Free NREMT Practice Test
60 EMT-level questions across all five NREMT content areas, one at a time — just like the real cognitive exam. Full explanations when you finish. No signup.
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The 60-Question NREMT Simulator
This exam runs in simulator mode: one question at a time — picking an answer saves it and moves you to the next, and you will not see right or wrong until you finish, just like the real NREMT. The live exam is computer-adaptive and decides its own length; here you answer a fixed 60. Score 42 of 60 (70%) or better — a reasonable readiness analog for the NREMT's adaptive pass standard — and you are on track.
Exam-simulator mode: picking an answer saves it and automatically moves you to the next question. You will not see right/wrong until you finish — just like the NREMT cognitive exam.
Question 1 of 60.You are preparing to insert an oropharyngeal airway (OPA) in an unresponsive adult. How should you select the correct size?
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You are preparing to insert an oropharyngeal airway (OPA) in an unresponsive adult. How should you select the correct size?
- Measure from the tip of the nose to the earlobe
- Measure from the center of the chin to the Adam's apple
- Measure from the corner of the mouth to the angle of the jaw (correct answer)
- Choose the largest airway that fits in the patient's mouth
An OPA is sized by measuring from the corner of the patient's mouth to the angle of the jaw (or the earlobe on the same side). A device that is too long can push the epiglottis over the glottic opening and obstruct the airway, while one that is too short can push the tongue back into the pharynx. Measuring from the nose to the earlobe is the sizing technique for a nasopharyngeal airway, not an OPA.
An unresponsive overdose patient gags when you attempt to insert an oropharyngeal airway. Which airway adjunct is most appropriate?
- A nasopharyngeal airway (correct answer)
- A smaller oropharyngeal airway
- No adjunct; use only manual head positioning
- A supraglottic airway device
An intact gag reflex is a contraindication to the oropharyngeal airway because it can trigger vomiting and aspiration. The nasopharyngeal airway is better tolerated by patients with a gag reflex and is the correct adjunct here. Trying a smaller OPA still risks stimulating the gag reflex, and relying on manual positioning alone gives up the benefit of an adjunct in a patient who needs airway support. Supraglottic airways are advanced devices that also require an absent gag reflex.
When suctioning the oropharynx of an adult patient, you should apply suction for no longer than:
- 5 seconds
- 30 seconds
- 60 seconds
- 15 seconds (correct answer)
Suctioning removes oxygen along with secretions, so each attempt in an adult should be limited to about 15 seconds, followed by reoxygenation or ventilation. Shorter limits are commonly taught for children (about 10 seconds) and infants (about 5 seconds). Suctioning for 30 to 60 seconds can cause significant hypoxia and vagal stimulation with bradycardia.
You are applying a nonrebreather mask to a patient with adequate breathing who needs high-concentration oxygen. What is the appropriate oxygen flow rate?
- 2 L/min
- 15 L/min (correct answer)
- 6 L/min
- 8 L/min
A nonrebreather mask should be run at 10 to 15 L/min, typically 15 L/min, which keeps the reservoir bag inflated and can deliver oxygen concentrations up to about 90%. Flows of 2 to 6 L/min are appropriate for a nasal cannula, not a nonrebreather, and 8 L/min is in the range used for a simple face mask; at any flow below 10 L/min the reservoir bag can collapse and the patient may rebreathe exhaled air.
An adult patient is unresponsive with a strong carotid pulse but no breathing. At what rate should you deliver ventilations with a bag-valve mask?
- One breath every 2 seconds
- One breath every 6 seconds (correct answer)
- One breath every 10 seconds
- One breath every 15 seconds
Current AHA guidelines call for rescue breathing in an adult with a pulse at one breath every 6 seconds (about 10 breaths per minute), with each breath delivered over 1 second and producing visible chest rise. Ventilating every 2 seconds (30 per minute) causes hyperventilation, gastric insufflation, and reduced venous return; every 10 to 15 seconds is too slow to maintain oxygenation.
While ventilating an apneic adult with a bag-valve mask, which finding best indicates that your ventilations are effective?
- The bag is difficult to squeeze
- The patient's abdomen expands with each breath
- The pop-off valve activates with each squeeze
- The chest rises visibly with each ventilation (correct answer)
Visible chest rise with each breath is the primary indicator of effective ventilation. An expanding abdomen suggests air is entering the stomach, which increases the risk of vomiting and aspiration. A bag that is hard to squeeze suggests airway obstruction or poor positioning, and pop-off valve activation indicates excessive pressure rather than effective ventilation. Two-rescuer BVM technique, with one rescuer sealing the mask and the other squeezing the bag, is preferred whenever staffing allows.
For which of the following patients is CPAP contraindicated?
- A patient who is unresponsive with slow, shallow respirations (correct answer)
- An alert patient with severe respiratory distress from pulmonary edema
- A patient with a history of congestive heart failure who is anxious and speaking in short phrases
- An alert asthma patient with wheezing who has not improved with a bronchodilator
CPAP requires a patient who is awake, able to follow commands, and breathing spontaneously with an adequate rate and tidal volume, because the device only supports the patient's own respiratory effort. An unresponsive patient with slow, shallow breathing needs positive pressure ventilation with a BVM instead. Other contraindications include hypotension, active vomiting, and suspected pneumothorax. Alert patients in severe distress from pulmonary edema or bronchospasm are classic CPAP candidates; follow local protocol for specific indications.
A patient was thrown from a motorcycle and is unresponsive. Which technique should you use first to open the airway?
- Head-tilt, chin-lift maneuver
- Tongue-jaw lift with a finger sweep
- Jaw-thrust maneuver (correct answer)
- Placing the patient in the recovery position
With a significant mechanism suggesting possible spinal injury, the jaw-thrust maneuver opens the airway while limiting movement of the cervical spine. The head-tilt, chin-lift extends the neck and should be reserved for patients without suspected spinal injury; however, if the jaw thrust fails to open the airway, current guidelines allow a careful head-tilt, chin-lift because a patent airway takes priority over spinal precautions. Blind finger sweeps are not recommended, and rolling this patient into a recovery position does not open the airway.
You find a middle-aged man unresponsive on the floor. He has occasional slow, gasping breaths. What should these respirations tell you?
- The patient is breathing adequately and needs only supplemental oxygen
- They are agonal gasps, and the patient should be treated as if he is not breathing (correct answer)
- The patient is hyperventilating and should be coached to slow his breathing
- They indicate a partial airway obstruction that requires abdominal thrusts
Occasional gasping breaths in an unresponsive patient are agonal respirations, which are ineffective and commonly occur in the first minutes of cardiac arrest. Current AHA guidance is to treat an unresponsive patient who is not breathing or only gasping as being in cardiac arrest: check for a pulse for no more than 10 seconds and begin CPR if no definite pulse is felt. Mistaking agonal gasps for adequate breathing is a leading cause of delayed CPR.
You hear a high-pitched crowing sound on inspiration in a child with a suspected airway problem. This sound, called stridor, most likely indicates:
- Partial obstruction of the upper airway (correct answer)
- Fluid in the alveoli
- Constriction of the lower airways
- Collapse of the alveoli during exhalation
Stridor is a high-pitched inspiratory sound produced by turbulent airflow through a narrowed upper airway, as seen with croup, epiglottitis, foreign bodies, or swelling from burns or anaphylaxis. Wheezing reflects narrowing of the lower airways, and crackles suggest fluid in the alveoli. Stridor is a red flag: keep the child calm, avoid agitating procedures, and be prepared for complete obstruction.
A patient who overdosed on an unknown substance is unresponsive but breathing adequately, with no evidence of trauma. While preparing for transport, how should you position this patient?
- Supine with the head elevated 30 degrees
- Prone with the head turned to the side
- Supine with legs elevated
- In the lateral recumbent (recovery) position (correct answer)
An unresponsive patient who is breathing adequately and has no suspected spinal injury should be placed in the lateral recumbent, or recovery, position. This uses gravity to keep the tongue from obstructing the airway and allows vomit or secretions to drain from the mouth rather than being aspirated. Supine positioning leaves the airway vulnerable to obstruction and aspiration, and prone positioning restricts chest wall movement and impairs breathing. Continue to monitor the airway closely and have suction ready.
According to current AHA guidelines, what is the correct chest compression depth for an average adult in cardiac arrest?
- At least 1 inch but no more than 1.5 inches
- At least 2 inches but no more than 2.4 inches (correct answer)
- At least 3 inches
- Approximately one-half the depth of the chest
Current AHA guidelines call for compressing the adult chest at least 2 inches (5 cm) but not more than 2.4 inches (6 cm), while allowing full chest recoil between compressions. Compressions shallower than 2 inches generate inadequate blood flow, and depths beyond 2.4 inches increase the risk of injury. One-third the anterior-posterior chest depth is the target for infants (about 1.5 inches) and children (about 2 inches), not one-half.
At what rate should chest compressions be delivered to an adult in cardiac arrest?
- 60 to 80 per minute
- 80 to 100 per minute
- 100 to 120 per minute (correct answer)
- At least 140 per minute
Current AHA guidelines specify a compression rate of 100 to 120 per minute for patients of all ages. Rates slower than 100 do not generate adequate perfusion, while rates faster than 120 tend to become too shallow and do not allow the heart to refill between compressions. Pushing hard and fast within this range, allowing full recoil, and minimizing interruptions are the pillars of high-quality CPR.
You are performing single-rescuer CPR on an adult in cardiac arrest. What is the correct ratio of compressions to ventilations?
- 30 compressions to 2 ventilations (correct answer)
- 15 compressions to 2 ventilations
- 5 compressions to 1 ventilation
- 100 compressions with no ventilations required
Adult CPR uses a ratio of 30 compressions to 2 ventilations whether there are one or two rescuers. The 15:2 ratio applies to two-rescuer CPR for infants and children. Compression-only CPR is taught to untrained lay bystanders, but trained EMS providers should deliver ventilations because oxygenation matters, particularly as arrest time lengthens or when the arrest has a respiratory cause.
Your partner is performing CPR on an adult in cardiac arrest when you arrive with the AED. What is your first action with the device?
- Attach the pads to the patient's bare chest
- Press the analyze button
- Stop CPR and check for a pulse
- Turn on the AED (correct answer)
The first step with any AED is to turn the power on, because the device then gives voice prompts that guide every subsequent step. Pads are attached to the bare, dry chest next while compressions continue, and only then does the device analyze the rhythm. Stopping CPR to check a pulse before the AED is ready causes an unnecessary interruption in compressions. Early defibrillation is a critical link in the chain of survival, so the AED should be applied as soon as it is available.
The AED announces that it is analyzing the rhythm of a patient in cardiac arrest. What must you do during the analysis?
- Continue chest compressions to minimize interruptions
- Ventilate the patient with a BVM
- Ensure that no one is touching the patient (correct answer)
- Palpate for a carotid pulse
During rhythm analysis, no one may touch the patient, because any movement, including compressions or ventilations, creates artifact that can prevent the AED from correctly identifying a shockable rhythm. This brief mandatory pause is different from all other phases of the resuscitation, where the goal is to keep hands on the chest as much as possible. Once the AED advises a shock, clear the patient visually and verbally before pressing the shock button, then resume compressions immediately.
The AED delivers a shock to an adult in cardiac arrest. What should you do immediately after the shock?
- Resume chest compressions, starting with compressions (correct answer)
- Check for a carotid pulse for up to 20 seconds
- Wait for the AED to reanalyze the rhythm
- Ventilate the patient twice, then check responsiveness
Immediately after a shock, resume CPR beginning with chest compressions, without pausing to check a pulse or rhythm. Even when a shock successfully terminates ventricular fibrillation, the heart rarely produces effective circulation right away, so compressions are needed to perfuse the heart and brain. CPR continues for about 2 minutes until the AED prompts the next rhythm analysis. Pulse checks should never exceed 10 seconds at any point in the resuscitation.
Medical direction orders you to administer aspirin to a 58-year-old man with crushing chest pain. Which finding would require you to withhold the aspirin?
- Blood pressure of 150/90 mm Hg
- A history of allergy to aspirin (correct answer)
- The patient took nitroglycerin 10 minutes ago
- A heart rate of 98 beats per minute
Aspirin is contraindicated in patients with a known aspirin allergy; other cautions include active gastrointestinal bleeding and recent bleeding disorders. For suspected acute coronary syndrome, 162 to 324 mg of chewable aspirin is given because it inhibits platelet aggregation and reduces mortality in myocardial infarction. Mild hypertension, tachycardia, and prior nitroglycerin use are not contraindications to aspirin. Always confirm allergies before administration and follow local protocol.
A patient with chest pain has prescribed nitroglycerin, and medical direction authorizes you to assist with its administration. Which finding contraindicates giving the nitroglycerin?
- A heart rate of 96 beats per minute
- Chest pain rated 8 out of 10
- A history of a previous heart attack
- A systolic blood pressure of 88 mm Hg (correct answer)
Nitroglycerin dilates blood vessels and lowers blood pressure, so it is contraindicated when the systolic pressure is already low; most protocols use a cutoff of 90 to 100 mm Hg. Giving nitroglycerin to a hypotensive patient can cause a catastrophic drop in perfusion. Use of erectile dysfunction medications (such as sildenafil) within the previous 24 to 48 hours is another key contraindication. Severe pain and a cardiac history are reasons the drug is indicated, not withheld. Recheck blood pressure before and after every dose.
To maximize the chance of survival during CPR, interruptions in chest compressions should be limited to no more than:
- 30 seconds
- 20 seconds
- 10 seconds (correct answer)
- 2 seconds
Current AHA guidelines emphasize limiting any interruption in chest compressions to less than 10 seconds, whether for ventilations, pulse checks, rhythm analysis, or moving the patient. Coronary perfusion pressure builds over successive compressions and collapses almost immediately when compressions stop, so every pause costs blood flow to the heart and brain. Rescuers should aim for a chest compression fraction of at least 60% throughout the resuscitation.
You and your partner are performing two-rescuer CPR on a 4-month-old infant in cardiac arrest. Which compression technique is preferred?
- Two thumb-encircling hands technique (correct answer)
- The heel of one hand on the center of the chest
- Two hands stacked on the lower sternum
- Three fingers placed over the xiphoid process
For two-rescuer infant CPR, the AHA recommends the two thumb-encircling hands technique: both thumbs compress the lower half of the sternum while the hands encircle the chest. It produces better depth and coronary perfusion than the two-finger technique, which remains an option for a lone rescuer. Compressions should be about one-third the depth of the chest (approximately 1.5 inches), at 100 to 120 per minute, with a 15:2 compression-to-ventilation ratio when two rescuers are present. Never compress over the xiphoid process.
Where should you place your hands to perform chest compressions on an adult in cardiac arrest?
- Over the upper third of the sternum
- Directly over the xiphoid process
- On the left side of the chest over the heart
- On the lower half of the sternum, in the center of the chest (correct answer)
Compressions are delivered with the heel of one hand on the lower half of the sternum in the center of the chest, with the second hand on top. This position transmits force to the heart between the sternum and spine. Compressing the upper sternum is ineffective, pressing on the xiphoid process risks lacerating the liver, and compressing over the left chest wall can fracture ribs without effectively squeezing the heart.
Which patient is most likely to experience an acute coronary syndrome without the classic complaint of crushing chest pain?
- A 45-year-old man with high cholesterol
- A 72-year-old woman with diabetes (correct answer)
- A 50-year-old man who smokes
- A 38-year-old man with a family history of heart disease
Older adults, women, and people with diabetes are the groups most likely to have atypical or 'silent' presentations of acute coronary syndrome, such as fatigue, weakness, nausea, shortness of breath, or epigastric discomfort without classic chest pain. Diabetic neuropathy can blunt cardiac pain perception. A 72-year-old woman with diabetes combines several of these risk factors, so maintain a high index of suspicion and assess for ACS even when chest pain is absent.
A chainsaw injury to a patient's thigh is bleeding heavily and does not stop with firm direct pressure. What should you do next?
- Elevate the leg and apply an ice pack
- Apply pressure to the femoral pressure point and wait 10 minutes
- Cover the wound loosely and begin rapid transport
- Apply a tourniquet proximal to the wound (correct answer)
When direct pressure fails to control life-threatening bleeding from an extremity, the next step is a tourniquet applied proximal to the wound and tightened until the bleeding stops. Current national guidelines, informed by battlefield and Stop the Bleed evidence, endorse early tourniquet use for severe extremity hemorrhage; elevation and pressure points are no longer emphasized because they are unreliable. Uncontrolled arterial bleeding can be fatal within minutes, so it must be stopped on scene, not managed en route with a loose dressing.
You are applying a tourniquet to control severe bleeding from a forearm laceration. Where should the tourniquet be placed?
- Two to three inches proximal to the wound (correct answer)
- Directly on top of the wound
- Distal to the wound, near the wrist
- Over the elbow joint for better leverage
A tourniquet is placed 2 to 3 inches proximal to the wound (between the wound and the heart), avoiding joints because vessels there are shielded by bone and cannot be effectively compressed. Tighten until bleeding stops, note and record the application time, and never cover the tourniquet or loosen it in the field. Placement distal to the wound does nothing to stop arterial inflow, and placing it on the wound itself fails to occlude the vessels above the injury.
A patient has been stabbed in the chest, and you hear air being sucked into the wound with each breath. How should you manage this wound?
- Pack the wound with sterile gauze
- Cover it with a bulky absorbent trauma dressing
- Apply an occlusive dressing, preferably a vented chest seal (correct answer)
- Leave the wound uncovered and ventilate with a BVM
An open (sucking) chest wound must be sealed with an occlusive dressing so air stops entering the pleural space through the wound; a commercial vented chest seal is preferred because its one-way valve lets trapped air escape while preventing entry. Absorbent gauze and bulky dressings are porous and allow continued air entry, and packing a chest wound is contraindicated. After sealing, monitor closely for the development of a tension pneumothorax.
After you seal an open chest wound with an occlusive dressing, the patient becomes more short of breath, and you note rising difficulty ventilating with absent breath sounds on the injured side. What should you do?
- Apply a second occlusive dressing over the first
- Lift one edge of the dressing to allow trapped air to escape (correct answer)
- Place the patient supine and elevate the legs
- Remove the dressing and pack the wound with gauze
Worsening respiratory distress after sealing an open chest wound suggests a tension pneumothorax: air is accumulating in the pleural space with no route of escape, collapsing the lung and compressing the great vessels. The EMT intervention is to 'burp' the dressing by lifting one edge momentarily so trapped air can vent. Adding another dressing worsens the problem, leg elevation does not address the chest, and packing the wound is contraindicated. Late signs of tension pneumothorax include tracheal deviation, jugular venous distention, and hypotension.
A patient has a screwdriver impaled in the abdomen. How should you manage the object?
- Stabilize it in place with bulky dressings (correct answer)
- Remove it quickly and apply direct pressure
- Shorten it by cutting off the handle
- Leave it alone and cover the site loosely with a sheet
An impaled object should be manually stabilized and secured in place with bulky dressings so it cannot move during care and transport; the object may be tamponading damaged vessels, and removing it can trigger massive hemorrhage. The classic exceptions are an object through the cheek that obstructs the airway or one that prevents chest compressions or transport. Cutting or shortening an object is done only when necessary for transport and only while it is firmly stabilized. Simply draping a sheet over it leaves it free to shift.
A 30-year-old man has significant internal bleeding after a motorcycle crash. Which findings are the earliest indicators of shock (hypoperfusion)?
- Falling blood pressure and dilated pupils
- Unresponsiveness and slow respirations
- Increased heart rate with anxiety and pale, cool skin (correct answer)
- Absent radial pulses and mottled skin
In compensated shock, the body maintains blood pressure through catecholamine release, so the earliest clues are tachycardia, anxiety or restlessness, and pale, cool, clammy skin from peripheral vasoconstriction. A falling blood pressure is a late sign that signals decompensated shock, and unresponsiveness with absent peripheral pulses indicates the patient is near cardiovascular collapse. Recognizing shock while the blood pressure is still normal is a core EMT skill; do not wait for hypotension to treat aggressively and transport rapidly.
Which fall would be considered a significant mechanism of injury for an adult patient?
- A fall from a standing position
- A fall of 6 feet onto grass
- A fall from a chair
- A fall of more than 20 feet (correct answer)
A fall of more than 20 feet (roughly two stories) is the classic adult threshold for a significant mechanism of injury taught in EMT texts, warranting a high index of suspicion and evaluation for transport to a trauma center. Note that the 2021 National Guideline for the Field Triage of Injured Patients simplified this criterion to a fall from higher than 10 feet for all ages. A 6-foot fall onto grass, a fall from a chair, or a ground-level fall does not meet either height criterion by mechanism alone, although ground-level falls can still cause serious injury in older adults, especially those taking anticoagulants.
A patient has an abdominal evisceration with loops of bowel protruding from the wound. How should you dress this injury?
- Gently replace the organs and cover with dry gauze
- Cover the organs with a moist sterile dressing, then an occlusive layer (correct answer)
- Pack dry sterile gauze directly against the organs
- Apply a dry adherent dressing secured with a tight bandage
Eviscerated organs should never be pushed back into the abdomen because this introduces contamination and can damage the bowel. Cover them with a sterile dressing moistened with sterile saline, then apply an occlusive layer to retain moisture and heat, since exposed bowel dries out and loses temperature rapidly. Dry or adherent dressings stick to and injure the tissue, and tight bandaging can compromise blood flow to the exposed organs. Keep the patient warm and transport promptly.
Using the adult rule of nines, what percentage of body surface area is burned in a patient with partial-thickness burns to one entire arm and the anterior trunk?
- 18%
- 36%
- 27% (correct answer)
- 45%
In the adult rule of nines, each entire arm is 9% of body surface area and the anterior trunk is 18%, so this patient has approximately 27% involvement. Other adult values: the head is 9%, each leg is 18%, the posterior trunk is 18%, and the genitalia are 1%. Estimating burn size accurately matters because it drives destination decisions; large partial- and full-thickness burns meet burn center referral criteria.
After blunt trauma to the chest, a section of a patient's chest wall moves inward during inhalation while the rest of the chest expands. This finding indicates which injury?
- Flail chest (correct answer)
- Simple pneumothorax
- Cardiac tamponade
- Diaphragmatic rupture
Paradoxical movement, where a chest wall segment moves opposite to the rest of the chest during breathing, is the hallmark of flail chest, caused by two or more adjacent ribs fractured in two or more places. The free-floating segment impairs ventilation, and the underlying pulmonary contusion is often the most lethal component. EMT care includes high-concentration oxygen, assisting ventilations with positive pressure if breathing is inadequate, and rapid transport. Pneumothorax and tamponade do not produce paradoxical chest wall motion.
Which three findings make up the Cincinnati Prehospital Stroke Scale?
- Blood pressure, pulse, and pupil response
- Facial droop, arm drift, and abnormal speech (correct answer)
- Headache, vomiting, and vision loss
- Grip strength, gait, and memory
The Cincinnati Prehospital Stroke Scale evaluates facial droop (ask the patient to smile), arm drift (ask the patient to hold both arms out with eyes closed), and abnormal speech (ask the patient to repeat a simple phrase). An abnormality in any one of the three suggests a possible stroke and warrants rapid transport to an appropriate stroke center with early hospital notification. These are the same elements the public learns as FAST: face, arms, speech, time.
You suspect a 68-year-old woman is having an acute stroke. Which piece of history is most critical to obtain and report to the receiving hospital?
- Her blood type
- Whether she has a family history of stroke
- What she ate that morning
- The time she was last known to be normal (correct answer)
The time the patient was last known to be in her normal state determines eligibility for time-sensitive stroke treatments such as clot-dissolving medication and mechanical clot retrieval, which are only offered within specific windows from symptom onset. If she woke with symptoms, the last-known-well time is when she went to bed, not when she awoke. Interview witnesses on scene, document the time precisely, and relay it in your hospital notification, because this single data point drives the entire treatment pathway.
A diabetic patient took her insulin this morning but skipped breakfast. Which presentation would you most expect?
- Rapid onset of confusion with pale, cool, sweaty skin (correct answer)
- Gradual onset of thirst and frequent urination over several days
- Sudden crushing chest pain with shortness of breath
- Warm, dry skin with slow onset of drowsiness
Insulin without food drives blood glucose down quickly, producing hypoglycemia: rapid onset of altered mental status, irritability or bizarre behavior, and pale, cool, diaphoretic skin from the sympathetic response. Because the brain depends on a continuous glucose supply, hypoglycemia can mimic stroke or intoxication and is rapidly life-threatening. Gradual thirst, frequent urination, and warm, dry skin with slowly developing drowsiness point to high blood glucose, which evolves over hours to days rather than minutes. Sudden crushing chest pain suggests a cardiac emergency, not a low-glucose reaction to insulin without a meal.
For which patient with suspected hypoglycemia is oral glucose contraindicated?
- An anxious patient who is sweating heavily
- A confused patient who can follow commands and swallow
- An unresponsive patient with a diminished gag reflex (correct answer)
- A patient with a history of type 2 diabetes on oral medications
Oral glucose requires that the patient be awake enough to swallow and protect the airway. Giving gel to an unresponsive patient or one who cannot swallow risks aspiration into the lungs. Confused patients who can still follow commands and swallow are appropriate candidates; sweating and the type of diabetes do not affect the decision. For patients who cannot take oral glucose, request ALS or transport promptly, since EMTs cannot administer intravenous dextrose.
A patient with a history of diabetes has had increasing thirst, frequent urination, and vomiting over two days. She has deep, rapid respirations and a fruity odor on her breath. What condition should you suspect?
- Insulin shock from too much insulin
- An acute stroke
- Hyperglycemia with diabetic ketoacidosis (correct answer)
- An anxiety attack with hyperventilation
Gradual onset over days, polydipsia, polyuria, vomiting, deep rapid (Kussmaul) respirations, and a fruity acetone breath odor are the classic picture of diabetic ketoacidosis from severe hyperglycemia. The deep breathing is the body's attempt to blow off carbon dioxide and compensate for metabolic acidosis. Hypoglycemia (insulin shock) presents rapidly with sweaty skin and altered mental status, not days of thirst and urination. Care includes airway support, oxygen as needed, and transport; these patients need insulin and fluids in the hospital.
You are assisting a patient with anaphylaxis in using her epinephrine auto-injector. Where should the injector be administered?
- Against the lateral (outer) thigh muscle (correct answer)
- Into the deltoid muscle of the upper arm
- Into the abdomen, pinching the skin
- Into the buttock at a 45-degree angle
An epinephrine auto-injector is pressed firmly against the lateral aspect of the mid-thigh and held in place for several seconds per the device instructions; it can be given through clothing if necessary. The thigh's large vastus lateralis muscle provides rapid intramuscular absorption. The standard adult dose is 0.3 mg and the pediatric dose is 0.15 mg. The deltoid, abdomen, and buttock are not appropriate sites for auto-injector use.
A patient stung by a bee has widespread hives and itching. Which additional finding would indicate anaphylaxis requiring epinephrine?
- Redness and swelling at the sting site
- A heart rate of 88 beats per minute
- Mild nausea that resolved on its own
- Wheezing with tightness in the throat (correct answer)
Anaphylaxis is distinguished from a simple allergic reaction by involvement of the airway, breathing, or circulation: wheezing, stridor, throat or tongue swelling, severe respiratory distress, or hypotension with signs of shock. Hives plus wheezing and throat tightness indicates anaphylaxis, and epinephrine is the first-line, life-saving treatment because it reverses bronchoconstriction and vasodilation. Local redness and swelling at the site with stable vital signs describes a local or mild reaction that does not by itself require epinephrine.
You arrive to find a patient actively seizing on the kitchen floor. What is the most appropriate immediate action?
- Restrain the patient's arms and legs to stop the movement
- Move nearby objects away and protect the patient's head (correct answer)
- Insert a bite block between the patient's teeth
- Immediately place the patient supine on the stretcher
During an active seizure, the priorities are protecting the patient from injury: clear hard objects away, cushion the head, and note the time the seizure started. Never restrain a seizing patient or force anything into the mouth; both cause injury and do not stop the seizure. Once the convulsion ends, open and suction the airway as needed and place the patient in the recovery position, since postictal patients often have secretions and diminished airway reflexes.
A patient's generalized seizure has continued for more than 5 minutes without stopping. How should you classify and treat this situation?
- Status epilepticus; a true emergency requiring aggressive airway support and rapid transport (correct answer)
- A typical seizure; wait on scene for the postictal phase to resolve
- A psychogenic episode; encourage the patient to calm down
- A simple febrile seizure; begin active cooling measures
A seizure lasting more than about 5 minutes, or repeated seizures without regaining consciousness between them, is status epilepticus, a life-threatening emergency that causes hypoxia, hyperthermia, and brain injury the longer it continues. EMT care includes protecting the patient, maintaining the airway, high-concentration oxygen or ventilatory support, and rapid transport with an early request for ALS, because these patients need benzodiazepines to stop the seizure. Waiting on scene for it to resolve loses critical time.
A woman at 39 weeks gestation has contractions 2 minutes apart, and you see the baby's head bulging at the vaginal opening during contractions. What should you do?
- Begin rapid transport to the nearest hospital
- Have the mother cross her legs and breathe slowly
- Prepare to deliver the baby on scene (correct answer)
- Wait 10 minutes to see if contractions slow down
Crowning, when the presenting part is visible at the vaginal opening, means delivery is imminent and must be managed where you are; attempting transport risks an uncontrolled delivery in the ambulance. Set up your obstetrics kit, position and drape the mother, and support the head as it delivers, allowing it to turn naturally. Never attempt to delay a delivery by holding the legs together or restraining the head, as this can injure both mother and baby.
Which of the following defines the first stage of labor?
- Delivery of the baby to delivery of the placenta
- Crowning to delivery of the baby's shoulders
- Rupture of the amniotic sac to crowning
- Onset of regular contractions to full dilation of the cervix (correct answer)
The first stage of labor begins with the onset of regular contractions and ends when the cervix is fully dilated; it is typically the longest stage, especially in first pregnancies. The second stage runs from full dilation through delivery of the baby, and the third stage ends with delivery of the placenta. Understanding the stages helps the EMT judge how much time remains: signs of second stage, such as the urge to push or crowning, mean delivery is imminent.
As a baby's head delivers, you see the umbilical cord wrapped around the neck. What should you do first?
- Immediately clamp and cut the cord
- Attempt to gently slip the cord over the baby's head (correct answer)
- Push the head back to relieve tension on the cord
- Tell the mother to stop pushing and transport immediately
A nuchal cord is common; the first action is to gently slip the cord over the baby's head so delivery can continue. Only if the cord is wrapped too tightly to reduce should you clamp it in two places and carefully cut between the clamps, because once the cord is cut the baby must deliver promptly to breathe. Never push the head back in, and do not delay a delivery in progress by transporting with the head delivered.
A newborn is limp and not breathing despite thorough drying, warming, and tactile stimulation. What should you do next?
- Begin chest compressions at 120 per minute
- Administer high-concentration oxygen by mask and reassess in 5 minutes
- Begin positive pressure ventilations with a bag-valve mask (correct answer)
- Suction the mouth and nose for 30 seconds
A newborn who remains apneic (or whose heart rate is below 100) after drying, warming, and stimulation needs positive pressure ventilation with an appropriately sized BVM at 40 to 60 breaths per minute; resuscitation guidelines start with room air for term newborns. Effective ventilation is the single most important intervention in newborn resuscitation, because most newborn compromise is respiratory in origin. Chest compressions are added only if the heart rate remains below 60 despite adequate ventilations. Prolonged suctioning delays ventilation and can cause bradycardia.
You find a 24-year-old unresponsive with pinpoint pupils, respirations of 6 per minute, and drug paraphernalia nearby. What is your first priority?
- Open the airway and ventilate with a bag-valve mask (correct answer)
- Administer intranasal naloxone immediately, before any other care
- Place the patient in the recovery position and monitor
- Perform a rapid full-body scan for hidden injuries
This patient shows the classic opioid toxidrome: unresponsiveness, pinpoint pupils, and severe respiratory depression. The immediate threat is hypoventilation, so the first priority is opening the airway and providing BVM ventilations with oxygen. Naloxone is then administered per protocol to reverse the opioid effect, but it takes minutes to work and must never delay ventilation, since hypoxia is what kills opioid overdose patients. The recovery position alone is inadequate for a patient breathing 6 times per minute.
A 60-year-old man is confused with slurred speech, and bystanders do not know his medical history. In addition to the primary assessment, which diagnostic check should you perform early?
- Palpate the abdomen for rigidity
- Measure the blood glucose level (correct answer)
- Check pupillary response to light only
- Auscultate for carotid bruits
Hypoglycemia is a common, rapidly reversible cause of altered mental status and can perfectly mimic a stroke, including slurred speech and one-sided weakness. Checking a blood glucose early, where scope of practice allows, prevents a treatable metabolic problem from being mistaken for a neurologic catastrophe. Stroke scales should also be performed, but glucose must be assessed to rule out mimics. The mnemonic AEIOU-TIPS helps recall the broad causes of altered mental status, and glucose is among the fastest to identify and correct.
A woman who is 36 weeks pregnant becomes dizzy, pale, and hypotensive when lying flat on your stretcher. What is the most appropriate intervention?
- Elevate her legs while keeping her flat on her back
- Sit her fully upright and apply a cold compress
- Administer oral fluids and reassess in 10 minutes
- Position her on her left side (correct answer)
In late pregnancy, the weight of the uterus can compress the inferior vena cava when the mother lies supine, reducing venous return to the heart and causing supine hypotensive syndrome: dizziness, pallor, and hypotension. Positioning her on her left side (or tilting the backboard or stretcher to the left) shifts the uterus off the vena cava and restores venous return. Leg elevation while still supine does not relieve the compression, which is positional, not volume-related.
You are dispatched to a reported overdose at a house. As you approach, you hear loud shouting and breaking glass inside. What should you do first?
- Enter quickly and begin patient care before the situation worsens
- Knock loudly and announce yourselves before entering
- Retreat to a safe location and request law enforcement (correct answer)
- Enter through the back door to avoid the disturbance
Scene safety is the first priority of every response; an EMT who becomes a casualty cannot help the patient and adds to the emergency. Sounds of violence mean the scene is not safe, so the correct action is to stage at a safe distance and request law enforcement to secure the scene before you enter. Entering an unsecured violent scene through any door places the crew at risk. Patient care always begins only after the scene is safe, and scene conditions should be reassessed continuously.
During START triage at a bus crash, you find a patient who is not breathing. After you open the airway by repositioning the head, the patient remains apneic. How do you categorize this patient?
- Immediate (red)
- Delayed (yellow)
- Minor (green)
- Expectant/deceased (black) (correct answer)
Under START, a patient who does not resume breathing after a single attempt to open the airway is triaged expectant/deceased (black), and the triage officer moves on. If breathing had resumed with airway positioning, the patient would be tagged immediate (red). This rule feels counter to everyday care, but mass-casualty triage aims to do the greatest good for the greatest number: performing CPR on one apneic patient would consume rescuers while salvageable patients go untreated.
Using the START triage system, an adult patient at a mass-casualty incident is breathing 34 times per minute. Which category should this patient receive?
- Minor (green)
- Immediate (red) (correct answer)
- Delayed (yellow)
- Expectant (black)
In START, an adult respiratory rate above 30 per minute immediately classifies the patient as immediate (red); no further assessment is needed before tagging and moving on. If respirations are 30 or below, the triage officer then checks perfusion (radial pulse or capillary refill) and mental status (ability to follow commands) to complete the RPM sequence. Failure at any step, absent radial pulse, capillary refill over 2 seconds, or inability to follow simple commands, also results in a red tag.
Arriving first at a multiple-vehicle collision with many injured people, you call out for anyone who can walk to move to a designated area. Patients who can walk there are initially triaged as:
- Minor (green) (correct answer)
- Delayed (yellow)
- Immediate (red)
- They cannot be triaged until vital signs are taken
The first step of START triage is directing everyone who can walk to a collection point; these 'walking wounded' are initially tagged minor (green) because walking demonstrates intact airway, breathing, circulation, and mental status. This step rapidly clears the scene so the triage officer can assess non-ambulatory patients using respirations, perfusion, and mental status. Green patients must still be reassessed later, because injuries can evolve and some patients walk despite significant trauma.
You treat and transport an unconscious man with no family present. Under which legal principle are you permitted to provide care?
- Expressed consent
- Involuntary consent
- The Good Samaritan doctrine
- Implied consent (correct answer)
Implied consent is the legal principle that allows treatment of a patient who is unconscious or otherwise unable to make decisions, on the presumption that a reasonable person would want life-saving care. Expressed consent requires a competent patient to agree verbally or nonverbally after being informed. Involuntary consent involves patients in custody or under specific legal holds. The Good Samaritan doctrine offers liability protection to those helping voluntarily; it is not a basis for consent.
A 45-year-old man with chest pain refuses transport. Before accepting his refusal, what must you establish first?
- That his family agrees with the refusal
- That he has decision-making capacity and understands the risks of refusing (correct answer)
- That he signs the refusal form in front of a police officer
- That medical direction has revoked his right to refuse
A valid refusal requires that the patient be an adult with decision-making capacity, oriented and not impaired by alcohol, drugs, hypoxia, or illness, and that he has been clearly informed of the risks of refusal, up to and including death. You should also involve medical direction per protocol, encourage him to call 911 again if symptoms change, document the encounter thoroughly, and obtain his signature with a witness. Family agreement and police presence are not legal requirements, and medical direction cannot revoke a competent adult's right to refuse.
An EMT initiates care for a patient, then leaves the scene before another provider of equal or higher training arrives. Which legal problem has the EMT committed?
- Abandonment (correct answer)
- Battery
- Libel
- False imprisonment
Abandonment is the termination of care without the patient's consent and without transferring care to a provider of equal or higher training. Once an EMT establishes a duty by initiating care, that duty continues until proper transfer, patient refusal, or the patient no longer needs care. Battery is unlawful touching without consent, libel is written defamation, and false imprisonment is unlawfully restraining or transporting a patient against their will. Handing off to a lower level of care, such as leaving a patient with a first responder, can also constitute abandonment.
For a patient to succeed in a negligence claim against an EMT, which four elements must be proven?
- Intent, harm, transport delay, and protocol violation
- Consent, capacity, refusal, and documentation
- Duty to act, breach of duty, damages, and proximate cause (correct answer)
- Licensure, certification, supervision, and medical direction
Negligence requires proof of all four elements: the EMT had a duty to act, the EMT breached that duty by failing to meet the standard of care, the patient suffered damages, and the breach was the proximate cause of those damages. If any single element is missing, the claim fails; for example, a care error that caused no harm does not constitute negligence. Thorough, accurate documentation is an EMT's best protection because it establishes what care was provided and why.
When performing the power lift to raise a loaded stretcher, which technique is correct?
- Bend at the waist and lift with the shoulders
- Keep the back straight and locked, and lift with the legs (correct answer)
- Keep the feet together and the load at arm's length
- Twist toward the stretcher while straightening the knees
The power lift protects the spine: keep the back straight and locked in normal curvature, spread the feet about shoulder-width, bend at the hips and knees, keep the weight close to the body, and drive upward with the leg muscles using a palms-up (power) grip. Bending at the waist, holding loads away from the body, and twisting while lifting are the classic mechanisms of career-ending back injury, which remains one of the most common injuries in EMS. Communicate and coordinate the lift with your partner before moving.
You wrote the wrong medication dose on a paper patient care report. How should you correct the error?
- Erase the incorrect entry completely, rewrite the correct dose, and initial the change
- Cover the error with correction fluid, write the correct dose over it, and date it
- Discard the original report, complete a new report, and submit only the corrected copy
- Draw a single line through the error, initial it, and write the correct information (correct answer)
The accepted method for correcting a paper PCR is to draw a single horizontal line through the error so it remains legible, initial (and date, per agency policy) the correction, and enter the correct information beside it. Erasing, obliterating, or using correction fluid looks like an attempt to hide something and destroys the document's credibility as a legal record. Destroying an original report is falsification. Electronic PCR systems use addendum functions for the same purpose; never alter a record to conceal what was originally written.
After transporting a patient, with whom may you appropriately share the details of the patient's condition and care?
- A curious neighbor who saw the ambulance
- Your friends, as long as you omit the patient's name
- The emergency department staff assuming care of the patient (correct answer)
- A reporter who asks what happened at the scene
Patient information is confidential and may be shared only with those who need it, such as the receiving hospital staff who are assuming care, for continuity of treatment, quality improvement, billing, or as required by law (for example, mandatory reporting or a valid subpoena). Discussing a call with friends, neighbors, or the media violates patient privacy even if the name is withheld, because details can identify the patient. Federal privacy law and state statutes impose penalties for improper disclosure, and breaches also destroy public trust in EMS.
Drill One Content Area at a Time
The simulator tells you where the points went — these focused drills win them back. Each has a full explanation for every answer, written against current national guidelines.
30 questions
Cardiology & Resuscitation
High-quality CPR, AED operation, cardiac arrest, and ACS across adults, children, and infants — every answer explained to current AHA guidelines.
25 questions
Trauma
Bleeding control and tourniquets, shock, chest injuries, burns, spinal motion restriction, splinting, and START triage — with the trap in every wrong answer called out.
After you pass
EMT Requirements & Certification
Registration is national — working as an EMT is state by state. See what it takes to certify and get on the job.
About the NREMT EMT Cognitive Exam
The NREMT cognitive exam is the national written test behind EMT certification, developed and administered by the National Registry of Emergency Medical Technicians (NREMT). Passing it, along with a psychomotor skills evaluation, earns the National EMS Certification that most states use as the basis for their EMT license. The exam is delivered at Pearson VUE test centers on a computer.
A computer-adaptive test, not a fixed exam
The single most important thing to understand about the NREMT is that it is computer-adaptive. It does not have a set number of questions or a passing percentage. Instead, the difficulty of each question adjusts to your performance: answer correctly and the next question is harder; miss one and the next is easier. The exam stops the moment it is about 95% confident that your true ability is clearly above — or clearly below — the entry-level competency standard. For the EMT exam that happens somewhere between 70 and 120 questions, and about 10 items are unscored pilot questions mixed in unannounced.
What passing actually means
Because of the adaptive design, there is no percent-correct cutoff and no fixed number of right answers to reach. You pass by demonstrating, question after question, that your ability sits above the standard — which is why a candidate can pass in 70 questions and another can pass in 120. This also means a shorter exam is not automatically good news and a longer one is not automatically bad. This simulator uses a fixed 60-question format and a 70% benchmark as a practical readiness analog; treat it as the floor, not the goal.
What the exam covers
The NREMT builds the EMT cognitive exam from five content areas, and this simulator mirrors them question for question:
| NREMT content area | Questions here | Matching drill |
|---|---|---|
| Airway, Respiration & Ventilation | 11 of 60 | In the simulator |
| Cardiology & Resuscitation | 12 of 60 | Cardiology & Resuscitation |
| Trauma | 10 of 60 | Trauma |
| Medical & Obstetrics/Gynecology | 16 of 60 | In the simulator |
| EMS Operations | 11 of 60 | In the simulator |
The National Registry weights the exam most heavily toward adult patients (about 85% adult, 15% pediatric). Confirm the current content-area proportions on the official EMT test plan at NREMT.org (accessed July 2026), since the Registry updates them periodically.
Eligibility, cost, and retakes
To sit for the NREMT you must complete a state-approved EMT education program and, in most cases, hold a current CPR credential. The EMT cognitive exam fee is $104 per attempt. If you do not pass, you can retest after 15 days; after three failed attempts you must complete remedial training before your next three tries. Your results report shows which content areas fell below the standard — use it, and this simulator's breakdown, to target your studying. Requirements and licensing beyond the national certification are set state by state; our EMT requirements guide walks through them.
How this practice test maps to the real exam
Every question here is original, written to mirror the style and difficulty of the NREMT and drawn from the National EMS Education Standards and current AHA guidelines, distributed across the five content areas. What this fixed simulator does that the adaptive exam cannot is show you exactly where your points went — and then link each weak area to a matching drill and a written explanation for every answer.
FreeEMTTest is an independent study resource and is not affiliated with, endorsed by, or sponsored by the National Registry of Emergency Medical Technicians (NREMT) or any certifying organization.
Frequently Asked Questions
How many questions are on the NREMT EMT exam?
The NREMT cognitive exam is computer-adaptive, so the length varies: the EMT exam gives you between 70 and 120 questions, and the test stops as soon as it is 95% confident your ability is clearly above or clearly below the passing standard. About 10 of the questions are unscored pilot items you cannot tell apart from the rest. This free simulator uses a fixed 60 questions across the same five content areas so you can practice the format and see where your points went — the real exam simply decides its own length as it goes.
How is the NREMT scored, and what does it take to pass?
The NREMT does not report a percent score. Because it is computer-adaptive, it feeds you harder questions when you answer correctly and easier ones when you miss, then passes you the moment it is statistically confident (about 95%) that your ability sits above the entry-level competency standard — regardless of how many questions that took. There is no fixed number of correct answers to hit. On a fixed practice test like this one, roughly 70% is a reasonable readiness analog, which is why this simulator benchmarks you at 42 of 60. Aim comfortably above that before you test.
What does the NREMT EMT exam cover?
The cognitive exam is built from five content areas: Airway, Respiration and Ventilation; Cardiology and Resuscitation; Trauma; Medical and Obstetrics/Gynecology; and EMS Operations. Around 85% of the questions are set at the adult level and about 15% at the pediatric level. This simulator mirrors those five areas so a weak spot shows up on your results breakdown, not on test day.
What happens if I fail the NREMT — how soon can I retake it?
You can retest 15 days after a failed attempt. After three failed attempts you must complete a remedial training program before three more tries, and the same pattern repeats. Your official results include a feedback report showing which content areas were below the standard — drill those first. Use the content-area breakdown on this simulator the same way: find your weakest area, drill it, and only rebook once your practice scores sit comfortably above the benchmark.
How much does the NREMT cost?
The EMT cognitive exam fee is $104, paid to the National Registry when you apply through your account. There is no refund for a failed attempt, and each retest costs the full fee again — a strong reason to drill free practice questions until your score sits well above the benchmark before you book. Confirm the current fee on NREMT.org, since it is updated from time to time.
Is this NREMT practice test free? Do I need to sign up?
Yes, it is free — all 60 simulator questions and all 55 drill questions — and no, there is no signup, credit card, or expiring trial. Every question comes with a written explanation, and you can retake any test as many times as you like.
How should I use this practice test to prepare?
Take the 60-question simulator first for a baseline — the results page breaks your score down by the five NREMT content areas, so you can see exactly where the points went. Drill your weakest area with a matching topic test, then retake the simulator. Most candidates need two or three cycles before scoring consistently above 70%. Because the real exam is adaptive and only gets harder as you succeed, practicing above 80% gives you a comfortable margin.
Passing the exam is step one
National certification is where you start — every state sets its own rules for licensing EMTs and getting you on an ambulance. See what it takes to certify and where to go next.