Free NREMT Paramedic Practice Test
A free 120-question paramedic practice test with answers and explanations, weighted like the National Registry paramedic exam blueprint: about a third clinical judgment, a quarter medical and OB/GYN, and the rest airway, cardiology, trauma, and EMS operations. Answer each question, then tap Show answer to check yourself. Quick 10-question quizzes for each of the 6 exam areas follow the full test.
Full 120-question practice test
A patient with acute kidney injury receives the usual dose of a renally cleared sedative and stays drowsy for many hours. The best explanation is that:
- A. The drug is building up
- B. AKI speeds up drug clearance
- C. The dose was given too slowly
- D. Uremia blocks the drug's effect
Show answer
Answer: A. The drug is building up
Drugs and active metabolites cleared by the kidneys accumulate in AKI, prolonging their effects, so many need lower doses or longer intervals. AKI slows clearance rather than speeding it, uremia does not block the drug, and a slow injection does not prolong the effect.
Early hospital notification for a 220-kg (485-lb) patient is especially important because:
- A. The hospital needs to approve the transport in advance
- B. It lets the hospital divert her elsewhere
- C. Bariatric patients go straight to the ICU
- D. Staff need time to prepare bariatric equipment
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Answer: D. Staff need time to prepare bariatric equipment
The receiving facility may need a bariatric bed, lift devices, large cuffs, and extra staff ready at the door. Hospitals do not need to approve transport, and a hospital with an emergency department cannot turn her away because of her size. Obesity alone does not mean ICU admission.
A 3-year-old weighing 15 kg is in septic shock with a delayed capillary refill and HR 180. The appropriate initial fluid bolus is:
- A. 50 mL of D10W over 20 minutes
- B. 600 mL of isotonic crystalloid over an hour
- C. 1,000 mL of lactated Ringer's
- D. 150 to 300 mL of isotonic crystalloid
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Answer: D. 150 to 300 mL of isotonic crystalloid
Pediatric shock is treated with 10 to 20 mL/kg boluses of isotonic crystalloid, here 150 to 300 mL, with reassessment after each. D10W treats hypoglycemia but is not a resuscitation fluid.
The key event that starts the change from fetal to newborn circulation is:
- A. Lung expansion with the first breaths
- B. Delivery of the placenta after the birth
- C. The first newborn feeding
- D. Closure of the ductus venosus
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Answer: A. Lung expansion with the first breaths
Air entering the alveoli and the rise in oxygen relax the pulmonary arterioles, so pulmonary vascular resistance falls sharply and blood flows to the lungs. Delivery of the placenta follows the birth and does not drive the circulatory change in the infant.
A locality rule in standard of care means:
- A. A single national standard applies to all
- B. Care is judged against similar communities
- C. Rural providers are exempt from standards
- D. Urban standards apply to every system
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Answer: B. Care is judged against similar communities
Communities with similar resources are the reference. Resources and transport times differ.
Dental health in middle adulthood:
- A. Affects nutrition and is linked to heart disease
- B. Declines steadily regardless of brushing and routine dental care
- C. Has little effect on overall health at this age
- D. Matters mainly for appearance and self-esteem
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Answer: A. Affects nutrition and is linked to heart disease
Gum disease. Gum disease is linked to cardiovascular disease.
After resuscitation ends for a man who died at home of an expected illness, his family asks to pray and perform a religious ritual at his side. The death is not suspicious. You should:
- A. Refuse until the medical examiner arrives
- B. Ask them to wait in another room
- C. Limit it to 2 minutes so you can clear
- D. Allow it and support them while they do
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Answer: D. Allow it and support them while they do
When a death is expected and not suspicious, the family's cultural and religious needs come first, and allowing rituals and time with the body helps them grieve; stay to support them and explain next steps. There is no reason to wait for the medical examiner in a non-suspicious death unless protocol requires notification first. Sending the family to another room separates them from the person at a key moment. Cutting their time short so the crew can clear disregards their needs; stay until the next steps are in place. (AHA 2015 ethics; NAEMSP TOR resource on family-centered care.)
What positioning is best for a conscious patient with an upper airway obstruction who is moving air?
- A. Prone with the head turned
- B. Supine with legs elevated
- C. Left lateral recumbent position
- D. Upright position of comfort
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Answer: D. Upright position of comfort
Allowing the patient to stay in the position that maximizes airflow, usually sitting up, avoids worsening the obstruction.
After you apply a traction splint, the patient's foot is now numb and pale. What should you do?
- A. Check and loosen the straps, then recheck
- B. Elevate the leg and recheck in 15 minutes
- C. Add more traction to secure the leg
- D. Remove the splint and move the patient
Show answer
Answer: A. Check and loosen the straps, then recheck
Distal pulse, motor, and sensation are checked before and after any splint, because a splint that is too tight can cut off circulation. New numbness and pallor mean you should check and loosen the straps or padding and recheck. Waiting to recheck or adding traction risks ischemia, and removing the splint loses stabilization.
Hypothermia in older adults can result from:
- A. Mild cold exposure
- B. Extreme cold only
- C. Winter weather only
- D. Outdoor exposure only
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Answer: A. Mild cold exposure
Indoor hypothermia. Thermoregulation is impaired, so indoor hypothermia occurs.
The trachea divides into the right and left mainstem bronchi at the:
- A. Hilum
- B. Glottis
- C. Alveolar sac
- D. Carina
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Answer: D. Carina
The carina is at about the level of the angle of Louis (T4-T5).
A patient with a temperature of 39.8 C has a regular tachycardia at 150/min with a visible P wave before every QRS. The rate drifts with activity. What is the most appropriate treatment?
- A. Synchronized cardioversion at 50 J
- B. Treat the fever and give fluids
- C. Diltiazem 0.25 mg/kg over 2 minutes
- D. Adenosine 6 mg rapid IV push
Show answer
Answer: B. Treat the fever and give fluids
A regular rate with P waves before each QRS that varies with activity in a febrile patient is sinus tachycardia, a compensatory response; treat the cause with fluids and fever control. Adenosine only slows it for a moment. Cardioversion cannot convert sinus rhythm and is harmful here. Slowing a compensatory rate with diltiazem can drop the cardiac output and BP.
In pregnancy, increased glomerular filtration rate means renally cleared drugs:
- A. May be eliminated faster
- B. Are eliminated more slowly
- C. Accumulate in the fetus only
- D. Cannot be used
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Answer: A. May be eliminated faster
Renal blood flow and GFR rise considerably during pregnancy.
Which training plan best maintains a rarely used skill such as surgical cricothyrotomy?
- A. A single long session every two years at recertification
- B. Reading the protocol once after each new release
- C. Short, repeated practice sessions over the year
- D. Waiting until a real patient needs it to practice
Show answer
Answer: C. Short, repeated practice sessions over the year
Procedural skills decay within months when they are not used. Spaced, repeated hands-on practice and simulation keep rare, high-stakes skills ready. A single session every two years, reading alone, or waiting for a real patient lets the skill fade.
The patient care report should be completed:
- A. Whenever it is convenient for the crew
- B. Only for patients who are transported
- C. Only after ALS interventions
- D. Promptly, per local policy
Show answer
Answer: D. Promptly, per local policy
Complete it promptly and accurately, generally before the end of shift or as local policy requires. Memory fades quickly, and the report is a legal document.
When descent is impossible because of weather, a climber with HAPE can be treated with oxygen and:
- A. Furosemide to clear the fluid
- B. Acetazolamide by mouth
- C. A portable hyperbaric bag
- D. Large IV fluid boluses
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Answer: C. A portable hyperbaric bag
A portable hyperbaric chamber pressurized by foot pump simulates a descent of about 1,500 to 2,000 m. It buys time but does not replace actual descent. Diuretics can worsen volume depletion and are not recommended, acetazolamide helps prevent AMS but does not treat HAPE, and large fluid boluses add to the lung edema.
Compared with an adult, a toddler exposed to the same hot tap water for the same time is likely to have a burn that is:
- A. Deeper, because the skin is thinner
- B. Shallower, because skin heals faster
- C. Shallower, because of more body fat
- D. Equal, since water temperature decides
Show answer
Answer: A. Deeper, because the skin is thinner
Young children have thinner skin, so a given temperature and contact time produces a deeper burn than in an adult; this is why water heaters should be set at or below 49°C (120°F). Faster healing does not make the initial burn shallower. Body fat does not protect the dermis. Temperature matters, but skin thickness changes the depth. (ABA ABLS.)
Vascular access in a pregnant patient in cardiac arrest should ideally be placed:
- A. In a vein of the foot
- B. In the femoral vein
- C. Above the diaphragm
- D. In the tibia by IO
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Answer: C. Above the diaphragm
Drugs given below the diaphragm may not reach the heart quickly because the gravid uterus compresses the inferior vena cava, so a humeral IO or an arm or neck vein is preferred. A foot vein, the femoral vein, and a tibial IO all drain through the compressed inferior vena cava. (AHA 2015 maternal arrest statement; 2025 AHA special circumstances.)
A patient who abruptly stopped long-term alprazolam 2 days ago is tremulous, anxious, and then has a generalized seizure. Which drug class treats the cause?
- A. A benzodiazepine
- B. An antipsychotic
- C. Flumazenil
- D. An opioid agonist
Show answer
Answer: A. A benzodiazepine
Abrupt benzodiazepine withdrawal, like alcohol withdrawal, causes GABA-related hyperexcitability with tremor, anxiety, and seizures, and it is treated with a benzodiazepine. Opioids do not treat it. Antipsychotics lower the seizure threshold. Flumazenil blocks benzodiazepine receptors and would worsen withdrawal.
A patient with an acute MI has occasional unifocal PVCs, a BP of 136/84, and no symptoms from them. What is the role of lidocaine?
- A. Not given; monitor and treat ischemia
- B. A 2 mg/min infusion throughout transport
- C. A 1 mg/kg bolus before each PVC run
- D. A 1.5 mg/kg bolus to prevent VF
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Answer: A. Not given; monitor and treat ischemia
Prophylactic lidocaine for PVCs in acute MI is no longer recommended; it did not lower mortality and may raise it through bradycardia and asystole. Treat the ischemia, correct hypoxia and electrolytes, and watch the monitor. A preventive bolus, a prophylactic infusion, or doses timed to PVCs all expose the patient to toxicity without benefit.
After transporting a patient with C. difficile, the ambulance should be cleaned with:
- A. Alcohol wipes
- B. A damp cloth
- C. A quaternary spray left for 10 seconds
- D. A sporicidal disinfectant
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Answer: D. A sporicidal disinfectant
Bleach-based or other sporicidal agents kill spores.
Local protocols vary between systems because:
- A. National standards are unclear or contradictory
- B. Directors adapt them to local resources
- C. Each state requires its systems to differ
- D. Disease patterns differ substantially by region
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Answer: B. Directors adapt them to local resources
Know the protocols of the system you are credentialed in. Medical directors account for transport times and system capabilities.
A newborn weighing about 3 kg has been intubated. Using the common estimate of weight in kilograms plus 6 cm, the tube mark at the lip should be about:
- A. 6 cm
- B. 12 cm
- C. 15 cm
- D. 9 cm
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Answer: D. 9 cm
Weight in kilograms plus 6 cm gives 9 cm at the lip for a 3-kg infant. The NRP 9th edition now measures depth at the upper gum using a gestational-age table or the nasal-tragus length plus 1 cm, so follow the reference your protocol uses; whatever the rule, confirm placement with a rising heart rate, CO2 detection, and equal breath sounds. Six centimeters leaves out the weight and would leave the tip high, near the cords. Twelve or 15 centimeters would likely place the tube in the right mainstem bronchus. (NRP 9th ed.; CPS 9th edition summary.)
Hand, foot, and mouth disease is caused by:
- A. Herpes simplex
- B. Varicella
- C. Staphylococcus
- D. Coxsackievirus
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Answer: D. Coxsackievirus
It causes painful mouth sores and a rash on the hands and feet.
A heat stroke patient being cooled begins to shiver vigorously. Per protocol, you may treat this with:
- A. An antipyretic
- B. A benzodiazepine
- C. An antihistamine
- D. A beta-blocker
Show answer
Answer: B. A benzodiazepine
Shivering generates heat and slows cooling, so a small dose of a benzodiazepine such as midazolam is used to suppress it and to control seizures. Antihistamines have anticholinergic effects that further impair sweating.
A restrained patient keeps spitting at the crew. The safest option is to:
- A. Drape a towel over his face and head
- B. Place a surgical mask over his mouth and nose
- C. Apply a nonrebreather mask with no oxygen flow
- D. Turn him face down on the stretcher
Show answer
Answer: B. Place a surgical mask over his mouth and nose
A loose surgical mask with provider face protection limits exposure while allowing breathing and airway observation. Covering the face with a towel hides the airway and vomiting.
A review of systems involves:
- A. A rapid head-to-toe survey
- B. A full hands-on physical examination
- C. Asking about symptoms by body system
- D. A complete set of baseline vital signs
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Answer: C. Asking about symptoms by body system
It finds problems the patient did not mention. It is abbreviated in the field.
A woman with PTSD from a sexual assault becomes distressed as a male paramedic approaches to examine her. You should:
- A. Offer a female provider if available
- B. Do the exam quickly so it ends sooner
- C. Ask police officers to hold her still
- D. Explain that the medic is a professional
Show answer
Answer: A. Offer a female provider if available
Giving her choice and control reduces retraumatization. Reassuring her of professionalism does not address the trigger, and holding her down is never appropriate for a cooperative patient.
During a drug shortage, your agency temporarily stocks an unfamiliar concentration of a drug. The main safety step is to:
- A. Give the same volume as with the usual product
- B. Store it mixed in with the usual product
- C. Rely on memory of the usual dose volume
- D. Train crews and flag the new concentration
Show answer
Answer: D. Train crews and flag the new concentration
A new concentration means the same dose is a different volume, so crews need training, clear labeling such as a bin flag, and updated dosing charts. To give the same volume as with the usual product, store it mixed in with the usual product, or rely on memory of the usual dose volume invites a large dosing error.
An occupant was partly ejected through a side window in a rollover. Even if he looks well, you should:
- A. Transport him to a trauma center per triage
- B. Release him if he has normal vital signs
- C. Transport him to the nearest clinic for x-rays
- D. Evaluate him further if he complains of pain
Show answer
Answer: A. Transport him to a trauma center per triage
Partial or complete ejection is a yellow (moderate-risk) mechanism criterion in the 2021 National Guideline for the Field Triage of Injured Patients, so the patient should go to a trauma center even if he looks well. Normal initial vital signs do not exclude serious injury, and waiting for him to complain of pain risks missing a hidden injury.
A good mitigation for availability bias is to:
- A. Recall similar recent cases in more detail
- B. Consider base rates for this population
- C. Trust the first diagnosis that comes to mind
- D. Treat the dispatch complaint as the diagnosis
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Answer: B. Consider base rates for this population
Grounding likelihood in actual prevalence corrects for memorable but rare cases. Base rates are how common each diagnosis actually is in this population. Recalling recent cases in more detail and trusting the first diagnosis that comes to mind both feed availability bias rather than correcting it.
A sucking chest wound requires:
- A. Wound packing with gauze
- B. A bulky pressure dressing
- C. An occlusive dressing
- D. Elevation of the injured side
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Answer: C. An occlusive dressing
Vented if possible.
Proper drug storage on an ambulance requires attention to:
- A. Label orientation and alphabetical order
- B. Temperature, light, and expiration dates
- C. Expiration dates only, since nothing else matters
- D. The color of each solution and nothing else
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Answer: B. Temperature, light, and expiration dates
Temperature extremes, light exposure, and expiration dates all matter. Heat and cold degrade many medications.
A father asks how to help his young children after a terror attack in their city. The best advice is to:
- A. Limit their repeated viewing of news coverage
- B. Keep them home from school for a month
- C. Avoid talking with them about what has happened
- D. Have them watch footage to understand it
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Answer: A. Limit their repeated viewing of news coverage
Repeated exposure to graphic media coverage is linked to more stress symptoms in children, while honest, age-appropriate conversation and normal routines help. Avoiding all discussion leaves children to fill in the gaps with fear.
Blood draw for lab samples in the field is typically done:
- A. From the IV bag's injection port
- B. At IV insertion, before fluids
- C. After fluids have run for 5 min
- D. Only after hospital arrival
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Answer: B. At IV insertion, before fluids
Samples should be undiluted by IV fluid.
Myocardial cells begin to die after approximately:
- A. About 5 minutes of occlusion
- B. About 2 hours of occlusion
- C. 20 to 40 minutes of occlusion
- D. About 24 hours of occlusion
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Answer: C. 20 to 40 minutes of occlusion
Cell death begins after roughly 20 to 40 minutes of complete occlusion. Time is muscle.
Dressler syndrome is:
- A. Heart failure months after MI
- B. Rupture within hours of MI
- C. Pericarditis weeks after MI
- D. VF in the first hour after MI
Show answer
Answer: C. Pericarditis weeks after MI
Dressler syndrome is an autoimmune pericarditis occurring weeks after MI.
A COPD patient's portable liquid oxygen unit leaked onto her hand while she refilled it. Her fingers are white, numb, and hard. What injury is this?
- A. A chemical burn from the oxygen reacting with skin
- B. A cold injury like frostbite from liquid oxygen
- C. A thermal burn from the oxygen catching fire
- D. An allergic reaction to the oxygen tubing
Show answer
Answer: B. A cold injury like frostbite from liquid oxygen
Liquid oxygen is stored at about -183 °C, so a spill can freeze tissue on contact; treat it like frostbite with gentle rewarming and no rubbing. Oxygen does not chemically burn skin. Fire causes a heat burn with charring, which did not happen. Tubing allergy causes a rash, not frozen fingers.
When assembling a prefilled cartridge syringe (such as a Luer-Jet), you should:
- A. Shake the vial hard before removing the caps
- B. Remove both caps, then screw the vial in
- C. Push the vial in with the caps left on
- D. Draw the drug out with a separate needle
Show answer
Answer: B. Remove both caps, then screw the vial in
Prefilled cartridge systems (used for epinephrine 0.1 mg/mL, dextrose, and bicarbonate) are assembled by removing the protective caps from the vial and the injector, threading them together, and expelling air. Shaking is unnecessary, caps left on prevent assembly, and drawing the drug out with a needle defeats the closed system.
Two patients from a fireworks injury have similar eye injuries. One of them is already blind in his other eye. How does this affect your priorities?
- A. It raises his priority for care
- B. It makes no difference
- C. He needs less care since he adapted to blindness
- D. The patient with two good eyes comes first
Show answer
Answer: A. It raises his priority for care
A serious injury to the only seeing eye threatens total blindness, so that patient has a higher priority for rapid transport and specialist care, and the injured eye must be protected carefully. It does make a difference, prior blindness in one eye does not mean he needs less care, and the patient with two good eyes still needs full care but has less to lose from one injury.
Diltiazem is contraindicated in:
- A. Hypotension, WPW with AF, or decompensated heart failure
- B. Patients with a history of asthma or COPD
- C. Stable atrial fibrillation with a ventricular rate over 120
- D. Patients with a long history of hypertension
Show answer
Answer: A. Hypotension, WPW with AF, or decompensated heart failure
Negative inotropy and vasodilation worsen these conditions. Wide-complex tachycardia of unknown origin is also a contraindication. Diltiazem is often chosen over beta blockers in asthma or COPD, and a history of hypertension is no barrier when the current BP is adequate.
You are hyperventilating a patient who showed a blown pupil and extensor posturing. Five minutes later, both pupils are equal and reactive and the posturing has stopped. You should:
- A. Increase the rate to keep the ETCO2 near 25
- B. Continue hyperventilating until hospital arrival
- C. Return to normal ventilation with ETCO2 35 to 45
- D. Stop ventilating and allow spontaneous breathing
Show answer
Answer: C. Return to normal ventilation with ETCO2 35 to 45
Hyperventilation is a temporary bridge used only while herniation signs are present; once they resolve, return to normoventilation to protect cerebral blood flow. Continuing it prolongs vasoconstriction without benefit.
Ipratropium should be used with caution in a patient with:
- A. Hypothyroidism
- B. Type 2 diabetes
- C. Narrow-angle glaucoma
- D. Controlled hypertension
Show answer
Answer: C. Narrow-angle glaucoma
As an anticholinergic, ipratropium can dilate the pupil and worsen narrow-angle glaucoma, especially if mist reaches the eyes.
Spina bifida is a defect in which the:
- A. Spinal cord is damaged by a birth-related injury
- B. Brain's ventricles enlarge after a fetal infection
- C. Vertebrae fuse together during early childhood
- D. Spinal column does not close during development
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Answer: D. Spinal column does not close during development
Spina bifida is a neural tube defect in which the vertebral arches fail to close; in myelomeningocele, the most severe form, the cord and meninges protrude, causing paralysis below the lesion. A birth-related brain injury describes cerebral palsy.
The main benefit of standardized protocols is:
- A. Consistent, safe care across providers
- B. Lower cost as the primary outcome
- C. Eliminating the need for paramedic thinking
- D. Shorter calls with less time on scene
Show answer
Answer: A. Consistent, safe care across providers
Standardization reduces variation and errors. Protocols create a shared expectation of care.
A healthy, active 86-year-old has a resting SpO2 of 94% on room air and no distress. How should you interpret this?
- A. Always indicates that an acute pneumonia is present
- B. Means the pulse oximeter must be malfunctioning
- C. May be normal; oxygenation falls slightly with age
- D. Requires high-flow oxygen by nonrebreather now
Show answer
Answer: C. May be normal; oxygenation falls slightly with age
With age the lungs lose elastic recoil, small airways close earlier, and ventilation-perfusion mismatch increases, so resting arterial oxygen falls gradually. A slightly lower SpO2 without distress may be this patient's baseline, so compare with known values and look for other signs. It does not prove pneumonia or a device fault, and high-flow oxygen is not indicated for a patient who is not hypoxic or distressed.
Application of principle refers to:
- A. Gathering more data before committing to a plan
- B. Writing the narrative portion of the report
- C. Turning the impression into a treatment plan
- D. Evaluating how the patient responded afterward
Show answer
Answer: C. Turning the impression into a treatment plan
It is the step from thinking to doing.
A soldier at a training range has burning particles of white phosphorus embedded in his leg. You should:
- A. Keep it wet with saline-soaked dressings
- B. Let the particles burn out, then apply a dry dressing
- C. Brush the particles off dry and leave the area open
- D. Cover the wound with an oil-based ointment and wrap
Show answer
Answer: A. Keep it wet with saline-soaked dressings
White phosphorus ignites on contact with air, so the area must stay wet or submerged until the particles are removed at the hospital. Dry dressings let it reignite, and oily ointments can increase absorption.
After forming a general impression with the Pediatric Assessment Triangle, the next step in assessing a child is to:
- A. Obtain a full SAMPLE history first
- B. Perform the hands-on primary survey
- C. Do a detailed head-to-toe exam
- D. Measure a full set of vital signs
Show answer
Answer: B. Perform the hands-on primary survey
The PAT tells you how sick the child looks; the hands-on primary survey then finds and treats threats to hemorrhage control, airway, breathing, and circulation. History, vital signs, and the detailed exam come later in the secondary assessment.
Theft or significant loss of controlled substances must be reported to the DEA using:
- A. DEA Form 224
- B. DEA Form 222
- C. DEA Form 106
- D. DEA Form 41
Show answer
Answer: C. DEA Form 106
DEA Form 106 documents theft or significant loss of controlled substances. Form 222 is for ordering, Form 41 for destruction, and Form 224 for registration.
A 52-year-old at a restaurant suddenly clutches his throat. He cannot speak or cough, and his face is turning dusky. What should you do?
- A. Give 5 back blows, then 5 chest thrusts
- B. Alternate 5 back blows and 5 abdominal thrusts
- C. Sweep his mouth with a finger, then give thrusts
- D. Encourage him to keep trying to cough
Show answer
Answer: B. Alternate 5 back blows and 5 abdominal thrusts
He cannot speak or cough, so this is a severe obstruction. The 2025 AHA adult BLS guideline recommends repeated cycles of 5 back blows followed by 5 abdominal thrusts until the object comes out or he becomes unresponsive, plus early EMS activation. Older guidance used abdominal thrusts alone, but observational data showed back blows cleared more obstructions with fewer injuries. Back blows with chest thrusts are for a rescuer who cannot reach around the abdomen or for late pregnancy, and he is neither. Blind finger sweeps can push the object deeper and are classed as harmful. Coughing is encouraged in a mild obstruction with good air exchange, not when he cannot cough. (2025 AHA Guidelines, Part 7: Adult BLS, section 10.)
When securing soft limb restraints on an ambulance stretcher, the straps should be attached to:
- A. The stretcher side rails
- B. The patient's belt
- C. Each other, wrist to ankle
- D. The stretcher frame
Show answer
Answer: D. The stretcher frame
Restraints should be tied to a fixed part of the stretcher frame so they stay secure and can be released quickly. Side rails can be lowered or moved, which can loosen the restraint or injure the limb. A belt gives no secure anchor. Tying wrists to ankles is hog-tying, which impairs breathing and is prohibited.
Oral medications have the slowest onset because:
- A. Their molecules are larger than IV drugs
- B. They pass through the gut and liver first
- C. The patient must chew them completely
- D. They are formulated at weaker strengths
Show answer
Answer: B. They pass through the gut and liver first
They must dissolve, pass through the stomach, be absorbed in the intestine, and undergo first-pass metabolism. Oral onset is typically 30–60 minutes.
Reverse 911 or emergency alerting is used to:
- A. Page volunteer members to respond to calls
- B. Notify the public of hazards or evacuations
- C. Call off-duty crews in during staffing shortages
- D. Dispatch units automatically to 911 callers
Show answer
Answer: B. Notify the public of hazards or evacuations
It supports disaster response.
Health promotion activities aim to:
- A. Help people control their own health
- B. Treat illness once symptoms have appeared
- C. Enforce public health and sanitation laws
- D. Expand local hospital and clinic capacity
Show answer
Answer: A. Help people control their own health
They often address lifestyle and environment. The WHO definition is enabling people to increase control over and improve their health.
A patient with known severe aortic stenosis has chest pain. Nitroglycerin should be used:
- A. Only at double doses to overcome the fixed obstruction
- B. Cautiously, because preload reduction can cause severe hypotension
- C. Liberally, because aortic stenosis raises the BP threshold
- D. Without concern, since the valve does not affect preload
Show answer
Answer: B. Cautiously, because preload reduction can cause severe hypotension
A fixed outflow obstruction makes cardiac output preload-dependent, so vasodilators can drop BP sharply.
Hepatitis B can survive on surfaces for up to:
- A. 1 minute
- B. 1 hour
- C. 7 days
- D. 1 year
Show answer
Answer: C. 7 days
Dried blood on surfaces can remain infectious for a week.
Increased intracranial pressure results from:
- A. Bleeding only, from trauma or aneurysm
- B. Mass, edema, hydrocephalus, or bleeding
- C. Edema only, from hypoxic brain injury
- D. Brain tumors only, from slow-growing masses
Show answer
Answer: B. Mass, edema, hydrocephalus, or bleeding
The Monro-Kellie doctrine. The skull is a fixed space.
Age-friendly EMS practice includes:
- A. Treating every patient identically by protocol
- B. Speaking loudly to every older patient
- C. Allowing time and checking sensory aids
- D. Assuming confusion is normal with aging
Show answer
Answer: C. Allowing time and checking sensory aids
Dignity matters at every age. Involve caregivers appropriately.
A patient who needs an IM injection has a dialysis fistula in her left arm. You should:
- A. Inject the left deltoid above the fistula
- B. Use the fistula arm if no thrill is felt
- C. Use the fistula arm below the access
- D. Use a site away from the fistula arm
Show answer
Answer: D. Use a site away from the fistula arm
Protect the dialysis access arm from injections, IVs, blood pressure cuffs, and tourniquets, because injury or clotting can destroy the patient's lifeline for dialysis. Use the other deltoid or a thigh. Injecting anywhere on the access arm, including below the fistula, risks bleeding, infection, and thrombosis, and a missing thrill suggests a clotted access that needs evaluation, not that the arm is safe to use.
A 33-year-old has severe angioedema of the lips and tongue. Two intubation attempts failed, an SGA does not ventilate, and SpO2 is 72% and falling despite BVM. What is indicated?
- A. Surgical cricothyrotomy
- B. Nebulized albuterol
- C. Nasal airway with BVM
- D. A third intubation attempt
Show answer
Answer: A. Surgical cricothyrotomy
This is a cannot-intubate, cannot-oxygenate situation. Proceed directly to a surgical airway.
Wound healing by first intention occurs with:
- A. Large open wounds left to granulate
- B. Clean wounds with edges together
- C. Full-thickness burn injuries
- D. Infected wounds packed open
Show answer
Answer: B. Clean wounds with edges together
Clean, closed wounds with edges approximated heal by first intention with minimal scarring.
Documentation of medical control contact should include:
- A. The physician's name, time, and orders
- B. Only the time contact was made
- C. Nothing, since calls are recorded
- D. Only the orders that were actually received
Show answer
Answer: A. The physician's name, time, and orders
It shows the chain of authority.
A patient speaks fluently but uses wrong words and cannot follow your commands. This is best described as:
- A. Expressive aphasia
- B. Dysarthria
- C. Dysphagia
- D. Receptive aphasia
Show answer
Answer: D. Receptive aphasia
Receptive (Wernicke) aphasia impairs comprehension with fluent but nonsensical speech. Dysarthria is slurred speech from impaired motor control with intact language.
The fluid rate for a patient in hypovolemic shock is guided by:
- A. A fixed volume set by protocol
- B. Perfusion signs and BP targets
- C. Patient comfort and thirst
- D. The maximum rate in all cases
Show answer
Answer: B. Perfusion signs and BP targets
Over-resuscitation can worsen bleeding and cause dilution. Titrate to mental status and blood pressure targets.
Aspiration before IM injection (pulling back on the plunger) is:
- A. Dangerous and never performed
- B. Always required for every site
- C. Not routine; follow protocol
- D. Required for SC injections only
Show answer
Answer: C. Not routine; follow protocol
Aspiration is not recommended for vaccines; practice varies for other IM drugs. It is no longer routinely recommended for most sites.
A syncope patient's ECG shows a coved ST elevation in V1-V2 with a right bundle branch pattern. This suggests:
- A. Wellens syndrome
- B. Pericarditis
- C. Brugada syndrome
- D. Left ventricular hypertrophy
Show answer
Answer: C. Brugada syndrome
Brugada pattern indicates a sodium channel disorder associated with polymorphic VT and sudden death; syncope in these patients is high risk.
During a daily check, you clamp the tubing of the portable suction unit and the gauge reads 120 mmHg. What does this mean?
- A. It is ready for oral suctioning
- B. It is set correctly for infants
- C. It is too weak and needs service
- D. It is ready after 5 more minutes
Show answer
Answer: C. It is too weak and needs service
A portable suction unit should reach a vacuum of at least about 300 mmHg when the tubing is clamped. 120 mmHg is too weak to clear thick vomitus or blood, so it is not ready for oral suctioning: take it out of service and repair or replace it. Lower settings for infants are chosen at the regulator during use; a weak unit is a failure, not an infant setting. Waiting 5 more minutes does not fix a weak pump.
A 6-year-old struck by a car has a bruised chest but no rib crepitus. His respiratory rate is 40 breaths/min, and his SpO2 is 90%. You should:
- A. Suspect underlying lung injury despite no fractures
- B. Assume a minor bruise, since the ribs are intact
- C. Suspect asthma, since children rarely have contusions
- D. Treat for anxiety, since the vitals are normal for age
Show answer
Answer: A. Suspect underlying lung injury despite no fractures
A child's flexible ribs transmit force to the lungs and heart without breaking, so serious internal injury can occur with intact ribs. A rate of 40 and an SpO2 of 90% are abnormal for a 6-year-old.
A 12-lead ECG in suspected ACS should be obtained:
- A. Only if chest pain persists after nitro
- B. After arrival at the receiving hospital
- C. After all medications have been given
- D. Within 10 minutes of patient contact
Show answer
Answer: D. Within 10 minutes of patient contact
Early transmission activates the catheterization team sooner.
Diltiazem 0.25 mg/kg IV is pushed over about 2 minutes, unlike adenosine. Pushing it rapidly mainly risks:
- A. Hyperkalemia
- B. Hypotension
- C. Hypoglycemia
- D. Tachycardia
Show answer
Answer: B. Hypotension
Diltiazem relaxes vascular smooth muscle and slows AV conduction, so a rapid push can drop blood pressure sharply; labeling calls for a 2-minute push. It does not raise potassium or lower glucose, and it slows rather than speeds the heart rate.
Capillary refill in a superficial partial-thickness burn is typically:
- A. Brisk
- B. Absent
- C. Delayed beyond 5 seconds
- D. Impossible to test
Show answer
Answer: A. Brisk
Dermal capillaries are intact and dilated, so the wound blanches and refills quickly. Absent refill means the capillaries are destroyed, as in full-thickness injury.
A child with chickenpox attended school the day before her rash appeared. This matters because chickenpox:
- A. Spreads 1 to 2 days before the rash
- B. Spreads mainly once the scabs fall off
- C. Spreads just by touching the dried scabs
- D. Cannot spread before the fever begins
Show answer
Answer: A. Spreads 1 to 2 days before the rash
Varicella is contagious from about 1 to 2 days before the rash until all lesions have crusted. Classmates may already have been exposed. Crusted scabs are not infectious.
Airborne transmission is different because the organisms:
- A. Stay suspended and are inhaled
- B. Are carried by insects or ticks
- C. Travel only a few feet, then fall
- D. Require direct physical contact
Show answer
Answer: A. Stay suspended and are inhaled
Tuberculosis, measles, and varicella spread this way and call for an N95 respirator. They can be inhaled at a distance.
If a patient has an adverse reaction to a medication you gave, you should:
- A. Treat it, document it, and report it
- B. Treat it and tell the nurse verbally
- C. Document it, then wait for orders to treat
- D. Stop the drug and wait for it to pass
Show answer
Answer: A. Treat it, document it, and report it
The hospital needs to know to avoid repeating it. Notify medical control as indicated, document objectively, and report it to the receiving provider. A verbal mention leaves no record, waiting for orders delays treatment you can give by protocol, and stopping the drug without treating the reaction can let it progress.
Dexmedetomidine is:
- A. A synthetic opioid agonist with minimal respiratory effects
- B. A dopamine antagonist used mainly as an antiemetic
- C. An alpha-2 agonist with little respiratory depression
- D. A benzodiazepine with a very short half-life
Show answer
Answer: C. An alpha-2 agonist with little respiratory depression
Causes bradycardia and hypotension. It is used mainly in critical care transport.
A competent patient refuses IV morphine but accepts intranasal fentanyl. This represents:
- A. A refusal of all care requiring a signed release
- B. A loss of decision-making capacity by the patient
- C. An error in the right route that must be reported
- D. The right to choose among acceptable options
Show answer
Answer: D. The right to choose among acceptable options
Patients may refuse a specific drug or route while accepting other appropriate treatment.
A patient found with pinpoint pupils is drowsy but rousable, breathing 14/min with good depth and an SpO2 of 96% on room air. What is the appropriate naloxone plan?
- A. No naloxone now; monitor breathing
- B. Give 4 mg IN to prevent decline
- C. Give 0.4 mg IM every 2 minutes now
- D. Give 2 mg IV to wake him up fully
Show answer
Answer: A. No naloxone now; monitor breathing
Naloxone is given for inadequate breathing, not for drowsiness or pinpoint pupils alone; with adequate rate, depth, and oxygenation, monitor closely (including ETCO2) and be ready to ventilate and titrate naloxone if breathing falls. Full reversal risks acute withdrawal, vomiting, and agitation. Prophylactic or scheduled doses are not indicated when breathing is adequate.
Blood pressure readings are of limited assessment value in children younger than about:
- A. 6 months
- B. 10 years
- C. 14 years
- D. 3 years
Show answer
Answer: D. 3 years
Blood pressure is hard to obtain and often unreliable in children under 3, so appearance, heart rate, pulses, and capillary refill guide perfusion assessment. In older children, blood pressure should be measured and compared with age-based norms.
For a medical patient, the equivalent of mechanism of injury is:
- A. Nature of the illness
- B. Chief complaint
- C. Past medical history
- D. Initial vital signs
Show answer
Answer: A. Nature of the illness
Gather it from the patient, family, and the scene itself.
When performing CPR on a small 2-year-old, you may compress the chest using:
- A. Two fingers on the lower sternum
- B. Two thumbs with hands encircling the chest
- C. A fist placed on the upper sternum
- D. One or two hands to reach one-third depth
Show answer
Answer: D. One or two hands to reach one-third depth
For a child, use the heel of one hand or two hands, whichever reaches at least one-third of the chest depth (about 5 cm) with full recoil. Two fingers cannot reach that depth, and the 2025 AHA/AAP guidelines dropped the two-finger technique even for infants. Two-thumb encircling is an infant technique (equal to the heel of one hand) and cannot compress a toddler's chest adequately. A fist on the upper sternum is the wrong tool and the wrong spot. (2025 AHA/AAP Pediatric BLS.)
NSAIDs such as ibuprofen reduce pain and inflammation by:
- A. Blocking histamine H1 receptors
- B. Stimulating beta-2 receptors on mast cells
- C. Binding opioid receptors in the spinal cord
- D. Inhibiting cyclooxygenase (COX) enzymes
Show answer
Answer: D. Inhibiting cyclooxygenase (COX) enzymes
They also affect platelet function and the gastric lining. COX inhibition reduces prostaglandin production.
School-age children's understanding of illness is usually:
- A. Fully abstract, like adults
- B. More concrete and logical
- C. Driven by magical thinking
- D. Absent until adolescence
Show answer
Answer: B. More concrete and logical
Simple honest explanations work well. They can follow directions and answer questions about their symptoms.
High altitude is generally defined as an elevation of about:
- A. 1,500 to 3,500 m (4,900 to 11,500 ft)
- B. 300 to 900 m (1,000 to 3,000 ft)
- C. Above 8,000 m (26,000 ft), the death zone
- D. Heights above 150 m (500 ft)
Show answer
Answer: A. 1,500 to 3,500 m (4,900 to 11,500 ft)
High altitude is 1,500 to 3,500 m, very high altitude 3,500 to 5,500 m, and extreme altitude above 5,500 m. Acute mountain sickness becomes common above about 2,500 m (8,200 ft).
Which best illustrates the engineering strategy?
- A. Fines for speeding through highway work zones
- B. Pamphlets that describe safe driving habits
- C. Defensive driving classes for new drivers
- D. Guardrails and breakaway signposts
Show answer
Answer: D. Guardrails and breakaway signposts
Design changes protect without requiring compliance.
Order: adenosine 6 mg rapid IV push. On hand: 3 mg/mL. Volume:
- A. 3 mL
- B. 0.5 mL
- C. 18 mL
- D. 2 mL
Show answer
Answer: D. 2 mL
6 mg ÷ 3 mg × 1 mL = 2 mL.
A postterm infant is more likely than a term infant to have:
- A. Abundant vernix and fine lanugo hair
- B. Very thin, gelatinous skin
- C. Meconium passage and low glucose
- D. Surfactant deficiency
Show answer
Answer: C. Meconium passage and low glucose
Postterm infants often pass meconium, may outgrow their placental supply, and have dry, cracked skin with little vernix and a risk of hypoglycemia. Abundant vernix and lanugo are features of a younger infant.
Under the current tissue-based definition, a transient ischemic attack is:
- A. Any deficit lasting under 24 hours
- B. A stroke that resolves within 1 hour
- C. A deficit lasting under 24 hours with infarct
- D. Transient deficit without infarction
Show answer
Answer: D. Transient deficit without infarction
TIA is now defined as transient neurologic dysfunction from focal ischemia without acute infarction on imaging. The old 24-hour time rule is no longer used because many short events still cause infarction.
Asked about drug allergies, a patient says morphine once 'made me throw up.' How should you classify this history?
- A. An IgE allergy to the whole opioid class
- B. A contraindication to giving ondansetron
- C. An expected side effect, not an allergy
- D. A sign morphine must be given IM instead
Show answer
Answer: C. An expected side effect, not an allergy
Nausea and vomiting are common, predictable opioid side effects, not an immune reaction; record the history and consider an antiemetic or a different opioid. It is not an IgE allergy that covers the whole opioid class (true allergy shows hives, swelling, wheezing, or hypotension), it is not a contraindication to ondansetron (ondansetron treats the nausea), and switching to IM does not prevent opioid-induced nausea.
An adult meets your termination protocol on scene, and medical control agrees. Transporting him with lights, siren, and CPR in progress would mainly:
- A. Greatly raise his chance of having ROSC
- B. Be needed for an ED physician to call death
- C. Give the family the most accurate news
- D. Put the crew at risk with almost no benefit
Show answer
Answer: D. Put the crew at risk with almost no benefit
Manual CPR in a moving ambulance is poor in quality and exposes the crew and public to crash and injury risk, while patients who meet validated TOR criteria have almost no chance of survival. Transport does not meaningfully raise the chance of ROSC. Death can be pronounced in the field under protocol with medical direction, so an ED physician is not needed. Transporting a patient who has already died can mislead the family about his chances and delays their grieving. (2025 AHA Part 9 TOR; NAEMSP TOR resource.)
Neutropenia is defined as:
- A. A high neutrophil count
- B. A low platelet count
- C. A low neutrophil count
- D. A high lymphocyte count
Show answer
Answer: C. A low neutrophil count
An absolute neutrophil count below 500/µL carries a high risk of serious infection.
Severe acidosis worsens shock mainly by:
- A. Making the blood vessels constrict more effectively
- B. Increasing the oxygen affinity of hemoglobin in the tissues
- C. Raising the blood pressure by retaining more sodium
- D. Depressing contractility and the response to pressors
Show answer
Answer: D. Depressing contractility and the response to pressors
A pH below about 7.2 depresses contractility and blunts the effect of endogenous and administered vasopressors. Acidosis actually shifts the oxyhemoglobin curve right, releasing more oxygen, so increased affinity is incorrect.
A patient with stable, regular narrow-complex SVT is actively wheezing from severe asthma, and vagal maneuvers failed. Which drug is the better choice?
- A. Diltiazem 0.25 mg/kg over 2 minutes
- B. Metoprolol 5 mg IV push
- C. Atropine 1 mg IV push
- D. Adenosine 12 mg as the first rapid IV push
Show answer
Answer: A. Diltiazem 0.25 mg/kg over 2 minutes
Adenosine can provoke bronchospasm, so in active, severe asthma a nondihydropyridine calcium channel blocker such as diltiazem is a reasonable alternative for a stable patient with a good BP. Starting adenosine at 12 mg adds to that risk. Beta blockers can worsen bronchospasm. Atropine speeds AV conduction and does not treat SVT.
How is a jaw thrust performed?
- A. Pull the tongue forward with gauze
- B. Push down firmly on the forehead
- C. Lift the jaw forward at its angles
- D. Press the chin down to open the mouth
Show answer
Answer: C. Lift the jaw forward at its angles
Place the fingers behind the angles of the mandible and lift it forward, which pulls the tongue off the pharynx.
Epinephrine helps in cardiac arrest mainly by:
- A. Beta-1 stimulation that directly converts VF to sinus rhythm
- B. Beta-2 bronchodilation that improves oxygenation during ventilation
- C. Alpha vasoconstriction raising perfusion pressure
- D. Lowering myocardial oxygen demand so the heart can recover
Show answer
Answer: C. Alpha vasoconstriction raising perfusion pressure
Its alpha effects matter more than its beta effects here. The vasoconstriction improves coronary and cerebral perfusion pressure during compressions.
An elderly patient has crackles, fever, and a cough, and pneumonia is as likely as heart failure. What is the main concern with giving furosemide?
- A. Furosemide reliably causes bronchospasm in pneumonia
- B. Furosemide loses its effect when the patient has a fever
- C. Diuresis can worsen dehydration and hypotension if it is not CHF
- D. Furosemide pushes the potassium up to dangerous levels within minutes
Show answer
Answer: C. Diuresis can worsen dehydration and hypotension if it is not CHF
Prehospital misdiagnosis is common; giving a diuretic to a patient with pneumonia or sepsis can cause harm. Fever does not block furosemide, and it lowers rather than raises potassium; the danger in a pneumonia or septic patient is volume loss.
Hypothermia worsens bleeding in trauma because it:
- A. Raises the platelet count
- B. Slows clotting enzymes
- C. Speeds up clot formation
- D. Increases fibrinogen production
Show answer
Answer: B. Slows clotting enzymes
Clotting enzymes and platelets work poorly when cold, even when lab tests run at normal body temperature look fine. Prevent heat loss in every bleeding patient. Cold does not raise platelet counts or fibrinogen.
An 87-year-old fell and has a shortened, externally rotated leg. An hour later she is pale and tachycardic, with no other injuries found. You should recognize that a hip fracture:
- A. Can lose enough blood to cause shock
- B. Rarely bleeds since the hip is small
- C. Causes pallor from pain, not blood loss
- D. Bleeds little unless the skin is broken
Show answer
Answer: A. Can lose enough blood to cause shock
Proximal femur fractures, especially intertrochanteric fractures, can bleed a liter or more into the thigh, and older adults with little reserve and on anticoagulants may become hypovolemic; treat for shock, splint to limit motion, and reassess often. The hip and thigh hold a large volume of blood. Pain can cause pallor, but tachycardia and pallor after an hour should be treated as blood loss until proven otherwise. Closed fractures bleed internally without broken skin.
Albumin and other colloids are not routinely preferred over crystalloids in prehospital resuscitation mainly because they:
- A. Have not shown better survival and cost more
- B. Cause severe hypernatremia in most patients
- C. Leave the vessels faster than crystalloids do
- D. Cannot be given through an IV or IO line
Show answer
Answer: A. Have not shown better survival and cost more
Large trials found no survival advantage for albumin over saline in mixed ICU patients, and synthetic starches increased kidney injury. Colloids actually stay in the vessels longer than crystalloids, so that is not the reason.
A 78-year-old with a history of alcohol use disorder fell in his kitchen 3 weeks ago. His family reports he has become increasingly confused and sleepy, with a worsening headache. You should suspect:
- A. An acute epidural hematoma
- B. Diffuse axonal injury
- C. Concussion recovery
- D. A chronic subdural hematoma
Show answer
Answer: D. A chronic subdural hematoma
Brain atrophy from age and alcohol stretches the bridging veins, so minor trauma can start a slow venous bleed that becomes symptomatic weeks later. Epidural hematomas are arterial and present within hours.
You arrive at a home where a woman delivered 10 minutes ago. The infant is cool and apneic with no heart rate, but there are no signs of decomposition or obvious lethal deformity. You should:
- A. Pronounce death at once
- B. Wait for police first
- C. Begin resuscitation
- D. Call for the coroner
Show answer
Answer: C. Begin resuscitation
Unless there are clear signs of prolonged death or anomalies incompatible with life, field resuscitation should begin and medical direction should be contacted. Pronouncing death without trying denies the infant a chance of survival.
A patient has sudden tearing chest pain radiating to the back and a 30 mm Hg difference in arm BPs. Which ACS drugs should be withheld?
- A. Fentanyl and ondansetron
- B. Labetalol and esmolol
- C. Aspirin and heparin
- D. Oxygen and IV fluids
Show answer
Answer: C. Aspirin and heparin
These findings suggest aortic dissection, where antiplatelets and anticoagulants can worsen bleeding into the aortic wall, so aspirin and heparin are withheld until it is excluded. Oxygen and IV access are still appropriate as indicated. Analgesia and antiemetics are given. Beta blockers such as esmolol or labetalol are used to lower heart rate and shear stress.
During CPR on an intubated adult, ETCO2 abruptly rises from 14 to 42 mm Hg just before a scheduled epinephrine dose. What is the best action?
- A. Hyperventilate the patient to bring the ETCO2 back down
- B. Give the epinephrine immediately to maintain the 3-minute schedule
- C. Check for a pulse, suspecting ROSC, before giving more epinephrine
- D. Give amiodarone because the rise signals refibrillation
Show answer
Answer: C. Check for a pulse, suspecting ROSC, before giving more epinephrine
A sudden sustained rise in ETCO2 is an early sign of ROSC; giving an arrest-dose epinephrine bolus to a perfusing patient can cause severe hypertension and dysrhythmias.
When drawing up medication, injecting air into the vial first:
- A. Equalizes pressure for easier withdrawal
- B. Is dangerous and may shatter the vial
- C. Dilutes the drug to a lower strength
- D. Is unnecessary for single-dose vials
Show answer
Answer: A. Equalizes pressure for easier withdrawal
Air equal to the volume to be withdrawn is injected into the vial.
A febrile 40-year-old has a regular rhythm at 132/min, an upright P wave before each QRS, a PR interval of 0.14 seconds, and a QRS of 0.08 seconds. What is the rhythm?
- A. Sinus tachycardia
- B. Supraventricular tachycardia
- C. Atrial flutter with 2:1 block
- D. Accelerated junctional rhythm
Show answer
Answer: A. Sinus tachycardia
Normal P waves before every QRS at a rate above 100 indicate sinus tachycardia, which here is a response to fever. Treat the cause rather than the rate.
The enzyme that breaks down fibrin is:
- A. Thrombin
- B. Factor X
- C. Heparin
- D. Plasmin
Show answer
Answer: D. Plasmin
Plasminogen is converted to plasmin. Fibrinolytic drugs such as alteplase work by speeding up this step.
Which approach reduces diagnostic error?
- A. Relying on years of experience alone
- B. Systematic assessment and reassessment
- C. Working faster to limit scene time
- D. Confidence in your first impression
Show answer
Answer: B. Systematic assessment and reassessment
Discipline. Considering alternatives also reduces error.
A medication order is clearly outside the protocol dose range. If medical control insists after clarification, the paramedic should:
- A. Give half the ordered dose as a reasonable compromise
- B. Give it, since medical control assumes all liability
- C. Decline, document the exchange, and report it
- D. Ask the patient to decide whether to accept the dose
Show answer
Answer: C. Decline, document the exchange, and report it
Paramedics are responsible for their own actions and should not give a medication they believe will harm the patient.
Which positioning is usually best for a stable patient with pelvic pain?
- A. Position of comfort
- B. Prone
- C. Flat with legs straight
- D. Trendelenburg
Show answer
Answer: A. Position of comfort
Many patients prefer lying with knees bent. If hypotensive, position supine with legs raised per protocol.
Patients with latex allergy may also react to:
- A. Rice, potatoes, and oats
- B. Milk, eggs, and cheese
- C. Bananas, avocados, kiwi
- D. Wheat, corn, and barley
Show answer
Answer: C. Bananas, avocados, kiwi
This latex-fruit syndrome is due to similar proteins.
At an extrication, the paramedic notices that a rescuer has cut a door post and left the jagged end bare. Before anyone moves past it, the metal should be:
- A. Wiped clean of the patient's blood
- B. Covered with edge protection
- C. Bent outward toward the street
- D. Marked with a strip of tape
Show answer
Answer: B. Covered with edge protection
Cut metal edges are sharp enough to cut through gloves and turnout gear, so rescuers cover them with edge protectors, tarps, or padding. Tape marks the hazard but does not protect anyone who brushes against it.
A patient with a head injury has a blood pressure of 120/60 mm Hg and an estimated ICP of 20 mm Hg. The cerebral perfusion pressure is approximately:
- A. 40 mm Hg
- B. 60 mm Hg
- C. 80 mm Hg
- D. 100 mm Hg
Show answer
Answer: B. 60 mm Hg
MAP is the diastolic pressure plus one-third of the pulse pressure: 60 + 20 = 80 mm Hg, and 80 - 20 = 60 mm Hg. The answer 80 mm Hg is the MAP itself, before the ICP is subtracted.
A patient hyperventilates and his CO2 falls. Using CO2 + H2O = H2CO3 = H+ + HCO3-, what happens to hydrogen ions and pH?
- A. H+ rises, so pH falls
- B. H+ is unchanged
- C. H+ falls, so pH falls
- D. H+ falls, so pH rises
Show answer
Answer: D. H+ falls, so pH rises
Removing CO2 pulls the reaction to the left, using up H+, so H+ falls and pH rises (respiratory alkalosis). Rising H+ with falling pH is what happens in hypoventilation. pH moves opposite to H+, so a fall in H+ cannot lower pH.
Your service carries a device that provides bilevel (BiPAP) noninvasive ventilation but not CPAP alone. Is it acceptable for an alert patient with cardiogenic pulmonary edema?
- A. Yes; CPAP and bilevel are both recommended
- B. No; bilevel is meant for COPD and asthma
- C. No; it raises the pressure in her lungs too much
- D. Yes, but just after she is intubated
Show answer
Answer: A. Yes; CPAP and bilevel are both recommended
ERS/ATS guidelines recommend either CPAP or bilevel NIV for acute cardiogenic pulmonary edema, since both reduce the need for intubation. Bilevel is not limited to COPD and asthma. Appropriate settings do not overpressurize the lungs. Noninvasive ventilation is used instead of intubation, not after it.
Hollow organ injuries are often missed on the initial exam because:
- A. Peritonitis can take hours to develop
- B. Bowel injuries cause early shock instead
- C. Rigidity appears in the first few minutes
- D. Bowel injuries are easily found on palpation
Show answer
Answer: A. Peritonitis can take hours to develop
Bowel contents leak slowly and inflammation builds over time, so the abdomen may be soft early on. This delay is why serial exams matter and why mechanism should drive transport decisions. Isolated bowel injuries rarely cause early shock, and rigidity develops over hours rather than minutes, so a normal early exam is common and palpation alone often misses them.
Why is lead II commonly used for continuous cardiac rhythm monitoring?
- A. It is the best lead to detect STEMI
- B. It views the posterior wall directly
- C. It usually shows clear upright P waves
- D. It needs only two electrodes placed
Show answer
Answer: C. It usually shows clear upright P waves
Lead II parallels the normal flow of depolarization, so P waves and QRS complexes are usually upright and easy to identify. A single lead cannot be used to diagnose STEMI.
A 12-lead ECG on a patient with long-standing COPD shows tall, peaked P waves in lead II. What do these most suggest?
- A. An acute inferior myocardial infarction
- B. High potassium from kidney failure
- C. Right atrial enlargement from lung disease
- D. Left ventricular hypertrophy from hypertension
Show answer
Answer: C. Right atrial enlargement from lung disease
Tall, peaked P waves in lead II (P pulmonale, over 2.5 mm) reflect right atrial enlargement from pulmonary hypertension, common in chronic lung disease. Inferior MI shows ST elevation in II, III, and aVF, not P-wave changes. Hyperkalemia peaks the T waves, not the P waves. LVH increases QRS voltage in the left-sided leads.
A patient with an old anterior MI has Q waves and 2 mm of ST elevation in V1 to V4, but no new symptoms. What is the most useful next step?
- A. Give a fibrinolytic right away to open the LAD
- B. Compare with a prior ECG if one is available
- C. Treat it as pericarditis
- D. Discard it as artifact
Show answer
Answer: B. Compare with a prior ECG if one is available
Persistent ST elevation with Q waves weeks after an anterior MI often reflects a ventricular aneurysm. Comparing with an older tracing shows whether the changes are new; if no prior ECG exists and symptoms suggest ischemia, treat it as possible STEMI. Fibrinolysis without clear evidence of a new infarct can cause harm, and pericarditis and artifact do not explain fixed Q waves.
A patient with scleroderma has white, cold fingertips, and the finger pulse oximeter will not give a reading. You should:
- A. Try an earlobe or forehead sensor
- B. Assume her SpO2 is under 80%
- C. Rub the finger hard for 2 minutes
- D. Record the oxygen level as normal
Show answer
Answer: A. Try an earlobe or forehead sensor
Raynaud phenomenon, common in scleroderma and lupus, causes spasm of the finger arteries, so finger probes often fail. Use an ear or forehead sensor and warm the hands. Do not guess a value.
Convert 0.3 mg to micrograms:
- A. 3,000 mcg
- B. 3 mcg
- C. 300 mcg
- D. 30 mcg
Show answer
Answer: C. 300 mcg
0.3 × 1,000 = 300 mcg.
Quick paramedic quizzes by exam area
Ten more questions for each NREMT content area, separate from the full test above: Airway, Respiration and Ventilation · Cardiology and Resuscitation · Trauma · Medical, Obstetrics and Gynecology · EMS Operations · Clinical Judgment.
Free paramedic Airway, Respiration and Ventilation quiz
An asthmatic who earlier wheezed only at the end of exhalation now wheezes through both inspiration and expiration. How should you interpret this?
- A. Her bronchospasm is starting to resolve
- B. This is an expected effect of albuterol
- C. She has developed pneumonia in one lobe
- D. Her airway narrowing is getting worse
Show answer
Answer: D. Her airway narrowing is getting worse
Wheezing usually progresses as obstruction worsens: first at end-expiration, then through all of expiration, then on both inspiration and expiration, and finally a quiet chest when too little air moves. Wheezing spreading into inspiration is worsening, not resolution. Albuterol does not cause inspiratory wheezing. Pneumonia causes focal crackles or bronchial sounds rather than diffuse two-phase wheezing.
A 9-year-old inhaled a plastic pen cap 20 minutes ago. He is coughing now and then but speaking and breathing comfortably. What should you do?
- A. Give back blows and thrusts right now
- B. Reassure the family; the cap has a hole
- C. Have him drink water to wash it down
- D. Keep him calm and transport for removal
Show answer
Answer: D. Keep him calm and transport for removal
A child who can speak and breathe has a partial obstruction; let him cough and transport him for removal, ready to give back blows and abdominal thrusts if he can no longer speak or breathe. Giving back blows and thrusts right now is for severe obstruction, not a child moving air. Many pen caps have a vent hole to let some air through if inhaled, but the cap must still be removed. Drinking water can cause aspiration.
A patient is on BiPAP with an inspiratory pressure (IPAP) of 14 cm H2O and an expiratory pressure (EPAP) of 6 cm H2O. How much pressure support does each breath receive above EPAP?
- A. 8 cm H2O
- B. 20 cm H2O
- C. 14 cm H2O
- D. 6 cm H2O
Show answer
Answer: A. 8 cm H2O
Pressure support is the difference between IPAP and EPAP: 14 - 6 = 8 cm H2O. This boost helps move air and lower CO2, while the EPAP of 6 acts like PEEP. 20 adds the two values. 14 is the IPAP itself. 6 is the EPAP.
An asthmatic's peak flow is 180 L/min, and her personal best is 400 L/min. What percentage of her personal best is this?
- A. 55%
- B. 22%
- C. 72%
- D. 45%
Show answer
Answer: D. 45%
Divide today's value by the personal best: 180 / 400 = 0.45, or 45%. A value at or below 50% indicates a severe exacerbation. 55% is the shortfall from her best, not the percentage achieved. 22% and 72% do not follow from the numbers.
Ten days after hip surgery, a 70-year-old briefly fainted. She is now dyspneic with a BP of 84/50, a heart rate of 126, distended neck veins, and clear lungs. What does this presentation suggest?
- A. A simple vasovagal faint after standing up quickly
- B. Dehydration from poor oral intake
- C. A high-risk PE straining the right heart
- D. A urinary infection with mild sepsis
Show answer
Answer: C. A high-risk PE straining the right heart
Syncope, hypotension, distended neck veins, and clear lungs after surgery point to a large PE causing right ventricular failure (high-risk PE). Handle her gently, give oxygen, use small fluid boluses or pressors per protocol, and transport to a center that can give lytics. A vasovagal faint resolves fully. Dehydration causes flat, not distended, neck veins. Mild sepsis would not cause distended neck veins.
Nasal flaring in an infant is a sign of:
- A. Respiratory distress
- B. Simple nasal congestion
- C. Normal newborn breathing
- D. Compensation for metabolic alkalosis
Show answer
Answer: A. Respiratory distress
It is often an early finding. Flaring widens the nostrils to lower airway resistance during labored breathing. Congestion alone does not cause it, and alkalosis is compensated by slower breathing, not increased effort.
Why is rocuronium dosed at 1 to 1.2 mg/kg for RSI rather than the 0.6 mg/kg used in the operating room?
- A. The larger dose shortens the duration
- B. The smaller dose causes fasciculations
- C. The smaller dose raises potassium
- D. The larger dose speeds the onset
Show answer
Answer: D. The larger dose speeds the onset
Higher doses of rocuronium bring intubating conditions in about 45 to 60 seconds, close to succinylcholine; 0.6 mg/kg takes longer. The larger dose lengthens, not shortens, the duration. Rocuronium is nondepolarizing and does not cause fasciculations or raise potassium at any dose.
An adult choking victim becomes unresponsive while you are giving abdominal thrusts. What should you do?
- A. Do a blind finger sweep
- B. Check a pulse for 30 seconds
- C. Lower him and start CPR
- D. Keep giving abdominal thrusts
Show answer
Answer: C. Lower him and start CPR
Once unresponsive, lower the patient to the ground and begin CPR. Look in the mouth before each set of breaths and remove any visible object.
The turbinates function to:
- A. Create turbulent airflow
- B. Support the hard palate
- C. Dry inspired air before the lungs
- D. Seal the nasopharynx when swallowing
Show answer
Answer: A. Create turbulent airflow
The turbulence warms and filters the air. They also make nasal airway insertion prone to bleeding. By slowing and mixing airflow over moist mucosa, they humidify rather than dry the air.
After intubating a patient who had a full stomach and gastric distension from BVM ventilation, which step helps decompress the stomach?
- A. Place an orogastric tube
- B. Deflate the ET tube cuff
- C. Hyperventilate the lungs
- D. Push on the epigastrium
Show answer
Answer: A. Place an orogastric tube
An orogastric tube decompresses the stomach, improving ventilation and reducing aspiration risk.
Free paramedic Cardiology and Resuscitation quiz
The components of post-cardiac arrest syndrome include brain injury, systemic ischemia-reperfusion response, the persisting cause of the arrest, and:
- A. Primary adrenal failure
- B. Cerebral vasospasm
- C. Myocardial dysfunction
- D. Pulmonary hypertension
Show answer
Answer: C. Myocardial dysfunction
Post-arrest myocardial stunning causes low cardiac output and hypotension that often improves over 24 to 72 hours, which is why vasopressors are commonly needed after ROSC. Adrenal insufficiency can occur, but it is not one of the four defined components. Cerebral vasospasm and pulmonary hypertension are not components either; the brain component is hypoxic-ischemic injury rather than vessel spasm.
A woman has a tender, red, firm cord along a visible vein on the surface of her calf. Her leg is not swollen. What is the most likely condition?
- A. An acute arterial embolism
- B. Superficial thrombophlebitis
- C. Lymphedema of the lower leg area
- D. A ruptured Achilles tendon
Show answer
Answer: B. Superficial thrombophlebitis
Superficial thrombophlebitis is a clot with inflammation in a surface vein, felt as a tender, red cord; it can extend into deep veins, so it still needs evaluation. Arterial embolism causes a cold, pale, pulseless limb, lymphedema causes swelling without a red cord, and an Achilles rupture affects the heel tendon, not a vein.
After 3 L of crystalloid for septic shock, a 66-year-old now has crackles, cool mottled legs, and a BP of 80/48 mmHg. The added problem is most likely:
- A. A return of normal tone in the blood vessels
- B. A delayed allergic reaction to the fluid given
- C. Sepsis-induced depression of heart function
- D. The infection clearing after initial treatment
Show answer
Answer: C. Sepsis-induced depression of heart function
Septic shock often includes myocardial depression (septic cardiomyopathy), so after volume is restored some patients develop cool, mottled skin and pulmonary congestion while staying hypotensive: a cardiogenic component on top of distributive shock. More fluid will worsen the lungs; the next step is a vasopressor, with an inotrope considered in hospital. Recovery of vascular tone would raise, not lower, the pressure. A fluid allergy would cause hives or bronchospasm. An infection does not clear within the first hours of treatment, and clearing would improve, not worsen, the picture.
For anterior-posterior defibrillation in an adult, the posterior pad is placed:
- A. Over the right shoulder blade, near the neck line
- B. On the lower back at the level of the waist
- C. Under the right flank over the kidney
- D. Below the left shoulder blade, near the spine
Show answer
Answer: D. Below the left shoulder blade, near the spine
In the anterior-posterior position, the front pad goes over the left precordium and the back pad goes below the left scapula, beside the spine, so current passes through the heart from front to back; this is the position used for vector change. Over the right shoulder blade, the current path misses much of the left ventricle. The lower back and right flank are too far below the heart to direct current through the ventricles. (AHA 2025 Part 9; DOSE-VF trial methods.)
In a patient with a known left bundle branch block and chest pain, which finding most strongly suggests acute MI?
- A. Discordant ST depression in V5 and V6
- B. QRS width of 0.14 seconds in V1
- C. Deep S waves in leads V1 and V2
- D. Concordant ST elevation of 1 mm or more
Show answer
Answer: D. Concordant ST elevation of 1 mm or more
Under the Sgarbossa criteria, ST elevation of 1 mm or more in the same direction as the QRS (concordant) strongly suggests acute MI. Discordant changes and deep S waves in V1 are expected with LBBB.
An 80-year-old with vomiting for 3 days has a temperature of 38.9 C, dry mucous membranes, AF at 140/min, and a BP of 92/60. Your partner wants to give diltiazem. What is best?
- A. Diltiazem 0.25 mg/kg IV over 2 min
- B. Metoprolol 5 mg IV every 5 minutes, x 3
- C. Treat the dehydration and fever first
- D. Adenosine 6 mg rapid IV push
Show answer
Answer: C. Treat the dehydration and fever first
The fast rate here is largely a response to fever and volume loss; fluids and fever control often slow it, and an AV nodal blocker in a dry, borderline-hypotensive patient can cause severe hypotension. Metoprolol carries the same risk. Adenosine does not convert AF and only slows it for seconds.
To deliver effective adult chest compressions with the least fatigue, the rescuer should position his:
- A. Hands on the upper sternum, elbows bent
- B. Body to the side, pushing with the arms
- C. Knees far from the patient, leaning back
- D. Shoulders over his hands, elbows locked
Show answer
Answer: D. Shoulders over his hands, elbows locked
Kneeling close to the patient with the shoulders directly over the hands and the elbows locked lets body weight drive compressions, giving adequate depth with less fatigue. Hands go on the lower half of the sternum. Bent elbows or pushing from the side relies on arm muscles and reduces depth.
Caution with nitroglycerin is warranted in suspected right ventricular infarction because:
- A. It causes profound bradycardia in RV infarction
- B. It worsens chest pain by causing coronary steal
- C. It sharply increases heart rate and oxygen demand
- D. RV infarct patients are preload dependent
Show answer
Answer: D. RV infarct patients are preload dependent
Nitroglycerin is a venodilator that reduces preload, and patients with right ventricular infarction depend on preload to fill the left heart, so they may become severely hypotensive; a right-sided ECG (V4R) helps identify them. Nitroglycerin does not cause profound bradycardia (RV infarction itself may), it does not cause coronary steal in ACS, and its reflex tachycardia is modest rather than a sharp rise in oxygen demand.
The maximum single dose of epinephrine in pediatric arrest is:
- A. 10 mg
- B. 0.5 mg
- C. 1 mg
- D. 0.1 mg
Show answer
Answer: C. 1 mg
Pediatric epinephrine is capped at the adult dose of 1 mg.
A patient with ongoing ischemic chest pain has a BP of 194/110 and no signs of RV infarction or PDE-5 inhibitor use. Which drug both treats the ischemia and lowers the BP?
- A. Furosemide 40 mg IV
- B. Labetalol alone, no nitrate
- C. Hydralazine 20 mg IM
- D. Nitroglycerin, titrated
Show answer
Answer: D. Nitroglycerin, titrated
Nitroglycerin relieves ischemic pain and lowers BP by reducing preload and afterload, so it is the usual first drug in hypertensive ACS, titrated (IV in many systems) to pain and BP. Furosemide is for volume overload. Labetalol may be added in some hospitals but does not replace nitrates for ischemia, and it is avoided with heart failure or cocaine use. Hydralazine causes reflex tachycardia, which raises myocardial oxygen demand.
Free paramedic Trauma quiz
Undertriage in a trauma system means:
- A. A minor injury is transported to a Level I center
- B. A seriously injured patient goes to a lesser center
- C. Mass-casualty triage tags are applied too early
- D. A patient is flown when ground transport was faster
Show answer
Answer: B. A seriously injured patient goes to a lesser center
Undertriage increases preventable death and is the error systems work hardest to avoid; the ACS target is under 5%. Sending minor injuries to a Level I center is overtriage, which wastes resources but is less dangerous.
An unresponsive trauma patient cannot report pain. Which assessment finding is most helpful in identifying an extremity fracture?
- A. A weaker distal pulse in that limb
- B. Withdrawal to a nail bed press
- C. Capillary refill time in the fingers
- D. Deformity, swelling, or instability
Show answer
Answer: D. Deformity, swelling, or instability
Without a pain report, you must rely on inspection and palpation for deformity, swelling, crepitus, and instability. A weak distal pulse or slow capillary refill tests perfusion rather than the presence of a fracture, and withdrawal to a nail bed press assesses the level of consciousness.
An open skull fracture is defined by:
- A. A fracture line wider than 5 mm
- B. Bone fragments driven inward into the brain
- C. A fracture involving the skull base
- D. A break in the scalp over the fracture
Show answer
Answer: D. A break in the scalp over the fracture
An open fracture communicates with the outside through a scalp wound, creating a route for infection. Depressed fragments define a depressed fracture, which may be open or closed.
A 35-year-old man with 25% TBSA burns needs IV access, but his only unburned extremity is his left leg, which has a deformed fracture. You may:
- A. Withhold fluids until hospital arrival
- B. Give fluids by mouth instead
- C. Use an IO in the fractured leg
- D. Use burned skin as an IV site
Show answer
Answer: D. Use burned skin as an IV site
An IV may be placed through burned tissue when no unburned site is available, or an IO can be used in an uninjured bone. An IO in a fractured bone will leak and is contraindicated.
A 45-year-old has a slowly enlarging subdural hematoma, yet his ICP remains near normal at first. The main early compensation is:
- A. Increased production of cerebrospinal fluid
- B. Expansion of the adult skull along the cranial suture lines
- C. Displacement of CSF and venous blood out of the skull
- D. Dilation of the cerebral arteries to add flow
Show answer
Answer: C. Displacement of CSF and venous blood out of the skull
Early on, CSF is pushed into the spinal subarachnoid space and venous blood leaves the cranium, buffering ICP. Increased CSF production would raise ICP, and adult sutures are fused and cannot expand.
A 7-year-old was splashed with hot cooking oil from a deep fryer. Compared with a scald from hot water, this burn is likely to be:
- A. Shallower, because oil cools very quickly
- B. Deeper, as oil gets far hotter and clings
- C. The same depth, since each is a liquid
- D. Shallower, since oil protects the skin
Show answer
Answer: B. Deeper, as oil gets far hotter and clings
Cooking oil can exceed 175 C (350 F), far above the 100 C ceiling of water, and its viscosity keeps it in contact with the skin longer, so oil and grease burns are typically deeper than water scalds. Cool with running water for about 20 minutes and transport; children with deep burns warrant burn center consultation.
When documenting vision in an eye-injured patient who cannot read any letters, the next step down in testing is to check whether he can:
- A. Count your fingers, then see hand motion
- B. Read a phone screen at one foot away
- C. Identify colors on a chart at a distance
- D. Describe the shape of the room's lights
Show answer
Answer: A. Count your fingers, then see hand motion
If a patient cannot read print, vision is recorded in descending order as counting fingers (at a stated distance), seeing hand motion, perceiving light, or no light perception. This gives the receiving team a baseline. Reading a phone screen is a print test he has already failed, and color or room-light descriptions are not standard measures.
A patient with lung cancer is coughing up large amounts of bright red blood, and you suspect it is from the right lung. You should position him:
- A. On his left side
- B. Supine and flat
- C. On his right side
- D. Prone with arms raised
Show answer
Answer: C. On his right side
Placing the bleeding lung down keeps blood from spilling into the healthy lung. Suction and airway readiness are critical, because massive hemoptysis kills by asphyxiation more often than by blood loss.
A pressure dressing is used to:
- A. Seal a sucking chest wound
- B. Control wound bleeding
- C. Hold a cold pack in place
- D. Keep a splint from slipping
Show answer
Answer: B. Control wound bleeding
Firm, even pressure over bulky dressings helps stop bleeding. Sealing a sucking chest wound requires an occlusive or vented chest seal, not a pressure dressing.
When realigning a long-bone fracture, you should stop and splint the limb as found if:
- A. The patient has a strong distal pulse
- B. Pain spikes or you meet resistance
- C. The bone fragments line up smoothly
- D. Swelling is present at the fracture site
Show answer
Answer: B. Pain spikes or you meet resistance
Resistance or a sharp increase in pain means further movement may injure vessels, nerves, or soft tissue. Swelling is present with nearly every fracture and is not a reason to stop.
Free paramedic Medical, Obstetrics and Gynecology quiz
Macrophages function to:
- A. Release histamine in allergy
- B. Engulf pathogens and present antigens
- C. Form platelet plugs in bleeding
- D. Produce antibodies against toxins
Show answer
Answer: B. Engulf pathogens and present antigens
They also clear debris. They bridge innate and adaptive immunity.
An 84-year-old with a pacemaker has a pelvic fracture after a fall. Her pulse is 70 and regular. This heart rate:
- A. Proves that she has not lost blood
- B. Means her pacemaker is malfunctioning
- C. Indicates cardiogenic shock is present
- D. May not rise in response to blood loss
Show answer
Answer: D. May not rise in response to blood loss
Many pacemakers hold a set rate, so a patient may bleed significantly without tachycardia; look for other signs of shock such as altered mentation, cool skin, and falling BP. A normal rate does not exclude hemorrhage.
In the history of a febrile, ill-appearing 18-month-old, which item has special significance?
- A. His birth order among siblings
- B. His vaccination history
- C. His usual bedtime routine
- D. His favorite foods
Show answer
Answer: B. His vaccination history
An unimmunized or underimmunized child is at risk for Hib, pneumococcal disease, measles and pertussis, which changes the likely diagnoses, the precautions you take, and what the hospital will look for. Birth order, bedtime routine and favorite foods do not change emergency care for a febrile, ill child. (Caroline 9th ed.)
Green (bilious) vomiting in a newborn is concerning because it suggests:
- A. Simple overfeeding by parents
- B. Pyloric muscle thickening
- C. Blockage below the bile duct
- D. Mild physiologic reflux
Show answer
Answer: C. Blockage below the bile duct
Bile enters the bowel in the duodenum, so bilious vomiting means the block is distal to that point. Malrotation with volvulus is a surgical emergency.
A man who drank windshield washer fluid is now complaining of blurred vision, describing it as 'like being in a snowstorm,' and is breathing fast. The toxin is most likely:
- A. Ethylene glycol
- B. Isopropyl alcohol
- C. Ethanol
- D. Methanol
Show answer
Answer: D. Methanol
Methanol is metabolized to formic acid, which damages the optic nerve and causes severe acidosis. Ethylene glycol mainly injures the kidneys.
Which patient right matters most in sexual assault care?
- A. The right to a police escort
- B. The right to a family member
- C. The right to skip documentation
- D. The right to decide about care
Show answer
Answer: D. The right to decide about care
Assault takes control away from the patient. Asking permission and respecting decisions restores some of it.
A patient with sudden aphasia takes apixaban. Why is it important to record the time of her last dose?
- A. Recent use may rule out thrombolytics
- B. It sets her prehospital BP target
- C. It sets the oxygen flow she needs
- D. It predicts how large the stroke will become
Show answer
Answer: A. Recent use may rule out thrombolytics
Recent direct oral anticoagulant use (generally within 48 hours) can exclude IV thrombolysis, so the drug, dose, and last-dose time help the stroke team choose between thrombolysis and thrombectomy. It does not set the field BP target or oxygen flow, and it does not predict stroke size.
Bacterial meningitis is time-sensitive because:
- A. It usually resolves on its own
- B. Antibiotic delay raises mortality
- C. Field steroids can cure it
- D. It is much less dangerous in adults
Show answer
Answer: B. Antibiotic delay raises mortality
Bacterial meningitis can progress to shock and death within hours, and each hour of delay in antibiotics worsens outcomes, so rapid transport and early notification matter. It does not resolve on its own, steroids are an adjunct given in the hospital with antibiotics and do not cure it, and it is dangerous at every age.
Magnesium sulfate for preterm labor (tocolysis) is:
- A. Given orally, 400 mg every 6 hours
- B. 1 g IV push, repeated every hour
- C. Contraindicated in preterm labor
- D. 4–6 g IV load, then 1–2 g/hr
Show answer
Answer: D. 4–6 g IV load, then 1–2 g/hr
Also provides fetal neuroprotection. This is a hospital or critical care therapy.
An 84-year-old with advanced dementia who cannot speak has begun striking out at staff during care over the last 2 days. The most useful first consideration is:
- A. A normal stage of dementia needing no workup
- B. A desire to harm staff on purpose
- C. A need for an antipsychotic right away
- D. An unrecognized source of pain or illness
Show answer
Answer: D. An unrecognized source of pain or illness
People with advanced dementia often show pain, urinary retention, constipation, infection, or a fracture through new agitation or resistance to care, so look for a physical cause (check the bladder, abdomen, skin, and limbs, vital signs, and glucose) before blaming the dementia. A new change over 2 days is not simply disease progression. The behavior is communication, not intent to harm. Antipsychotics carry a boxed warning in dementia and do not treat the underlying cause.
Free paramedic EMS Operations quiz
A liquid with a high vapor pressure is more dangerous to breathe around because it:
- A. Evaporates readily into the air
- B. Sinks below the water surface
- C. Mixes completely with water
- D. Needs high heat to give off vapor
Show answer
Answer: A. Evaporates readily into the air
Vapor pressure reflects how readily a liquid evaporates; the higher it is, the more vapor builds up above a spill and the greater the inhalation hazard. Mixing with water describes solubility, a separate property.
When nursing home residents are evacuated by ambulance, each resident should travel with:
- A. The clothes and shoes the resident has on
- B. Medication list, records, and ID
- C. A copy of the facility's insurance
- D. Family contact numbers on a sign-out
Show answer
Answer: B. Medication list, records, and ID
Records, medication lists, advance directives, and identification must go with each resident so receiving staff can continue care. Patients separated from their records are at risk of medication errors and loss of tracking.
During a terror bombing, command receives a credible threat that the attackers may target the trauma center next. EMS should:
- A. Keep it private for now so the public will not panic
- B. Divert the patients out of the region
- C. Share it at once with the hospital and police
- D. Stop transports until police respond
Show answer
Answer: C. Share it at once with the hospital and police
Hospitals have been targeted in secondary attacks, so threats must be passed immediately to the hospital and law enforcement so security can be increased. Keeping it quiet to avoid panic leaves the hospital unprotected.
State health departments are generally responsible for:
- A. Writing and enforcing federal health regulations
- B. Managing daily operations of local hospitals
- C. Conducting national biomedical research programs
- D. Statewide disease reporting and licensing
Show answer
Answer: D. Statewide disease reporting and licensing
They also hold most legal public health authority. They also coordinate local health departments.
A patient is pinned with both legs crushed under the dash, and you cannot find a vein in his arms. The best vascular access is:
- A. A tibial IO line in a pinned leg
- B. A distal femur IO line on one side
- C. Waiting until he is freed from the car
- D. A proximal humerus IO line
Show answer
Answer: D. A proximal humerus IO line
The proximal humerus is reachable in a seated, trapped patient and gives fast access above the injury. A tibial or femoral IO in a crushed, pinned leg may lose fluid into damaged tissue and is hard to reach.
Studies of communication suggest that:
- A. Written content matters far more than delivery style
- B. Spoken words carry nearly all of a message's meaning
- C. Tone and nonverbal cues carry much of the meaning
- D. Nonverbal cues are too unreliable to interpret well
Show answer
Answer: C. Tone and nonverbal cues carry much of the meaning
A large share of meaning travels through tone and nonverbal cues. Your calm posture may reassure more than your explanation.
A paramedic reading a study should first consider:
- A. Who funded the study and why
- B. Whether the methods support the conclusion
- C. The abstract, since it summarizes everything
- D. The conclusion stated by the authors
Show answer
Answer: B. Whether the methods support the conclusion
Check whether the methods support the conclusion and whether the study population resembles your own. Conclusions can outrun the data.
Level A protection consists of:
- A. A vapor-tight encapsulating suit with SCBA
- B. A splash suit with an SCBA worn outside it
- C. A splash suit with an air-purifying respirator
- D. A work uniform with gloves and safety glasses
Show answer
Answer: A. A vapor-tight encapsulating suit with SCBA
Level A gives the highest protection for both skin and lungs, with SCBA worn inside a fully encapsulating, vapor-tight suit. A splash suit with SCBA is Level B, which protects the lungs fully but not the skin from vapor.
JumpSTART was designed for patients who are roughly:
- A. Under 1 year old
- B. 1 to 8 years old
- C. 8 to 14 years old
- D. 12 to 18 years old
Show answer
Answer: B. 1 to 8 years old
JumpSTART is meant for children about 1 to 8 years old, or those who look like children. Older children and adolescents are triaged with adult START. Infants who cannot walk are assessed with JumpSTART and checked for obvious injuries.
Planners expect 60,000 people at an outdoor music festival next month. To prepare EMS for a possible MCI, the most useful step is to:
- A. Wait until the day of the event to plan
- B. Preplan access, staging, and an MCI response
- C. Rely on attendees to call 9-1-1 for help
- D. Let venue security plan the medical response
Show answer
Answer: B. Preplan access, staging, and an MCI response
Mass gatherings are predictable MCI risks, so EMS should plan ahead with the event and the other agencies: on-site medical posts, access and egress routes, staging areas, communications, an ICS structure, and hospital notification. Waiting until event day leaves no time to set up resources or train for the plan. Attendee 9-1-1 calls alone overload dispatch and cannot reach patients in a dense crowd. Venue security has a role in the plan, but it cannot design or run the medical response.
Free paramedic Clinical Judgment quiz
Core temperature is best measured:
- A. Rectally or by esophageal probe
- B. In the axilla under a closed arm
- C. Orally with a digital thermometer
- D. Tympanically with an infrared probe
Show answer
Answer: A. Rectally or by esophageal probe
Important in hypothermia.
A sunken fontanelle in an infant suggests:
- A. Raised intracranial pressure
- B. Meningitis
- C. Dehydration
- D. Hydrocephalus
Show answer
Answer: C. Dehydration
A bulging fontanelle suggests increased intracranial pressure.
While withdrawing from an inverted vial, air keeps entering the syringe. The fix is to:
- A. Pull the plunger back faster and much harder
- B. Turn the vial upright while drawing
- C. Keep the needle tip below the fluid line
- D. Inject more air after each 0.1 mL drawn
Show answer
Answer: C. Keep the needle tip below the fluid line
Air enters when the needle tip rises above the fluid into the air space, so keep the tip below the fluid line as the level drops. Pulling harder draws in more air and foam, turning the vial upright puts the tip in the air space, and repeated air injections build pressure without fixing the tip position.
The 'zebra retreat' error is:
- A. Retreating to protocol when a case is unusual
- B. Overlooking common conditions in rare settings
- C. Pursuing exotic diagnoses before common ones
- D. Abandoning a rare diagnosis as too unlikely
Show answer
Answer: D. Abandoning a rare diagnosis as too unlikely
Sometimes the rare diagnosis IS right; dismissing it because it's rare is an error.
Toddlers are defined as ages:
- A. 1 to 3 years
- B. Birth to 1
- C. 5 to 7 years
- D. 3 to 5 years
Show answer
Answer: A. 1 to 3 years
Preschool is 3 to 5.
Which is NOT a typical prehospital indication for magnesium sulfate?
- A. Severe refractory bronchospasm
- B. Eclamptic seizures
- C. Stable sinus tachycardia
- D. Torsades de pointes
Show answer
Answer: C. Stable sinus tachycardia
Magnesium is used for eclampsia, torsades, and severe asthma, not for sinus tachycardia.
Trending vital signs is more useful than a single set because:
- A. Direction of change shows deterioration
- B. Averaging values removes all error
- C. Single readings are always inaccurate
- D. Hospitals require multiple readings
Show answer
Answer: A. Direction of change shows deterioration
Trends reveal improvement as well as deterioration. Rising heart rate, falling pressure.
Pregnancy affects assessment through:
- A. Altered vitals, anatomy, two patients
- B. No meaningful change in assessment
- C. Changes in vital signs only
- D. Changes in anatomy only
Show answer
Answer: A. Altered vitals, anatomy, two patients
There are two patients to consider. Left lateral positioning matters.
Drugs derived from plants include:
- A. Insulin, heparin, and Premarin
- B. Streptomycin, penicillin, and nystatin
- C. Morphine, atropine, and digoxin
- D. Calcium chloride and magnesium
Show answer
Answer: C. Morphine, atropine, and digoxin
Opium poppy (morphine), belladonna (atropine), and foxglove (digoxin) are plant sources.
A 6-year-old has a barking cough, low-grade fever, and inspiratory stridor that worsens at night. The most likely field impression is:
- A. Epiglottitis
- B. Asthma
- C. Croup
- D. Foreign body aspiration
Show answer
Answer: C. Croup
A barking seal-like cough with stridor and low-grade fever in a young child is classic croup.
How this practice test is weighted
The 120 questions are split across the six NREMT paramedic content domains near the middle of each published range, adjusted to total 120. MedicQBank has no single Clinical Judgment chapter, so that share is drawn from the patient assessment, clinical decision-making, and pharmacology chapters.
| NREMT domain | Share of exam | Questions here |
|---|---|---|
| Airway, Respiration and Ventilation | 8 to 12% | 12 |
| Cardiology and Resuscitation | 10 to 14% | 14 |
| Trauma | 6 to 10% | 10 |
| Medical, Obstetrics and Gynecology | 24 to 28% | 31 |
| EMS Operations | 8 to 12% | 12 |
| Clinical Judgment (drawn from our assessment, decision-making and pharmacology chapters) | 34 to 38% | 41 |
Sources: NREMT Paramedic Examination Specifications and Paramedic exam overview, checked November 4, 2026.
NREMT paramedic exam: common questions
How many questions are on the NREMT paramedic exam?
Between 110 and 150. The National Registry lists the paramedic exam as 110 to 150 questions, and every candidate answers at least 110. The exam includes 20 unscored pilot questions that are not identified and do not affect your result.
How long is the NREMT paramedic exam?
3 hours and 30 minutes. It is taken at Pearson VUE testing centers.
Is the NREMT paramedic exam adaptive?
Yes. It uses computerized adaptive testing (CAT). After an initial set of questions, the computer chooses questions more closely matched to the candidate. The exam ends once it can make a pass or fail decision with 95% confidence, which can happen at the minimum number of questions; otherwise it continues until the maximum number of questions or the time limit is reached.
What content areas does the paramedic exam cover?
Six domains: Airway, Respiration and Ventilation (8 to 12%), Cardiology and Resuscitation (10 to 14%), Trauma (6 to 10%), Medical, Obstetrics and Gynecology (24 to 28%), EMS Operations (8 to 12%), and Clinical Judgment (34 to 38%). Pediatric questions are integrated throughout, and 30% of the Cardiology and Resuscitation domain uses ECG rhythm strips.
What types of questions are on the exam?
Multiple choice (one correct answer out of four), multiple response (two or three correct answers out of five or six), build list, drag and drop, options box, graphical items such as ECG strips and images, and scenario-based sets. Every item is scored all or nothing, with no partial credit.
Does this practice test predict whether I will pass?
No. This is a fixed set of multiple-choice study questions, not an adaptive exam, and its score is not a prediction of an NREMT result. Use it to find weak areas, then study those chapters.
Sources: NREMT Paramedic Examination Specifications and Paramedic exam overview, checked November 4, 2026. The National Registry can change its exams, so confirm the details on nremt.org before you test.
How to use this practice test
Take the full test in one sitting without looking at the answers, count how many you got right, and then study the chapters behind the questions you missed. The real exam is adaptive and uses several question formats; this page is multiple choice only. When you finish, go deeper with a full 100-question chapter test or a 5-in-a-row drill on any single section.
Practice by exam area
- Airway, Respiration, and Ventilation — 850 questions
- Cardiology and Resuscitation — 1,237 questions
- Medical Emergencies — 3,146 questions
- Pharmacology — 1,891 questions
- EMS Operations — 3,525 questions
- Clinical Judgment and Patient Assessment — 1,600 questions
- Trauma — 2,000 questions
- Pediatrics, Geriatrics, and Special Populations — 600 questions
Highest-yield chapters to review
- Chapter 16: Airway Management — 305 questions
- Chapter 17: Respiratory Emergencies — 300 questions
- Chapter 18: Cardiovascular Emergencies — 336 questions
- Chapter 19: Neurologic Emergencies — 300 questions
- Chapter 15: Emergency Medications — 627 questions
- Chapter 13: Principles of Pharmacology — 617 questions
- Chapter 14: Medication Administration — 647 questions
- Chapter 11: Patient Assessment — 529 questions
- Chapter 9: Pathophysiology — 634 questions
Or browse all 453 paramedic topics.
These practice questions were written for this site. MedicQBank is not affiliated with or endorsed by the National Registry of Emergency Medical Technicians, Jones & Bartlett Learning, or the American Academy of Orthopaedic Surgeons, and these are not actual exam questions.