PARAMEDIC NATIONAL REGISTRY
EXAM (NREMT PARAMEDIC)
ACTUAL QUESTIONS AND
CORRECT ANSWERS
LATEST UPDATE THIS YEAR
EXAM SPECIFICATIONS
Time Allocation: 2.5 Hours
Total Questions: 80-150 CAT Adaptive
Question Format: Multiple Choice, Multi-Select, Scenarios
Minimum Competency: Entry-Level Paramedic
Core Focus: Airway, Cardiology, Medical, Trauma, OB/Peds, Operations
NREMT Paramedic Exam Latest Update Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
NREMT Paramedic Exam validates entry-level competency for paramedics per National EMS
Education Standards. Computer Adaptive Test (CAT) 80-150 questions. Tests cognitive knowledge
for National EMS Certification. Psychomotor exam separate.
CONTENT DISTRIBUTION
• Airway, Respiration, Ventilation (18-22%) — RSI, CPAP, BiPAP, surgical airway, capnography
• Cardiology & Resuscitation (20-24%) — ACLS, 12-lead ECG, STEMI, arrhythmias, cardiac arrest
• Trauma (14-18%) — Hemorrhage control, shock, head/spinal injury, burns, PHTLS principles
• Medical/OB/Peds (27-31%) — Stroke, sepsis, anaphylaxis, overdose, DKA, OB emergencies,
pediatric assessment
• EMS Operations (11-15%) — Scene safety, MCI, hazmat, ambulance operations, medical-legal
QUESTION FORMAT & SCORING
Computer Adaptive Test. Correct answers are highlighted in green with checkmark (✓). Every
question includes detailed rationale with AHA, NAEMT, and NREMT standards. Passing = entry-level
competency via CAT algorithm.
STUDY STRATEGY
Master AHA ACLS/PALS algorithms. Know 12-lead interpretation and STEMI criteria. Understand
RSI procedure and difficult airway. Study pharmacology: doses, indications, contraindications.
Review trauma assessment and shock management. Know pediatric vital signs and equipment sizes.
Practice priority questions.
CURRICULUM ALIGNMENT
Questions reflect current standards: AHA 2020 Guidelines, NAEMT PHTLS 9th Ed, NREMT
Paramedic Standards, and National EMS Education Standards.
NREMT Paramedic Exam Latest Update Page 2
, SECTION I: Airway, Respiration, Ventilation
1. RSI (Rapid Sequence Intubation) induction agent of choice for head injury:
A. Ketamine
✓ B. Etomidate
C. Succinylcholine
D. Midazolam
Rationale: RSI for head injury: Etomidate 0.3 mg/kg IV - hemodynamically stable, minimal effect on ICP,
cerebral protective. Ketamine increases ICP - contraindicated. Succinylcholine is paralytic, not induction.
Midazolam causes hypotension. Paralytic: Succinylcholine 1.5 mg/kg or Rocuronium 1 mg/kg.
Pre-oxygenate, Sellick maneuver, confirm with capnography ETCO2 35-45.
2. CPAP indication:
A. Apnea
✓ B. CHF with pulmonary edema, COPD, asthma with respiratory distress
C. Pneumothorax
D. Unconscious patient
Rationale: CPAP: Continuous Positive Airway Pressure for awake, spontaneously breathing patients with
respiratory distress. Indications: CHF/pulmonary edema, COPD, asthma, pneumonia. Contraindications:
Apnea, hypotension SBP <90, pneumothorax, vomiting risk, altered LOC, facial trauma. Settings: 5-15
cmH2O. Monitor: SpO2, work of breathing, BP. Reduces intubation need.
3. Surgical cricothyrotomy indicated when:
A. First attempt at intubation
✓ B. Cannot intubate, cannot ventilate situation
C. Conscious patient
D. Routine airway
Rationale: Surgical cric: Last resort when cannot intubate AND cannot ventilate with BVM/SGA. Indications:
severe facial trauma, airway obstruction, failed RSI. Contraindication: age <8 years (use needle cric).
Landmark: cricothyroid membrane between thyroid and cricoid cartilage. Complications: bleeding,
esophageal perforation, subglottic stenosis. Verify with capnography.
4. Capnography waveform shows normal ETCO2:
A. 0 mmHg
✓ B. 35-45 mmHg with rectangular waveform
C. 100 mmHg
D. Flat line
Rationale: ETCO2 normal 35-45 mmHg. Waveform: Phase I baseline (0), Phase II upstroke, Phase III
plateau (alveolar), Phase IV downstroke. Uses: Confirm ETT placement (gold standard), monitor CPR
quality (ETCO2 >10-20 = good compressions), ROSC (sudden increase), ventilation status. Shark fin =
bronchospasm. Flat line = esophageal intubation, disconnection, cardiac arrest.
5. Pediatric endotracheal tube size for 4-year-old:
NREMT Paramedic Exam Latest Update Page 3
EXAM (NREMT PARAMEDIC)
ACTUAL QUESTIONS AND
CORRECT ANSWERS
LATEST UPDATE THIS YEAR
EXAM SPECIFICATIONS
Time Allocation: 2.5 Hours
Total Questions: 80-150 CAT Adaptive
Question Format: Multiple Choice, Multi-Select, Scenarios
Minimum Competency: Entry-Level Paramedic
Core Focus: Airway, Cardiology, Medical, Trauma, OB/Peds, Operations
NREMT Paramedic Exam Latest Update Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
NREMT Paramedic Exam validates entry-level competency for paramedics per National EMS
Education Standards. Computer Adaptive Test (CAT) 80-150 questions. Tests cognitive knowledge
for National EMS Certification. Psychomotor exam separate.
CONTENT DISTRIBUTION
• Airway, Respiration, Ventilation (18-22%) — RSI, CPAP, BiPAP, surgical airway, capnography
• Cardiology & Resuscitation (20-24%) — ACLS, 12-lead ECG, STEMI, arrhythmias, cardiac arrest
• Trauma (14-18%) — Hemorrhage control, shock, head/spinal injury, burns, PHTLS principles
• Medical/OB/Peds (27-31%) — Stroke, sepsis, anaphylaxis, overdose, DKA, OB emergencies,
pediatric assessment
• EMS Operations (11-15%) — Scene safety, MCI, hazmat, ambulance operations, medical-legal
QUESTION FORMAT & SCORING
Computer Adaptive Test. Correct answers are highlighted in green with checkmark (✓). Every
question includes detailed rationale with AHA, NAEMT, and NREMT standards. Passing = entry-level
competency via CAT algorithm.
STUDY STRATEGY
Master AHA ACLS/PALS algorithms. Know 12-lead interpretation and STEMI criteria. Understand
RSI procedure and difficult airway. Study pharmacology: doses, indications, contraindications.
Review trauma assessment and shock management. Know pediatric vital signs and equipment sizes.
Practice priority questions.
CURRICULUM ALIGNMENT
Questions reflect current standards: AHA 2020 Guidelines, NAEMT PHTLS 9th Ed, NREMT
Paramedic Standards, and National EMS Education Standards.
NREMT Paramedic Exam Latest Update Page 2
, SECTION I: Airway, Respiration, Ventilation
1. RSI (Rapid Sequence Intubation) induction agent of choice for head injury:
A. Ketamine
✓ B. Etomidate
C. Succinylcholine
D. Midazolam
Rationale: RSI for head injury: Etomidate 0.3 mg/kg IV - hemodynamically stable, minimal effect on ICP,
cerebral protective. Ketamine increases ICP - contraindicated. Succinylcholine is paralytic, not induction.
Midazolam causes hypotension. Paralytic: Succinylcholine 1.5 mg/kg or Rocuronium 1 mg/kg.
Pre-oxygenate, Sellick maneuver, confirm with capnography ETCO2 35-45.
2. CPAP indication:
A. Apnea
✓ B. CHF with pulmonary edema, COPD, asthma with respiratory distress
C. Pneumothorax
D. Unconscious patient
Rationale: CPAP: Continuous Positive Airway Pressure for awake, spontaneously breathing patients with
respiratory distress. Indications: CHF/pulmonary edema, COPD, asthma, pneumonia. Contraindications:
Apnea, hypotension SBP <90, pneumothorax, vomiting risk, altered LOC, facial trauma. Settings: 5-15
cmH2O. Monitor: SpO2, work of breathing, BP. Reduces intubation need.
3. Surgical cricothyrotomy indicated when:
A. First attempt at intubation
✓ B. Cannot intubate, cannot ventilate situation
C. Conscious patient
D. Routine airway
Rationale: Surgical cric: Last resort when cannot intubate AND cannot ventilate with BVM/SGA. Indications:
severe facial trauma, airway obstruction, failed RSI. Contraindication: age <8 years (use needle cric).
Landmark: cricothyroid membrane between thyroid and cricoid cartilage. Complications: bleeding,
esophageal perforation, subglottic stenosis. Verify with capnography.
4. Capnography waveform shows normal ETCO2:
A. 0 mmHg
✓ B. 35-45 mmHg with rectangular waveform
C. 100 mmHg
D. Flat line
Rationale: ETCO2 normal 35-45 mmHg. Waveform: Phase I baseline (0), Phase II upstroke, Phase III
plateau (alveolar), Phase IV downstroke. Uses: Confirm ETT placement (gold standard), monitor CPR
quality (ETCO2 >10-20 = good compressions), ROSC (sudden increase), ventilation status. Shark fin =
bronchospasm. Flat line = esophageal intubation, disconnection, cardiac arrest.
5. Pediatric endotracheal tube size for 4-year-old:
NREMT Paramedic Exam Latest Update Page 3
