Free NREMT Practice Test · Topic Drill
Cardiology & Resuscitation Practice Test
30 NREMT-style questions, one at a time — just like the real exam. Score and full explanations at the end. Free, no signup.
Cardiology and resuscitation is one of the highest-stakes areas on the NREMT, and the questions reward precise, current numbers: compression rate and depth, compression-to-ventilation ratios by age, AED steps, and the contraindications for aspirin and nitroglycerin. These 30 questions drill high-quality CPR, AED operation, cardiac arrest management, and acute coronary syndrome across adults, children, and infants — every answer explained against current AHA guidelines so the reasoning sticks, not just the number.
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Question 1 of 30.When performing chest compressions on an adult in cardiac arrest, the EMT should compress at a rate of:
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When performing chest compressions on an adult in cardiac arrest, the EMT should compress at a rate of:
- 60 to 80 compressions per minute
- 80 to 100 compressions per minute
- 100 to 120 compressions per minute (correct answer)
- At least 140 compressions per minute
Current AHA guidelines call for a compression rate of 100 to 120 per minute for victims of all ages. Rates slower than 100 do not generate adequate coronary and cerebral perfusion, while rates faster than 120 tend to produce shallow compressions and incomplete chest recoil, both of which reduce blood flow. Pushing hard and fast within this window, with minimal interruptions, is the foundation of high-quality CPR.
What is the correct chest compression depth for an average adult in cardiac arrest?
- At least 1 inch (2.5 cm) but not more than 1.5 inches (4 cm)
- At least 2 inches (5 cm) but not more than 2.4 inches (6 cm) (correct answer)
- At least 3 inches (7.5 cm) but not more than 3.5 inches (9 cm)
- At least 1.5 inches (4 cm) but not more than 2 inches (5 cm)
AHA guidelines specify a compression depth of at least 2 inches (5 cm) for adults while avoiding depths greater than 2.4 inches (6 cm), because excessive depth increases the risk of injury without improving outcomes. Compressions shallower than 2 inches do not adequately squeeze the heart between the sternum and spine. The 'at least one-third the chest depth' framing applies to infants and children, not adults.
A single EMT is performing CPR on an adult without an advanced airway in place. What compression-to-ventilation ratio should be used?
- 30 compressions to 2 ventilations (correct answer)
- 15 compressions to 2 ventilations
- 5 compressions to 1 ventilation
- Continuous compressions with 1 ventilation every 6 seconds
For adults without an advanced airway, the ratio is 30 compressions to 2 ventilations whether one or two rescuers are present. The 15:2 ratio applies to two-rescuer CPR on infants and children, and the 5:1 ratio does not correspond to any current guideline. The continuous-compression option applies in a different circumstance covered elsewhere in this drill.
Two EMTs are performing CPR on a 4-year-old child without an advanced airway. What compression-to-ventilation ratio is correct?
- 30 compressions to 2 ventilations
- 5 compressions to 1 ventilation
- 3 compressions to 1 ventilation
- 15 compressions to 2 ventilations (correct answer)
When two rescuers perform CPR on an infant or child, AHA guidelines specify a ratio of 15 compressions to 2 ventilations, reflecting the greater importance of ventilation in pediatric arrests, which are usually caused by respiratory failure rather than a primary cardiac event. A lone rescuer would use 30:2 for a child. The 3:1 ratio is used only in newborn resuscitation immediately after birth, and the 5:1 ratio is an obsolete standard no longer taught.
What is the correct compression depth when performing CPR on an infant?
- At least 2.4 inches (6 cm), about one-third the depth of the chest
- About 2 inches (5 cm)
- About 1.5 inches (4 cm), at least one-third the depth of the chest (correct answer)
- About 0.5 inch (1.3 cm) to avoid injuring the ribs
For infants, compressions should be at least one-third the anterior-posterior diameter of the chest, which is approximately 1.5 inches (4 cm). Deeper adult-range depths would exceed one-third of an infant's small chest, and compressions of only half an inch are far too shallow to circulate blood. Fear of causing injury should never lead to inadequate compression depth.
Two EMTs are resuscitating an infant in cardiac arrest. Which chest compression technique is preferred for the rescuer performing compressions?
- The heel of one hand centered on the sternum
- Two thumbs side by side with the hands encircling the infant's chest (correct answer)
- Two fingers placed on the upper third of the sternum
- Both hands stacked as for an adult, with reduced force
The two thumb-encircling hands technique is the preferred method for infant compressions when two rescuers are present, because it produces better compression depth and coronary perfusion than the two-finger technique. Compressions are delivered on the lower half of the sternum, not the upper third. Adult-style hand placement is inappropriate for an infant's small chest.
What is the correct compression depth for a school-age child in cardiac arrest?
- About 2 inches (5 cm), at least one-third the depth of the chest (correct answer)
- About 1 inch (2.5 cm), at least one-third the depth of the chest
- At least 2.6 inches (6.5 cm)
- About 1.5 inches (4 cm)
For children, compressions should be at least one-third the anterior-posterior diameter of the chest, which is about 2 inches (5 cm). One inch, though sometimes claimed to reach one-third of a small child's chest, is too shallow to produce meaningful blood flow, while depths beyond about 2.4 inches risk injury without added benefit. Estimating one-third of the chest depth, rather than memorizing a single number, is what the guideline emphasizes.
During a prolonged two-rescuer resuscitation, how often should the compressor role be switched to limit rescuer fatigue?
- About every 30 seconds, whenever the AED is analyzing the rhythm
- About every 10 minutes, when the compressor requests relief
- About every 5 minutes, at the end of each pulse check
- About every 2 minutes, ideally during the rhythm check (correct answer)
Compression quality measurably declines after about 2 minutes even when the rescuer does not feel tired, so compressors should switch roughly every 2 minutes (about 5 cycles of 30:2), completing the change in less than 5 seconds. Timing the switch to coincide with the AED rhythm analysis avoids adding an extra pause in compressions. Waiting for the compressor to report fatigue allows quality to deteriorate unnoticed.
Why is allowing full chest recoil between compressions essential during CPR?
- It reduces the chance of fracturing the patient's ribs
- It allows the heart to refill with blood, maintaining venous return and coronary perfusion (correct answer)
- It gives the rescuer a brief rest between compressions
- It prevents air from entering the stomach during ventilations
Complete recoil creates negative pressure in the chest that draws blood back into the heart, so the next compression has blood to eject; leaning on the chest between compressions raises intrathoracic pressure and reduces both venous return and coronary perfusion. Recoil has no meaningful effect on rib fracture risk, is not intended as rescuer rest, and is unrelated to gastric insufflation, which is caused by ventilating too forcefully or too quickly.
An AED delivers a shock to an adult in cardiac arrest. What should the EMT do immediately after the shock?
- Resume chest compressions right away and continue CPR for about 2 minutes (correct answer)
- Check the carotid pulse for up to 10 seconds
- Wait for the AED to reanalyze the rhythm before touching the patient
- Deliver 2 rescue breaths and then check for breathing
Compressions should resume immediately after shock delivery and continue for about 2 minutes before the next rhythm analysis, because even a successfully defibrillated heart usually cannot generate an effective pulse right away and needs perfusion support. Pausing to check a pulse or waiting for reanalysis leaves the heart without blood flow during a critical window. The AED will prompt the next analysis at the appropriate time.
While applying AED pads to a man in cardiac arrest, the EMT notices a hard lump with a surgical scar below his right clavicle, consistent with an implanted pacemaker. The EMT should:
- Withhold defibrillation because a shock could destroy the device
- Place the pad directly over the device to maximize energy delivery
- Avoid placing the pad directly over the device, positioning it at least 1 inch away, and proceed with the AED (correct answer)
- Delay defibrillation until medical direction confirms the device type
An implanted pacemaker or defibrillator is not a contraindication to AED use; the pad should simply not be placed directly on top of the device, since the device can absorb some of the shock energy and reduce its effectiveness. Positioning the pad at least about an inch to the side of the lump solves the problem. Withholding defibrillation, or delaying it to confirm the device type with medical direction, dramatically reduces the chance of survival in a patient with a shockable rhythm.
A 6-year-old child is in cardiac arrest, and the only AED available has adult pads with no pediatric attenuator. The EMT should:
- Withhold the AED because adult pads are dangerous for children
- Cut the adult pads in half before applying them
- Apply both adult pads to the front of the chest even if they overlap
- Use the adult pads, making sure the pads do not touch each other (correct answer)
Pediatric pads or a dose attenuator are preferred for children under 8 years old, but if they are not available, adult pads should be used rather than withholding defibrillation, since an unshocked shockable rhythm is almost uniformly fatal. If the pads are too large for the chest, an anterior-posterior placement keeps them from touching. Pads must never be cut or modified, and they must never be allowed to touch or overlap, which would short-circuit the shock across the skin instead of through the heart.
Where should the EMT palpate for a pulse on an unresponsive infant?
- The brachial artery on the inside of the upper arm (correct answer)
- The carotid artery in the neck
- The radial artery at the wrist
- The dorsalis pedis artery on the foot
The brachial artery is the recommended pulse check site in infants because an infant's short, chubby neck makes the carotid pulse difficult to locate reliably. The carotid or femoral artery is used for children and adults. The radial and dorsalis pedis pulses are peripheral sites that may be impalpable during poor perfusion even when a central pulse is present.
An EMT is assessing an unresponsive adult who is not breathing. How long should the EMT take to check for a carotid pulse before starting compressions?
- Up to 30 seconds, to be certain a pulse is absent
- Up to 15 seconds, rechecking at a second site to confirm
- No more than 10 seconds (correct answer)
- Up to 20 seconds, then a second 20-second check if unsure
Healthcare providers should take no more than 10 seconds to check for a pulse, and if no definite pulse is felt within that time, chest compressions should begin immediately. Every alternative here prolongs the check to 15, 20, or 30 seconds, and rechecking at a second site or repeating the count only compounds the delay. Prolonged pulse checks delay CPR in a patient whose brain is already without perfusion, and briefly compressing a beating heart is far less harmful than withholding compressions from an arrested one.
In the adult out-of-hospital chain of survival, what is the first link?
- Rapid defibrillation with an AED
- Recognition of cardiac arrest and activation of the emergency response system (correct answer)
- Advanced resuscitation by EMS providers
- Post-cardiac arrest care at the hospital
Nothing else in the chain of survival can happen until someone recognizes that a cardiac arrest has occurred and calls for help, so recognition and activation of the emergency response system form the first link. It is followed by high-quality CPR, defibrillation, advanced resuscitation, post-cardiac arrest care, and recovery. Each link depends on the ones before it, which is why bystander recognition and early 911 activation so strongly influence survival.
An EMT finds an unresponsive 58-year-old man who takes an occasional slow, gasping breath every 15 to 20 seconds as a pulse check is about to be performed. The EMT should recognize these gasps as:
- Effective breathing that rules out cardiac arrest
- A sign of an isolated airway obstruction
- Agonal respirations, a sign of cardiac arrest (correct answer)
- Slow but adequate respirations requiring only supplemental oxygen
Agonal gasps are occasional, irregular, snoring or gasping breaths produced by a dying brainstem; they are common in the first minutes of cardiac arrest and do not move meaningful air. Mistaking them for effective breathing is one of the most frequent causes of delayed CPR. In an unresponsive patient, agonal gasps should prompt an immediate pulse check, and if no definite pulse is felt, compressions are started at once.
Which presentation is most consistent with an acute coronary syndrome?
- Pressure-like substernal chest discomfort radiating to the left arm and jaw, with sweating and nausea (correct answer)
- Sharp chest pain that is reproducible when the chest wall is pressed
- Sudden tearing pain radiating straight through to the back between the shoulder blades
- Chest pain occurring only with deep inspiration after a fall onto the ribs
The classic ACS picture is a dull pressure, squeezing, or heaviness beneath the sternum that may radiate to the arm, jaw, neck, or back, often accompanied by diaphoresis, nausea, and shortness of breath. Pain reproduced by palpation suggests a musculoskeletal cause, tearing pain radiating to the back is the classic description of aortic dissection, and pleuritic pain after trauma points to a chest wall injury. No single feature rules ACS in or out, however, so patients with concerning symptoms deserve a full assessment regardless.
Which patients are most likely to have a myocardial infarction WITHOUT classic chest pain, presenting instead with symptoms such as sudden weakness, shortness of breath, or epigastric discomfort?
- Young athletes and patients with well-controlled hypertension
- Patients with asthma and seasonal allergies
- Smokers and patients with high cholesterol
- Older adults, women, and patients with diabetes (correct answer)
Older adults, women, and people with diabetes are the groups best known for atypical or 'silent' myocardial infarctions, presenting with dyspnea, unusual fatigue, syncope, nausea, or vague epigastric discomfort rather than crushing chest pain; diabetic nerve damage in particular can blunt cardiac pain perception. The EMT should keep a high index of suspicion for ACS in these patients even when chest pain is absent. Smoking and high cholesterol are major risk factors for developing coronary disease, but along with athletic status, hypertension, and asthma they are not the features that characteristically mask or blunt the pain of an infarction once it occurs.
An EMT's protocol authorizes aspirin for a patient with suspected acute coronary syndrome. What is the correct dose and administration method?
- 650 mg swallowed whole with water
- 160 to 325 mg chewed before swallowing (correct answer)
- 81 mg placed under the tongue to dissolve
- 325 mg given only after nitroglycerin has been administered
The standard prehospital aspirin dose for suspected ACS is 160 to 325 mg (commonly two to four 81-mg chewable tablets), chewed to speed absorption of its antiplatelet effect, which slows the growth of the clot occluding the coronary artery. A single 81-mg tablet is below the therapeutic range for this purpose, and 650 mg exceeds it. Aspirin does not need to wait for nitroglycerin; it is given as early as protocol allows.
Which finding would prevent an EMT from administering aspirin to a patient with suspected acute coronary syndrome?
- A known allergy to aspirin (correct answer)
- The patient already takes 81 mg of aspirin every morning
- A blood pressure of 150/90 mmHg
- A history of coronary stents
A true aspirin allergy is a contraindication, as are conditions such as active gastrointestinal bleeding; giving the drug could trigger anaphylaxis or worsen hemorrhage. Daily low-dose aspirin use does not by itself prohibit the ACS dose under most protocols, elevated blood pressure is not a contraindication to aspirin (unlike nitroglycerin, which depends on adequate pressure), and prior stents actually increase the importance of antiplatelet therapy. Always follow local protocol and medical direction.
A 60-year-old man with chest pain has his own prescribed nitroglycerin. Which finding should cause the EMT to withhold assistance with the medication and contact medical direction?
- He rates his chest pain as 8 out of 10
- He had a heart attack two years ago
- He chewed 324 mg of aspirin five minutes ago
- His systolic blood pressure is 84 mmHg (correct answer)
Nitroglycerin dilates blood vessels and lowers blood pressure, so it must be withheld when the systolic pressure is already low; national guidelines commonly set the cutoff around 90 to 100 mmHg systolic, and 84 mmHg is below any accepted threshold. Severe pain and a prior infarction are reasons the medication may help, not contraindications, and aspirin and nitroglycerin are routinely given to the same ACS patient. Exact blood pressure cutoffs vary by local protocol, so EMTs should know their own system's number.
A patient with crushing chest pain has prescribed nitroglycerin and an adequate blood pressure, but mentions he took sildenafil (Viagra) last night. The EMT should:
- Assist with the nitroglycerin as usual since sildenafil is not a heart medication
- Withhold the nitroglycerin and consult medical direction, because the combination can cause severe hypotension (correct answer)
- Give half the usual nitroglycerin dose as a precaution
- Have the patient take a second aspirin instead of any other intervention
Erectile dysfunction drugs such as sildenafil, vardenafil, and tadalafil are phosphodiesterase inhibitors that potentiate nitroglycerin's vasodilation; combining them within roughly 24 to 48 hours of use can cause profound, refractory hypotension. The correct action is to withhold the nitroglycerin, notify medical direction, and continue other indicated care such as oxygen as needed, aspirin per protocol, and rapid transport. There is no 'half dose' workaround, and substituting extra aspirin is not an equivalent therapy.
Nitroglycerin helps a patient with cardiac chest pain primarily by:
- Dilating blood vessels, which reduces the heart's preload and oxygen demand (correct answer)
- Increasing the force of cardiac contractions
- Breaking down the clot blocking the coronary artery
- Slowing the heart rate through the vagus nerve
Nitroglycerin relaxes vascular smooth muscle, dilating veins in particular, which reduces the volume of blood returning to the heart (preload) and therefore the heart's workload and oxygen demand; it also dilates coronary arteries, which can improve myocardial blood supply. It has no clot-dissolving action, does not strengthen contractions, and does not act through the vagus nerve. Its common side effects, headache and a drop in blood pressure, follow directly from this vasodilation.
After assisting a chest pain patient with one dose of nitroglycerin, the pain persists. Under most protocols, how may dosing continue?
- Every 15 minutes, up to 2 doses, if pain persists
- Every minute, up to 5 doses, until the pain resolves
- Every 5 minutes, up to 3 doses, reassessing blood pressure before each (correct answer)
- Every 10 minutes, up to 4 doses, if the systolic pressure stays above 80
Nitroglycerin is typically repeated at about 5-minute intervals up to a maximum of three doses if pain persists, but only if the blood pressure remains adequate, which is why vital signs must be reassessed before every dose. Dosing every minute risks precipitous hypotension, while 15-minute intervals leave ischemic myocardium untreated too long; a four-dose regimen and a fixed 80 mmHg cutoff both exceed common protocol limits. Exact dose limits, intervals, and pressure thresholds are set by local protocol and medical direction, so EMTs must follow their own system's rules.
During the two-minute CPR cycle, which observation most strongly suggests the patient has achieved return of spontaneous circulation (ROSC)?
- The chest rises each time a bag-valve-mask breath is delivered
- The patient begins to move and breathe, and a definite carotid pulse is palpable (correct answer)
- The patient's pupils are unchanged from the initial assessment
- A single gasp occurs during chest compressions
ROSC is marked by the return of a definite pulse, often accompanied by purposeful movement, breathing, coughing, or improving color. Chest rise with bagging only confirms that ventilations are entering the lungs, unchanged pupils provide no evidence of circulation, and an isolated gasp during compressions may simply be an agonal breath. When signs of life appear, the EMT should pause, confirm a pulse, and transition to post-ROSC care.
A cardiac arrest patient regains a pulse after defibrillation but remains unresponsive. Which action is most appropriate for the EMT?
- Monitor the airway, breathing, and vital signs closely, support oxygenation, and be prepared for the patient to re-arrest (correct answer)
- Ventilate as rapidly as possible to correct the buildup of carbon dioxide
- Detach the AED pads now that the shockable rhythm has resolved
- Perform a detailed secondary assessment on scene before initiating transport
Patients are extremely unstable immediately after ROSC and frequently re-arrest, so continuous monitoring of the pulse, breathing, and blood pressure, with the AED left attached, is essential. Ventilation should be delivered at a normal rate because hyperventilation raises intrathoracic pressure, reduces venous return, and worsens outcomes, while oxygen should be titrated to keep saturation in the normal range. The AED stays attached because these patients frequently re-arrest, and transport to an appropriate receiving facility should not be delayed for a detailed on-scene secondary assessment, which is performed en route while reassessment continues.
An advanced provider places a supraglottic airway in an adult cardiac arrest patient. How should CPR now be performed?
- Pause after every 30 compressions to deliver 2 breaths
- Alternate 2 minutes of compressions with 2 minutes of ventilations
- Stop compressions entirely and focus on ventilation
- Continuous compressions without pauses, with 1 ventilation every 6 seconds (correct answer)
Once an advanced airway is in place in an adult, rescuers no longer pause compressions for breaths: compressions continue uninterrupted at 100 to 120 per minute while ventilations are delivered at 1 breath every 6 seconds (10 per minute). This maximizes chest compression fraction, the portion of arrest time during which blood is actually being circulated. The 30:2 pattern applies only before an advanced airway is placed.
A 7-month-old infant is responsive but cannot cry or cough after choking on a piece of food. The EMT should:
- Perform blind finger sweeps to locate the object, holding the infant upright
- Give 5 abdominal thrusts followed by 5 back slaps, keeping the head elevated
- Deliver 5 back slaps followed by 5 chest thrusts, keeping the head lower than the body (correct answer)
- Deliver rapid two-finger chest compressions until the object is expelled
For a responsive infant with a severe airway obstruction, the correct treatment is alternating 5 back slaps and 5 chest thrusts, holding the infant with the head lower than the trunk, repeating until the object is expelled or the infant becomes unresponsive. Abdominal thrusts are not used on infants because of the risk of injuring the liver and other abdominal organs, and blind finger sweeps can push the object deeper. Chest compressions are begun only once the infant becomes unresponsive, not while the infant is still responsive.
An adult at a restaurant is coughing forcefully and says in a strained voice, "Something went down the wrong way." The EMT should:
- Immediately begin abdominal thrusts before the airway closes completely
- Encourage continued coughing and monitor closely, intervening only if the obstruction becomes severe (correct answer)
- Slap the patient firmly between the shoulder blades while they are still coughing effectively
- Have the patient drink water to wash the object down
A patient who can speak and cough forcefully has a mild airway obstruction with good air exchange, and their own cough is more effective at expelling the object than anything a rescuer can do. Intervening with thrusts or blows during effective coughing is unnecessary and could worsen the situation, and giving liquids risks further aspiration. The EMT should stand by and act immediately if signs of severe obstruction develop, such as a silent cough, inability to speak, or cyanosis.
While receiving abdominal thrusts for a severe airway obstruction, an adult becomes unresponsive. After lowering him to the floor and sending someone to call for additional help, the EMT should:
- Begin CPR starting with chest compressions, looking in the mouth for the object before each set of ventilations (correct answer)
- Continue abdominal thrusts with the patient supine
- Perform repeated blind finger sweeps until the object is found
- Wait for advanced providers to remove the object with forceps
When a choking victim becomes unresponsive, the rescuer begins CPR starting with compressions, which also generate chest pressure that can dislodge the object. Before each set of breaths, the rescuer opens the mouth and looks; an object is removed only if it is actually seen, because blind finger sweeps can push it deeper into the airway. Continuing abdominal thrusts on an unresponsive patient and passively waiting for advanced help both delay the perfusion and dislodgement that compressions provide.
FAQ: Cardiology & Resuscitation on the NREMT
What CPR numbers do I have to know cold for the NREMT?
The workhorses are a compression rate of 100 to 120 per minute for every age, an adult depth of at least 2 inches (5 cm) but no more than 2.4 inches (6 cm), and roughly one-third the chest depth for children (about 2 inches) and infants (about 1.5 inches). Know your compression-to-ventilation ratios too: 30:2 for adults with one or two rescuers, 30:2 for a lone rescuer with a child or infant, and 15:2 for two-rescuer child or infant CPR. Full recoil, minimal interruptions (under 10 seconds), and switching compressors about every 2 minutes round out the high-quality CPR picture this drill tests.
How does the NREMT test aspirin and nitroglycerin?
It tests the contraindications, because that is where candidates lose points. Aspirin is withheld for a known aspirin allergy or active GI bleeding, and the ACS dose is 160 to 325 mg chewed. Nitroglycerin is withheld when systolic blood pressure is too low (most protocols use a 90 to 100 mmHg cutoff) and when the patient has used an erectile-dysfunction drug such as sildenafil in the past 24 to 48 hours, because the combination can cause severe hypotension. Reassess blood pressure before every nitroglycerin dose. Exact numbers vary by local protocol and medical direction.
What is the correct order of steps once an AED arrives?
Turn the AED on first — it then voice-prompts every step. Attach the pads to the bare, dry chest while compressions continue, then let the device analyze while no one touches the patient. If a shock is advised, clear the patient and deliver it, then resume CPR beginning with compressions immediately, without pausing to check a pulse. An implanted pacemaker is not a contraindication: just keep the pad about an inch off the device.
Are these questions taken from the real NREMT?
No. Real NREMT items are confidential and belong to the National Registry — be wary of any site claiming to have them. Our questions are original, written to mirror the style, difficulty, and published content areas of the exam, drawing on the National EMS Education Standards and current AHA guidelines. Scoring well here is strong evidence you are ready, not a preview of the exact questions you will see.
Is this practice test really free?
Yes. Every question, explanation, and score report on FreeEMTTest is free, with no signup, no credit card, and no trial that expires. Retake any test as many times as you want.
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