NCOEMS Practice Exam 1 – North Carolina EMS Certification
Study Guide, Practice Questions & Exam Review 2026
This document is a comprehensive study resource for candidates preparing for the North
Carolina Office of Emergency Medical Services (NCOEMS) Certification Exam. It covers
essential EMS topics commonly tested on state credentialing examinations, including EMS
operations, patient assessment, airway management, respiration and ventilation, cardiovascular
emergencies, medical emergencies, traumatic injuries, and special patient populations. The guide
includes practice questions, answer explanations, clinical scenarios, and exam-focused review
material designed to strengthen critical-thinking skills and improve readiness for EMT, AEMT,
and Paramedic credentialing examinations. NCOEMS exams are developed from a job task
analysis and assess real-world EMS knowledge and decision-making across multiple domains.
Question 1:
EMTs should wear high-efficiency particulate air (HEPA) respirators when they are in
contact with patients who have which of the following?
A) HIV (Human Immunodeficiency Virus) or AIDS (Acquired Immune Deficiency
Syndrome)
B) Tuberculosis (TB)
C) Open Wounds
D) Hepatitis B
Answer: B) Tuberculosis (TB)
Rationale: HEPA respirators (N95 or higher) are designed to filter airborne particles and
are required when caring for patients with suspected or confirmed airborne diseases such
as tuberculosis. HIV, Hepatitis B, and open wounds require standard precautions but not
HEPA respirators because they are not transmitted via the airborne route.
Question 2:
You are called to assist a 60-year-old female complaining of a severe headache. Upon
entering the home, you smell a strong odor of natural gas. What is your first action?
A) Check the patient's airway, breathing, and circulation.
B) Insert a nasopharyngeal airway and assess vital signs.
,C) Remove the patient from the house to your ambulance.
D) Open all windows and determine the source of the gas leak.
Answer: C) Remove the patient from the house to your ambulance.
Rationale: Scene safety is the EMT's highest priority. The strong odor of natural gas
indicates a potentially explosive environment. The patient must be removed to a safe
location before any assessment or treatment is performed. Opening windows could create
sparks, and staying inside risks both the EMT and patient.
Question 3:
The most common electrical rhythm disturbance that results in sudden cardiac arrest is
called:
A) Pulseless electrical activity
B) Ventricular Fibrillation
C) Ventricular Tachycardia
D) Asystole
Answer: B) Ventricular Fibrillation
Rationale: Ventricular fibrillation (V-fib) is the most common initial rhythm in sudden
cardiac arrest. It is characterized by disorganized electrical activity in the ventricles,
resulting in no effective cardiac output. Early defibrillation is critical for survival. While V-
tach can also cause arrest, V-fib is more common.
Question 4:
A non-trauma patient was pulseless and apneic. Assisted ventilation was attempted, but
unsuccessful. If the head is repositioned and a repeat ventilation is unsuccessful, which
of the following is the next most appropriate step?
A) Check for an airway obstruction.
B) Continue with chest compressions only.
C) Attempt ventilations using an alternative method.
D) Continue to reposition the head until assisted ventilations are successful.
,Answer: A) Check for an airway obstruction.
Rationale: After repositioning the head, if ventilations are still unsuccessful, the next step is
to check for a foreign body airway obstruction. This follows the standard BLS algorithm for
suspected airway obstruction when ventilations fail despite proper head positioning.
Question 5:
During the management of a cardiac arrest, the AED gives a 'no shock advised' message.
Which of the following conditions most likely prompted this message?
A) The patient is in V tach.
B) The patient is hypothermic.
C) The patient is in V fib.
D) The patient's rhythm is asystole.
Answer: D) The patient's rhythm is asystole.
Rationale: An AED delivers a shock only for shockable rhythms (ventricular fibrillation and
pulseless ventricular tachycardia). Asystole (flatline) and pulseless electrical activity (PEA)
are non-shockable rhythms, and the AED will advise "no shock." CPR should continue
immediately.
Question 6:
ALS and EMS providers are preparing to hyperventilate a patient who has a suspected
brainstem herniation. As capnography becomes available, what should be the target
end-tidal carbon-dioxide level during hyperventilation?
A) 20-25 mmHg
B) 60-70 mmHg
C) 30-35 mmHg
D) 40-45 mmHg
*Answer: C) 30-35 mmHg*
*Rationale: For patients with suspected brainstem herniation, controlled hyperventilation
is used to lower intracranial pressure. The target EtCO2 level is 30-35 mmHg, which
, causes cerebral vasoconstriction and reduces cerebral blood volume. Hyperventilation
below 30 mmHg is avoided due to risk of cerebral ischemia.*
Question 7:
Which of the following is the highest priority patient?
A) 57-year-old male with chest pain and systolic blood pressure of 80.
B) 40-year-old female with moderate pain from a leg injury.
C) 75-year-old male who appears confused but responds to commands.
D) 25-year-old female in labor with contractions six minutes apart.
*Answer: A) 57-year-old male with chest pain and systolic blood pressure of 80.*
*Rationale: This patient presents with chest pain (possible cardiac compromise) and
hypotension (SBP 80), indicating shock or a severe cardiac event. This is a life-
threatening condition requiring immediate intervention. The other patients have less
urgent presentations.*
Question 8:
Of the following, which body fluid has the most potential to transmit blood-borne
diseases?
A) Nasal discharge
B) Vomitus
C) Amniotic fluid
D) Feces
Answer: C) Amniotic fluid
Rationale: Amniotic fluid is considered a potentially infectious body fluid and can transmit
blood-borne pathogens if it contains blood. Standard precautions should always be
followed during childbirth. Nasal discharge, vomitus, and feces are generally lower risk
unless visibly bloody.
Study Guide, Practice Questions & Exam Review 2026
This document is a comprehensive study resource for candidates preparing for the North
Carolina Office of Emergency Medical Services (NCOEMS) Certification Exam. It covers
essential EMS topics commonly tested on state credentialing examinations, including EMS
operations, patient assessment, airway management, respiration and ventilation, cardiovascular
emergencies, medical emergencies, traumatic injuries, and special patient populations. The guide
includes practice questions, answer explanations, clinical scenarios, and exam-focused review
material designed to strengthen critical-thinking skills and improve readiness for EMT, AEMT,
and Paramedic credentialing examinations. NCOEMS exams are developed from a job task
analysis and assess real-world EMS knowledge and decision-making across multiple domains.
Question 1:
EMTs should wear high-efficiency particulate air (HEPA) respirators when they are in
contact with patients who have which of the following?
A) HIV (Human Immunodeficiency Virus) or AIDS (Acquired Immune Deficiency
Syndrome)
B) Tuberculosis (TB)
C) Open Wounds
D) Hepatitis B
Answer: B) Tuberculosis (TB)
Rationale: HEPA respirators (N95 or higher) are designed to filter airborne particles and
are required when caring for patients with suspected or confirmed airborne diseases such
as tuberculosis. HIV, Hepatitis B, and open wounds require standard precautions but not
HEPA respirators because they are not transmitted via the airborne route.
Question 2:
You are called to assist a 60-year-old female complaining of a severe headache. Upon
entering the home, you smell a strong odor of natural gas. What is your first action?
A) Check the patient's airway, breathing, and circulation.
B) Insert a nasopharyngeal airway and assess vital signs.
,C) Remove the patient from the house to your ambulance.
D) Open all windows and determine the source of the gas leak.
Answer: C) Remove the patient from the house to your ambulance.
Rationale: Scene safety is the EMT's highest priority. The strong odor of natural gas
indicates a potentially explosive environment. The patient must be removed to a safe
location before any assessment or treatment is performed. Opening windows could create
sparks, and staying inside risks both the EMT and patient.
Question 3:
The most common electrical rhythm disturbance that results in sudden cardiac arrest is
called:
A) Pulseless electrical activity
B) Ventricular Fibrillation
C) Ventricular Tachycardia
D) Asystole
Answer: B) Ventricular Fibrillation
Rationale: Ventricular fibrillation (V-fib) is the most common initial rhythm in sudden
cardiac arrest. It is characterized by disorganized electrical activity in the ventricles,
resulting in no effective cardiac output. Early defibrillation is critical for survival. While V-
tach can also cause arrest, V-fib is more common.
Question 4:
A non-trauma patient was pulseless and apneic. Assisted ventilation was attempted, but
unsuccessful. If the head is repositioned and a repeat ventilation is unsuccessful, which
of the following is the next most appropriate step?
A) Check for an airway obstruction.
B) Continue with chest compressions only.
C) Attempt ventilations using an alternative method.
D) Continue to reposition the head until assisted ventilations are successful.
,Answer: A) Check for an airway obstruction.
Rationale: After repositioning the head, if ventilations are still unsuccessful, the next step is
to check for a foreign body airway obstruction. This follows the standard BLS algorithm for
suspected airway obstruction when ventilations fail despite proper head positioning.
Question 5:
During the management of a cardiac arrest, the AED gives a 'no shock advised' message.
Which of the following conditions most likely prompted this message?
A) The patient is in V tach.
B) The patient is hypothermic.
C) The patient is in V fib.
D) The patient's rhythm is asystole.
Answer: D) The patient's rhythm is asystole.
Rationale: An AED delivers a shock only for shockable rhythms (ventricular fibrillation and
pulseless ventricular tachycardia). Asystole (flatline) and pulseless electrical activity (PEA)
are non-shockable rhythms, and the AED will advise "no shock." CPR should continue
immediately.
Question 6:
ALS and EMS providers are preparing to hyperventilate a patient who has a suspected
brainstem herniation. As capnography becomes available, what should be the target
end-tidal carbon-dioxide level during hyperventilation?
A) 20-25 mmHg
B) 60-70 mmHg
C) 30-35 mmHg
D) 40-45 mmHg
*Answer: C) 30-35 mmHg*
*Rationale: For patients with suspected brainstem herniation, controlled hyperventilation
is used to lower intracranial pressure. The target EtCO2 level is 30-35 mmHg, which
, causes cerebral vasoconstriction and reduces cerebral blood volume. Hyperventilation
below 30 mmHg is avoided due to risk of cerebral ischemia.*
Question 7:
Which of the following is the highest priority patient?
A) 57-year-old male with chest pain and systolic blood pressure of 80.
B) 40-year-old female with moderate pain from a leg injury.
C) 75-year-old male who appears confused but responds to commands.
D) 25-year-old female in labor with contractions six minutes apart.
*Answer: A) 57-year-old male with chest pain and systolic blood pressure of 80.*
*Rationale: This patient presents with chest pain (possible cardiac compromise) and
hypotension (SBP 80), indicating shock or a severe cardiac event. This is a life-
threatening condition requiring immediate intervention. The other patients have less
urgent presentations.*
Question 8:
Of the following, which body fluid has the most potential to transmit blood-borne
diseases?
A) Nasal discharge
B) Vomitus
C) Amniotic fluid
D) Feces
Answer: C) Amniotic fluid
Rationale: Amniotic fluid is considered a potentially infectious body fluid and can transmit
blood-borne pathogens if it contains blood. Standard precautions should always be
followed during childbirth. Nasal discharge, vomitus, and feces are generally lower risk
unless visibly bloody.
