Paramedic National Registry Exam 2026 | Advanced EMS
Practice Questions
Question 1
A 68-year-old male presents with crushing substernal chest pain radiating to the left arm. He
is pale, diaphoretic, and hypotensive at 82/50 mmHg. The cardiac monitor shows ST
elevation in leads II, III, and aVF. What is the MOST appropriate medication consideration?
A. Nitroglycerin
B. Aspirin only
C. Dopamine infusion
D. Furosemide
Correct Answer: C. Dopamine infusion
Rationale:
This patient is experiencing an inferior STEMI with hypotension, suggesting possible right
ventricular involvement. Nitroglycerin can significantly worsen hypotension in right
ventricular infarction. Dopamine may help maintain perfusion pressure while transport and
reperfusion are arranged. Aspirin is appropriate but does not address the shock state.
Question 2
A trauma patient has absent breath sounds on the left, severe respiratory distress, jugular
venous distention, and tracheal deviation. What should the paramedic do FIRST?
A. Obtain a 12-lead ECG
B. Perform needle decompression
C. Administer CPAP
D. Start two large-bore IVs
Correct Answer: B. Perform needle decompression
Rationale:
The patient shows classic signs of tension pneumothorax. Immediate decompression is
lifesaving and takes priority over diagnostics or IV access.
Question 3
A 4-year-old child is lethargic with a respiratory rate of 8/min and weak pulses. Which
finding MOST strongly indicates impending respiratory failure?
,A. Nasal flaring
B. Tachycardia
C. Bradycardia
D. Wheezing
Correct Answer: C. Bradycardia
Rationale:
In pediatric patients, bradycardia is often a late and critical sign of hypoxia and impending
respiratory arrest.
Question 4
A patient in ventricular tachycardia becomes pulseless while you are preparing amiodarone.
What is the NEXT intervention?
A. Administer epinephrine
B. Defibrillate immediately
C. Intubate the patient
D. Begin synchronized cardioversion
Correct Answer: B. Defibrillate immediately
Rationale:
Pulseless VT is a shockable rhythm. Immediate defibrillation and high-quality CPR take
priority.
Question 5
A diabetic patient is confused and combative. Blood glucose reads 34 mg/dL. IV access
cannot be established. What is the BEST treatment?
A. Oral glucose
B. Dextrose 50% IV
C. Glucagon IM
D. Epinephrine IM
Correct Answer: C. Glucagon IM
Rationale:
Glucagon is indicated for severe hypoglycemia when IV access is unavailable. Oral glucose
is unsafe in altered patients.
Question 6
, A patient with severe sepsis presents with fever, tachycardia, hypotension, and altered mental
status. Which intervention is MOST important early in management?
A. Fluid resuscitation
B. Sodium bicarbonate
C. Dopamine first-line
D. Immediate pacing
Correct Answer: A. Fluid resuscitation
Rationale:
Aggressive isotonic fluid administration is essential in septic shock to improve perfusion
before vasopressors are considered.
Question 7
You are ventilating an intubated patient and notice progressively increasing resistance with
absent right-sided breath sounds after trauma. What is the MOST likely cause?
A. Pulmonary embolism
B. Esophageal intubation
C. Right mainstem intubation
D. Tension pneumothorax
Correct Answer: D. Tension pneumothorax
Rationale:
Trauma plus worsening ventilation resistance and unilateral absent breath sounds strongly
suggest tension pneumothorax.
Question 8
A patient with a head injury suddenly develops hypertension, bradycardia, and irregular
respirations. This is MOST consistent with:
A. Neurogenic shock
B. Cushing reflex
C. Septic shock
D. Spinal shock
Correct Answer: B. Cushing reflex
Rationale:
Cushing’s triad indicates increased intracranial pressure and impending brain herniation.
Practice Questions
Question 1
A 68-year-old male presents with crushing substernal chest pain radiating to the left arm. He
is pale, diaphoretic, and hypotensive at 82/50 mmHg. The cardiac monitor shows ST
elevation in leads II, III, and aVF. What is the MOST appropriate medication consideration?
A. Nitroglycerin
B. Aspirin only
C. Dopamine infusion
D. Furosemide
Correct Answer: C. Dopamine infusion
Rationale:
This patient is experiencing an inferior STEMI with hypotension, suggesting possible right
ventricular involvement. Nitroglycerin can significantly worsen hypotension in right
ventricular infarction. Dopamine may help maintain perfusion pressure while transport and
reperfusion are arranged. Aspirin is appropriate but does not address the shock state.
Question 2
A trauma patient has absent breath sounds on the left, severe respiratory distress, jugular
venous distention, and tracheal deviation. What should the paramedic do FIRST?
A. Obtain a 12-lead ECG
B. Perform needle decompression
C. Administer CPAP
D. Start two large-bore IVs
Correct Answer: B. Perform needle decompression
Rationale:
The patient shows classic signs of tension pneumothorax. Immediate decompression is
lifesaving and takes priority over diagnostics or IV access.
Question 3
A 4-year-old child is lethargic with a respiratory rate of 8/min and weak pulses. Which
finding MOST strongly indicates impending respiratory failure?
,A. Nasal flaring
B. Tachycardia
C. Bradycardia
D. Wheezing
Correct Answer: C. Bradycardia
Rationale:
In pediatric patients, bradycardia is often a late and critical sign of hypoxia and impending
respiratory arrest.
Question 4
A patient in ventricular tachycardia becomes pulseless while you are preparing amiodarone.
What is the NEXT intervention?
A. Administer epinephrine
B. Defibrillate immediately
C. Intubate the patient
D. Begin synchronized cardioversion
Correct Answer: B. Defibrillate immediately
Rationale:
Pulseless VT is a shockable rhythm. Immediate defibrillation and high-quality CPR take
priority.
Question 5
A diabetic patient is confused and combative. Blood glucose reads 34 mg/dL. IV access
cannot be established. What is the BEST treatment?
A. Oral glucose
B. Dextrose 50% IV
C. Glucagon IM
D. Epinephrine IM
Correct Answer: C. Glucagon IM
Rationale:
Glucagon is indicated for severe hypoglycemia when IV access is unavailable. Oral glucose
is unsafe in altered patients.
Question 6
, A patient with severe sepsis presents with fever, tachycardia, hypotension, and altered mental
status. Which intervention is MOST important early in management?
A. Fluid resuscitation
B. Sodium bicarbonate
C. Dopamine first-line
D. Immediate pacing
Correct Answer: A. Fluid resuscitation
Rationale:
Aggressive isotonic fluid administration is essential in septic shock to improve perfusion
before vasopressors are considered.
Question 7
You are ventilating an intubated patient and notice progressively increasing resistance with
absent right-sided breath sounds after trauma. What is the MOST likely cause?
A. Pulmonary embolism
B. Esophageal intubation
C. Right mainstem intubation
D. Tension pneumothorax
Correct Answer: D. Tension pneumothorax
Rationale:
Trauma plus worsening ventilation resistance and unilateral absent breath sounds strongly
suggest tension pneumothorax.
Question 8
A patient with a head injury suddenly develops hypertension, bradycardia, and irregular
respirations. This is MOST consistent with:
A. Neurogenic shock
B. Cushing reflex
C. Septic shock
D. Spinal shock
Correct Answer: B. Cushing reflex
Rationale:
Cushing’s triad indicates increased intracranial pressure and impending brain herniation.
