NREMT Paramedic Exam Prep Document
2026/2027 | National Registry EMT-P
Certification | Advanced Prehospital Care |
150 Verified Questions with Detailed
Explanations
SECTION 1: AIRWAY MANAGEMENT &
RESPIRATION (Questions 1-25)
Q1. A 45-year-old male is found apneic with a patent airway and a
palpable carotid pulse. Which initial ventilation rate is most
appropriate?
A) 8–10 breaths/min
B) 10–12 breaths/min
C) 12–20 breaths/min
D) 20–24 breaths/min
Correct Answer: B
Rationale: AHA guidelines for adult respiratory arrest with a perfusing
rhythm recommend 10–12 breaths/min (1 breath every 5–6 seconds).
Hyperventilation reduces venous return and cerebral blood flow, which can
worsen outcomes .
Q2. A 60-year-old male is apneic. The jaw-thrust maneuver fails to
open the airway due to the tongue obstructing. What is the next
most appropriate action?
A) Insert a nasopharyngeal airway (NPA)
B) Insert an oropharyngeal airway (OPA) and ventilate with BVM
C) Perform surgical cricothyrotomy
D) Insert a supraglottic airway (SGA)
Correct Answer: B
,Rationale: The OPA is designed specifically to lift the tongue off the posterior
pharynx, relieving this common cause of obstruction. After placement, BVM
ventilation should be initiated immediately .
Q3. A 56-year-old patient in respiratory distress has diminished
breath sounds, tripod positioning, and SpO₂ of 84% despite oxygen
via non-rebreather. What is the most appropriate next intervention?
A) Nasal cannula at 6 L/min
B) CPAP therapy
C) Oral glucose administration
D) Immediate defibrillation
Correct Answer: B
Rationale: The patient presents with signs of severe respiratory distress
likely due to COPD or pulmonary edema. CPAP improves oxygenation and
decreases preload/afterload. A nasal cannula is insufficient, glucose is
unrelated, and defibrillation is not indicated without a shockable rhythm .
Q4. A 60-year-old with a tracheostomy tube is in respiratory
distress. The inner cannula is clogged with dried secretions. Your
first action is:
A) Remove and replace the inner cannula
B) Suction the tracheostomy tube
C) Ventilate with a BVM over the stoma
D) Deflate the cuff and remove the outer tube
Correct Answer: A
Rationale: Most tracheostomy tubes have a removable inner cannula.
Removing it immediately relieves the obstruction. If no inner cannula is
present, suction or replace the entire tube .
Q5. Which airway structure is primarily responsible for preventing
aspiration during swallowing?
A) Epiglottis
B) Trachea
C) Carina
D) Alveoli
Correct Answer: A
,Rationale: The epiglottis folds over the glottic opening during swallowing,
preventing aspiration. The trachea is an airway conduit, the carina is a
bifurcation point, and alveoli are gas exchange units .
Q6. A patient with severe COPD has an SpO₂ of 78% on room air. You
apply a nasal cannula at 2 L/min. Over 10 minutes, SpO₂ rises to 94%
but the patient becomes lethargic and is breathing 8 times per
minute. What is the most likely cause?
A) Oxygen-induced hypoventilation (Haldane effect)
B) Carbon dioxide narcosis
C) Pulmonary embolism
D) Tension pneumothorax
Correct Answer: B
Rationale: COPD patients with chronic hypercapnia may rely on a hypoxic
drive. High-flow O₂ can worsen hypercapnia, leading to CO₂ narcosis. Target
SpO₂ 88–92% in these patients .
Q7. A trauma patient has noisy, snoring respirations after a head
injury. What is the best initial airway maneuver?
A) Jaw-thrust maneuver
B) Head-tilt chin-lift
C) Insert an oropharyngeal airway
D) Suction the oropharynx
Correct Answer: A
Rationale: For trauma patients with suspected cervical spine injury, the jaw-
thrust maneuver is preferred as it opens the airway without moving the neck,
minimizing the risk of further spinal cord damage .
Q8. A 25-kg child is being ventilated with a BVM at 20 breaths/min.
The chest rises adequately, but SpO₂ remains 88%. What is the next
best action?
A) Increase rate to 30/min
B) Add PEEP of 10 cm H₂O
C) Perform gastric decompression
D) Switch to non-rebreather mask
Correct Answer: C
, Rationale: Gastric distention from positive pressure ventilation can splint the
diaphragm, reducing lung compliance and oxygenation. Decompression via
an orogastric or nasogastric tube can relieve this and improve ventilation .
Q9. A 54-year-old man is short of breath and has rales in both lungs.
He is hypertensive, with a moist cough producing pink frothy
sputum. You should first:
A) Give IV furosemide
B) Intubate immediately
C) Give high-flow oxygen and sit him upright
D) Administer sublingual nitroglycerin
Correct Answer: C
Rationale: Initial management of pulmonary edema is oxygenation and
upright positioning; definitive therapies (diuretics, nitrates) come after
stabilizing airway and oxygenation .
Q10. Confirmation of proper endotracheal tube (ETT) placement
includes which of the following? (Select All That Apply)
A) Bilateral breath sounds
B) Mist in the tube
C) End-tidal CO₂ >30 mmHg after 6 breaths
D) Epigastric gurgling
E) SpO₂ rising
Correct Answer: A, B, C, E
Rationale: Epigastric gurgling (D) indicates esophageal intubation and is an
incorrect placement finding. Bilateral breath sounds, mist in the tube,
adequate EtCO₂, and rising SpO₂ are all positive confirmation indicators .
Q11. A patient with facial burns, stridor, and inability to visualize
the cords has an SpO₂ of 82% on a non-rebreather. What is the best
course of action?
A) Sedate and intubate orally
B) BVM with PEEP and OPA
C) Nasal cannula at 15 L/min
D) Rapid sequence intubation (RSI)
Correct Answer: B
Rationale: The patient has impending airway compromise from upper airway
edema (likely inhalation injury). Non-invasive positive pressure ventilation
2026/2027 | National Registry EMT-P
Certification | Advanced Prehospital Care |
150 Verified Questions with Detailed
Explanations
SECTION 1: AIRWAY MANAGEMENT &
RESPIRATION (Questions 1-25)
Q1. A 45-year-old male is found apneic with a patent airway and a
palpable carotid pulse. Which initial ventilation rate is most
appropriate?
A) 8–10 breaths/min
B) 10–12 breaths/min
C) 12–20 breaths/min
D) 20–24 breaths/min
Correct Answer: B
Rationale: AHA guidelines for adult respiratory arrest with a perfusing
rhythm recommend 10–12 breaths/min (1 breath every 5–6 seconds).
Hyperventilation reduces venous return and cerebral blood flow, which can
worsen outcomes .
Q2. A 60-year-old male is apneic. The jaw-thrust maneuver fails to
open the airway due to the tongue obstructing. What is the next
most appropriate action?
A) Insert a nasopharyngeal airway (NPA)
B) Insert an oropharyngeal airway (OPA) and ventilate with BVM
C) Perform surgical cricothyrotomy
D) Insert a supraglottic airway (SGA)
Correct Answer: B
,Rationale: The OPA is designed specifically to lift the tongue off the posterior
pharynx, relieving this common cause of obstruction. After placement, BVM
ventilation should be initiated immediately .
Q3. A 56-year-old patient in respiratory distress has diminished
breath sounds, tripod positioning, and SpO₂ of 84% despite oxygen
via non-rebreather. What is the most appropriate next intervention?
A) Nasal cannula at 6 L/min
B) CPAP therapy
C) Oral glucose administration
D) Immediate defibrillation
Correct Answer: B
Rationale: The patient presents with signs of severe respiratory distress
likely due to COPD or pulmonary edema. CPAP improves oxygenation and
decreases preload/afterload. A nasal cannula is insufficient, glucose is
unrelated, and defibrillation is not indicated without a shockable rhythm .
Q4. A 60-year-old with a tracheostomy tube is in respiratory
distress. The inner cannula is clogged with dried secretions. Your
first action is:
A) Remove and replace the inner cannula
B) Suction the tracheostomy tube
C) Ventilate with a BVM over the stoma
D) Deflate the cuff and remove the outer tube
Correct Answer: A
Rationale: Most tracheostomy tubes have a removable inner cannula.
Removing it immediately relieves the obstruction. If no inner cannula is
present, suction or replace the entire tube .
Q5. Which airway structure is primarily responsible for preventing
aspiration during swallowing?
A) Epiglottis
B) Trachea
C) Carina
D) Alveoli
Correct Answer: A
,Rationale: The epiglottis folds over the glottic opening during swallowing,
preventing aspiration. The trachea is an airway conduit, the carina is a
bifurcation point, and alveoli are gas exchange units .
Q6. A patient with severe COPD has an SpO₂ of 78% on room air. You
apply a nasal cannula at 2 L/min. Over 10 minutes, SpO₂ rises to 94%
but the patient becomes lethargic and is breathing 8 times per
minute. What is the most likely cause?
A) Oxygen-induced hypoventilation (Haldane effect)
B) Carbon dioxide narcosis
C) Pulmonary embolism
D) Tension pneumothorax
Correct Answer: B
Rationale: COPD patients with chronic hypercapnia may rely on a hypoxic
drive. High-flow O₂ can worsen hypercapnia, leading to CO₂ narcosis. Target
SpO₂ 88–92% in these patients .
Q7. A trauma patient has noisy, snoring respirations after a head
injury. What is the best initial airway maneuver?
A) Jaw-thrust maneuver
B) Head-tilt chin-lift
C) Insert an oropharyngeal airway
D) Suction the oropharynx
Correct Answer: A
Rationale: For trauma patients with suspected cervical spine injury, the jaw-
thrust maneuver is preferred as it opens the airway without moving the neck,
minimizing the risk of further spinal cord damage .
Q8. A 25-kg child is being ventilated with a BVM at 20 breaths/min.
The chest rises adequately, but SpO₂ remains 88%. What is the next
best action?
A) Increase rate to 30/min
B) Add PEEP of 10 cm H₂O
C) Perform gastric decompression
D) Switch to non-rebreather mask
Correct Answer: C
, Rationale: Gastric distention from positive pressure ventilation can splint the
diaphragm, reducing lung compliance and oxygenation. Decompression via
an orogastric or nasogastric tube can relieve this and improve ventilation .
Q9. A 54-year-old man is short of breath and has rales in both lungs.
He is hypertensive, with a moist cough producing pink frothy
sputum. You should first:
A) Give IV furosemide
B) Intubate immediately
C) Give high-flow oxygen and sit him upright
D) Administer sublingual nitroglycerin
Correct Answer: C
Rationale: Initial management of pulmonary edema is oxygenation and
upright positioning; definitive therapies (diuretics, nitrates) come after
stabilizing airway and oxygenation .
Q10. Confirmation of proper endotracheal tube (ETT) placement
includes which of the following? (Select All That Apply)
A) Bilateral breath sounds
B) Mist in the tube
C) End-tidal CO₂ >30 mmHg after 6 breaths
D) Epigastric gurgling
E) SpO₂ rising
Correct Answer: A, B, C, E
Rationale: Epigastric gurgling (D) indicates esophageal intubation and is an
incorrect placement finding. Bilateral breath sounds, mist in the tube,
adequate EtCO₂, and rising SpO₂ are all positive confirmation indicators .
Q11. A patient with facial burns, stridor, and inability to visualize
the cords has an SpO₂ of 82% on a non-rebreather. What is the best
course of action?
A) Sedate and intubate orally
B) BVM with PEEP and OPA
C) Nasal cannula at 15 L/min
D) Rapid sequence intubation (RSI)
Correct Answer: B
Rationale: The patient has impending airway compromise from upper airway
edema (likely inhalation injury). Non-invasive positive pressure ventilation
