Free NREMT Practice Test: 50 EMT Questions with Explanations

Your EMT class tests were designed to see if you read the chapter. The NREMT is designed to see if you can think like a provider. The questions are not straightforward recall. They are scenario-based, and they often have two or three answers that seem correct.

The key to passing is thinking in terms of what is the most life-threatening thing happening right now and what is my most immediate intervention. The NREMT tests your ability to prioritize, not just your ability to memorize.

Here are 50 practice questions that mirror the actual NREMT format.

Airway and Breathing

Question 1. You arrive to find a 67-year-old male sitting in a tripod position, speaking in 2 to 3 word sentences, with audible wheezing and an SpO2 of 88 percent. Your first intervention should be to apply high-flow oxygen via non-rebreather mask. The patient is in respiratory distress with hypoxia. High-flow oxygen is always the first intervention for a hypoxic patient. You will assist with the inhaler next if prescribed, but oxygen comes first.

Question 2. The proper suctioning technique is to measure from the corner of the mouth to the earlobe to determine insertion depth. Insert without suction to avoid grabbing tissue. Suction while withdrawing. Limit suctioning to 15 seconds in adults, 10 seconds in children, and 5 seconds in infants to avoid hypoxia.

Question 3. For a conscious choking child over age 1, perform abdominal thrusts. Back blows followed by chest thrusts are for infants under 1 year. Never perform blind finger sweeps. Only remove visible objects.

Question 4. Adequate breathing requires both an appropriate rate and adequate tidal volume. A patient can have clear lung sounds and normal SpO2 but still be breathing too fast and shallow in early compensation. Always assess rate, depth, and effort together.

Question 5. BVM ventilation rate for an apneic adult is 10 to 12 breaths per minute, one breath every 5 to 6 seconds. Over-ventilation increases intrathoracic pressure, decreases venous return, and lowers cardiac output.

Question 6. A nasopharyngeal airway is contraindicated in suspected basilar skull fracture because it could enter the cranial vault. Unlike an OPA, an NPA can be used in patients with an intact gag reflex.

Question 7. A patient with a respiratory rate of 6 and shallow breaths with SpO2 of 82 percent needs assisted ventilations with a BVM, not just supplemental oxygen. A non-rebreather provides oxygen but does not help with ventilation. The patient is not moving enough air.

Cardiology

Question 8. A patient with chest pain, diaphoresis, and blood pressure of 88 over 60 should not receive nitroglycerin. Nitroglycerin is contraindicated in hypotension because it causes vasodilation and will drop the BP further.

Question 9. The normal cardiac conduction pathway is SA node to AV node to Bundle of His to bundle branches to Purkinje fibers.

Question 10. Left-sided heart failure causes fluid to back up into the lungs, producing dyspnea, crackles, and pink frothy sputum. Right-sided heart failure causes systemic fluid backup with JVD, peripheral edema, and hepatomegaly.

Question 11. For suspected STEMI at the EMT level, give 324 mg aspirin chewed for rapid absorption, supplemental oxygen if SpO2 is below 94 percent, obtain a 12-lead if available, and transport rapidly to a STEMI-receiving center.

Question 12. If an AED says no shock advised on a pulseless patient, the rhythm is not VF or pulseless VT. It could be PEA or asystole. Begin high-quality CPR immediately and re-analyze after 2 minutes.

Question 13. High-quality adult CPR means compressions at a rate of 100 to 120 per minute, at least 2 inches deep but no more than 2.4 inches, with full chest recoil between compressions and minimal interruptions.

Question 14. Phosphodiesterase inhibitors like Viagra within 24 hours or Cialis within 48 hours combined with nitroglycerin can cause severe, life-threatening hypotension. Always ask about these medications before giving nitroglycerin.

Trauma

Question 15. The golden hour is the concept that a critically injured trauma patient has the best chance of survival if they receive definitive surgical care within 60 minutes of injury. Your ambulance is not an operating room. Load and go.

Question 16. An open chest wound should be treated with either a three-sided occlusive dressing or a commercial vented chest seal. The concept is to seal the wound to prevent air entry during inspiration but allow air to escape during expiration to prevent tension pneumothorax.

Question 17. The most common cause of shock in trauma patients is hemorrhagic or hypovolemic shock. Assume every hypotensive trauma patient is bleeding until proven otherwise. Control external bleeding with direct pressure and tourniquets for extremity hemorrhage.

Question 18. Never remove an impaled object in the field with the exception of objects through the cheek obstructing the airway. The object may be tamponading a blood vessel. Removing it could cause uncontrolled hemorrhage.

Question 19. Cushing's triad is hypertension, bradycardia, and irregular respirations, indicating dangerously increased intracranial pressure. It is a late sign and indicates brainstem herniation is occurring or imminent.

Question 20. Current tourniquet guidelines say to apply high and tight on the extremity, tighten until bleeding stops and distal pulse is absent, note the time, and do not remove or loosen once applied.

Medical

Question 21. An unresponsive diabetic patient with blood glucose of 42 should not receive oral glucose because of aspiration risk. They need IV dextrose or glucagon. Maintain the airway, give high-flow oxygen, and transport emergently.

Question 22. Stroke signs per the Cincinnati scale are facial droop, arm drift, and speech abnormality. Also check for sudden onset, worst headache of life, and note the last known well time because this determines treatment eligibility.

Question 23. Epinephrine is the first-line treatment for anaphylaxis, not an antihistamine, not a bronchodilator, not just oxygen. Delay in epinephrine administration is the primary factor in anaphylaxis deaths.

Question 24. Classic opioid toxidrome is pinpoint pupils, respiratory depression, and altered consciousness. Treat with naloxone and assist ventilations with BVM. Ventilation is critical because naloxone takes 2 to 3 minutes to work.

Question 25. The hypoxic drive theory should never prevent you from treating hypoxia in an emergency. A hypoxic patient will die from hypoxia faster than from any theoretical respiratory depression from oxygen.

Operations

Question 26. The hot zone is the contaminated area of immediate danger. Only trained hazmat technicians in appropriate PPE operate there. EMS stages in the cold zone.

Question 27. Stay at least 100 feet from downed power lines. Do not drive over them. Do not attempt to move them. Wait for the power company to de-energize.

Question 28. In START triage, any patient who cannot follow simple commands is categorized Red, or immediate, regardless of other findings.

Question 29. Once you begin patient care, you cannot discontinue care until you transfer the patient to an equal or higher level of care. Stopping care without proper transfer is abandonment.

Question 30. A competent adult has the right to refuse treatment and transport. Your obligations are to ensure decision-making capacity, explain risks including death, attempt to persuade, have the patient sign a refusal form, and document thoroughly.

StruckBox has thousands of NREMT-style EMT and Paramedic questions organized by topic with timed practice exams and instant scoring. Start your free trial at struckbox.com.