Free NREMT Practice Questions
Respiratory Emergencies
Work of breathing, oxygenation, ventilation failure. Escalate support early and reassess often.
What you'll master
- ✓Oxygen vs ventilation decisions
- ✓Failure pattern recognition
- ✓BVM timing and escalation
- ✓Red flags for transport urgency
Common misses
- –Treating hypoxia without ventilation
- –Delayed escalation
- –No reassessment
Sample questions.
25 free respiratory emergencies 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 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 2
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 3
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 4
At a bus terminal, a 52-year-old female has stridor and hives after an insect sting. What does stridor indicate?
Why:Correct. Stridor suggests upper airway narrowing and is a serious sign in anaphylaxis.
Question 5
A young adult with asthma has wheezing, an empty rescue inhaler, and worsening fatigue. What is the best EMT-B plan?
Why:Correct. Without a usable prescribed inhaler and with fatigue, support airway and breathing, oxygenate, request ALS, and transport.
Question 6
You respond to a 34-year-old male with acute severe asthma. After two albuterol treatments he remains in severe distress. SpO2 is 88%, RR 38. His wheeze, which was very loud on arrival, is now almost inaudible. His partner says this means he is getting better. Is this correct?
Why:Correct. Silent chest in severe asthma is a pre-arrest sign. Wheeze requires turbulent airflow. When bronchospasm is so severe that air movement approaches zero, wheeze disappears. This is profoundly different from the wheeze-free breath sounds of a recovered asthmatic. Combined with SpO2 88% and RR 38, near-absent wheeze indicates imminent respiratory arrest. Prepare BVM, Priority 1 ALS intercept.
Question 7
A wheezing patient has a prescribed albuterol inhaler and is alert. What is appropriate for an EMT-B?
Why:Correct. EMT-Basics may assist with the patient's prescribed MDI when wheezing is present and protocol allows.
Question 8
At a train platform, a 37-year-old female fire victim has hoarseness, facial burns, and soot around the mouth. SpO2 reads 98 percent. What is the key concern?
Why:Correct. Hoarseness and soot suggest inhalation injury with possible delayed airway swelling.
Question 9
You respond to an 8-year-old male with inspiratory stridor that started suddenly 2 hours ago. His mother says he has been well until today. He has no fever. He is anxious and is drooling and cannot swallow his secretions. He is sitting bolt upright refusing to lie down. His voice sounds muffled. What presentation distinguishes this from croup?
Why:Correct. Epiglottitis vs croup: Epiglottitis — sudden onset, no viral prodrome, drooling and dysphagia (cannot swallow), muffled voice, prefers sitting bolt upright, no coughing. Croup — gradual onset with viral symptoms, seal-bark cough, inspiratory stridor, responds to humidified air. NEVER examine the epiglottitis throat — stimulation causes complete obstruction. Minimal stimulation and ALS intercept.
Question 10
You respond to a 72-year-old male with a known COPD history who called 911 for severe shortness of breath. He is seated in a tripod position, using accessory muscles, and has pursed-lip breathing. His SpO2 is 82% on room air. His wife says he has had multiple hospitalizations and his pulmonologist told her never to give him too much oxygen. Vital signs: HR 112, BP 148/90, RR 28. What is the CORRECT oxygen delivery for this patient?
Why:Correct. COPD patients with chronic CO2 retention may rely on hypoxic drive for respiratory stimulus. Target SpO2 88-92% using low-flow O2 via nasal cannula. Over-oxygenation can suppress the hypoxic drive and worsen hypercapnia. The goal is adequate — not maximum — oxygenation.
Question 11
You respond to a 52-year-old male with a 3-week history of progressive dyspnea and bilateral lower leg edema. He reports waking at night short of breath and needing to sit up. He has no cardiac history but has been diagnosed with sleep apnea. On assessment his JVD is elevated at 30 degrees, bilateral crackles at the bases, HR 108, BP 142/88, SpO2 91%. He is overweight. What condition caused by obesity and sleep apnea can lead to right heart failure and pulmonary hypertension?
Why:Correct. Obesity hypoventilation syndrome (cor pulmonale): chronic hypoxemia from obesity and sleep apnea causes hypoxic pulmonary vasoconstriction raising pulmonary artery pressure chronically. This leads to right ventricular hypertrophy and eventually right heart failure — cor pulmonale. JVD, peripheral edema, bilateral crackles. High-flow oxygen target 88-92% (chronic CO2 retainer). ALS Priority 1.
Question 12
You respond to a 53-year-old COPD male with 5 days of green sputum and worsening dyspnea. SpO2 on room air is 80%. His wife asks you to apply maximum oxygen because his reading is so low. What is the correct oxygen titration approach?
Why:Correct. COPD patients with chronic CO2 retention depend partly on hypoxic drive because chronic hypercapnia blunts the central CO2 response. High-flow oxygen can suppress this residual drive worsening hypercapnia and respiratory acidosis. Target 88-92%. SpO2 80% requires intervention — titrate from low flow.
Question 13
You respond to a 58-year-old male with sudden dyspnea and right-sided pleuritic chest pain. He works as a cattle farmer and has been ill with a productive cough for 4 days. Today he developed fever, chills, and shaking rigors. Temperature is 40.1 degrees C. HR 128, BP 96/68. SpO2 87%. On auscultation you hear a friction rub over the right lower lobe. What does a pleural friction rub indicate about the pleural space?
Why:Correct. Pleural friction rub: roughened inflamed pleural surfaces rub together during breathing producing a scratchy leathery sound. Pleuritis from bacterial pneumonia (pleuropneumonia) is the most common cause in this context. Combined with fever, rigors, hypoxia, and hemodynamic compromise this is severe pneumonia progressing to septic shock. Priority 1 ALS transport.
Question 14
A 36-year-old female at a train platform has asthma, speaks in one-word phrases, and looks exhausted. What is the priority?
Why:Correct. Exhaustion and one-word speech suggest severe respiratory distress requiring oxygen and ventilatory support as needed.
Question 15
A 31-year-old male has sudden dyspnea, unilateral absent breath sounds, and falling BP after chest trauma. What is EMT-B care?
Why:Correct. EMT-B care is oxygenation, rapid transport, and ALS intercept. Needle decompression is not EMT-B scope.
Question 16
You respond to a 67-year-old male with chronic productive cough, barrel chest, and pursed-lip breathing at rest. He is in moderate respiratory distress with SpO2 90% on his home 2 LPM oxygen. His wife says he has been worse for 3 days with increasing sputum that turned yellow. He is using tripod positioning. RR 28, HR 104, BP 136/82. What is the clinical term for the barrel chest in this COPD patient and what causes it?
Why:Correct. Barrel chest in COPD: chronic air trapping from loss of elastic recoil and airway obstruction causes progressive hyperinflation. The chest wall gradually expands anteroposteriorly into a barrel shape. The diaphragm flattens, reducing its mechanical advantage. This is a chronic structural change indicating significant irreversible emphysema. Manage the acute exacerbation with titrated O2 and ALS transport.
Question 17
A 22-year-old female at a fitness center has asthma, speaks in one-word phrases, and looks exhausted. What is the priority?
Why:Correct. Exhaustion and one-word speech suggest severe respiratory distress requiring oxygen and ventilatory support as needed.
Question 18
A 34-year-old female at a grocery store has asthma, speaks in one-word phrases, and looks exhausted. What is the priority?
Why:Correct. Exhaustion and one-word speech suggest severe respiratory distress requiring oxygen and ventilatory support as needed.
Question 19
A 66-year-old male has sudden dyspnea, unilateral absent breath sounds, and falling BP after chest trauma. What is EMT-B care?
Why:Correct. EMT-B care is oxygenation, rapid transport, and ALS intercept. Needle decompression is not EMT-B scope.
Question 20
At a soccer field, a 30-year-old female fire victim has hoarseness, facial burns, and soot around the mouth. SpO2 reads 98 percent. What is the key concern?
Why:Correct. Hoarseness and soot suggest inhalation injury with possible delayed airway swelling.
Question 21
You respond to a 35-year-old male who is anxious and breathing rapidly. He reports tingling in his fingers and around his mouth and says his hands feel like they are cramping. Vital signs: HR 112, BP 128/82, SpO2 98%, RR 34. He has no cardiac or pulmonary history. His symptoms started after an argument with his partner. His hands show visible carpopedal spasm. What is the MOST likely cause and what is the management?
Why:Correct. Hyperventilation causes hypocapnia (low CO2) which causes cerebral vasoconstriction (perioral tingling) and ionized calcium changes (carpopedal spasm). SpO2 98% confirms adequate oxygenation — the problem is CO2 not O2. Calm reassurance and controlled breathing retraining are appropriate. Always rule out cardiac and pulmonary causes first.
Question 22
You respond to a 44-year-old female who was in a house fire and escaped through a smoke-filled hallway. She is coughing and her voice is hoarse. She has minor facial burns and her eyebrows are singed. SpO2 reads 99%, HR 104, BP 128/82. She feels fine and wants to refuse transport. What is your MOST important concern and how do you address it?
Why:Correct. Supraglottic thermal injury from smoke inhalation causes progressive edema. Patients feel well early then develop complete airway obstruction as edema progresses. SpO2 is unreliable with CO exposure. The window for securing the airway closes. Strongly advise transport and document refusal risk explanation if she declines.
Question 23
At a dialysis center, a 68-year-old male with severe asthma stops wheezing and becomes drowsy. What should this suggest?
Why:Correct. A quiet chest with drowsiness in severe asthma can indicate fatigue and impending respiratory failure.
Question 24
You respond to a 62-year-old male with severe COPD exacerbation. SpO2 is 82%, RR is 36, HR is 128. He is using all accessory muscles and speaks only single words. After 2 albuterol treatments and 2 LPM oxygen, SpO2 improves to 87% but he is still in severe distress. What does failure of the initial treatment to substantially improve SpO2 beyond 87% with severe distress indicate?
Why:Correct. Treatment-refractory severe COPD exacerbation = impending respiratory failure: SpO2 87% with single-word speech, full accessory muscle use, and RR 36 after initial treatment indicates the patient is approaching respiratory arrest. BVM immediately ready. Priority 1 ALS intercept. If he loses consciousness or his breathing effort fails, BVM ventilation will be required.
Question 25
At a soccer field, a 31-year-old female child with croup-like stridor is sitting upright and drooling. What should you avoid?
Why:Correct. Agitation can worsen airway obstruction. Keep the child calm and transport promptly.
Keep going
The exam mixes domains. So should your practice.
Questions only get you so far.
Run a live respiratory emergencies 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.