Free NREMT Practice Test · 2026
Free NREMT practice test.
50 questions across all five 2026 EMT-B domains. No account, no email, no card. Pick an answer and the explanation appears immediately — you get your score as you go.
What the real exam looks like
70–120
Questions on the real exam
Adaptive; it stops when it has measured you.
2 hours
Time limit
Most candidates finish well under it.
95% confidence
Passing standard
Above the entry-level competency line — not a percentage score.
$104
Exam fee
Per attempt, at the time of writing.
The NREMT cognitive exam is computer-adaptive: it adjusts difficulty as you answer and stops once it can place you above or below the entry-level competency line with 95% confidence. That is why a short exam is not automatically a good sign or a bad one, and why a raw percentage — including the one on this page — is practice feedback rather than a predicted result.
Start the test.
Answer in any order. Each question locks once answered so your score reflects your first instinct — which is the one that matters on exam day.
Question 1
You respond to a 19-year-old male from a diving accident hitting the pool bottom head-first. He is pulseless and apneic. You must open the airway for CPR. What is the correct technique?
Why:Correct. Jaw thrust with in-line cervical spine stabilization is correct when spinal injury is suspected. Head-tilt chin-lift extends the cervical spine and is contraindicated. Resuscitation does not wait for spinal clearance — airway management and CPR proceed with spinal precautions.
Question 2
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 3
You arrive on scene of a residential house fire and encounter a patient outside the structure who is conscious with facial burns, singed nasal hairs, and a hoarse voice. He was inside the structure when it was burning. He is currently breathing but his SpO2 is 97%. What is your PRIORITY concern about this patient?
Why:Correct. Singed nasal hairs, facial burns, and hoarseness are signs of supraglottic thermal injury. The airway will progressively edema and can close completely within 30-60 minutes. SpO2 may be normal initially because CO poisoning reads falsely normal. Priority 1 transport with ALS intercept for early definitive airway management before edema occludes it.
Question 4
At a church basement, a 63-year-old male is bitten by a snake and has swelling around the bite. What is appropriate care?
Why:Correct. Keep the patient calm, limit movement, remove constricting items, and transport.
Question 5
You respond to a 71-year-old female who her son says has been increasingly confused over the past 3 weeks since she started a new blood pressure medication (hydrochlorothiazide). She is confused today. BGL is 88, HR 76, BP 112/68, GCS 12. She is on a low-sodium diet and has been drinking large amounts of water. She has no fever. What electrolyte abnormality should you suspect?
Why:Correct. Hyponatremia is a classic complication of hydrochlorothiazide in elderly patients — especially those on low-sodium diets and drinking excess water. Symptoms: confusion, weakness, seizure (at severe levels). BGL is normal so hypoglycemia is not the cause. Sodium correction at the hospital (carefully — rapid correction causes osmotic demyelination syndrome). Priority 1 transport.
Question 6
You have delivered a baby in the field. The neonate is limp and not crying at 1 minute. His skin is centrally cyanotic. His heart rate is 82. His APGAR score calculated is 3 out of 10. After drying and stimulating the neonate with no improvement what is the NEXT intervention?
Why:Correct. APGAR 3 with HR 82 and apnea requires positive pressure ventilation (PPV) after stimulation fails. PPV is initiated when HR is below 100 or breathing is inadequate. Compressions begin only after 30 seconds of PPV if HR remains below 60. The neonatal BVM rate is 40-60 breaths per minute.
Question 7
You respond to a 37-year-old male who is in severe abdominal pain. He reports the pain started suddenly about 4 hours ago in his umbilical region and has now migrated to his right lower quadrant at a point one-third of the way between the anterior superior iliac spine and the umbilicus. Palpation at this point produces the most intense pain he has ever felt. On releasing the pressure suddenly he cries out even louder. What does rebound tenderness at McBurney's point indicate?
Why:Correct. McBurney's point: located one-third of the way from the anterior superior iliac spine to the umbilicus — the anatomical surface projection of the appendix. Pain migrating from periumbilical to McBurney's point is the classic appendicitis progression as inflammation spreads to the parietal peritoneum. Rebound tenderness confirms peritoneal irritation. Priority 1 surgical transport.
Question 8
A 74-year-old female with a suspected hip fracture asks if her living will means you cannot treat her. How do you respond?
Why:Correct. A living will addresses end-of-life care in terminal or permanently unconscious states — it does not restrict fracture treatment, pain management, or transport for a conscious patient. Treat and transport her fracture appropriately. Document the living will and explain the distinction.
Question 9
You respond to a 61-year-old male with an acute asthma exacerbation. His albuterol MDI is available. Before assisting with the MDI, you observe him shake the inhaler once and immediately actuate it without exhaling first. What two technique errors must you correct before assisting with the next dose?
Why:Correct. MDI technique errors: (1) Shaking: 10-15 vigorous shakes before each actuation resuspends the drug particles in the propellant — one shake is insufficient. (2) Exhale fully before actuating: complete exhalation maximizes inspiratory volume available to carry drug particles into the lower airways. Both errors significantly reduce drug deposition in the bronchioles. Correct both before the next dose.
Question 10
You respond to a reported unresponsive male at a bus stop. On arrival bystanders state he collapsed suddenly. He is unresponsive. You perform the AVPU assessment and receive no response. He is not breathing and has no palpable carotid pulse. A bystander shouts that the patient has a DNR. What do you do?
Why:Correct. A valid prehospital DNR or POLST form that applies to the patient's current situation should be followed. However if the document is unavailable unclear or does not apply to the current situation resuscitation should be initiated. The EMT-B must see a valid document — verbal statements from bystanders alone are not sufficient.
Question 11
You respond to a 67-year-old male with COPD in moderate exacerbation. After applying low-flow oxygen at 2 LPM his SpO2 improves from 84% to 89%. He is still using accessory muscles and speaking in 3-4 word bursts. Should you increase the oxygen to target higher SpO2?
Why:Correct. COPD oxygen targeting: 88-92% SpO2. SpO2 89% is within the target range — the current 2 LPM is working. Do not increase toward 96% — over-oxygenation risks suppressing hypoxic drive in chronic CO2 retainers. The accessory muscle use reflects exacerbation severity, not oxygen inadequacy. ALS intercept given the moderate-severe exacerbation presentation.
Question 12
At a mall corridor, a 46-year-old female is being assessed. Your first impression of a scene includes hazards, patient count, and mechanism. What domain is this?
Why:Correct. Hazards, patient count, mechanism, and resources are core scene size-up elements.
Question 13
You respond to a 44-year-old male with sudden onset of bright red rectal bleeding. He passed a large volume of blood with clots approximately 30 minutes ago. He feels lightheaded when standing. HR is 138, BP is 88/62. He has a known history of diverticulosis. What does painless bright red rectal bleeding in a patient with diverticulosis most commonly represent?
Why:Correct. Diverticular hemorrhage: the vasa recta arteries that supply diverticula can erode and bleed massively. Painless (no diverticulitis = no infection/inflammation) bright red or maroon rectal bleeding with hemodynamic compromise in a patient with known diverticulosis is diverticular hemorrhage until proven otherwise. Priority 1 ALS transport — hemodynamic instability from GI hemorrhage requires IV fluid resuscitation and urgent endoscopy/surgery.
Question 14
At a farm driveway, a 71-year-old male trauma patient has weak radial pulses and restlessness after blunt abdominal injury. What should you suspect?
Why:Correct. Restlessness and weak pulses after abdominal trauma suggest shock from internal bleeding.
Question 15
You respond to a garage where a 55-year-old male was found slumped over. His wife found him 30 minutes after he had been working alone with the garage door closed. On arrival he is conscious with confusion, headache, and nausea. SpO2 98%, HR 104. The garage has a running lawn mower inside. You move him outside. What is the critical management step beyond oxygen administration?
Why:Correct. CO poisoning requires: evacuation from the source, high-flow NRB oxygen regardless of SpO2 (SpO2 is unreliable), and assessment for other exposed persons. Family members, pets, and anyone in the structure must be evacuated. CO is odorless — the patient and others may not know the extent of exposure. SpO2 98% is a false reassurance.
Question 16
A pelvic-injury patient is pale and hypotensive. What is your main concern?
Why:Correct. Pelvic trauma can cause severe internal bleeding. Treat for shock and transport rapidly.
Question 17
At a manufacturing floor, a 58-year-old male is unresponsive with wet snoring respirations and vomit at the lips. What should you do first?
Why:Correct. Visible fluid and vomit threaten airway patency. Suction first, then reassess breathing and ventilation.
Question 18
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 19
You respond to a 55-year-old male who was involved in an industrial accident. He has crush injuries to both lower extremities. His employer insists on accompanying the patient in the back of the ambulance and says company policy requires a representative during all work injuries. You have a critically ill patient requiring active care. What is your response?
Why:Correct. Employer representative during critical transport: the front seat is appropriate for any authorized family member or representative. The clinical compartment during active critical care is not appropriate for non-clinical personnel — safety risks include injury in a moving vehicle, emotional harm from witnessing resuscitation, and possible interference with care. Professional explanation and front seat offer is the appropriate response.
Question 20
Multiple lightning-strike patients are down. One is pulseless and apneic. What triage principle applies?
Why:Correct. Lightning arrest may be reversible with prompt ventilation, CPR, and AED use, so reverse triage may apply.
Question 21
At a hotel room, a 40-year-old male has one-sided weakness that resolved before you arrived. What is appropriate?
Why:Correct. Resolved stroke-like symptoms may represent TIA and still require evaluation.
Question 22
At a soccer field, a 31-year-old female child has a fever-related seizure and is now postictal. What is the priority?
Why:Correct. Postictal pediatric care focuses on airway, breathing, glucose when indicated, cooling support, and reassessment.
Question 23
You respond to a 47-year-old male who reports sudden onset of his right foot dropping while he was crossing the street. He says it happened once before 2 months ago and resolved after a few days. He has no pain. His right ankle cannot dorsiflex (lift up) — it hangs in a downward position. His sensation over the dorsum of his right foot is reduced. GCS is 15. BP is 136/78. What nerve is affected in foot drop from a common peroneal nerve palsy?
Why:Correct. Common peroneal nerve palsy: the common peroneal nerve wraps around the fibular head and is vulnerable to compression. It innervates the anterior compartment (tibialis anterior, extensor digitorum) producing foot drop when injured. Dorsal foot sensory loss is also present. Recurrent brief episodes distinguish this from stroke (stroke foot drop does not resolve and recur). Transport for evaluation to confirm peripheral vs central cause.
Question 24
You respond to a 62-year-old male with severe abdominal pain. While packaging him for transport his wife asks if you can turn on the heat in the ambulance because he is shivering from cold. The ambulance is already at 21 degrees C (70 degrees F). Is there any clinical concern with patient shivering during transport for abdominal pain?
Why:Correct. Shivering at comfortable ambient temperature may indicate fever or sepsis: the hypothalamus raises the body's temperature setpoint in response to infection, triggering the shivering reflex to generate heat to reach the new setpoint. Shivering at 21 degrees C without cold exposure is a clinical sign of possible systemic infection. Combined with abdominal pain, this suggests possible sepsis. Temperature assessment and notification of the receiving team are appropriate.
Question 25
You respond to a 49-year-old female with severe chest pain. BP 136/84. No PDE5 inhibitor use. After one NTG 0.4 mg SL, pain is still 8 out of 10 four minutes later. BP is now 124/78. Can you administer a second dose?
Why:Correct. Standard NTG protocol allows up to three doses 3-5 minutes apart provided SBP remains above 90 mmHg and pain persists. BP 124/78 clears the threshold. Document dose number, time, pre-dose BP, post-dose BP, and pain score for each administration.
Question 26
At a college dorm, a 20-year-old female is alert with no life threats after your primary assessment. What comes next?
Why:Correct. Once primary threats are ruled out, move to history, focused exam, and ongoing reassessment.
Question 27
A patient with suspected CHF is sitting upright, pink frothy sputum present, and your protocol allows CPAP. Which finding would make CPAP unsafe?
Why:Correct. Vomiting prevents safe CPAP use because the patient cannot protect the airway well under positive pressure.
Question 28
You are treating a patient at a residence when you smell natural gas — a faint but distinct odor. The patient's family says there may be a gas leak they have not reported. The patient has fallen and has a probable hip fracture. She is stable. What is the correct action?
Why:Correct. Natural gas leak — immediate evacuation: any suspected gas leak requires immediate evacuation of everyone from the structure. Do not activate any electrical switches — even turning a light off creates a spark that can ignite gas. No radio transmissions inside. Remove the patient and yourself. Call the gas utility once outside. Treat the patient in the open air. Do not re-enter.
Question 29
You are assessing a 77-year-old male who reports feeling dizzy. He is conscious with GCS 15 and vital signs: HR 44, BP 88/60, SpO2 96%. He has no chest pain. He takes metoprolol and lisinopril. On his medication list you also see diltiazem (Cardizem). What medication interaction concern should this raise?
Why:Correct. Beta-blockers and non-dihydropyridine calcium channel blockers (diltiazem, verapamil) both slow AV nodal conduction and heart rate. Combined use can cause severe symptomatic bradycardia and heart block — a known and dangerous drug interaction. HR 44 with hypotension and dizziness in a patient on both warrants ALS intercept for calcium gluconate or glucagon reversal.
Question 30
You respond to a 44-year-old male who was in a industrial accident and had a large metal press trap his abdomen and chest for approximately 25 minutes before rescue. He is now free and conscious but his abdomen is massively distended. HR 138, BP 88/56, SpO2 91%. He has no external abdominal wounds. What specific injury pattern occurs when the chest and abdomen are compressed simultaneously under high force?
Why:Correct. Traumatic diaphragmatic rupture from compressive force allows abdominal organs to herniate into the thoracic cavity. This can present with absent or bowel sounds heard in the left chest, respiratory distress, and hemodynamic compromise. High-flow oxygen, Priority 1 surgical transport. Auscultate both chest fields carefully.
Question 31
At a warehouse, two workers collapse after chemical exposure. Your partner wants to rush in. What should you do?
Why:Correct. Multiple collapses after chemical exposure indicate a hazardous scene. Stage, isolate, request hazmat, and avoid secondary contamination.
Question 32
You respond to a 26-year-old male who was struck by a car while crossing the street. He is unconscious at the scene. HR 152, BP 62/38, SpO2 88%, RR 6, GCS 5. He has obvious deformity of his left femur, a rigid abdomen, and an unstable pelvis on gentle compression. Your transport time to a Level I Trauma Center is 8 minutes. How should you allocate those 8 minutes?
Why:Correct. Load-and-go for multisystem trauma with hemodynamic collapse. Airway management and pelvic binder are performed during the loading process. BVM for RR 6 is immediate. Scene time beyond immediate life threats approaches zero. 8 minutes to a trauma center with a hemodynamically unstable patient means movement within 60-90 seconds of arrival.
Question 33
You respond to a 58-year-old male with GCS 6 who needs airway management. When you test his gag reflex by touching the posterior pharynx, he gags briefly. You opt for an NPA. As you insert the NPA into the right nostril, you encounter resistance and cannot advance it. What is the correct next step?
Why:Correct. NPA insertion resistance: never force an NPA — significant resistance indicates anatomical obstruction. Try the other nostril. The NPA should advance with gentle steady pressure along the floor of the nasal passage. If resistance continues in both nostrils, reassess whether an OPA is appropriate given the current gag reflex status. Document the difficulty and the approach used.
Question 34
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 35
At a mall corridor, a 44-year-old female hospital radio report should include what?
Why:Correct. A concise report includes patient condition, key findings, care given, and ETA.
Question 36
You respond to a 48-year-old male who was in the ocean and had a close encounter with a jellyfish. He has raised linear welts across his right arm with intense burning pain. His skin is erythematous. HR 108, BP 118/76, SpO2 97%. He is not having systemic reactions. His companion suggests urinating on the sting. What is the evidence-based management?
Why:Correct. Urine (hypotonic) and fresh water trigger remaining nematocyst discharge — both are contraindicated. Seawater rinse does not trigger discharge. Tentacle removal with a barrier (gloves, card). Hot water immersion (as hot as tolerable without burning) inactivates venom proteins. Monitor for systemic anaphylaxis — this patient currently has only localized effects.
Question 37
At a restaurant, a 31-year-old male head injury patient vomits and becomes harder to arouse. What does this suggest?
Why:Correct. Vomiting and declining mental status after head injury suggest worsening neurologic status.
Question 38
At a warehouse, a 27-year-old male breech birth is in progress. What is the EMT-B priority?
Why:Correct. Breech delivery is high risk. Support per protocol, request ALS, and transport rapidly if possible.
Question 39
At a college dorm, a 19-year-old female takes warfarin and fell with a head strike. Why does this matter?
Why:Correct. Anticoagulants increase bleeding risk after trauma, including intracranial bleeding.
Question 40
You are transporting a 58-year-old male in hemorrhagic shock following a high-speed MVC. You have controlled external bleeding with a tourniquet. En route to the hospital he becomes more confused and his BP drops from 88/60 to 72/44. His HR increases from 118 to 138. What is the CORRECT interpretation and action?
Why:Correct. Falling BP and rising HR in a trauma patient indicates decompensating hemorrhagic shock — the body's compensatory mechanisms are failing. This patient needs definitive hemorrhage control in the OR. Notify the receiving facility immediately and transport Priority 1. The window for survival is closing.
Question 41
A poison-control order allows activated charcoal. What must be true before giving it?
Why:Correct. Activated charcoal requires medical direction or protocol and a patient able to protect the airway.
Question 42
At a assisted-living room, a 70-year-old male is awake but has a weak radial pulse after major trauma. What does this suggest?
Why:Correct. A weak radial pulse after trauma suggests possible shock and should raise transport priority.
Question 43
You respond to a 32-year-old male with cystic fibrosis who has an acute exacerbation. He is in moderate distress with SpO2 89%, RR 30, HR 116. He has a significant productive cough with thick purulent sputum. He uses a flutter valve device at home for airway clearance. His parents say he has chronic hypoxia and his baseline SpO2 is 91%. What is the target SpO2 range for supplemental oxygen in this cystic fibrosis patient?
Why:Correct. Cystic fibrosis with chronic hypercapnia and hypoxia is managed like COPD — target SpO2 88-93% to avoid suppressing hypoxic respiratory drive. His baseline of 91% guides therapy. Over-oxygenation can worsen hypercapnia. Titrate low-flow oxygen to just above his baseline, not to 99%.
Question 44
You respond to a reported shooting at a shopping mall. Law enforcement dispatch says one shooter is down but the situation is still developing. You are staged outside. A mall security guard runs out and says there is a critically injured gunshot victim inside the main entrance, approximately 30 feet from the door, and the area appears clear. He offers to escort you in. What is the correct action?
Why:Correct. Active shooter scene clearance requires law enforcement incident command authorization after a systematic tactical sweep. A security guard's visual observation is not a scene clearance. Appearing clear from one vantage point does not confirm the absence of threats. Stage until law enforcement incident command authorizes EMS entry.
Question 45
A 45-year-old female has severe right flank and groin pain and is constantly writhing, unable to stay still. Temperature 37.0 degrees C. What behavioral feature distinguishes renal colic from peritonitis?
Why:Correct. Renal colic = writhing restlessly (movement does not worsen ureteral spasm). Peritonitis = completely still (any movement stretches the inflamed peritoneum and worsens pain dramatically). This behavioral distinction is clinically useful even before other assessments.
Question 46
You respond to a 44-year-old male who was a restrained driver in a frontal collision at moderate speed. He is conscious with GCS 14. HR 118, BP 96/72. He has diffuse left upper quadrant tenderness. No external signs of hemorrhage. His seatbelt sign is visible — a linear bruise across his left upper abdomen from the lap belt. What specific abdominal injury pattern is associated with a seatbelt sign across the upper abdomen?
Why:Correct. Seatbelt sign abdominal pattern: the compressive force of the lap belt over the abdomen during deceleration causes predictable injuries — splenic/hepatic laceration, mesenteric tear, bowel injury, and the Chance fracture (flexion-distraction lumbar spine fracture from the fulcrum effect). Left UQ seatbelt sign with hemodynamic instability = splenic injury until proven otherwise. Priority 1 trauma center.
Question 47
At a mall corridor, a 45-year-old female has taken unknown pills. Which scene item is most useful for ED handoff?
Why:Correct. Medication containers can show drug names, quantities, and doses.
Question 48
A 55-year-old male fell 20 feet. He is unconscious. On rapid trauma assessment, a section of the right chest wall moves inward on inspiration and outward on expiration. What injury causes paradoxical chest wall movement?
Why:Correct. Flail chest: free-floating rib segment moves paradoxically (inward on inspiration, outward on expiration). The underlying pulmonary contusion is the more serious injury. BVM-assisted ventilation if tidal volume is insufficient. Priority 1 ALS transport.
Question 49
When is continuous compression CPR with asynchronous ventilations at 10 per minute appropriate for EMT-Bs?
Why:Correct. Continuous compressions with asynchronous ventilation is appropriate only when a supraglottic or advanced airway device protects the airway. Without an airway device, asynchronous BVM ventilation during compressions inflates the stomach, risking regurgitation and aspiration. Without an advanced airway, EMT-Bs use 30:2.
Question 50
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.
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