National Registry
Paramedic Cognitive
Examination (NRP) —
Advanced Practice
Question Bank a well
detailed exam 2025/2026
graded A+ upgraded !!!
Exam Format: Computer-Adaptive Test (CAT) | 110–150 questions | 2.5-hour time limit |
Passing standard: scaled score of 950/1500
Content Domains: Airway, Respiration & Ventilation (8–12%) | Cardiology &
Resuscitation (10–14%) | Trauma (6–10%) | Medical/Obstetrics/Gynecology (24–28%) |
EMS Operations (8–12%) | Clinical Judgment (34–38%)
,AIRWAY, RESPIRATION & VENTILATION (Questions 1–25)
1. A 68-year-old male with a history of COPD presents with severe respiratory
distress, tripod positioning, and audible stridor. You note absent breath sounds on
the left side and hyperresonance to percussion. Which of the following is the
MOST appropriate immediate intervention?
A. Needle decompression at the 2nd intercostal space, midclavicular line
B. Endotracheal intubation with rapid sequence induction
C. Bilateral pleural decompression followed by intubation
D. Continuous positive airway pressure (CPAP) at 10 cm H₂O
Correct Answer: A
Rationale: The presentation of respiratory distress with absent breath sounds and
hyperresonance on one side is consistent with a tension pneumothorax. Needle
decompression at the 2nd intercostal space, midclavicular line on the affected side is the
immediate life-saving intervention. Intubation without decompression would worsen the
condition by increasing intrathoracic pressure. CPAP is contraindicated in tension
pneumothorax as it can worsen the pneumothorax.
2. You are preparing to perform rapid sequence intubation (RSI) on a 45-year-old
trauma patient with a GCS of 6. Which of the following medication sequences is
CORRECT for RSI?
A. Etomidate 0.3 mg/kg followed by succinylcholine 1.5 mg/kg
B. Succinylcholine 1.5 mg/kg followed by etomidate 0.3 mg/kg
C. Ketamine 2 mg/kg followed by rocuronium 1 mg/kg
D. Midazolam 5 mg followed by vecuronium 0.1 mg/kg
,Correct Answer: A
Rationale: The correct RSI sequence is sedation (induction agent) followed by
neuromuscular blockade. Etomidate (0.3 mg/kg) provides sedation with hemodynamic
stability, followed by succinylcholine (1.5 mg/kg) for rapid paralysis. Ketamine is an
alternative induction agent but is typically dosed at 1–2 mg/kg IV. Reversing the order
(paralytic before sedation) is a critical error that causes awareness during paralysis.
3. A 7-year-old child with epiglottitis is in severe respiratory distress. Which of the
following findings would MOST strongly suggest the need for immediate surgical
airway intervention?
A. Stridor that improves with positioning
B. Drooling and inability to swallow
C. Complete airway obstruction with inability to ventilate
D. Fever of 39.5°C (103.1°F)
Correct Answer: C
Rationale: Complete airway obstruction with inability to ventilate is an immediate
indication for surgical airway (cricothyrotomy in adults, needle cricothyrotomy in
children). Stridor improving with positioning is reassuring. Drooling and fever are
common findings in epiglottitis but do not alone indicate surgical airway. The "can't
intubate, can't ventilate" scenario is the absolute indication for surgical airway.
4. Which of the following waveform capnography patterns is MOST consistent
with severe bronchospasm in a patient with status asthmaticus?
, A. Normal rectangular waveform with rapid upstroke and plateau
B. Shark fin appearance with prolonged downsloping
C. Curtain effect with progressively decreasing amplitude
D. Absent waveform with ETCO₂ of 0 mmHg
Correct Answer: B
Rationale: The "shark fin" appearance on capnography—characterized by a prolonged,
sloping downstroke—is classic for bronchospasm and obstructive airway disease. This
pattern reflects slow, prolonged exhalation through narrowed airways. A normal
rectangular waveform indicates unobstructed airflow. The curtain effect suggests
inadequate sampling or disconnection. An absent waveform indicates esophageal
intubation or complete airway obstruction.
5. You are ventilating a 3200g newborn with a bag-valve-mask device. The heart
rate is 60 bpm despite 30 seconds of effective ventilation with room air. What is
the NEXT step?
A. Continue ventilation with room air for another 30 seconds
B. Begin chest compressions at a 3:1 compression-to-ventilation ratio
C. Administer epinephrine 0.1 mg/kg via endotracheal tube
D. Initiate positive pressure ventilation with 100% oxygen
Correct Answer: B
Rationale: In neonatal resuscitation, if the heart rate remains below 60 bpm after 30
seconds of effective positive pressure ventilation, chest compressions should be initiated
at a 3:1 ratio (90 compressions, 30 breaths per minute). The 2025 AHA guidelines
emphasize this threshold. Epinephrine is indicated only after chest compressions have
been started and the heart rate remains <60 bpm. The neonate is already being
ventilated; the issue is inadequate perfusion.
Paramedic Cognitive
Examination (NRP) —
Advanced Practice
Question Bank a well
detailed exam 2025/2026
graded A+ upgraded !!!
Exam Format: Computer-Adaptive Test (CAT) | 110–150 questions | 2.5-hour time limit |
Passing standard: scaled score of 950/1500
Content Domains: Airway, Respiration & Ventilation (8–12%) | Cardiology &
Resuscitation (10–14%) | Trauma (6–10%) | Medical/Obstetrics/Gynecology (24–28%) |
EMS Operations (8–12%) | Clinical Judgment (34–38%)
,AIRWAY, RESPIRATION & VENTILATION (Questions 1–25)
1. A 68-year-old male with a history of COPD presents with severe respiratory
distress, tripod positioning, and audible stridor. You note absent breath sounds on
the left side and hyperresonance to percussion. Which of the following is the
MOST appropriate immediate intervention?
A. Needle decompression at the 2nd intercostal space, midclavicular line
B. Endotracheal intubation with rapid sequence induction
C. Bilateral pleural decompression followed by intubation
D. Continuous positive airway pressure (CPAP) at 10 cm H₂O
Correct Answer: A
Rationale: The presentation of respiratory distress with absent breath sounds and
hyperresonance on one side is consistent with a tension pneumothorax. Needle
decompression at the 2nd intercostal space, midclavicular line on the affected side is the
immediate life-saving intervention. Intubation without decompression would worsen the
condition by increasing intrathoracic pressure. CPAP is contraindicated in tension
pneumothorax as it can worsen the pneumothorax.
2. You are preparing to perform rapid sequence intubation (RSI) on a 45-year-old
trauma patient with a GCS of 6. Which of the following medication sequences is
CORRECT for RSI?
A. Etomidate 0.3 mg/kg followed by succinylcholine 1.5 mg/kg
B. Succinylcholine 1.5 mg/kg followed by etomidate 0.3 mg/kg
C. Ketamine 2 mg/kg followed by rocuronium 1 mg/kg
D. Midazolam 5 mg followed by vecuronium 0.1 mg/kg
,Correct Answer: A
Rationale: The correct RSI sequence is sedation (induction agent) followed by
neuromuscular blockade. Etomidate (0.3 mg/kg) provides sedation with hemodynamic
stability, followed by succinylcholine (1.5 mg/kg) for rapid paralysis. Ketamine is an
alternative induction agent but is typically dosed at 1–2 mg/kg IV. Reversing the order
(paralytic before sedation) is a critical error that causes awareness during paralysis.
3. A 7-year-old child with epiglottitis is in severe respiratory distress. Which of the
following findings would MOST strongly suggest the need for immediate surgical
airway intervention?
A. Stridor that improves with positioning
B. Drooling and inability to swallow
C. Complete airway obstruction with inability to ventilate
D. Fever of 39.5°C (103.1°F)
Correct Answer: C
Rationale: Complete airway obstruction with inability to ventilate is an immediate
indication for surgical airway (cricothyrotomy in adults, needle cricothyrotomy in
children). Stridor improving with positioning is reassuring. Drooling and fever are
common findings in epiglottitis but do not alone indicate surgical airway. The "can't
intubate, can't ventilate" scenario is the absolute indication for surgical airway.
4. Which of the following waveform capnography patterns is MOST consistent
with severe bronchospasm in a patient with status asthmaticus?
, A. Normal rectangular waveform with rapid upstroke and plateau
B. Shark fin appearance with prolonged downsloping
C. Curtain effect with progressively decreasing amplitude
D. Absent waveform with ETCO₂ of 0 mmHg
Correct Answer: B
Rationale: The "shark fin" appearance on capnography—characterized by a prolonged,
sloping downstroke—is classic for bronchospasm and obstructive airway disease. This
pattern reflects slow, prolonged exhalation through narrowed airways. A normal
rectangular waveform indicates unobstructed airflow. The curtain effect suggests
inadequate sampling or disconnection. An absent waveform indicates esophageal
intubation or complete airway obstruction.
5. You are ventilating a 3200g newborn with a bag-valve-mask device. The heart
rate is 60 bpm despite 30 seconds of effective ventilation with room air. What is
the NEXT step?
A. Continue ventilation with room air for another 30 seconds
B. Begin chest compressions at a 3:1 compression-to-ventilation ratio
C. Administer epinephrine 0.1 mg/kg via endotracheal tube
D. Initiate positive pressure ventilation with 100% oxygen
Correct Answer: B
Rationale: In neonatal resuscitation, if the heart rate remains below 60 bpm after 30
seconds of effective positive pressure ventilation, chest compressions should be initiated
at a 3:1 ratio (90 compressions, 30 breaths per minute). The 2025 AHA guidelines
emphasize this threshold. Epinephrine is indicated only after chest compressions have
been started and the heart rate remains <60 bpm. The neonate is already being
ventilated; the issue is inadequate perfusion.
