NREMT Paramedic Trauma Exam Practice Test

NREMT-PTE Exam Format | Course Contents | Course Outline | Exam Syllabus | Exam Objectives

Exam Details:
- Number of Questions: The number of questions in the NREMT Paramedic Trauma Exam (NREMT-PTE) can vary, but it typically consists of approximately 80 to 120 multiple-choice questions. The exact number of questions may vary depending on the specific version of the exam.

- Time: Candidates are usually given a specific time limit to complete the NREMT-PTE, which is typically around 2 to 3 hours. It is important to manage time effectively to ensure all questions are answered within the allocated time.

Course Outline:
The NREMT-PTE exam focuses on assessing the knowledge and skills of paramedics in the area of trauma management. While the exact course outline and content may vary, the exam generally covers the following key areas:

1. Trauma Assessment and Management:
- Primary and secondary survey techniques
- Recognition and management of life-threatening injuries
- Identification and management of shock
- Assessment and treatment of head, neck, spine, and chest injuries
- Management of abdominal and pelvic trauma
- Assessment and treatment of musculoskeletal injuries
- Management of burns and thermal injuries

2. Airway Management and Ventilation:
- Airway assessment and maintenance techniques
- Use of airway adjuncts (e.g., oral airway, supraglottic airway devices)
- Bag-mask ventilation techniques
- Endotracheal intubation and advanced airway management
- Management of complications related to airway interventions

3. Cardiac and Cardiovascular Emergencies:
- Recognition and management of cardiac arrest
- Cardiovascular assessment and monitoring
- Use of defibrillation and advanced cardiac life support techniques
- Management of acute coronary syndromes
- Identification and treatment of dysrhythmias
- Hemodynamic monitoring and management

4. Medical Emergencies:
- Assessment and management of respiratory emergencies
- Neurologic emergencies and stroke management
- Allergic reactions and anaphylaxis management
- Endocrine emergencies (e.g., diabetic emergencies, adrenal crisis)
- Management of toxicological emergencies
- Assessment and treatment of psychiatric emergencies

5. Pediatric and Geriatric Trauma:
- Assessment and management of trauma in pediatric and geriatric populations
- Special considerations for pediatric and geriatric patients
- Age-specific assessment techniques and interventions

Exam Objectives:
The objectives of the NREMT-PTE exam typically include:
- Assessing the candidate's knowledge and understanding of trauma assessment and management principles.
- Evaluating the candidate's ability to apply critical thinking skills in the context of trauma scenarios.
- Testing the candidate's knowledge of airway management, ventilation, and cardiac emergencies.
- Assessing the candidate's ability to apply appropriate interventions for medical emergencies.
- Evaluating the candidate's understanding of special considerations for pediatric and geriatric trauma patients.

Exam Syllabus:
The specific exam syllabus for the NREMT-PTE may vary, but it generally includes the following topics:

1. Trauma Assessment and Management:
- Primary and secondary survey
- Life-threatening injuries
- Shock management
- Head, neck, spine, and chest injuries
- Abdominal and pelvic trauma
- Musculoskeletal injuries
- Burns and thermal injuries

2. Airway Management and Ventilation:
- Airway assessment and maintenance
- Airway adjuncts
- Bag-mask ventilation
- Endotracheal intubation
- Advanced airway management
- Airway intervention complications

3. Cardiac and Cardiovascular Emergencies:
- Cardiac arrest management
- Cardiovascular assessment and monitoring


- Defibrillation and advanced cardiac life support
- Acute coronary syndromes
- Dysrhythmia recognition and treatment
- Hemodynamic monitoring

4. Medical Emergencies:
- Respiratory emergencies
- Neurologic emergencies and stroke
- Allergic reactions and anaphylaxis
- Endocrine emergencies
- Toxicological emergencies
- Psychiatric emergencies

5. Pediatric and Geriatric Trauma:
- Pediatric and geriatric trauma assessment and management
- Age-specific considerations

It is important to note that the specific content and emphasis of the NREMT-PTE may vary depending on the NREMT's guidelines and updates. Candidates should refer to the official study materials and resources provided by the NREMT for the most accurate and up-to-date information regarding the exam syllabus and content.

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NREMT Paramedic Trauma Exam
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Question: 41
Which of the following most accurately describes the finding of jugular venous
distension in pneumothorax?
A. It is an early finding of even minor pneumothoraxes
B. It indicates relative hypovolemia in the thorax due to hemorrhage
C. It is indicative of high intrathoracic pressure
D. Pneumothorax is more likely to cause jugular vein flattening
Answer: C
JVD is typically a sign of increased intrathoracic pressure, but can be a very late
finding. It presents when increased pressure on the great vessels in the thorax
cause a backup of blood returning from the head. This typically presents in
serious tension pneumothoraxes and does not appear in minor cases.
Question: 42
Becks triad is a combination of increased JVD, hypotension and muffled heart
tones and occurs in which of the following?
A. Hemothorax
B. Cardiac tamponade
C. Aortic dissection
D. Traumatic brain injury
Answer: B
Becks triad is observed in cases of cardiac tamponade and is caused by the
increase in pressure in the pericardial sac, which, in turn, causes the inability of
the ventricles to expand fully. This results in hypotension systemically and a
backup of blood in the jugular veins.
Question: 43
Upon arrival to the scene of a stabbing, you find a patient with a stab wound to
the left chest, midclavicular, 4th intercostal space. The patient is in peri-arrest,
hypotensive, with a rapid, thready pulse and jugular venous distension. The
patients GCS score is 3. You perform bilateral needle decompression, but there is
no rush of air or improvement in patients condition. The patient no longer has a
pulse and now presents in PEA. Which of the following is suspected in assessing
the patient?
A. Cardiac rupture
B. Diaphragmatic rupture
C. Hemopneumothorax
D. Pericardial tamponade
Answer: D -Hypotension presenting with JVD and clear mechanism of
traumatic injury is highly suspect for pericardial tamponade. Consideration for a
hemothorax, pneumothorax, or hemopneumothorax should be made and can be
differentiated by considering location of penetrating trauma, presence of Becks
triad and clinical suspicion. Cardiac rupture is almost entirely caused by blunt
force trauma, particularly in MVAs.
Question: 44
Other than rapid transport to a trauma center, which of the following is most
helpful for a patient suffering from pericardial tamponade?
A. Needle thoracostomy
B. Positive pressure ventilation therapy
C. Aggressive IV fluid administration
D. Remote ischemic conditioning
Answer: C
The best prehospital treatment for patients with pericardial tamponade is to
maintain vital signs and keep perfusion up. Oxygenation is typically not a
problem for these patients, but the increase in pressure around the heart requires
that adequate preload be maintained.
Question: 45
Which type of mechanism of injury is not likely in patients with posterior rib
fractures of the second and third ribs?
A. Frontal strike
B. Compression of the ribcage from the side
C. Relatively high force impact
D. All of the above.
Answer: A
Frontal impacts are more likely to cause lateral fractures, not posterior fractures.
Posterior second and third rib fractures are usually a result of high velocity side
impact to the chest. The first, second, and third ribs in healthy adults are strong
and require a high degree of force to fracture. When posterior fractures do occur,
it is usually from side impact.
Question: 46
You are called to the scene of an elderly patient female who slipped and fell,
landing on her chest. She complains of dyspnea and chest pain that increases with
inspiration and palpation. She states that her symptoms are much better when she
holds pressure on her left side. What is the most likely cause of her symptoms?
A. Hypovolemia from hip fracture
B. Tension pneumothorax
C. Rib fracture
D. Traumatic asphyxiation
Answer: C
This patient likely has a fractured rib. Elderly patients are more vulnerable to rib
fractures due to their bones becoming more brittle with age. The presentation of
mild dyspnea with improvement in symptoms when being held is very typical of
rib fractures.
Question: 47
You are called to the scene of an elderly patient female who is displaying classic
symptoms of a fractured rib. The patients GCS level is 15, oxygen saturation on
room air is 93%. Heart rate is 112, blood pressure is 142/102. What is the most
appropriate course of treatment for this patient?
A. Use rib binders for comfort, apply high flow O2, transport to a trauma center
B. Apply supplemental O2 via nasal cannula, monitor for ventilatory changes,
transport to a trauma center
C. Bind the ribs for comfort, apply nebulized albuterol for dyspnea, give 324mg
aspirin for chest pain, transport to a trauma center
D. Give nitroglycerine 0.4mg sublingual for chest pain, apply high flow O2,
transport to a cardiac center
Answer: B
The optimal treatment for patients with broken ribs includes supplemental O2 as
needed and monitor for changes during transport to trauma center. C-spine
precautions should be considered per protocol. The use of chest binders is
contraindicated as it can result in hypoventilation. This patient should receive an
assessment for cardiac chest pain, but this etiology is unlikely given the
mechanism of injury and nature of complaints.
Question: 48
Flail chest occurs when a segment of the rib cage is broken and detached
following trauma. This typically presents as a section of the rib cage moving out
of sync and independent of from breathing motions. What is this phenomenon
called?
A. Pulsus paradoxus
B. Rib contusion
C. Paradoxic chest wall movement
D. Traumatic pneumonia
Answer: C
This pattern of chest wall movement is called paradoxic chest wall movement.
This paradoxical movement causes significant pain and dyspnea and is usually
accompanied by a pulmonary contusion, the latter of which and can lead to
respiratory compromise.
Question: 49
What is the best management for a patient with flail chest who is deteriorating
and developing severe respiratory distress?
A. Analgesia to reduce the pain of respiration
B. Needle thoracostomy to reduce internal pressure
C. Encouragement to hold their breath to increase the internal pressure
D. CPAP or positive pressure by BVM to internally splint the injury
Answer: D
Patients that are starting to develop severe respiratory distress require ventilation
assistance in order to avoid complete respiratory compromise. By applying
positive airway pressure carefully, the flail segment can become splinted
internally, allowing for better ventilation. Analgesics would have been more
applicable before a patient reaches this point. Needle thoracostomy would not
help this patient.

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