Free NREMT Practice Questions
Cardiology
Chest pain, rhythm clues, and shock patterns. Treat threats, not labels, and protect the timeline.
What you'll master
- ✓First‑step chest pain priorities
- ✓Shock recognition patterns
- ✓Medication safety checks
- ✓ALS escalation timing
Common misses
- –Delaying aspirin/oxygen decisions
- –Ignoring hypotension risk
- –Missing shock progression
Sample questions.
25 free cardiology questions with answers and explanations. MedRelay's full question bank covers every NREMT domain, plus live scenarios that grade the decision, not just the answer.
Question 1
At a community center, the AED says no shock advised after analysis. What is next?
Why:Correct. Resume CPR immediately and continue following AED prompts.
Question 2
At a fitness center, a 22-year-old female pulseless adult collapses in front of you. Your partner brings the AED. What should happen?
Why:Correct. Cardiac arrest requires immediate high-quality CPR and AED use.
Question 3
A 58-year-old has crushing chest pressure and took sildenafil earlier today. He asks for help with nitroglycerin. What should you do?
Why:Correct. Recent PDE-5 inhibitor use is a contraindication to nitroglycerin assistance because severe hypotension can occur.
Question 4
A 27-year-old male has chest pressure, sweating, and nausea. No aspirin allergy is reported. What medication is indicated?
Why:Correct. Suspected ACS without contraindication is an indication for 324 mg chewed aspirin per protocol.
Question 5
You respond to a 52-year-old male who is conscious and complaining of severe chest pain rated 10 out of 10. He states the pain has been constant for 90 minutes. He is diaphoretic. His aspirin has already been given by a first responder on scene. His BP is 138/86. His prescribed nitroglycerin is available. He tells you he takes finasteride (Proscar) for an enlarged prostate. Can you administer nitroglycerin?
Why:Correct. Finasteride (Proscar) is a 5-alpha reductase inhibitor used for BPH — it does not interact with nitroglycerin. The dangerous interaction is with PDE5 inhibitors (sildenafil, tadalafil, vardenafil). Finasteride has a completely different mechanism with no hemodynamic interaction. NTG is appropriate with SBP 138 and no PDE5 inhibitor use.
Question 6
At a dialysis center, a 68-year-old male chest pain patient took tadalafil yesterday. What medication assistance is unsafe?
Why:Correct. Recent PDE-5 inhibitor use makes nitroglycerin unsafe because profound hypotension can occur.
Question 7
You respond to a 44-year-old male with chest pain during a work meeting. He describes the pain as pressure rated 7 out of 10 that also goes to his right arm — not the left. His coworker says he had a heart attack 2 years ago. Vital signs: HR 96, BP 138/86, SpO2 96%. He has his prescribed nitroglycerin. Can right-sided arm radiation be from a cardiac event?
Why:Correct. Cardiac pain radiation is not limited to the left arm. It can radiate to either arm, both arms, the jaw, neck, back, or epigastrium. Right arm or bilateral radiation is documented in ACS. The absence of classic left arm radiation does not exclude a cardiac etiology — a dangerous misconception.
Question 8
You respond to a 54-year-old male with chest pain. He shows you three different medications: his nitroglycerin, his sildenafil (taken 6 hours ago for erectile dysfunction), and his daily aspirin. He wants you to give him all three medications. Which of these three should you withhold and why?
Why:Correct. Sildenafil taken within 24 hours is an absolute contraindication to nitroglycerin. The combination causes severe potentially fatal hypotension through additive cGMP pathway vasodilation. Administer aspirin, withhold NTG, transport Priority 1. Document the sildenafil and timing clearly for the receiving team.
Question 9
You respond to a 75-year-old male who was found by his wife. He is pulseless and apneic. She reports he was talking to her 6 minutes ago. She begins crying and says she does not want you to do CPR because he told her he never wanted it. She does not have any paperwork. She says the DNR is at their attorney's office. No valid DNR document is present. What do you do?
Why:Correct. No valid DNR = resuscitate: implied consent requires treating a pulseless patient when no valid written DNR is present. A spouse's verbal description of the patient's wishes — without documentation — does not override the legal obligation to treat. Begin CPR, contact medical control, document the spouse's statements and your clinical decision. A verbal report of wishes is compassionately acknowledged but cannot legally withhold resuscitation.
Question 10
At a farm driveway, a 71-year-old male with suspected ACS becomes pale and hypotensive. What is the transport priority?
Why:Correct. Suspected ACS with poor perfusion requires rapid transport, reassessment, and notification.
Question 11
You respond to a 78-year-old female in cardiac arrest. The AED advises a shock. Just before you deliver it you notice a pacemaker bulge under her left clavicle. How does this change your AED use?
Why:Correct. AED use with implanted cardiac devices: position pads at least 1 inch away from the device. Deliver the shock normally. The benefit of defibrillation far outweighs any risk to the pacemaker or ICD. Some energy may be absorbed but defibrillation efficacy is maintained. Resume CPR immediately after the shock.
Question 12
You respond to a 68-year-old male who is 8 days post-anterior MI treated with PCI. Today he has new onset sharp chest pain that is worse lying flat and better sitting forward. He has a low-grade fever of 37.8 degrees C. HR 102, BP 118/82. SpO2 98%. On auscultation you hear a scratchy grating sound synchronous with the heartbeat. What is this post-MI complication?
Why:Correct. Dressler syndrome: post-MI autoimmune pericarditis occurring 1-6 weeks after infarction. The immune system generates antibodies against released cardiac antigens causing pericardial inflammation. Classic: positional pleuritic chest pain, pericardial friction rub, low-grade fever. Aspirin and NSAIDs are hospital treatments. Transport for echo to exclude effusion causing tamponade.
Question 13
A stable patient has palpitations after heavy caffeine use, HR 150, and no chest pain. What is appropriate?
Why:Correct. Tachycardia can be clinically significant. Monitor, assess, transport, and request ALS if unstable or worsening.
Question 14
You respond to a 55-year-old male who is conscious with HR 188 and the monitor shows a narrow complex regular tachycardia. BP is 112/76. He is mildly symptomatic — slightly lightheaded but alert. He has no prior cardiac history. You attempt a Valsalva maneuver which fails to terminate the rhythm. ALS is 8 minutes away. What is the modified Valsalva maneuver and what evidence supports its use?
Why:Correct. Modified Valsalva (REVERT trial): bear down for 15 seconds then immediately lay flat with legs elevated 45 degrees for 15 more seconds. The supine leg-up position augments venous return and vagal tone after the Valsalva strain. The REVERT trial showed 43% conversion rate versus 17% for standard Valsalva. This is safe, within EMT-B scope, and has strong evidence. Try before ALS arrives.
Question 15
You respond to a 59-year-old male with chest pain. He has his prescribed NTG. You ask about current medications and he reports he takes ranolazine (Ranexa) — a medication for chronic angina. You are unfamiliar with this medication. What is the correct approach when encountering an unfamiliar medication?
Why:Correct. Unfamiliar medication approach: (1) check available drug references or contact medical control, (2) ranolazine (Ranexa) is a cardiac anti-anginal with no significant interaction with NTG or aspirin, (3) proceed per protocol if no contraindication is identified, (4) document all medications for the receiving team. When truly uncertain, medical control guidance is always appropriate.
Question 16
A chest pain patient has SpO2 97 percent and no respiratory distress. What oxygen approach is best?
Why:Correct. Routine high-flow oxygen is not needed when oxygenation is adequate. Monitor and treat if hypoxia develops.
Question 17
You respond to a 77-year-old male with severe cardiogenic pulmonary edema. SpO2 is 88%, HR 116, BP 158/96. You have positioned him upright and applied oxygen. SpO2 improved to 91%. BP is 148/90. He has prescribed NTG and no PDE5 inhibitor use. Is NTG appropriate and what is its mechanism?
Why:Correct. NTG in cardiogenic pulmonary edema: primarily reduces preload (venous dilation reduces venous return and pulmonary venous pressure) and reduces afterload. With BP 148/90, no contraindications, NTG is appropriate. Recheck BP before each dose.
Question 18
You respond to a 59-year-old male with chest pain. He shows you an empty nitroglycerin bottle and says he used the last tablet 10 minutes ago with no relief. His BP is 146/88. He has no PDE5 inhibitor use. You have unit-stocked nitroglycerin per your standing orders. Can you administer it?
Why:Correct. Standing orders for NTG: like albuterol and oral glucose, nitroglycerin is a standing order medication in most EMS systems — EMT-Bs can administer it from unit stock when the patient meets criteria regardless of whether the patient has their own prescription. Criteria: suspected ACS, SBP above 90, no PDE5 inhibitor within the contraindication window, no contraindications. Document the standing order basis.
Question 19
At a train platform, a 36-year-old female pulseless adult collapses in front of you. Your partner brings the AED. What should happen?
Why:Correct. Cardiac arrest requires immediate high-quality CPR and AED use.
Question 20
At a fitness center, a 24-year-old female cardiac arrest patient regains pulses after AED shock. What should you do next?
Why:Correct. After ROSC, reassess airway, breathing, circulation, mental status, and prepare rapid transport.
Question 21
You respond to a 62-year-old female who is having chest pain. She has a history of asthma and takes theophylline (a bronchodilator) daily. Before giving aspirin, does theophylline create any interaction with aspirin?
Why:Correct. Theophylline and aspirin: no clinically significant interaction in the prehospital ACS context. Theophylline is a methylxanthine that inhibits PDE enzymes broadly but does not create the dangerous vasodilatory interaction of PDE5-specific inhibitors with NTG. Aspirin 324 mg chewed is appropriate. Note: theophylline has a narrow therapeutic index — document use for the receiving team.
Question 22
At a hotel room, a 41-year-old male chest pain patient took tadalafil yesterday. What medication assistance is unsafe?
Why:Correct. Recent PDE-5 inhibitor use makes nitroglycerin unsafe because profound hypotension can occur.
Question 23
You respond to a 61-year-old male with crushing chest pain and diaphoresis. His BP is 128/82. He has his prescribed NTG spray. He also has a prescription bottle for isosorbide mononitrate (Imdur) — a long-acting nitrate he takes daily for stable angina. He asks if taking his daily nitrate means he cannot use the NTG now. What is the correct answer?
Why:Correct. Prior nitrate use is not a contraindication to sublingual NTG: long-acting nitrates (isosorbide mononitrate, isosorbide dinitrate) can be combined with sublingual NTG for acute chest pain. The specific contraindication to NTG is PDE5 inhibitor use within the drug-specific window. Daily nitrate therapy does not prevent acute sublingual NTG use.
Question 24
You respond to a 48-year-old female with sudden onset severe tearing chest pain radiating to her upper back. BP is 192/118 in the right arm and 168/96 in the left arm. She is diaphoretic and very anxious. She takes hydralazine for hypertension. You are deciding whether to administer aspirin. She has a known connective tissue disorder — Marfan syndrome. Why does Marfan syndrome increase aortic dissection risk and why does it affect your medication decision?
Why:Correct. Marfan syndrome and aortic dissection: cystic medial necrosis from fibrillin-1 gene mutation weakens the aortic media making it prone to dissection — especially with hypertension. BP arm differential over 20 mmHg confirms aortic arch involvement. Both aspirin (worsens intramural bleeding) and NTG (drops perfusion pressure) are absolutely contraindicated. Priority 1 vascular surgical transport.
Question 25
A 61-year-old male has chest pressure, sweating, and nausea. No aspirin allergy is reported. What medication is indicated?
Why:Correct. Suspected ACS without contraindication is an indication for 324 mg chewed aspirin per protocol.
Keep going
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