Free NREMT Practice Questions
Pharmacology
Indications, contraindications, and dose checks for common EMT medications. No shortcuts.
What you'll master
- ✓Indication vs contraindication checks
- ✓Dose and route selection
- ✓Side effect monitoring
- ✓Medication documentation
Common misses
- –Skipping contraindications
- –Wrong route decisions
- –No monitoring after administration
Sample questions.
25 free pharmacology 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 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 2
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 3
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 4
A 53-year-old female has acute asthma and left her spacer at home. You have a paper cup available. What is the clinical priority regarding improvised spacers?
Why:Correct. Improvised spacers are better than no spacer: any enclosed container that slows aerosol velocity and allows inhalation from it significantly improves lower airway drug deposition. Use the improvised paper cup. Document the device used.
Question 5
You respond to a 33-year-old female in anaphylaxis. You administer epinephrine 0.3 mg IM to her right anterolateral thigh. She improves significantly over 4 minutes. Five minutes after the injection she reports her heart is pounding and she has a severe headache. Her HR is 168 and BP is 182/118. Are these expected findings and do they change your management?
Why:Correct. Tachycardia and hypertension are expected pharmacological effects of epinephrine. These effects are transient and significantly less harmful than the anaphylaxis that was treated. In true anaphylaxis there are no absolute contraindications to epinephrine. Reassure the patient, monitor continuously, and transport. NTG is contraindicated because her anaphylactic state is still evolving.
Question 6
At a clinic waiting room, a 63-year-old male took aspirin before EMS arrival. What should you document?
Why:Correct. Document medication taken before EMS, including dose, time, and response if known.
Question 7
At a train platform, a 38-year-old female EMT-B medication decision varies by state protocol. What should you follow?
Why:Correct. EMT-B medication authorization depends on state and local medical direction.
Question 8
You respond to a 61-year-old male with severe chest pain consistent with ACS. You have administered aspirin 324 mg chewed and are preparing his prescribed nitroglycerin. Before his first dose you check his blood pressure: 136/84. Before his second dose 5 minutes later you check again: 108/68. Before his third dose 5 minutes later you check: 88/56. What do you do?
Why:Correct. Sequential NTG-induced hypotension: SBP dropped to 88 mmHg which is below the absolute threshold of 90 mmHg. Withhold all further NTG. The trend (136 to 108 to 88) shows progressive hypotension — a third dose would likely cause severe hemodynamic compromise. Position supine with legs elevated. Notify receiving facility of NTG-induced hypotension.
Question 9
A patient with anaphylaxis improves after epinephrine but still wheezes and has his prescribed MDI. What may be appropriate?
Why:Correct. Assisting with a prescribed albuterol MDI may be appropriate for wheezing after epinephrine, per protocol.
Question 10
You respond to a 48-year-old male having an asthma attack. He has his prescribed albuterol MDI with a dose counter showing 8 remaining doses. He tells you he has already taken 6 puffs in the past hour with some but incomplete relief. SpO2 is 91%, RR 28. Should you assist with additional albuterol given that he has already used 6 puffs today?
Why:Correct. Albuterol dosing in acute exacerbation: no fixed daily maximum dose limits field treatment of acute severe bronchospasm. Prior home doses do not cap further field treatment. The clinical need (SpO2 91%, significant work of breathing) drives the decision. Assist with 2 more puffs, reassess in 5 minutes, and transport Priority 1 with ALS intercept for a patient with an incomplete response to multiple albuterol treatments.
Question 11
You respond to a 66-year-old female with ACS symptoms. She has her prescribed nitroglycerin. You verify no PDE5 inhibitor use. BP is 136/84. Pain is 8/10. You administer the first NTG dose sublingually. She asks how she will know when it is working. What are the expected effects of a correctly absorbed sublingual nitroglycerin tablet?
Why:Correct. Expected sublingual NTG effects: mild burning or tingling under the tongue confirms sublingual absorption. Headache from cerebral vasodilation is common and expected. BP reduction within 3-5 minutes. Pain relief within 3-5 minutes if ACS is preload-responsive. Absence of burning/tingling may indicate the tablet was swallowed rather than absorbed sublingually — which significantly reduces effectiveness.
Question 12
You respond to a 61-year-old male with chest pain and signs of ACS. He is alert with BP 138/86. He has no PDE5 inhibitor use. He has taken one NTG at home 8 minutes ago with partial relief — pain went from 9/10 to 6/10. You have his prescription bottle with 3 tablets remaining. Can you assist with a second dose?
Why:Correct. Second NTG dose criteria: up to 3 total doses, 3-5 minute intervals, SBP above 90 before each dose, persistent chest pain. It has been 8 minutes (within the interval range), BP 138/86 is above threshold, pain persists. All criteria are met. Assist with the second dose. Document time, BP before and after, and pain score for each dose. Reassess BP before the third dose.
Question 13
A 44-year-old female develops HR 178 and palpitations after receiving 0.3 mg epinephrine IM for anaphylaxis. She says you gave her a heart attack. How do you respond?
Why:Correct. Epinephrine expected side effects: tachycardia, palpitations, anxiety, tremor, and headache are normal beta-adrenergic effects. They are transient (5-15 minutes) and confirm the medication is working as intended. These effects are far less dangerous than progressive anaphylaxis with airway compromise. Reassure the patient and document vital signs and side effects.
Question 14
You respond to a 28-year-old male with a known peanut allergy who is in anaphylaxis. He has been prescribed both an EpiPen (0.3 mg) and a second EpiPen for biphasic reactions. After the first dose his BP improves from 62/40 to 88/62 and his stridor resolves. He is still anxious with some hives. He asks if he should use the second EpiPen right away to prevent a relapse. Should the second EpiPen be given immediately?
Why:Correct. The second epinephrine dose is reserved for: inadequate response to the first dose after 5-15 minutes, or recurrence of anaphylaxis (biphasic reaction). This patient responded — BP improved and stridor resolved. The second dose is held in reserve. Monitor closely for biphasic recurrence. ALS intercept and hospital observation are still required.
Question 15
You respond to a 53-year-old male with ACS symptoms. He has his prescribed NTG. His BP is 144/88. He reports he has been taking his doctor's sample medications including a new medication for pulmonary hypertension that he does not know the name of. He shows you the sample package — it is riociguat (a soluble guanylate cyclase stimulator used for pulmonary hypertension). Is riociguat a contraindication to NTG?
Why:Correct. Riociguat (soluble guanylate cyclase stimulator) absolute contraindication with NTG: both drugs increase cGMP causing vasodilation — their combination produces severe additive hypotension. This is the same mechanism as the PDE5 inhibitor-nitrate interaction. Riociguat is an absolute NTG contraindication. Withhold NTG. Document clearly and communicate to the receiving team. Priority 1 transport.
Question 16
At a grocery store, a 35-year-old female has wheezing after anaphylaxis treatment and has a prescribed inhaler. What is albuterol's role?
Why:Correct. Albuterol may help bronchospasm but does not replace epinephrine for anaphylaxis.
Question 17
You respond to a 55-year-old male with known COPD who is having chest pain. His SpO2 is 86% and RR is 28. He has his prescribed albuterol inhaler. He also has prescribed nitroglycerin. His BP is 94/62. HR is 118. He is diaphoretic. Which medication should you NOT administer and why?
Why:Correct. Nitroglycerin is absolutely contraindicated when SBP is below 90 mmHg. SBP 94 is marginally above 90 but many protocols specify greater than 100 mmHg as the safe threshold. More importantly this patient shows signs of shock (diaphoresis, tachycardia, hypotension) making NTG dangerous. Albuterol for bronchospasm is appropriate. This is one of the most critical drug safety rules.
Question 18
At a college dorm, a 20-year-old female has anaphylaxis with hypotension. What medication is first line?
Why:Correct. Epinephrine is the first-line medication for anaphylaxis per EMT-B protocol.
Question 19
You respond to a 21-year-old male with a known bee sting allergy who was stung 4 minutes ago. He has diffuse hives and his lips are swelling. SpO2 is 97%, HR is 108, BP is 118/76. He has no stridor and no wheezing. He is anxious. He has his prescribed EpiPen. A bystander insists you use the EpiPen immediately. Should you administer epinephrine at this point?
Why:Correct. Epinephrine is for anaphylaxis — systemic involvement with hemodynamic or respiratory compromise. This patient has a localized-appearing allergic reaction with stable vitals and no airway involvement. Monitor very closely for progression — lip angioedema can rapidly involve the tongue and airway. Have the EpiPen ready. Administer immediately if stridor, wheezing, or hypotension develops.
Question 20
You respond to a 53-year-old male with new-onset severe chest pain. He has his prescribed nitroglycerin spray. He also takes amlodipine (Norvasc — a dihydropyridine calcium channel blocker) for hypertension. Unlike non-dihydropyridine CCBs, amlodipine does not significantly affect AV nodal conduction or heart rate. Does amlodipine affect the NTG decision?
Why:Correct. Amlodipine (DHP CCB) plus NTG: both are vasodilators producing additive hypotension. Unlike non-DHP CCBs (diltiazem, verapamil) amlodipine does not cause bradycardia or heart block. NTG can still be given but expect greater-than-usual BP drop. Monitor BP carefully before each dose. Amlodipine is NOT a PDE5 inhibitor and does not produce the NTG-PDE5 inhibitor fatal interaction.
Question 21
At a farm driveway, a 70-year-old male is being assessed. Poison control orders activated charcoal for an alert patient. What route is used?
Why:Correct. Activated charcoal is given orally when ordered and safe for the patient.
Question 22
A wheezing patient has no prescribed inhaler. What should an EMT-B do?
Why:Correct. EMT-B medication assistance must follow protocol and usually requires the patient's own prescribed inhaler.
Question 23
You respond to a 17-year-old male having a severe anaphylactic reaction to shellfish. He has diffuse urticaria, severe angioedema of the lips, and is beginning to wheeze. SpO2 is 91%, HR 152, BP 84/58. He has no prescribed EpiPen. His mother says he should not receive epinephrine because he has a heart condition — a previously repaired ASD (atrial septal defect) that was closed surgically at age 4. Is his cardiac history a contraindication to epinephrine?
Why:Correct. Epinephrine in anaphylaxis has no absolute contraindications. A repaired ASD has no special interaction with epinephrine. The American Academy of Allergy states that in anaphylaxis, epinephrine should never be withheld for fear of side effects — the risk of death from untreated anaphylaxis exceeds any cardiac risk from standard IM epinephrine. Administer immediately.
Question 24
An opioid overdose patient is breathing poorly. What medication may be given per many EMT-B protocols?
Why:Correct. Naloxone is commonly authorized for opioid overdose with respiratory depression, but local protocol controls route and dose.
Question 25
You respond to a 58-year-old male in cardiac arrest. During the resuscitation your ALS partner gives epinephrine 1 mg IV. A bystander who identifies himself as a physician says the dose should be higher — he read a study suggesting higher doses are better. What is the correct response?
Why:Correct. Epinephrine dosing in cardiac arrest: current AHA guidelines specify 1 mg IV/IO every 3-5 minutes. High-dose epinephrine trials have not shown improved survival and may worsen neurological outcomes. Protocol adherence to current evidence-based guidelines is the standard of care. Bystander physician suggestions do not override established protocols — document the suggestion and your continued adherence to protocol.
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