- 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 · 7.1% of the NREMT EMT NREMT Secondary Assessment practice questions
Secondary Assessment is 7.1% of the NREMT EMT. Answer 10 questions (6 on Secondary Assessment) and see your score by domain, with every answer explained. Free, no sign-up.
An EMT splints a 24-year-old woman's painful, deformed forearm with a padded rigid splint secured by roller gauze. Before splinting, her radial pulse was strong and her fingers were warm with normal sensation. Five minutes after splinting, her fingers are cool and pale, she reports tingling, and the radial pulse is weaker. What should the EMT do next?
Tap an answer, or press A to D
SAMPLE and OPQRST history, focused and full-body exams, stroke scales, and reassessing vitals and interventions.
What the NREMT EMT exam tests in Secondary Assessment
- Investigate the patient's current condition through focused physical assessment, interviewing and past medical history to build a continued treatment plan: SAMPLE and OPQRST, pertinent negatives, DCAP-BTLS, rapid full-body scan vs focused exam, system exams (respiratory, cardiovascular, neurologic including stroke scales, abdominal, musculoskeletal with pulse/motor/sensation checks), medication lists and medical devices
- Reassess previous findings and interventions to detect changes in the patient's condition: repeating the primary assessment and vital signs (about every 5 minutes if unstable, every 15 minutes if stable), trending, checking the effect of oxygen, medications, splints and bleeding control
High-yield secondary assessment facts
- SAMPLE: Signs/symptoms, Allergies, Medications, Pertinent past history, Last oral intake, Events leading up.
- OPQRST: Onset, Provocation/palliation, Quality, Region/radiation, Severity (0–10; faces scale for young children), Time.
- Pertinent negatives are relevant findings that are absent (e.g., chest pain without dyspnea). Document them.
- High-yield medications to ask about: anticoagulants (bleeding risk), beta blockers (mask tachycardia), insulin and oral hypoglycemics, PDE-5 inhibitors (before NTG), home O2. Look for medical ID jewelry; bring medication lists and bottles.
- Interviewing: open-ended questions first, then closed questions to clarify. Ask one question at a time and avoid leading questions. Use interpreters, use caregivers for young or confused patients, and ask sensitive questions privately.
- Rapid full-body scan (head to toe, ~60–90 s) for unresponsive patients or significant MOI. Focused exam for responsive medical patients or isolated injuries.
| Quadrant | Key organs | Classic pain |
|---|---|---|
| RUQ | Liver, gallbladder | Cholecystitis after fatty meal |
| LUQ | Spleen, stomach | Splenic injury (Kehr's sign, left shoulder) |
| RLQ | Appendix | Appendicitis (starts periumbilical) |
| LLQ | Sigmoid colon | Diverticulitis |
| Retroperitoneal | Kidneys, aorta | Flank pain (stones), back pain (AAA) |
The full NREMT High-Yield Cram Sheet comes with full prep.
Common secondary assessment traps
- A critical patient may never get a full secondary assessment on scene; do it en route after life threats.
- The P in OPQRST is provocation/palliation; the E in SAMPLE is events leading up.
- Pertinent negatives belong in the report.
- Don't repeat pelvic compression on an unstable or painful pelvis.
- Last known well is not the time found.
- Reassess unstable patients every 5 minutes and stable patients every 15 minutes, not the reverse.
- Check PMS both before and after splinting.
- Palpate the painful quadrant last.
Free NREMT secondary assessment practice questions
Question 1
A 67-year-old woman suddenly developed slurred speech while eating lunch. You are performing a Cincinnati-type stroke screen and want to test for arm drift. Which instruction is correct?
- AClose your eyes and hold both arms straight out, palms up, for 10 seconds.
- BSqueeze both of my hands as hard as you can at the same time.
- CKeep your eyes open and raise your right arm over your head.
- DTouch your nose with your finger, then touch my finger.
Show answer and explanation
Answer: A. Arm drift is tested with eyes closed and both arms extended for about 10 seconds; one arm drifting down or not moving is abnormal.
Why not B: Grip strength is a different motor check and is not the arm drift component of the stroke screen.
Why not C: Testing one arm with eyes open lets the patient correct visually and gives no side-to-side comparison.
Why not D: Finger-to-nose tests coordination (cerebellar function), not the arm drift used in the stroke screen.
Remember: Cincinnati-type screening checks facial droop, arm drift with eyes closed for 10 seconds, and abnormal speech.
Question 2
A 68-year-old man's wife says he went to bed at 22:00 acting normally. He woke at 06:30 with right-sided weakness and garbled speech. She called 911 at 06:45, and you reached his side at 06:55. What time should you report as his last known well?
- A06:55
- B06:30
- C06:45
- D22:00
Show answer and explanation
Answer: D. When a patient wakes up with symptoms, last known well is the last time he was seen normal before sleep.
Why not A: EMS patient contact time is not related to stroke onset. Using it would wrongly suggest a very short symptom window.
Why not B: 06:30 is when the symptoms were discovered. He may have had the stroke at any point while asleep.
Why not C: The 911 call time has no bearing on when the symptoms began.
Remember: Last known well is the last time the patient was confirmed normal (for wake-up strokes, before sleep), not when symptoms were found.
Question 3
You find a 70-year-old woman unresponsive on her bedroom floor. No one saw what happened. You have opened her airway, confirmed adequate breathing and a pulse, and started oxygen. What physical exam should you perform next?
- AA focused exam of the chest and heart only
- BA rapid head-to-toe full-body scan
- CNo exam until family provides a medical history
- DOrthostatic vital signs to check for volume loss
Show answer and explanation
Answer: B. An unresponsive patient cannot describe her complaints, and hidden trauma is possible, so a rapid full-body scan is needed to find injuries and other clues.
Why not A: A focused exam fits a responsive patient with a localized complaint. Here the cause is unknown and could include unseen injuries.
Why not C: Waiting for history delays finding important problems. The exam proceeds while you gather history from any available sources.
Why not D: Orthostatic vital signs require standing or sitting the patient up. That is unsafe in an unresponsive patient with possible injury.
Remember: Use a rapid full-body scan for unresponsive patients or a significant mechanism of injury, and a focused exam for responsive patients with a localized complaint.
Question 4
A 58-year-old man reports crushing substernal chest pain that started 30 minutes ago while he was shoveling snow. He rates it 7 out of 10, takes lisinopril daily, and his skin is pale and sweaty. When asked, he says he has no shortness of breath. Which finding should be documented as a pertinent negative?
- APain rated 7 out of 10
- BSkin pale and diaphoretic
- CTakes lisinopril daily
- DDenies shortness of breath
Show answer and explanation
Answer: D. A pertinent negative is an expected or relevant symptom that is absent; shortness of breath commonly goes with cardiac chest pain, so its absence is worth recording.
Why not A: This is a positive finding that describes severity under OPQRST, not an absent finding.
Why not B: This is a positive physical exam finding that is present, not one that is absent.
Why not C: This is part of the medication history in SAMPLE, not a pertinent negative.
Remember: A pertinent negative is a relevant sign or symptom the patient does not have, and it belongs in the report.
Question 5
A 45-year-old man fell down a full flight of concrete stairs and is responsive only to painful stimuli. His left forearm is obviously deformed. You have managed his airway, breathing and circulation during the primary assessment. Which physical exam is most appropriate next?
- AA rapid trauma assessment from head to toe
- BA focused exam of the deformed left forearm
- COrthostatic vital signs to estimate blood loss
- DA focused exam of the head and neck only
Show answer and explanation
Answer: A. A patient with altered mental status (responding only to pain) and a significant mechanism of injury needs a rapid head-to-toe trauma assessment to find injuries he cannot report.
Why not B: A focused exam fits a responsive patient with an isolated injury; the obvious deformity could distract you from hidden life-threatening injuries.
Why not C: Orthostatic vitals are unsafe with suspected spinal injury or altered mental status and would not identify injuries.
Why not D: With a significant mechanism and a patient with altered mental status, limiting the exam to the head misses chest, abdominal, pelvic and extremity injuries.
Remember: Use a rapid trauma assessment (head-to-toe) for patients with altered mental status or a significant mechanism, and a focused exam for responsive patients with an isolated injury.
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