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NREMT FINAL EXAM 2026 TEST BANK | 150+ PRACTICE QUESTIONS
WITH ANSWERS & RATIONALES | A-GRADE STUDY GUIDE
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1.
A 66-year-old male is found sitting upright in a tripod position, gasping for air, with audible
wheezing and pink frothy sputum around his mouth. His blood pressure is 176/102, heart rate
118, respirations 34 and labored, and oxygen saturation 82% on room air. He states he has a
history of congestive heart failure and stopped taking his medications three days ago.
What is the MOST appropriate initial treatment?
A. Assist ventilations with BVM and high-flow oxygen
B. Administer oxygen via non-rebreather mask
C. Apply CPAP with high-flow oxygen
D. Place patient in supine position and transport immediately
Correct Answer: C
Rationale: This is classic acute pulmonary edema from CHF with severe respiratory
distress but spontaneous respirations. CPAP reduces preload and afterload and improves
oxygenation rapidly.
2.
You respond to a 23-year-old female found unresponsive on a couch by her roommate. There
are empty opioid pill bottles nearby. Her respirations are 6 per minute and shallow, pulse 52,
BP 104/70, pupils are pinpoint, and oxygen saturation is 78% on room air.
What should you do FIRST?
A. Administer naloxone IM
B. Begin chest compressions
C. Assist ventilations with BVM and high-flow oxygen
D. Place patient in recovery position
Correct Answer: C
Rationale: Airway and breathing come before antidotes. Naloxone does not work without
ventilation first.
3.
A 45-year-old construction worker was struck in the chest by a falling beam. He is
tachycardic at 132, hypotensive at 84/56, has jugular vein distention, muffled heart sounds,
and complains of severe chest pain and shortness of breath.
What life-threatening condition is MOST likely present?
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A. Tension pneumothorax
B. Cardiac tamponade
C. Flail chest
D. Hemothorax
Correct Answer: B
Rationale: Beck’s triad — hypotension, JVD, muffled heart sounds — = cardiac
tamponade.
4.
A 71-year-old woman presents with slurred speech, right-sided facial droop, and inability to
lift her right arm. Symptoms began approximately 50 minutes ago. Blood glucose is 112
mg/dL and oxygen saturation is 95%.
What is the MOST critical transport decision?
A. Transport to nearest community hospital
B. Delay transport for IV access
C. Rapid transport to stroke-capable facility
D. Monitor on scene for improvement
Correct Answer: C
Rationale: She is within the tPA window. Time is brain.
5.
A 5-year-old child is found lethargic with flushed skin, hot to the touch, dry mucous
membranes, and a temperature of 104.2°F after being locked in a car for 45 minutes.
What is the MOST appropriate initial treatment?
A. Wrap child in warm blankets
B. Administer aspirin
C. Begin active cooling measures
D. Delay treatment until hospital
Correct Answer: C
Rationale: This is heat stroke — immediate active cooling saves lives.
6.
A 32-year-old female complains of sudden onset lower abdominal pain with vaginal
bleeding. She states she missed her last period. BP 88/54, HR 122, pale and diaphoretic.
What is the MOST likely diagnosis?
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A. Placenta previa
B. Ruptured ectopic pregnancy
C. Abruptio placentae
D. Miscarriage
Correct Answer: B
Rationale: Missed period + hypotension + abdominal pain = ruptured ectopic until proven
otherwise.
7.
A 58-year-old diabetic male is found confused, pale, and diaphoretic. His blood glucose reads
36 mg/dL. He is unable to swallow and does not follow commands.
What is the MOST appropriate treatment?
A. Oral glucose
B. Insulin injection
C. IM glucagon or IV dextrose
D. Encourage sugary drink
Correct Answer: C
Rationale: Altered mental status + hypoglycemia = IV dextrose or IM glucagon only.
8.
A 40-year-old male presents with chest pain radiating to the left arm, nausea, diaphoresis, BP
78/44, HR 48, and cool clammy skin.
Which medication is CONTRAINDICATED?
A. Aspirin
B. Oxygen
C. Nitroglycerin
D. Morphine
Correct Answer: C
Rationale: Hypotension and bradycardia = no nitroglycerin.
9.
You are treating a trauma patient with absent breath sounds on the right side, tracheal
deviation to the left, severe respiratory distress, and hypotension.
This presentation is MOST consistent with:
NREMT FINAL EXAM 2026 TEST BANK | 150+ PRACTICE QUESTIONS
WITH ANSWERS & RATIONALES | A-GRADE STUDY GUIDE
,2|Page
1.
A 66-year-old male is found sitting upright in a tripod position, gasping for air, with audible
wheezing and pink frothy sputum around his mouth. His blood pressure is 176/102, heart rate
118, respirations 34 and labored, and oxygen saturation 82% on room air. He states he has a
history of congestive heart failure and stopped taking his medications three days ago.
What is the MOST appropriate initial treatment?
A. Assist ventilations with BVM and high-flow oxygen
B. Administer oxygen via non-rebreather mask
C. Apply CPAP with high-flow oxygen
D. Place patient in supine position and transport immediately
Correct Answer: C
Rationale: This is classic acute pulmonary edema from CHF with severe respiratory
distress but spontaneous respirations. CPAP reduces preload and afterload and improves
oxygenation rapidly.
2.
You respond to a 23-year-old female found unresponsive on a couch by her roommate. There
are empty opioid pill bottles nearby. Her respirations are 6 per minute and shallow, pulse 52,
BP 104/70, pupils are pinpoint, and oxygen saturation is 78% on room air.
What should you do FIRST?
A. Administer naloxone IM
B. Begin chest compressions
C. Assist ventilations with BVM and high-flow oxygen
D. Place patient in recovery position
Correct Answer: C
Rationale: Airway and breathing come before antidotes. Naloxone does not work without
ventilation first.
3.
A 45-year-old construction worker was struck in the chest by a falling beam. He is
tachycardic at 132, hypotensive at 84/56, has jugular vein distention, muffled heart sounds,
and complains of severe chest pain and shortness of breath.
What life-threatening condition is MOST likely present?
,3|Page
A. Tension pneumothorax
B. Cardiac tamponade
C. Flail chest
D. Hemothorax
Correct Answer: B
Rationale: Beck’s triad — hypotension, JVD, muffled heart sounds — = cardiac
tamponade.
4.
A 71-year-old woman presents with slurred speech, right-sided facial droop, and inability to
lift her right arm. Symptoms began approximately 50 minutes ago. Blood glucose is 112
mg/dL and oxygen saturation is 95%.
What is the MOST critical transport decision?
A. Transport to nearest community hospital
B. Delay transport for IV access
C. Rapid transport to stroke-capable facility
D. Monitor on scene for improvement
Correct Answer: C
Rationale: She is within the tPA window. Time is brain.
5.
A 5-year-old child is found lethargic with flushed skin, hot to the touch, dry mucous
membranes, and a temperature of 104.2°F after being locked in a car for 45 minutes.
What is the MOST appropriate initial treatment?
A. Wrap child in warm blankets
B. Administer aspirin
C. Begin active cooling measures
D. Delay treatment until hospital
Correct Answer: C
Rationale: This is heat stroke — immediate active cooling saves lives.
6.
A 32-year-old female complains of sudden onset lower abdominal pain with vaginal
bleeding. She states she missed her last period. BP 88/54, HR 122, pale and diaphoretic.
What is the MOST likely diagnosis?
, 4|Page
A. Placenta previa
B. Ruptured ectopic pregnancy
C. Abruptio placentae
D. Miscarriage
Correct Answer: B
Rationale: Missed period + hypotension + abdominal pain = ruptured ectopic until proven
otherwise.
7.
A 58-year-old diabetic male is found confused, pale, and diaphoretic. His blood glucose reads
36 mg/dL. He is unable to swallow and does not follow commands.
What is the MOST appropriate treatment?
A. Oral glucose
B. Insulin injection
C. IM glucagon or IV dextrose
D. Encourage sugary drink
Correct Answer: C
Rationale: Altered mental status + hypoglycemia = IV dextrose or IM glucagon only.
8.
A 40-year-old male presents with chest pain radiating to the left arm, nausea, diaphoresis, BP
78/44, HR 48, and cool clammy skin.
Which medication is CONTRAINDICATED?
A. Aspirin
B. Oxygen
C. Nitroglycerin
D. Morphine
Correct Answer: C
Rationale: Hypotension and bradycardia = no nitroglycerin.
9.
You are treating a trauma patient with absent breath sounds on the right side, tracheal
deviation to the left, severe respiratory distress, and hypotension.
This presentation is MOST consistent with:
