NREMT 2026/2027 ADVANCED
PRACTICE EXAM QUESTIONS AND
ANSWERS
1. A 68-year-old male presents with sudden onset dyspnea and sharp chest pain. He is
tachypneic and has a history of recent hip surgery. Lung sounds are clear bilaterally. Which
finding is most suggestive of a pulmonary embolism?
A. Elevated ST segments in V1-V4
B. Diffuse wheezing
C. S1Q3T3 pattern on ECG
D. Bilateral pedal edema
Answer: C
Conceptual Explanation: While not always present, the S1Q3T3 pattern is a classic ECG
finding for right heart strain associated with pulmonary embolism. Clear lung sounds with
acute dyspnea in a post-surgical patient strongly point to PE.
,2. You are treating a 45-year-old female in septic shock. After a 2L fluid bolus, her BP remains
78/40 mmHg. What is the next most appropriate pharmacological intervention per current
standards?
A. Atropine 1mg IV
B. Norepinephrine infusion
C. Amiodarone 150mg IV
D. Epinephrine 1:1,000 IM
Answer: B
Conceptual Explanation: Norepinephrine is the first-line vasopressor for septic shock that
is refractory to fluid resuscitation to maintain mean arterial pressure.
3. A patient presents with a ‘tearing’ pain between the shoulder blades and a blood pressure
discrepancy of 30 mmHg between the right and left arms. What is the most likely diagnosis?
A. Aortic Dissection
B. Tension Pneumothorax
C. Acute Myocardial Infarction
D. Esophageal Rupture
Answer: A
Conceptual Explanation: Tearing pain radiating to the back and unequal bilateral blood
pressures are hallmark signs of a thoracic aortic dissection.
, 4. During neonatal resuscitation, the heart rate is 50 bpm after 30 seconds of effective
positive pressure ventilation. What is the next step?
A. Initiate chest compressions
B. Administer IV Epinephrine
C. Increase oxygen concentration to 100%
D. Perform endotracheal intubation
Answer: A
Conceptual Explanation: In neonatal resuscitation, if the heart rate remains below 60
bpm despite 30 seconds of effective PPV, chest compressions should be initiated at a 3:1
ratio.
5. Which of the following capnography waveforms would you expect to see in a patient with
an acute asthma exacerbation?
A. Sudden loss of waveform
B. Shark-fin appearance
C. Decreased EtCO2 with rapid rate
D. Increased EtCO2 with plateau
Answer: B
Conceptual Explanation: A ‘shark-fin’ waveform indicates bronchospasm and obstructive
air trapping, commonly seen in asthma and COPD.
PRACTICE EXAM QUESTIONS AND
ANSWERS
1. A 68-year-old male presents with sudden onset dyspnea and sharp chest pain. He is
tachypneic and has a history of recent hip surgery. Lung sounds are clear bilaterally. Which
finding is most suggestive of a pulmonary embolism?
A. Elevated ST segments in V1-V4
B. Diffuse wheezing
C. S1Q3T3 pattern on ECG
D. Bilateral pedal edema
Answer: C
Conceptual Explanation: While not always present, the S1Q3T3 pattern is a classic ECG
finding for right heart strain associated with pulmonary embolism. Clear lung sounds with
acute dyspnea in a post-surgical patient strongly point to PE.
,2. You are treating a 45-year-old female in septic shock. After a 2L fluid bolus, her BP remains
78/40 mmHg. What is the next most appropriate pharmacological intervention per current
standards?
A. Atropine 1mg IV
B. Norepinephrine infusion
C. Amiodarone 150mg IV
D. Epinephrine 1:1,000 IM
Answer: B
Conceptual Explanation: Norepinephrine is the first-line vasopressor for septic shock that
is refractory to fluid resuscitation to maintain mean arterial pressure.
3. A patient presents with a ‘tearing’ pain between the shoulder blades and a blood pressure
discrepancy of 30 mmHg between the right and left arms. What is the most likely diagnosis?
A. Aortic Dissection
B. Tension Pneumothorax
C. Acute Myocardial Infarction
D. Esophageal Rupture
Answer: A
Conceptual Explanation: Tearing pain radiating to the back and unequal bilateral blood
pressures are hallmark signs of a thoracic aortic dissection.
, 4. During neonatal resuscitation, the heart rate is 50 bpm after 30 seconds of effective
positive pressure ventilation. What is the next step?
A. Initiate chest compressions
B. Administer IV Epinephrine
C. Increase oxygen concentration to 100%
D. Perform endotracheal intubation
Answer: A
Conceptual Explanation: In neonatal resuscitation, if the heart rate remains below 60
bpm despite 30 seconds of effective PPV, chest compressions should be initiated at a 3:1
ratio.
5. Which of the following capnography waveforms would you expect to see in a patient with
an acute asthma exacerbation?
A. Sudden loss of waveform
B. Shark-fin appearance
C. Decreased EtCO2 with rapid rate
D. Increased EtCO2 with plateau
Answer: B
Conceptual Explanation: A ‘shark-fin’ waveform indicates bronchospasm and obstructive
air trapping, commonly seen in asthma and COPD.
