Free NREMT Practice Test · Topic Drill
Trauma Practice Test
25 NREMT-style questions, one at a time — just like the real exam. Score and full explanations at the end. Free, no signup.
Trauma questions on the NREMT are scenario-driven: bleeding you have to control, a chest wound you have to seal, a mechanism you have to size up. These 25 questions cover hemorrhage control and tourniquets, the stages of shock, chest injuries and tension pneumothorax, burns and the rule of nines, spinal motion restriction, splinting, and START mass-casualty triage. Every explanation reflects current national bleeding-control and trauma guidance, and calls out the trap each wrong option is built to catch.
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Question 1 of 25.A 24-year-old man has bright red blood spurting from a deep laceration to his mid-thigh. Direct pressure with a gloved hand over a dressing has not controlled the bleeding. What should the EMT do next?
Prefer to read? All 25 questions with answers
A 24-year-old man has bright red blood spurting from a deep laceration to his mid-thigh. Direct pressure with a gloved hand over a dressing has not controlled the bleeding. What should the EMT do next?
- Stack additional dressings on the wound and continue direct pressure only
- Apply a commercial tourniquet proximal to the wound (correct answer)
- Elevate the leg above the level of the heart and reassess
- Compress the femoral pressure point until bleeding slows
Life-threatening extremity hemorrhage that is not rapidly controlled by direct pressure calls for immediate tourniquet application proximal to the wound. Current national guidance de-emphasizes elevation and pressure points because they delay definitive control, and stacking more dressings over uncontrolled arterial bleeding simply hides ongoing blood loss.
Which statement about prehospital tourniquet use is correct?
- The tourniquet should be loosened every 10 to 15 minutes to allow some blood flow
- The tourniquet should be placed directly over the knee or elbow when the wound is near a joint
- The tourniquet should be tightened until bleeding stops and the application time should be recorded (correct answer)
- The tourniquet should be concealed under clothing or blankets so it is not disturbed
A tourniquet is tightened until hemorrhage stops (distal pulse eliminated), and the time of application is documented and communicated at handoff. Once applied it is not loosened in the field, it is placed on the long bones about 2 to 3 inches proximal to the wound rather than over a joint, and it should remain visible so receiving providers see it immediately.
An EMT applies a tourniquet high on the thigh for an arterial bleed, tightens it fully, but bright red bleeding from the wound continues. What is the best next action?
- Apply a second tourniquet adjacent to and just proximal to the first (correct answer)
- Remove the first tourniquet and return to direct pressure
- Loosen the first tourniquet slightly and then retighten it
- Elevate the limb and wait several minutes before reassessing
If a properly tightened tourniquet fails to stop the bleeding, national bleeding-control guidance calls for a second tourniquet placed side by side with, and just proximal to, the first. Removing or loosening a tourniquet on an uncontrolled arterial bleed allows renewed hemorrhage, and passive measures such as elevation do not control arterial bleeding.
A patient has heavy, dark red bleeding from a deep stab wound at the groin crease, where a tourniquet cannot be positioned effectively. How should the EMT manage this junctional hemorrhage?
- Cover the wound with an occlusive dressing taped on three sides
- Apply ice packs over a loosely secured gauze dressing
- Compress the proximal pressure point and avoid touching the wound itself
- Pack the wound tightly with gauze and apply firm, sustained direct pressure (correct answer)
Junctional wounds at the groin, axilla, or neck base are managed with tight wound packing, using hemostatic gauze where available and plain gauze otherwise, followed by firm continuous pressure. Occlusive dressings are for open chest wounds, ice does not stop severe hemorrhage, and pressure-point-only techniques are no longer emphasized in national bleeding-control guidance.
A 30-year-old woman with significant external blood loss is anxious, with a heart rate of 124, respirations of 24, and pale, cool, clammy skin. Her blood pressure is 112/78 mm Hg. Which of the following best describes this patient's condition?
- Irreversible shock
- Compensated shock (correct answer)
- Decompensated shock
- Obstructive shock
Tachycardia, tachypnea, anxiety, and pale, cool, clammy skin with a still-normal blood pressure define compensated shock, in which vasoconstriction and increased heart rate maintain perfusion pressure. Decompensated shock is marked by hypotension and deteriorating mental status, irreversible shock by profound unresponsive hypoperfusion, and obstructive shock by a mechanical block to cardiac output such as tension pneumothorax or tamponade rather than blood loss.
Which finding most clearly indicates that a trauma patient has progressed from compensated to decompensated shock?
- A heart rate of 110 beats per minute
- Pale, cool extremities
- Complaints of anxiety and thirst
- A falling systolic blood pressure (correct answer)
Hypotension is the hallmark of decompensated shock: it appears only after the body's compensatory vasoconstriction and tachycardia are exhausted, typically alongside deteriorating mental status. Tachycardia, pale cool skin, anxiety, and thirst are all present during the compensated stage, which is why blood pressure is a late and unreliable early-warning sign.
An adult with hemorrhagic shock has had the external bleeding controlled. Which action is appropriate EMT management during transport?
- Give warm liquids by mouth to replace lost volume
- Keep the patient supine and prevent heat loss (correct answer)
- Maintain the patient in a head-down (Trendelenburg) position
- Complete a full detailed physical exam on scene before departing
After hemorrhage control, care for shock centers on supine positioning, preventing hypothermia, administering oxygen as indicated, and rapid transport, because hypothermia worsens bleeding and outcomes. Oral fluids are withheld from shock patients, the Trendelenburg position is no longer recommended in national curricula, and a detailed exam must never delay transport of an unstable trauma patient.
Which statement about shock from blood loss in young children is most accurate?
- Capillary refill is unreliable in children and should not guide assessment
- Skin signs remain normal until the blood pressure begins to fall
- A normal blood pressure does not rule out life-threatening blood loss (correct answer)
- A slowing heart rate is typically the first sign of pediatric shock
Children compensate powerfully through tachycardia and vasoconstriction and can maintain a normal blood pressure until they have lost a large fraction of their blood volume, after which they deteriorate abruptly. Hypotension in a pediatric trauma patient is therefore a late and ominous finding, and assessment should rely on heart rate, skin signs, capillary refill, and mental status instead.
A patient has an open wound to the chest wall that makes a sucking sound with each inhalation. Which dressing should the EMT apply?
- A moist sterile dressing secured on all four sides
- A porous gauze dressing that allows the wound to breathe
- A bulky trauma dressing wrapped circumferentially around the chest
- A vented occlusive dressing over the wound (correct answer)
An open (sucking) chest wound is sealed with an occlusive dressing to stop air from entering the pleural space, and current national guidance prefers a vented (one-way valve) design; a nonvented occlusive dressing may be used with close monitoring for tension physiology. Porous or moist gauze does not create a seal, and circumferential chest wraps restrict ventilation.
An EMT seals an open chest wound with a nonvented occlusive dressing. En route, the patient develops rapidly worsening respiratory distress and a falling blood pressure. What should the EMT do first?
- Lift an edge of the dressing briefly to let trapped air escape (correct answer)
- Apply a second occlusive dressing on top of the first
- Reinforce the dressing so it seals more tightly on all four sides
- Lay the patient supine and elevate the legs
Deterioration after sealing an open chest wound suggests a developing tension pneumothorax, and the immediate EMT action is to burp the dressing by lifting an edge so trapped pleural air can vent. Adding dressings or tightening the seal worsens the pressure buildup, and positioning changes do not address the underlying problem.
After a steering-wheel impact, a section of a patient's chest wall moves inward during inhalation and bulges outward during exhalation. This finding most likely indicates which injury?
- Tension pneumothorax
- Flail chest (correct answer)
- Cardiac tamponade
- Hemothorax
Paradoxical chest wall movement, where a segment moves opposite to the rest of the chest during breathing, is the classic sign of flail chest, caused by two or more adjacent ribs fractured in two or more places. It signals significant force and frequently overlies a pulmonary contusion, so these patients need oxygenation support, ventilation assistance if breathing is inadequate, and rapid transport.
A patient with a closed chest injury is developing a tension pneumothorax. Which of the following is typically a late finding rather than an early one?
- Increasing heart rate
- Diminished breath sounds on the injured side
- Anxiety and worsening respiratory distress
- Tracheal deviation toward the uninjured side (correct answer)
Tracheal deviation away from the injured side is a late and often absent sign of tension pneumothorax, appearing only after substantial mediastinal shift. EMTs should recognize the earlier pattern of worsening distress, unilateral diminished breath sounds, tachycardia, and then hypotension and jugular venous distention, rather than waiting for tracheal deviation to act.
Under modern selective spinal motion restriction guidelines, which patient requires spinal motion restriction?
- An alert, sober adult with no neck pain, no midline tenderness, and a normal exam after a low-speed crash
- An alert adult with midline cervical spine tenderness after a fall (correct answer)
- An alert adult with lateral neck muscle soreness but no midline tenderness or deficits
- An alert, ambulatory adult with paraspinal lumbar muscle ache and a normal neurologic exam
National guidance reserves spinal motion restriction for patients with findings such as midline spinal pain or tenderness, altered mental status, intoxication, focal neurologic deficits, a significant distracting injury, or inability to communicate. Midline cervical tenderness alone meets criteria, whereas lateral or paraspinal muscle soreness without midline tenderness, deficits, or other criteria does not, and a fully reliable patient with a negative exam can be transported without immobilization; local protocols may add specific criteria.
A patient with a severe head injury has a blood pressure of 190/100 mm Hg, a heart rate of 52, and an irregular breathing pattern. This combination of vital signs most strongly suggests which condition?
- Hypovolemic shock
- Neurogenic shock
- Rising intracranial pressure (correct answer)
- Tension pneumothorax
Hypertension, bradycardia, and irregular respirations form Cushing's triad, the classic sign of critically elevated intracranial pressure threatening brain herniation. Hypovolemic shock produces hypotension with tachycardia, neurogenic shock produces hypotension with a normal or slow heart rate, and tension pneumothorax produces hypotension with tachycardia, so the hypertensive-bradycardic pattern points to the brain.
A trauma patient opens her eyes when spoken to, is confused when answering questions, and follows commands to squeeze the EMT's hand. What is her Glasgow Coma Scale score?
- 11
- 12
- 13 (correct answer)
- 14
Eye opening to verbal stimulus scores 3, confused conversation scores 4, and obeying commands scores the maximum motor score of 6, for a total of 13. Working through each component separately prevents the most common exam error of confusing confused speech (4) with inappropriate words (3) or eye opening to voice (3) with spontaneous opening (4).
Which statement about the long backboard reflects current national guidance for trauma care?
- It serves mainly as an extrication and movement device rather than a transport requirement (correct answer)
- Trauma patients meeting spinal motion restriction criteria should remain strapped to the board during transport
- A cervical collar adds little additional benefit once a long backboard is in use
- Ambulatory patients meeting spinal motion restriction criteria should be boarded via standing takedown
Current national positions treat the long backboard primarily as a tool for extrication and patient movement; patients who need spinal motion restriction can be maintained with a cervical collar secured on the ambulance stretcher, and reliable ambulatory patients may self-extricate to the stretcher. Prolonged rigid-board transport causes pain, pressure injury, and respiratory compromise without proven benefit.
Using the adult rule of nines, what percentage of body surface area is burned in a patient with burns covering one entire arm and the entire anterior trunk?
- 18%
- 22.5%
- 27% (correct answer)
- 36%
In the adult rule of nines, each entire arm is 9% and the anterior trunk (chest and abdomen) is 18%, so the total is 27%. Remembering the adult map — head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, genitalia 1% — allows quick estimation; pediatric proportions differ, with the head counting for more and the legs for less.
Which of the following burns is classified as critical under standard EMT burn-severity criteria?
- A superficial burn covering 20% of the back
- A partial-thickness burn covering 5% of one forearm
- Full-thickness burns involving both hands (correct answer)
- A partial-thickness burn covering 3% of the thigh
Full-thickness burns involving the hands, feet, face, airway, or genitalia are classified as critical regardless of their total surface area because of their functional and life-threat implications, and such patients warrant transport toward burn-center care. Superficial burns are not critical even when extensive, and small partial-thickness burns on the forearm or thigh are minor to moderate.
An adult has partial- and full-thickness thermal burns over approximately 25% of the body. The burning process has been stopped. Which dressing and care approach is appropriate?
- Apply ice directly to the burned areas to relieve pain
- Cover the burns with continuously moistened dressings throughout transport
- Apply a thin layer of antibiotic ointment before covering the burns
- Cover the burns with dry sterile dressings and keep the patient warm (correct answer)
Large burns are covered with dry sterile dressings and the patient is actively kept warm, because burned skin loses thermoregulation and extensive wet dressings or ice cause hypothermia and further tissue injury. Brief cooling with water is reserved for small burns, and ointments are avoided in the field since they must be removed for burn evaluation.
Before and after splinting a suspected forearm fracture, the EMT should assess which of the following?
- Proximal pulses in the injured limb
- Distal circulation, sensation, and motor function (correct answer)
- Blood pressure in both arms
- Active range of motion of the injured joint
Checking pulse, sensation, and motor function distal to the injury before and after splinting is the standard that detects vascular or nerve compromise caused by the injury or by the splint itself. Findings are documented at both checks; asking a patient to actively move a suspected fracture is contraindicated, and proximal pulses or bilateral blood pressures do not evaluate distal perfusion.
For which patient is a traction splint indicated?
- A patient with a painful, deformed mid-thigh and no other injuries to that limb (correct answer)
- A patient with a femur fracture and a suspected unstable pelvic fracture
- A patient with deformity and swelling centered at the knee joint
- A patient with hip pain and a shortened, externally rotated leg after a fall
A traction splint is indicated for a suspected isolated mid-shaft femur fracture, where steady traction reduces muscle spasm, pain, and internal bleeding. It is contraindicated when the same limb or region has pelvic, hip, knee, or lower-leg and ankle injuries, because the device anchors against those structures and would worsen them.
A patient has a severely angulated fracture of the forearm, and the hand below it is cold, pale, and pulseless. What should the EMT do?
- Splint the limb exactly as found and reassess on arrival at the hospital
- Make one gentle attempt to realign the limb with in-line traction, then splint (correct answer)
- Apply a traction splint to restore distal circulation
- Apply cold packs to the hand and splint the limb in the position found
When a deformed long-bone fracture has no distal pulse, national curricula direct one gentle attempt to realign the limb with in-line traction to restore perfusion before splinting, stopping if resistance or significant pain is encountered. Splinting a pulseless limb as found risks losing the extremity, a traction splint is reserved for suspected isolated mid-shaft femur fractures and does not treat forearm ischemia, and cold packs further reduce perfusion in an already pulseless hand; local protocols may vary on realignment specifics, so follow medical direction.
At a multiple-casualty incident using the START system, an adult who is not walking has a respiratory rate of 32 breaths per minute after the airway is clear. Which triage category is assigned?
- Minor (green)
- Delayed (yellow)
- Immediate (red) (correct answer)
- Expectant (black)
In START, any adult breathing faster than 30 per minute is tagged Immediate without further assessment, because severe tachypnea marks physiologic failure. Perfusion and mental status are checked only when respirations are 30 or fewer, and walking wounded are tagged Minor before individual assessment begins.
During START triage at a building collapse, an adult is found apneic. The EMT repositions the airway, and the patient remains apneic. Which category is assigned?
- Immediate (red)
- Delayed (yellow)
- Minor (green)
- Expectant/deceased (black) (correct answer)
In the adult START algorithm, a patient who remains apneic after one airway repositioning is tagged Expectant/deceased so that scarce resources go to salvageable patients; a patient who resumes breathing after repositioning would instead be tagged Immediate. The pediatric JumpSTART modification differs by giving an apneic child with a pulse a brief trial of rescue breaths.
Using START triage, a non-ambulatory adult breathes 24 times per minute, has no palpable radial pulse, and follows commands. Which category is assigned?
- Immediate (red) (correct answer)
- Delayed (yellow)
- Minor (green)
- Expectant (black)
START assesses respirations, perfusion, and mental status in sequence, and failure at any step tags the patient Immediate. Here the respiratory rate passes (30 or fewer), but the absent radial pulse indicates failed perfusion, so the patient is tagged Immediate even though he follows commands; only a patient passing all three checks is tagged Delayed.
FAQ: Trauma on the NREMT
What does the NREMT expect for controlling severe bleeding?
Direct pressure first; if that fails to control life-threatening extremity hemorrhage, apply a commercial tourniquet 2 to 3 inches proximal to the wound (never over a joint), tighten until the bleeding stops, and record the time — then leave it visible and never loosen it in the field. If one tourniquet does not stop the bleeding, place a second side by side just proximal to the first. Junctional wounds at the groin, axilla, or neck are packed tightly, ideally with hemostatic gauze, and held with firm pressure. Current national guidance de-emphasizes elevation and pressure points because they delay definitive control.
How do I recognize the stages of shock on the exam?
Compensated shock is tachycardia, tachypnea, anxiety, and pale, cool, clammy skin with a still-normal blood pressure — the body is holding pressure through vasoconstriction. A falling systolic blood pressure marks the shift to decompensated shock and is a late sign. That is doubly true in children, who compensate powerfully and can crash abruptly, so a normal blood pressure never rules out serious blood loss. Treat aggressively on the compensated signs; do not wait for hypotension.
What are the START triage cutoffs I need for a mass-casualty question?
START runs respirations, then perfusion, then mental status (RPM). Walking wounded are tagged Minor (green) first. An adult breathing faster than 30 per minute is Immediate (red) with no further checks. If respirations are 30 or fewer, check perfusion (a radial pulse or capillary refill under 2 seconds) and mental status (ability to follow commands); failure at either step is also Immediate. A patient who stays apneic after one airway repositioning is tagged Expectant/deceased (black) so resources go to salvageable patients.
Are these questions taken from the real NREMT?
No. Real NREMT items are confidential and belong to the National Registry — be wary of any site claiming to have them. Our questions are original, written to mirror the style, difficulty, and published content areas of the exam, drawing on the National EMS Education Standards and current AHA guidelines. Scoring well here is strong evidence you are ready, not a preview of the exact questions you will see.
Is this practice test really free?
Yes. Every question, explanation, and score report on FreeEMTTest is free, with no signup, no credit card, and no trial that expires. Retake any test as many times as you want.
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