Free NREMT Practice Questions
Primary Assessment
Find life threats fast. Airway, breathing, perfusion, and mental status with decisive sequencing.
What you'll master
- ✓ABCs with rapid correction of threats
- ✓Recognition of impending respiratory failure
- ✓Perfusion checks and shock suspicion
- ✓Mental status changes and immediate actions
Common misses
- –Fixating on secondary details
- –Delaying oxygen and ventilation
- –Not treating shock early
Sample questions.
25 free primary 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 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 2
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 3
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 4
You arrive on scene of a single-car MVC. The driver is unconscious in the vehicle. The car is stable on a flat surface and there are no hazards present. You have donned BSI. As you approach the vehicle and open the door to reach the patient, what is the FIRST assessment you perform?
Why:Correct. The first step after scene safety and BSI is establishing unresponsiveness. A patient who appears unconscious may be asleep, heavily sedated, or in a postictal state and may respond to stimulation. Tapping shoulders and shouting while looking for response is the correct first step before any intervention.
Question 5
You respond to a 5-year-old male who was struck by a bicycle. He is lying on the ground, not moving. From across the room you observe: he does not respond to your voice, his chest is barely moving, his color is mottled purple-grey, and he has audible gurgling. Before you reach him, what is your immediate working diagnosis and priority?
Why:Correct. The Pediatric Assessment Triangle (PAT) is designed for assessment from across the room before touching the patient. All three components abnormal (appearance, work of breathing, circulation to skin) = critically ill child with immediate life threats. Approach rapidly, suction the gurgling airway, perform jaw thrust, begin BVM if breathing is inadequate. This child is in cardiopulmonary failure.
Question 6
You respond to a 66-year-old male with altered mental status for 1 hour. Blood glucose is 22 mg/dL. GCS is 10. He is drooling and coughs when attempting to swallow. Can you administer oral glucose?
Why:Correct. Oral glucose requires a patient who can safely swallow and protect their airway. GCS 10 combined with active drooling and coughing on swallowing indicates impaired swallow function — aspiration risk is significant. Buccal gel application without swallowing is acceptable per protocol. ALS for IV dextrose.
Question 7
You respond to a 44-year-old male who collapsed at a gym. He is pulseless and apneic. A gym trainer has been doing CPR for approximately 3 minutes. As you take over compressions your partner attaches the AED. Before the AED analyzes, the trainer says he thinks he felt a pulse and asks if you should stop compressions to check. What is the best response?
Why:Correct. Bystander pulse impression during CPR: do not interrupt compressions for an unverified bystander observation. The AED will analyze imminently and provide objective rhythm information. Any interruption degrades coronary perfusion pressure. If the bystander felt movement, it was likely the compressions themselves or muscle activity — not a pulse. Continue CPR until the AED is ready to analyze.
Question 8
At a church basement, a 64-year-old male has a patent airway but respirations are 6/min. What is the priority intervention?
Why:Correct. Inadequate respiratory rate requires assisted ventilations with oxygen.
Question 9
At a parking garage, a 75-year-old female is cyanotic with poor chest rise. What should be your immediate focus?
Why:Correct. Cyanosis and poor chest rise suggest inadequate oxygenation and ventilation.
Question 10
You respond to a 4-year-old male who was found at the bottom of the family pool. His mother called 911. He is pulseless and apneic. Water temperature is 68 degrees F (20 degrees C). His mother says he has been in the water for approximately 8 minutes. His pupils are fixed and dilated. A bystander suggests not resuscitating. What is the correct decision?
Why:Correct. Fixed dilated pupils in a drowning victim are expected findings from pulselessness and do not indicate irreversible death. Water temperature of 20 degrees C provides moderate cerebral cooling. Pediatric drowning victims have remarkable recovery potential. The not dead until warm and dead principle applies. Begin CPR immediately and continue through transport.
Question 11
At a dialysis center, a 66-year-old male has hives, hoarseness, and dizziness after eating. What life threat should be suspected?
Why:Correct. Skin, airway, and perfusion symptoms suggest anaphylaxis.
Question 12
You respond to a 9-year-old male who was struck by a car while crossing the street. He is conscious and crying. HR is 138, BP is 82/60, SpO2 is 96%, RR is 28. His minimum acceptable SBP using the formula for his age is 88 mmHg. What does a BP of 82/60 with tachycardia indicate?
Why:Correct. Pediatric minimum SBP: 70 + (2 x age in years). For a 9-year-old: 70 + 18 = 88 mmHg minimum. BP 82/60 is below this threshold — the child has decompensated beyond his compensatory vasoconstriction. Tachycardia plus below-minimum BP = decompensated hemorrhagic shock. Children compensate well then deteriorate suddenly. Priority 1 trauma transport immediately.
Question 13
At a assisted-living room, a 68-year-old male has labored breathing and pale clammy skin. Which priority is correct?
Why:Correct. Breathing and perfusion findings are primary assessment priorities.
Question 14
You respond to a 22-year-old male in cardiac arrest with track marks on both arms and a used syringe nearby. Your partner says to give naloxone before CPR. What is the correct sequence?
Why:Correct. Naloxone reverses opioid receptor binding — it does not restart a heart in cardiac arrest. CPR and defibrillation are the priorities in pulseless cardiac arrest. Naloxone is appropriate for respiratory depression with a pulse. In cardiac arrest it is given concurrently after CPR is established.
Question 15
You respond to a 19-year-old female found by her roommate. She is unconscious on the floor of their apartment. GCS is 5. There are no pill bottles visible. No drug paraphernalia. Her roommate says she was fine 4 hours ago. RR is 14 with adequate depth. SpO2 is 97%. HR 118, BP 148/96, temperature 39.2 degrees C. Her pupils are 2 mm bilaterally and reactive. What combination of pinpoint pupils with fever and altered mental status in a young woman without obvious drug use should prompt consideration of?
Why:Correct. Bilateral pinpoint pupils have multiple causes: opioid overdose (most common), pontine hemorrhage, organophosphate toxicity, pilocarpine eye drops. Combined with fever and acute AMS without obvious drug use, CNS infection or pontine hemorrhage must be considered. Administer naloxone to rule out opioids — if no response, the differential expands. ALS intercept urgently.
Question 16
You respond to a report of an unresponsive infant. On arrival a 4-month-old male is found limp and unresponsive in his crib. He is pale and not breathing. You cannot feel a brachial or femoral pulse. CPR training tells you to check the brachial pulse in infants. After 10 seconds you feel no pulse. What is the correct CPR technique for this infant?
Why:Correct. Infant CPR (under 1 year): two-thumb encircling technique is preferred with 2 rescuers (most effective). Compressions at the center of the chest just below the nipple line. Depth: 1.5 inches (about 1/3 anterior-posterior diameter). Rate: 100-120 per minute. Ratio: 3:1 for neonates, 15:2 for infants with 2 rescuers.
Question 17
After two minutes of CPR, the AED announces, "No shock advised." What should the EMT do next?
Why:Correct. The AED determines whether a shock is advised. When no shock is advised, immediately resume CPR for about two minutes, then allow the AED to analyze again. EMTs do not interpret or name the underlying rhythm.
Question 18
At a apartment hallway, a 43-year-old male trauma patient has severe bleeding from the neck. What should you do during primary assessment?
Why:Correct. Major bleeding is an immediate life threat and must be controlled during primary assessment.
Question 19
A patient is apneic and pulseless. What is the immediate priority?
Why:Correct. Cardiac arrest requires immediate CPR and AED use. Vitals and history do not come first.
Question 20
You respond to a 77-year-old female who fell in her home. She is on the floor with right hip pain. HR is 92, BP is 118/76. As you perform your primary assessment she asks you to stop touching her and says she does not want help. She is alert and oriented and appears to understand her situation. How do you assess her decision-making capacity for refusing care?
Why:Correct. Capacity assessment for refusal: four elements: (1) understanding of the situation, (2) understanding the proposed intervention, (3) understanding the risks of refusal, (4) ability to make a consistent reasoned choice. If all four are demonstrated, the patient has capacity. Document your assessment of each element. A fall does not automatically override a competent patient's refusal.
Question 21
You respond to a 19-year-old male found in his dormitory room. He is unconscious with GCS 5. His roommate says he drank heavily and 'took something.' RR is 6, SpO2 is 78%, pupils are 2 mm bilaterally. You have already administered naloxone 4 mg IN with no response after 5 minutes. SpO2 is still 78%. What is the priority intervention regardless of the etiology?
Why:Correct. BVM ventilation is the treatment regardless of etiology: SpO2 78% with RR 6 requires immediate BVM ventilation — this is life-threatening regardless of the cause. Naloxone non-response confirms non-opioid CNS depressant. BVM corrects hypoxia. The etiology of the overdose does not change the airway management imperative.
Question 22
A 34-year-old male with a history of asthma is found sitting upright, speaking one-word sentences, and becoming drowsy. His respirations are 10/min and shallow. SpO2 remains 86% despite oxygen. What should the EMT do next?
Why:Correct. Slow, shallow respirations, hypoxia, exhaustion, and decreasing mental status indicate inadequate ventilation. EMT-B care is immediate BVM-assisted ventilation with high-flow oxygen, rapid transport, and ALS intercept when available.
Question 23
You respond to a 71-year-old male with sudden onset confusion. His wife says he was normal 2 hours ago. GCS is 11. BGL is 42 mg/dL. He has an intact gag reflex and actively swallows his secretions. You plan to administer oral glucose gel. He appears to understand your instructions and can follow simple commands. What is the minimum safe criterion for oral glucose administration?
Why:Correct. Oral glucose administration criteria: (1) conscious with ability to follow commands, (2) intact gag reflex, (3) demonstrated safe swallowing. GCS 11 with intact gag and active secretion swallowing meets all three criteria. Administer buccal glucose gel and monitor for improvement. Reassess GCS after 5 minutes. ALS intercept if no improvement or if mental status deteriorates.
Question 24
At a grocery store, a 36-year-old female answers only when you shout and then becomes quiet. How should this affect care?
Why:Correct. Declining responsiveness is a primary assessment concern and may threaten airway protection.
Question 25
A patient has hives, wheezing, and dizziness after a wasp sting. Which life threat should you suspect?
Why:Correct. Skin findings plus respiratory and perfusion symptoms after a sting suggest anaphylaxis.
Keep going
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