National Registry of Emergency
Medical Technicians (NREMT)
Paramedic (NRP)cognitive exam
questions and correct
answers
This document checks on advanced clinical reasoning, pharmacology, trauma management, and
cardiology without multiple-choice options, mirroring the rigorous analytical depth required for
modern paramedic testing.
(Bledsoe, Bryan E., Robert S. Porter, and Richard A. Cherry. Paramedic Care:
Principles & Practice, Vols. 1-7. Emergency Care and Transportation of the Sick
and Injured by Pollak and Andrew)
Section 1: Cardiology and Resuscitation
1. Question: What is the initial pharmacological intervention and specific adult dosage for a
stable patient presenting with symptomatic monomorphic wide-complex tachycardia?
Answer: Amiodarone 150 mg IV/IO administered over 10 minutes.
2. Question: During pediatric cardiac arrest, what is the correct energy dose (in Joules per
kilogram) for the first defibrillation attempt using a manual defibrillator? Answer: 2
J/kg.
3. Question: What specific lead placement modification is utilized to diagnose a suspected
right ventricular myocardial infarction during a 12-lead ECG? Answer: Placement of
lead V4 on the right fifth intercostal space at the midclavicular line, designated as
V4R
4. Question: What is the primary mechanism of action of adenosine when administered for
narrow-complex supraventricular tachycardia (SVT)? Answer: Temporary slowing of
conduction through the atrioventricular (AV) node, interrupting re-entry pathways.
5. Question: In the setting of severe symptomatic bradycardia unresponsive to atropine,
what are the two preferred medications for continuous infusion titration according to
, current advanced cardiac life support guidelines? Answer: Dopamine infusion and
Epinephrine infusion.
6. Question: Calculate the systemic vascular resistance (SVR) implication when a patient
presents with a blood pressure of 70/40 mmHg, warm skin, and bounding pulses
following an acute spinal cord injury. Answer: Pathological vasodilation leading to a
marked decrease in SVR due to loss of sympathetic tone (neurogenic shock).
7. Question: What is the precise electrical joule setting recommendation for biphasic
manual defibrillation during adult ventricular fibrillation arrest when the specific
manufacturer's optimal energy level is unknown? Answer: 120 to 200 Joules.
8. Question: Which cardiac enzyme appears earliest in the serum following acute
myocardial injury, typically rising within 1 to 3 hours? Answer: Myoglobin.
9. Question: What is the primary electrophysiological danger of administering calcium
chloride or calcium gluconate too rapidly via peripheral intravenous access in a non-
cardiac arrest setting? Answer: Severe bradyarrhythmias, coronary artery spasm,
and vein sclerosis/extravasation tissue necrosis.
10. Question: Describe the specific ECG presentation of Brugada syndrome in precordial
leads V1 through V3. Answer: Coved-type ST-segment elevation greater than or
equal to 2 mm followed by a negative T-wave.
Section 2: Airway and Respiration
11. Question: What is the primary anatomical landmark utilized to confirm proper
endotracheal tube placement using direct visualization during laryngoscopy? Answer:
The tip of the endotracheal tube passing directly between the vocal cords.
12. Question: What physiological parameter does quantitative continuous waveform
capnography directly measure and display on the monitor? Answer: End-tidal carbon
dioxide (EtCO 2), reflecting alveolar ventilation and systemic metabolism/perfusion.
13. Question: What is the recommended needle insertion site and gauge size for performing
an emergency needle decompression of a tension pneumothorax in an adult patient?
Answer: Second intercostal space at the midclavicular line or the fifth intercostal
space at the anterior/mid-axillary line using a 14-gauge or 16-gauge, 2-inch to 3.25-
inch angiocatheter.
14. Question: When performing rapid sequence intubation (RSI) on a patient with suspected
severe intracranial pressure elevation, which induction agent is traditionally avoided due
to potential increases in cerebral metabolic rate and cerebral blood flow? Answer:
Ketamine (historically restricted, though modern evidence shows nuanced use;
Etomidate or Thiopental are classical answers for blunting ICP).
, 15. Question: What physical finding during a Mallampati assessment indicates maximum
visualization of posterior pharyngeal structures (Class I)? Answer: The soft palate,
fauces, uvula, and pillars are fully visible.
16. Question: During surgical cricothyroidotomy, what is the precise name of the membrane
incised between the thyroid cartilage and the cricoid cartilage? Answer: The
cricothyroid membrane.
17. Question: What is the immediate physiological consequence of excessive positive
pressure ventilation (hyperventilation) during cardiac arrest resuscitation? Answer:
Increased intrathoracic pressure leading to decreased venous return (preload),
reduced cardiac output, and compromised coronary perfusion pressure.
18. Question: What physical device parameter is utilized to maintain cuff pressure within an
endotracheal tube below 30 cmH 2 Oto prevent tracheal mucosal ischemia? Answer: A
manometer.
19. Question: Define the term "shunt" regarding pulmonary pathophysiology. Answer:
Perfusion of alveoli that are inadequately ventilated, resulting in blood passing
through the pulmonary circulation without gas exchange.
20. Question: What is the standard adult dose and concentration of succinylcholine when
utilized as a neuromuscular blocking agent for rapid sequence intubation? Answer: 1.5
mg/kg IV/IO (maximum typically 200 mg).
Section 3: Pharmacology and Toxicology
21. Question: What is the definitive pharmacological antidote administered for severe
organophosphate poisoning that acts by blocking muscarinic receptors? Answer:
Atropine.
22. Question: What is the mechanism of action of naloxone when reversing an opioid
overdose? Answer: Competitive antagonism at central nervous system opioid
receptors ( μ, κ , δ ).
23. Question: What intravenous fluid is strictly contraindicated in patients presenting with
acute traumatic brain injury due to the risk of exacerbating cellular edema? Answer:
Hypotonic solutions, such as 0.45% Sodium Chloride (half-normal saline) or D5W.
24. Question: In the management of severe tricyclic antidepressant (TCA) toxicity
presenting with wide QRS intervals and ventricular dysrhythmias, what medication is
administered to alkalinize the serum? Answer: Sodium Bicarbonate.
25. Question: What is the primary pharmacological class and action of flumazenil? Answer:
Competitive benzodiazepine receptor antagonist.
Medical Technicians (NREMT)
Paramedic (NRP)cognitive exam
questions and correct
answers
This document checks on advanced clinical reasoning, pharmacology, trauma management, and
cardiology without multiple-choice options, mirroring the rigorous analytical depth required for
modern paramedic testing.
(Bledsoe, Bryan E., Robert S. Porter, and Richard A. Cherry. Paramedic Care:
Principles & Practice, Vols. 1-7. Emergency Care and Transportation of the Sick
and Injured by Pollak and Andrew)
Section 1: Cardiology and Resuscitation
1. Question: What is the initial pharmacological intervention and specific adult dosage for a
stable patient presenting with symptomatic monomorphic wide-complex tachycardia?
Answer: Amiodarone 150 mg IV/IO administered over 10 minutes.
2. Question: During pediatric cardiac arrest, what is the correct energy dose (in Joules per
kilogram) for the first defibrillation attempt using a manual defibrillator? Answer: 2
J/kg.
3. Question: What specific lead placement modification is utilized to diagnose a suspected
right ventricular myocardial infarction during a 12-lead ECG? Answer: Placement of
lead V4 on the right fifth intercostal space at the midclavicular line, designated as
V4R
4. Question: What is the primary mechanism of action of adenosine when administered for
narrow-complex supraventricular tachycardia (SVT)? Answer: Temporary slowing of
conduction through the atrioventricular (AV) node, interrupting re-entry pathways.
5. Question: In the setting of severe symptomatic bradycardia unresponsive to atropine,
what are the two preferred medications for continuous infusion titration according to
, current advanced cardiac life support guidelines? Answer: Dopamine infusion and
Epinephrine infusion.
6. Question: Calculate the systemic vascular resistance (SVR) implication when a patient
presents with a blood pressure of 70/40 mmHg, warm skin, and bounding pulses
following an acute spinal cord injury. Answer: Pathological vasodilation leading to a
marked decrease in SVR due to loss of sympathetic tone (neurogenic shock).
7. Question: What is the precise electrical joule setting recommendation for biphasic
manual defibrillation during adult ventricular fibrillation arrest when the specific
manufacturer's optimal energy level is unknown? Answer: 120 to 200 Joules.
8. Question: Which cardiac enzyme appears earliest in the serum following acute
myocardial injury, typically rising within 1 to 3 hours? Answer: Myoglobin.
9. Question: What is the primary electrophysiological danger of administering calcium
chloride or calcium gluconate too rapidly via peripheral intravenous access in a non-
cardiac arrest setting? Answer: Severe bradyarrhythmias, coronary artery spasm,
and vein sclerosis/extravasation tissue necrosis.
10. Question: Describe the specific ECG presentation of Brugada syndrome in precordial
leads V1 through V3. Answer: Coved-type ST-segment elevation greater than or
equal to 2 mm followed by a negative T-wave.
Section 2: Airway and Respiration
11. Question: What is the primary anatomical landmark utilized to confirm proper
endotracheal tube placement using direct visualization during laryngoscopy? Answer:
The tip of the endotracheal tube passing directly between the vocal cords.
12. Question: What physiological parameter does quantitative continuous waveform
capnography directly measure and display on the monitor? Answer: End-tidal carbon
dioxide (EtCO 2), reflecting alveolar ventilation and systemic metabolism/perfusion.
13. Question: What is the recommended needle insertion site and gauge size for performing
an emergency needle decompression of a tension pneumothorax in an adult patient?
Answer: Second intercostal space at the midclavicular line or the fifth intercostal
space at the anterior/mid-axillary line using a 14-gauge or 16-gauge, 2-inch to 3.25-
inch angiocatheter.
14. Question: When performing rapid sequence intubation (RSI) on a patient with suspected
severe intracranial pressure elevation, which induction agent is traditionally avoided due
to potential increases in cerebral metabolic rate and cerebral blood flow? Answer:
Ketamine (historically restricted, though modern evidence shows nuanced use;
Etomidate or Thiopental are classical answers for blunting ICP).
, 15. Question: What physical finding during a Mallampati assessment indicates maximum
visualization of posterior pharyngeal structures (Class I)? Answer: The soft palate,
fauces, uvula, and pillars are fully visible.
16. Question: During surgical cricothyroidotomy, what is the precise name of the membrane
incised between the thyroid cartilage and the cricoid cartilage? Answer: The
cricothyroid membrane.
17. Question: What is the immediate physiological consequence of excessive positive
pressure ventilation (hyperventilation) during cardiac arrest resuscitation? Answer:
Increased intrathoracic pressure leading to decreased venous return (preload),
reduced cardiac output, and compromised coronary perfusion pressure.
18. Question: What physical device parameter is utilized to maintain cuff pressure within an
endotracheal tube below 30 cmH 2 Oto prevent tracheal mucosal ischemia? Answer: A
manometer.
19. Question: Define the term "shunt" regarding pulmonary pathophysiology. Answer:
Perfusion of alveoli that are inadequately ventilated, resulting in blood passing
through the pulmonary circulation without gas exchange.
20. Question: What is the standard adult dose and concentration of succinylcholine when
utilized as a neuromuscular blocking agent for rapid sequence intubation? Answer: 1.5
mg/kg IV/IO (maximum typically 200 mg).
Section 3: Pharmacology and Toxicology
21. Question: What is the definitive pharmacological antidote administered for severe
organophosphate poisoning that acts by blocking muscarinic receptors? Answer:
Atropine.
22. Question: What is the mechanism of action of naloxone when reversing an opioid
overdose? Answer: Competitive antagonism at central nervous system opioid
receptors ( μ, κ , δ ).
23. Question: What intravenous fluid is strictly contraindicated in patients presenting with
acute traumatic brain injury due to the risk of exacerbating cellular edema? Answer:
Hypotonic solutions, such as 0.45% Sodium Chloride (half-normal saline) or D5W.
24. Question: In the management of severe tricyclic antidepressant (TCA) toxicity
presenting with wide QRS intervals and ventricular dysrhythmias, what medication is
administered to alkalinize the serum? Answer: Sodium Bicarbonate.
25. Question: What is the primary pharmacological class and action of flumazenil? Answer:
Competitive benzodiazepine receptor antagonist.
