Free NREMT Practice Questions
Patient Assessment
Build a working impression fast. Trend vitals, identify life threats, and stay protocol‑true under stress.
What you'll master
- ✓Primary vs secondary priorities and when to switch
- ✓Vital trends and reassessment cadence
- ✓History that changes care decisions
- ✓Transport urgency and destination logic
Common misses
- –Skipping reassessment after an intervention
- –Treating labels instead of threats
- –Missing time‑critical red flags
Sample questions.
25 free patient assessment 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
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 2
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 3
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 4
You respond to a 62-year-old female who reports that her hands go pale then turn blue then red when she goes outside in the cold. Today both hands are white and she reports numbness and pain in her fingers. She warms her hands and they slowly return to normal color. She has no trauma history. HR 76, BP 126/78, SpO2 98%. What is this triphasic color change of the digits in response to cold called?
Why:Correct. Raynaud's phenomenon: vasospasm of digital arteries triggered by cold (or stress) causes triphasic color change — white (vasospasm/ischemia), blue (cyanosis from stagnant blood), red (reactive hyperemia). Primary Raynaud's is benign vasospasm. Secondary Raynaud's is associated with connective tissue diseases (scleroderma, lupus). Warm the hands, transport for workup.
Question 5
At a office lobby, a 57-year-old female says chest pain moves into the jaw. Which OPQRST element is this?
Why:Correct. Radiation describes where pain travels.
Question 6
At a dialysis center, a 67-year-old male with chest pain says it improves when sitting forward. What does this belong to?
Why:Correct. Factors that improve or worsen pain are provocation/palliation details.
Question 7
You respond to a 48-year-old male with severe right flank pain, hematuria, and nausea. He is unable to stay still. Temperature is 37.0 degrees C. His BGL is 96. As you assess him he reports tingling in his right groin and scrotum. What does the radiation of ureteral pain to the groin and scrotum indicate about the stone's location?
Why:Correct. Ureteral stone pain radiation: as the stone migrates distally the pain tracks down the ureter dermatomal distribution — flank (upper ureter) → groin (mid-ureter) → scrotum/labia (distal ureter/UVJ). Distal ureteral stones are the most painful due to the narrow UVJ. This radiation pattern helps localize stone position. Transport for CT evaluation.
Question 8
You respond to a 66-year-old male reporting dizziness and weakness on his right side that started 45 minutes ago while eating breakfast. His wife states his speech sounds garbled. On arrival he has left-sided facial droop, right arm drift on arm raise, and slurred speech. His last known well time was 45 minutes ago. Vital signs: HR 88, BP 196/114, SpO2 96%, GCS 12. What is the PRIORITY action?
Why:Correct. The Cincinnati Stroke Scale identifies three findings: facial droop, arm drift, and speech abnormality — all three are present here. Last known well time of 45 minutes makes this patient potentially eligible for thrombolytics at the hospital. Priority 1 transport to a stroke center is the critical action. Aspirin is contraindicated until hemorrhagic stroke is ruled out by CT.
Question 9
You respond to a 38-year-old female with sudden onset of right-sided facial pain described as a brief electric shock quality lasting 2-3 seconds. It is triggered by touching her cheek or eating. She has had 6 of these episodes today. She has no weakness or numbness between episodes. GCS is 15, BP 128/82. What cranial nerve is involved in the most severe facial pain syndrome in medicine?
Why:Correct. Trigeminal neuralgia involves CN V (trigeminal nerve). Brief electric shock-like unilateral facial pain triggered by light touch or eating in the CN V distribution (face, forehead, jaw) is classic trigeminal neuralgia (tic douloureux). One of the most severe pain conditions. Transport for neurological evaluation. Do not trigger pain during assessment — these attacks are extraordinarily painful.
Question 10
You respond to a 48-year-old male who is very agitated and confused. He is pacing the room, swinging his arms. Temperature is 40.2 degrees C. HR is 178. BP is 168/108. His pupils are 8 mm bilaterally. He is sweating profusely. He has spontaneous rhythmic jerking of both lower legs. He took fluoxetine for depression and sumatriptan for migraines today. What do the spontaneous lower leg muscle jerks (clonus) specifically distinguish from a pure sympathomimetic toxidrome?
Why:Correct. Serotonin syndrome vs sympathomimetic toxidrome: both cause hyperthermia, tachycardia, hypertension, agitation, diaphoresis, dilated pupils. The distinguishing feature: serotonin syndrome produces CLONUS and HYPERREFLEXIA from spinal serotonin receptor activation causing neuromuscular excitability. Sympathomimetics do not. Fluoxetine + sumatriptan = two serotonergic agents = serotonin syndrome. Cooling priority. ALS urgently.
Question 11
A patient with abdominal pain says it began suddenly while lifting. Which OPQRST element is this?
Why:Correct. Onset asks when and how the complaint began.
Question 12
A stable fall patient has wrist pain. What secondary assessment is most useful?
Why:Correct. A focused exam of the injured area with distal pulse, motor, and sensation is appropriate after primary threats are ruled out.
Question 13
You respond to a 55-year-old male with sudden onset severe right flank pain. He is writhing on the gurney and cannot find a comfortable position. The pain radiates to his right groin and testicle. He is nauseated. His urine appears pink. Temperature is 37.1 degrees C. HR is 118 (pain-driven), BP is 132/84. His abdomen is soft and non-tender. What is the single most important distinction between this presentation and an abdominal aortic aneurysm?
Why:Correct. Renal colic vs ruptured AAA: ruptured AAA = pulsatile midline mass + hemodynamic collapse (BP 72/44) + inability to move without severe pain. Renal colic = writhing in pain (ureteral spasm not worsened by movement) + soft abdomen + no pulsatile mass + normal hemodynamics. The absence of hemodynamic compromise and absent pulsatile mass are the key distinguishing features.
Question 14
At a manufacturing floor, during reassessment, a patient's respiratory rate rises and SpO2 falls. What does this show?
Why:Correct. Worsening vital signs indicate deterioration and require action.
Question 15
You respond to a 55-year-old female who complains of 3 months of fatigue, weight gain despite dieting, depression, and constipation. She is constantly cold. Today she feels confused. HR 52, BP 102/66, temperature 35.8 degrees C, GCS 12. She is pale with dry coarse skin, and her eyebrows appear thinned particularly at the outer third. What is the significance of outer third eyebrow thinning?
Why:Correct. Queen Anne's sign (lateral eyebrow thinning) is a classic hypothyroid finding from reduced thyroid hormone effects on hair follicles. Combined with the full constellation of hypothyroid symptoms and hemodynamic compromise (bradycardia, hypothermia, hypotension) and AMS this is myxedema coma. Priority 1 ALS for IV levothyroxine and supportive care.
Question 16
A 33-year-old female at 8 weeks gestation has sudden onset severe right lower quadrant pain with HR 132, BP 78/44, pallor, and diaphoresis. What is this presentation until proven otherwise?
Why:Correct. Hemodynamic collapse (HR 132, BP 78/44) plus sudden severe lower quadrant pain in an 8-week pregnancy is ruptured ectopic pregnancy until proven otherwise. The fertilized egg implanted outside the uterus ruptures as it grows, causing massive intraperitoneal hemorrhage. Every minute without surgery is potentially fatal. Priority 1 surgical transport.
Question 17
You respond to a 61-year-old male who has been vomiting large amounts of blood for the past 2 hours. He reports this has happened before. He has known liver cirrhosis and has had fluid drained from his abdomen twice this year. His abdomen is visibly distended. HR is 148, BP is 64/38, GCS is 11. On examination you note prominent dilated veins on his abdominal wall radiating outward from the umbilicus. What is this venous pattern called and what does it indicate?
Why:Correct. Caput medusae: dilated collateral veins radiating from the umbilicus caused by portal hypertension forcing blood through recanalized paraumbilical veins. Classic finding of portal hypertension from cirrhosis. Combined with hematemesis, ascites, and hemodynamic collapse in a cirrhotic = esophageal variceal hemorrhage. Priority 1 ALS transport — aspiration of blood is an immediate airway risk.
Question 18
You respond to a 34-year-old female with severe fatigue and palpitations for 3 months. She has been having heavy menstrual periods for years. HR is 118, BP is 108/72, SpO2 is 97%. On inspection her conjunctivae appear very pale (pallor). Her nails have a concave spoon-shaped appearance (koilonychia). She feels short of breath on minimal exertion. What do pale conjunctivae and koilonychia together suggest?
Why:Correct. Iron deficiency anemia: koilonychia (spoon-shaped concave nails from iron depletion) plus pale conjunctivae plus compensatory tachycardia in a woman with heavy menstrual periods. Iron deficiency is the most common cause of anemia worldwide. The tachycardia and dyspnea are compensatory responses to reduced oxygen-carrying capacity. Transport for CBC and iron studies.
Question 19
You respond to a 64-year-old male with severe flank pain that started suddenly 1 hour ago. He describes the pain as 10 out of 10, colicky, and radiating from his right flank down to his right groin and testicle. He is writhing and cannot find a comfortable position. His urine appears pink. HR 124 (pain-driven), BP 142/88, SpO2 97%, temperature 37.2 degrees C. On palpation his abdomen is soft and non-tender. What does a soft non-tender abdomen distinguish this from?
Why:Correct. Key distinction: peritoneal irritation causes rigidity and a patient lying completely still (movement worsens pain). Renal colic patients writhe and cannot find a comfortable position because ureteral spasm is not worsened by movement. Soft non-tender abdomen plus writhing plus radiating colicky pain plus hematuria = renal colic.
Question 20
You respond to an assisted living facility for a 79-year-old female with sudden onset difficulty speaking. She can follow commands and squeeze your hand but cannot form words. Her face is symmetric, both arms lift equally, but she cannot speak. Her husband states she was speaking normally 30 minutes ago. Vital signs: HR 82, BP 168/106, SpO2 96%. What does isolated expressive aphasia without motor deficits suggest and what is the management?
Why:Correct. Expressive aphasia — inability to produce speech while comprehension and motor function remain intact — localizes to Broca area in the left frontal hemisphere. This is an ischemic stroke until proven otherwise. Last known well of 30 minutes makes this patient potentially within the thrombolytic window. Priority 1 stroke center transport. Do not delay for extended on-scene assessment.
Question 21
You respond to a 55-year-old male with confusion. His wife says he may have taken too many of his phenytoin (Dilantin) tablets. On assessment: horizontal nystagmus on lateral gaze, slurred speech, and ataxia. BGL is 98. GCS 12. What signs are classic for phenytoin toxicity?
Why:Correct. Phenytoin toxicity classic triad: nystagmus (early), ataxia (moderate), dysarthria (moderate-severe). Cerebellar and vestibular toxicity. BGL 98 rules out hypoglycemia. Priority 1 ALS transport for phenytoin level and possible activated charcoal.
Question 22
At a church basement, a 63-year-old male says chest pressure started while shoveling snow. Which OPQRST element is this?
Why:Correct. Onset asks when and how the complaint began.
Question 23
At a church basement, during reassessment, a patient's respiratory rate rises and SpO2 falls. What does this show?
Why:Correct. Worsening vital signs indicate deterioration and require action.
Question 24
You respond to a 31-year-old male at a construction site who fell approximately 15 feet from scaffolding onto a hard surface. He is conscious but confused. He has a deformity to his left femur and a laceration to his scalp actively bleeding. As you approach you note he is struggling to breathe with an RR of 32 and SpO2 of 88%. His partner says he hit the scaffolding with his chest before hitting the ground. Which injury takes priority?
Why:Correct. Primary assessment priority: airway then breathing then circulation. SpO2 88% and RR 32 are immediate life threats that take priority over visible but not immediately life-threatening injuries. The chest impact mechanism suggests pneumothorax or flail chest. Manage the breathing immediately.
Question 25
At a soccer field, you treated wheezing with an inhaler assist. What should you assess next?
Why:Correct. Every intervention requires reassessment of symptoms, vitals, and patient response.
Keep going
The exam mixes domains. So should your practice.
Questions only get you so far.
Run a live patient assessment scenario and get graded on decision order and timing, not just the right answer — plus the full 2025 question bank and PCR training in Student Pro.