15 Secondary Assessment Practice Questions & Answers

Every Secondary Assessment practice question from the EMT (NREMT) Practice Test, with the correct answer and a short explanation.

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1. A 70-year-old woman with diabetes reports unusual fatigue, nausea, and mild shortness of breath but denies chest pain. What is the most appropriate action?
- A.Delay transport until chest pain begins
- B.Reassure her that her heart is fine
- C.Treat her for simple indigestion only
- D.Treat as a heart attack and transport✓ Answer
Women, the elderly, and diabetics often have atypical or 'silent' MI presentations without classic chest pain — diabetic neuropathy blunts the pain signal — so these symptoms warrant treating and transporting for possible acute coronary syndrome.
Source: ACS assessment — atypical/silent MI presentations in women, elderly, and diabeticsReport a problem with this question
2. A patient's chest discomfort came on with exertion, lasted about 5 minutes, and went away completely with rest. This pattern is most consistent with:
- A.An acute heart attack
- B.Unstable angina pectoris
- C.Acute cardiac tamponade
- D.Stable angina pectoris✓ Answer
Stable angina is transient ischemia — typically brief (under about 15 minutes) and relieved by rest or nitroglycerin — without the myocardial cell death that occurs in an MI. Unstable angina, by contrast, comes on at rest or with less and less exertion and is not fully relieved by rest.
Source: ACS spectrum — stable angina: transient, <15 min, relieved by rest/nitroglycerinReport a problem with this question
3. A patient with a history of heart failure is short of breath, has crackles in both lungs, and coughs up pink, frothy sputum. If blood pressure allows, how should you position this patient?
- A.Trendelenburg, with the head down
- B.The left lateral recumbent position
- C.Supine and lying completely flat
- D.Sitting upright (semi-Fowler's)✓ Answer
These signs indicate pulmonary edema from left-sided heart failure; sitting the patient upright eases the work of breathing and reduces venous return to the congested lungs.
Source: Left-sided heart failure/pulmonary edema — position upright (semi-Fowler's)Report a problem with this question
4. A patient with a stab wound to the left chest develops increasing dyspnea, absent breath sounds on the left, distended neck veins, and hypotension. What condition is MOST likely developing?
- A.Panic hyperventilation
- B.Acute asthma attack
- C.Tension pneumothorax✓ Answer
- D.Simple rib fracture
Air trapped under pressure in the pleural space collapses the lung and shifts mediastinal structures, producing absent breath sounds on the affected side, jugular venous distension, hypotension, and severe dyspnea — the classic picture of a tension pneumothorax.
Source: National EMS Education Standards — Thoracic traumaReport a problem with this question
5. During assessment of a chest-trauma patient, you note a segment of the chest wall that moves inward during inspiration and outward during expiration. This finding indicates:
- A.Accessory muscle use
- B.Subcutaneous emphysema
- C.Simple pneumothorax
- D.Flail chest segment✓ Answer
When two or more adjacent ribs are each fractured in two or more places, a free-floating segment moves opposite to the rest of the chest — paradoxical motion — which is the defining sign of flail chest and impairs ventilation.
Source: National EMS Education Standards — Thoracic trauma / flail chestReport a problem with this question
6. A patient with a severe head injury develops hypertension, bradycardia, and irregular respirations. This triad indicates:
- A.Neurogenic shock from cord injury
- B.Rising intracranial pressure✓ Answer
- C.A normal response to severe pain
- D.Compensated hypovolemic shock
The combination of hypertension, bradycardia, and irregular respirations is Cushing's triad, the body's response to rising intracranial pressure; it is a late and ominous sign of brain herniation requiring airway support and rapid transport.
Source: National EMS Education Standards — Traumatic brain injury / Cushing triadReport a problem with this question
7. You find clear fluid draining from the ears and bruising behind both ears (Battle sign) in a head-injury patient. These findings suggest:
- A.Basilar skull fracture✓ Answer
- B.Simple scalp laceration
- C.Isolated nasal fracture
- D.Mandible fracture only
Cerebrospinal fluid leaking from the ears or nose, along with Battle sign (mastoid bruising) and raccoon eyes, are classic indicators of a basilar skull fracture; you should not pack the ears/nose but allow drainage.
Source: National EMS Education Standards — Head/face trauma; basilar skull fracture signsReport a problem with this question
8. A patient thrown from a motorcycle is hypotensive with a heart rate of 52 and warm, dry, pink skin below the injury. Which type of shock does this BEST describe?
- A.Anaphylactic shock
- B.Hypovolemic shock
- C.Neurogenic shock✓ Answer
- D.Cardiogenic shock
Neurogenic shock from spinal cord injury causes loss of sympathetic tone, producing hypotension WITH bradycardia and warm, dry, pink skin — the opposite of the tachycardia and cool, clammy skin of hypovolemic shock, which helps distinguish the two.
Source: National EMS Education Standards — Spinal trauma / neurogenic shockReport a problem with this question
9. Using the Rule of Nines for an adult, a patient with burns to the entire front of the chest and abdomen (anterior trunk) has approximately what percentage of total body surface area burned?
- A.9% of body surface area
- B.4.5% of body surface area
- C.36% of body surface area
- D.18% of body surface area✓ Answer
In the adult Rule of Nines the anterior trunk (chest plus abdomen) equals 18% of total body surface area — each of the two regions is 9%, together forming the front of the torso.
Source: National EMS Education Standards — Burns / Rule of NinesReport a problem with this question
10. A restrained driver in a high-speed crash is alert with stable vital signs but has abdominal bruising across the lower abdomen and mild tenderness. What is the BEST management approach?
- A.Release the patient after a brief scene exam
- B.Suspect internal bleeding and transport rapidly✓ Answer
- C.Have the patient walk to rule out injury
- D.Recheck the abdomen on scene in 30 minutes
Blunt abdominal trauma can cause hidden internal bleeding that a patient tolerates while looking stable; the seatbelt bruising and mechanism warrant a high index of suspicion, so you treat for shock and transport rapidly rather than being reassured by normal vitals.
Source: National EMS Education Standards — Abdominal trauma / occult hemorrhageReport a problem with this question
11. You arrive to find a 60-year-old man unresponsive with no signs of trauma. After completing your primary assessment and correcting any immediate life threats, what is the BEST next step?
- A.Rapid full-body exam, then get the history✓ Answer
- B.Detailed SAMPLE history from the patient first
- C.Focused exam of the chief-complaint area only
- D.Immediate transport with no further exam
For an unresponsive medical patient the EMT performs a rapid full-body exam and then obtains the history from bystanders or family, because the patient cannot give a reliable history; a responsive medical patient instead receives a history-focused exam first.
Source: National EMS Education Standards — Medical patient assessment (unresponsive medical patient)Report a problem with this question
12. A 45-year-old is found with an altered mental status and no obvious cause. Until proven otherwise, EMTs should assume the cause includes which two immediately reversible conditions?
- A.Anxiety and intoxication
- B.Hypoglycemia and hypoxia✓ Answer
- C.Dehydration and fever
- D.Recent stroke and seizure
Altered mental status is assumed to involve hypoglycemia and/or hypoxia until ruled out because both are rapidly reversible and immediately life-threatening, so glucose and oxygenation are assessed early.
Source: National EMS Education Standards — Altered mental status (AEIOU-TIPS differential)Report a problem with this question
13. Which set of findings BEST fits hypoglycemia rather than hyperglycemia (DKA)?
- A.Rapid onset with cool, pale, sweaty skin✓ Answer
- B.Warm, dry skin with Kussmaul breathing
- C.Acetone breath with dehydration signs
- D.Gradual onset with thirst and urination
Hypoglycemia has a rapid onset with cool, pale, diaphoretic skin and altered mental status, whereas hyperglycemia/DKA develops gradually with warm, dry skin, Kussmaul respirations, fruity breath, and polyuria/polydipsia.
Source: National EMS Education Standards — Endocrine emergencies (hypo- vs hyperglycemia presentation)Report a problem with this question
14. Several people in a home with a faulty furnace have headache and nausea. Regarding pulse oximetry in suspected carbon monoxide (CO) poisoning, which statement is TRUE?
- A.Pulse oximetry may read falsely normal✓ Answer
- B.Withhold oxygen until SpO2 drops to 90%
- C.A normal SpO2 rules out hypoxia here
- D.CO has no effect on oxygen delivery
A standard pulse oximeter cannot distinguish carboxyhemoglobin from oxyhemoglobin and may read falsely normal, so suspected CO patients receive high-flow oxygen and immediate removal from the source regardless of the SpO2 number.
Source: National EMS Education Standards — Toxicology (carbon monoxide; pulse oximetry limitation)Report a problem with this question
15. An older patient reports sudden tearing abdominal and back pain, and you feel a pulsating mass in the abdomen. What is the BEST management?
- A.Delay transport to repeat the vital signs
- B.Give oral fluids and treat for shock
- C.Handle gently, treat shock, transport✓ Answer
- D.Palpate the mass firmly to gauge its size
Tearing pain with a pulsatile abdominal mass suggests an abdominal aortic aneurysm, so the EMT handles the patient gently, keeps them NPO (nothing by mouth), treats for shock, and transports rapidly, because deep palpation could precipitate rupture.
Source: National EMS Education Standards — Abdominal emergencies (suspected AAA)Report 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 →

1. A 70-year-old woman with diabetes reports unusual fatigue, nausea, and mild shortness of breath but denies chest pain. What is the most appropriate action?

2. A patient's chest discomfort came on with exertion, lasted about 5 minutes, and went away completely with rest. This pattern is most consistent with:

3. A patient with a history of heart failure is short of breath, has crackles in both lungs, and coughs up pink, frothy sputum. If blood pressure allows, how should you position this patient?

4. A patient with a stab wound to the left chest develops increasing dyspnea, absent breath sounds on the left, distended neck veins, and hypotension. What condition is MOST likely developing?

5. During assessment of a chest-trauma patient, you note a segment of the chest wall that moves inward during inspiration and outward during expiration. This finding indicates:

6. A patient with a severe head injury develops hypertension, bradycardia, and irregular respirations. This triad indicates:

7. You find clear fluid draining from the ears and bruising behind both ears (Battle sign) in a head-injury patient. These findings suggest:

8. A patient thrown from a motorcycle is hypotensive with a heart rate of 52 and warm, dry, pink skin below the injury. Which type of shock does this BEST describe?

9. Using the Rule of Nines for an adult, a patient with burns to the entire front of the chest and abdomen (anterior trunk) has approximately what percentage of total body surface area burned?

10. A restrained driver in a high-speed crash is alert with stable vital signs but has abdominal bruising across the lower abdomen and mild tenderness. What is the BEST management approach?

11. You arrive to find a 60-year-old man unresponsive with no signs of trauma. After completing your primary assessment and correcting any immediate life threats, what is the BEST next step?

12. A 45-year-old is found with an altered mental status and no obvious cause. Until proven otherwise, EMTs should assume the cause includes which two immediately reversible conditions?

13. Which set of findings BEST fits hypoglycemia rather than hyperglycemia (DKA)?

14. Several people in a home with a faulty furnace have headache and nausea. Regarding pulse oximetry in suspected carbon monoxide (CO) poisoning, which statement is TRUE?

15. An older patient reports sudden tearing abdominal and back pain, and you feel a pulsating mass in the abdomen. What is the BEST management?