once she regains consciousness
    • B.the medical history obtained later at the hospital
    • C.bystanders who saw what happened before you arrived✓ Answer
    • D.the head-to-toe secondary physical examination

    When a patient cannot communicate, the primary assessment task of determining the chief complaint shifts to bystanders and family, who can describe complaints voiced before the collapse, how it happened, and relevant history. A physical exam reveals signs but not the history of the event, and waiting for the hospital or for her to wake up delays information you need to guide care right now.

    Source: NREMT EMT Test Plan, Domain 2 — communicate with bystanders and determine chief complaint when the patient cannot communicateReport a problem with this question

Practice questions modeled on the National EMS Education Standards and NREMT cognitive-exam content areas. Not medical advice and not affiliated with or endorsed by the National Registry of Emergency Medical Technicians (NREMT) or NHTSA. Always follow your instructor, medical director, and local protocols. Study the official materials at nremt.org. Official NREMT →