- Scene Size-Up and Safety 17.2%
- Primary Assessment 41.4%
- Secondary Assessment 7.1%
- Patient Treatment and Transport 22.2%
- Operations 12.1%
Free · 2026 · 41.4% of the NREMT EMT NREMT Primary Assessment practice questions
Primary Assessment is 41.4% of the NREMT EMT. Answer 10 questions (6 on Primary Assessment) and see your score by domain, with every answer explained. Free, no sign-up.
An 84-year-old nursing home resident with an indwelling urinary catheter has become confused over the past day. Staff say she is normally alert and conversational. Findings: temperature 97.5 °F (36.4 °C), pulse 118, respirations 26, BP 96/58, mottled skin over the knees, cloudy foul-smelling urine, and no facial droop or arm drift. Blood glucose is 112 mg/dL. What is the most likely cause of her altered mental status?
Tap an answer, or press A to D
Mental status, airway, breathing and circulation, the chief complaint and life threats for medical, trauma, OB and pediatric patients, baseline vitals, and when to transport now. The biggest domain.
What the NREMT EMT exam tests in Primary Assessment
- Communicate with the patient and bystanders to establish rapport: introductions and consent, therapeutic communication, patients who are pediatric, older, hearing or vision impaired, non-English speaking, or have behavioral emergencies
- Form a general impression of the patient: sick vs not sick, medical vs trauma, Pediatric Assessment Triangle (appearance, work of breathing, circulation to skin)
- Assess level of consciousness: AVPU, orientation, Glasgow Coma Scale, causes of altered mental status (hypoxia, hypoglycemia, stroke, head injury, overdose, sepsis, seizure)
- Assess the airway: patency, snoring/gurgling/stridor, head tilt-chin lift vs jaw thrust, when to suction or insert an oral or nasal airway, foreign-body airway obstruction, pediatric airway differences
- Assess breathing status: rate, depth, effort and rhythm, adequate vs inadequate breathing, accessory muscle use and retractions, abnormal breathing patterns, lung sounds, pulse oximetry, when to assist ventilation, give oxygen or use CPAP
- Assess circulation: pulse rate and quality at the right site for age, skin color/temperature/moisture, capillary refill, major external bleeding, signs of compensated vs decompensated shock, recognizing cardiac arrest (no normal breathing, no definite pulse in 10 seconds)
- Determine the chief complaint and life threats: respiratory (asthma, COPD, pulmonary edema, pneumonia, pulmonary embolism, pneumothorax, croup, epiglottitis), cardiovascular (acute coronary syndrome, heart failure, aortic emergencies, cardiac arrest), neurologic (stroke, seizure, syncope), diabetic, allergic/anaphylaxis, toxicologic and overdose, sepsis, environmental, behavioral, abdominal, obstetric/gynecologic, and traumatic (head, chest, abdominal, musculoskeletal, burns) emergencies
- Obtain baseline vital signs and diagnostic testing: blood pressure, pulse, respirations, SpO2, blood glucose, temperature, pupils, skin, 12-lead ECG acquisition and transmission, normal ranges by age
- Identify the need for rapid treatment, rapid transport or additional resources: priority (unstable) patients, scene time for critical trauma, ALS intercept, destination choice (trauma, stroke, STEMI, burn, pediatric and obstetric capable facilities)
High-yield primary assessment facts
- Order of the primary assessment: general impression (sick vs not sick, medical vs trauma), then LOC (AVPU) and chief complaint, then airway, breathing, circulation, then the priority/transport decision. Fix each life threat the moment you find it.
- Control massive external bleeding as soon as you see it. Hold manual spinal stabilization if spinal injury is suspected and the patient can't limit their own movement.
- Cardiac arrest: unresponsive with no breathing or only gasping, and no definite pulse after checking breathing and pulse together for 5–10 seconds. Start compressions (C-A-B). Agonal gasps are not breathing.
- Rapport: introduce yourself, get consent, and use the patient's name. Get to eye level, ask open-ended questions, and avoid jargon and false reassurance.
- Special communication needs: involve caregivers for children; speak directly to older adults (don't assume deafness or confusion). Face hearing-impaired patients and write notes. Describe your actions to vision-impaired patients. Use an interpreter for non-English speakers. For behavioral patients, stay calm and honest and keep an exit.
- AVPU = Alert, Verbal, Painful, Unresponsive. Orientation x4 = person, place, time, event.
| Component | 4/5/6 | 3 | 2 | 1 |
|---|---|---|---|---|
| Eyes (max 4) | 4 spontaneous | to voice | to pain/pressure | none |
| Verbal (max 5) | 5 oriented; 4 confused | inappropriate words | incomprehensible sounds | none |
| Motor (max 6) | 6 obeys; 5 localizes; 4 withdraws | abnormal flexion (decorticate) | extension (decerebrate) | none |
The full NREMT High-Yield Cram Sheet comes with full prep.
Common primary assessment traps
- Treat each life threat when found: don't assess breathing while the airway still gurgles.
- Agonal gasps = start CPR; check breathing and pulse together, ≤10 seconds.
- A normal SpO2 doesn't rule out CO poisoning or inadequate ventilation.
- Restlessness is the earliest shock sign; hypotension is late, especially in children.
- A slow heart rate in a hypoxic child means ventilate now, not wait.
- Check glucose in every altered patient, including suspected strokes and drunks.
- Stridor = upper airway; wheezing = lower airway. Snoring = reposition; gurgling = suction.
- Kussmaul breathing points to DKA, not hypoglycemia.
Free NREMT primary assessment practice questions
Question 1
A 38-year-old man found at home after a suspected overdose responds only to painful stimuli. His respiratory rate is 32/min with very shallow breaths and minimal chest rise. SpO2 is 87%, and his airway is open and clear. What should the EMT do next?
- AAssist his ventilations with a bag-valve mask attached to supplemental oxygen
- BApply a non-rebreather mask at 15 L/min, because his respiratory rate is above normal
- CApply CPAP to improve his oxygenation and reduce his work of breathing
- DPlace a nasal cannula at 4 L/min and reassess his breathing in 5 minutes
Show answer and explanation
Answer: A. Shallow breathing with minimal chest rise and hypoxia means his minute volume is inadequate even though the rate is fast. He needs assisted ventilation with a BVM and oxygen.
Why not B: A fast rate does not mean adequate breathing. Shallow breaths move too little tidal volume, so passive oxygen by mask will not fix his inadequate ventilation.
Why not C: CPAP requires an awake patient who can follow commands and protect the airway. A patient who responds only to pain is a contraindication.
Why not D: Low-flow oxygen does nothing for inadequate tidal volume. Waiting 5 minutes leaves a life threat untreated.
Remember: Adequate breathing needs both an adequate rate and adequate depth, so fast, shallow breathing with poor chest rise calls for BVM-assisted ventilation, not just a mask.
Question 2
A 19-year-old with type 1 diabetes has had vomiting for 2 days. She is confused. Her skin is warm and dry, her breath has a fruity odor, and she is breathing deeply and rapidly at 32 breaths/min. Which breathing pattern and cause best fit these findings?
- AKussmaul respirations caused by diabetic ketoacidosis
- BAnxiety hyperventilation caused by a panic attack
- CCheyne-Stokes respirations caused by a stroke
- DKussmaul respirations caused by hypoglycemia
Show answer and explanation
Answer: A. Deep, rapid breathing is the body blowing off acid. Together with fruity breath, dehydration and a gradual onset in a type 1 diabetic, it indicates DKA.
Why not B: Panic attacks don't cause fruity breath, dehydration or a 2-day illness. Hyperventilation should be blamed on anxiety only after serious causes are ruled out.
Why not C: Cheyne-Stokes breathing waxes and wanes with periods of apnea. It is not continuous deep, rapid breathing.
Why not D: Hypoglycemia typically has a fast onset with pale, cool, sweaty skin. It does not cause Kussmaul breathing or fruity breath.
Remember: Deep, rapid Kussmaul respirations with fruity breath point to DKA (high sugar), not hypoglycemia.
Question 3
On a cold winter night you are called to a home where all four family members have headaches and nausea that started after the furnace was turned on. A 34-year-old woman is slow to answer questions. Her pulse oximeter reads 99% on room air. How should you interpret this reading?
- AIt confirms adequate oxygenation, so supplemental oxygen is not needed.
- BIt means her symptoms are most likely from a viral illness shared by the family.
- CIt is accurate, and her confusion is better explained by anxiety.
- DIt may be falsely normal; remove her from the home and give high-flow oxygen.
Show answer and explanation
Answer: D. Standard pulse oximeters cannot tell carboxyhemoglobin from oxyhemoglobin, so SpO2 can read normal. Treat suspected CO with high-flow oxygen by non-rebreather.
Why not A: This trusts the number over the presentation. In carbon monoxide poisoning the oximeter can read normal while tissues are hypoxic.
Why not B: Several people in one home with headache and nausea after the furnace starts suggests carbon monoxide. A normal SpO2 does not support a viral cause.
Why not C: Attributing altered mental status to anxiety is dangerous before ruling out toxic, hypoxic and metabolic causes.
Remember: A normal SpO2 does not rule out carbon monoxide poisoning; treat the patient, not the number.
Question 4
You transmit a 12-lead ECG on a 59-year-old woman with chest pain, and the receiving physician confirms a STEMI. She is alert with a BP of 136/84. The closest hospital is 8 minutes away but has no cardiac catheterization lab. A PCI-capable center is 20 minutes away. Under the regional STEMI plan, where should she go?
- AThe PCI-capable center, with an early STEMI alert so the cath team is ready
- BWait on scene for a paramedic unit to reinterpret the ECG before choosing a destination
- CThe closest hospital for stabilization, followed by an interfacility transfer
- DThe closest hospital, because chest pain patients must always go to the nearest emergency department
Show answer and explanation
Answer: A. STEMI patients benefit most from direct transport to a facility that can open the artery, and early notification shortens time to reperfusion.
Why not B: A physician has already confirmed the STEMI. Waiting on scene only delays definitive care.
Why not C: Stopping at a non-PCI hospital adds a second transport and delays reperfusion when a PCI center is reachable.
Why not D: Destination should match the patient's condition. Specialty centers for STEMI are chosen over the nearest hospital when the system plan allows.
Remember: A confirmed STEMI should go directly to a PCI-capable center with early notification, even if a non-PCI hospital is closer.
Question 5
A 67-year-old woman who takes insulin was found by her husband 30 minutes ago with new right-sided weakness and slurred speech. Her airway is patent and her breathing is adequate. Before you conclude this is a stroke and choose a stroke center, which assessment is most important to complete?
- AA body temperature to look for an infection
- BA blood glucose level to look for hypoglycemia
- COrthostatic vital signs to check for volume loss
- DA 12-lead ECG to look for a heart attack
Show answer and explanation
Answer: B. Hypoglycemia can cause one-sided weakness and slurred speech, especially in insulin users. Glucose is checked in every patient with altered or focal neurologic findings.
Why not A: Sepsis can alter mental status, but a temperature reading is less useful here than ruling out low blood sugar, which is common and reversible.
Why not C: Orthostatic testing is not appropriate for a patient with acute neurologic deficits. It would not identify a stroke mimic.
Why not D: An ECG is useful for suspected cardiac problems, but it does not identify or exclude the most common, rapidly reversible stroke mimic.
Remember: Check blood glucose in every patient with altered mental status or stroke-like signs; hypoglycemia is a common stroke mimic.
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