NRCME QUESTIONS AND MULTIPLE
CHOICE CORRECT ANSWERS 2025(108
PAGES EXAM), Exams of Nursing
A 20-year-old person approaches you and asks you to perform a medical examination for him as he is
planning to apply for an interstate CMV driver job advertised by a local transportation company.
According to the FMCSA standards, a person under 21 is not eligible to work as an interstate CMV driver;
however, you can still perform the examination because:
a. The person is only applying for the job and not yet employed.
b. There's no indication that he intends to work as an interstate CMV driver.
c. It is not your responsibility to ensure that the person meets the age requirements.
d. From his physical appearance he seems quite healthy.ANSWERCorrect answer is "C" - It is not your
responsibility to ensure that the person meets the age requirements. Per the FMCSA, it is the
responsibility of the motor carrier to ensure that their interstate CMV drivers meet the age
requirements. As a certified medical examiner, you can perform the driver physical examination for any
person who requests it.A 25-year-old driver denies a history of any medical problems. She is a
nonsmoker who exercises regularly without symptoms. The medical examiner auscultates bilateral
wheezes during the examination. The driver's SpO2 is 90 percent in the medical examiner's office. The
rest of the examination is normal. The driver should be:
a. Temporarily disqualified pending results of a cardiac workup.
b. Qualified since she has no cardiac symptoms.
c. Temporarily disqualified until further evaluation.
d. Qualified because her O2 saturation exceeds the minimum.ANSWERCorrect Answer "C". This is the
correct response because the driver has a non-diagnosed respiratory or thoracic illness that might
interfere with the ability to safely operate a CMV. The driver should not be certified until the etiology is
confirmed and treatment has been shown to be effective, safe, and stable. Also, according to FMCSA
medical guidelines, a SpO2 of less than 92 percent warrants obtaining an arterial blood gas analysis.A 26
year-old driver presents for a first-time certification. He has a long-standing history of ADHD and is
taking methylphenidate. You have verified his diagnosis and obtained clearance from his treating
psychiatrist. As the certified examiner, you:
a. Should disqualify the driver, explaining that use of such stimulants is cause for disqualification.
b. May certify for a maximum of 6 months.
c. May certify for a maximum of 12 months.
d. May certify for a maximum of 2 years.ANSWERc. May certify for a maximum of 12 months.A 35-year-
old right-handed female driver reports for a recertification. She reports in her history that she has
recently been diagnosed with Carpal Tunnel Syndrome in her left wrist. Additionally, she reports using a
brace at night, taking NSAIDS as needed, and seeing her PCP and a physical therapist for treatment. She
,NRCME QUESTIONS AND MULTIPLE
CHOICE CORRECT ANSWERS 2025(108
PAGES EXAM), Exams of Nursing
has no current restrictions from work. Her grip strength in her right and left hand is 5/5. The rest of her
examination is unremarkable. The best next step is:
a. Disqualify the driver and require her to apply for an SPE.
b. Certify the driver but require more frequent monitoring.
c. Disqualify the driver pending an orthopedic evaluation.
d. Order a Nerve Conduction Test to determine severity.ANSWERCorrect answer is "B". An SPE is not
available for this driver because CTS is not a "Fixed Deficit". If the driver can meet the functions of a
CMV driver involving hand strength, s/he should be certified to drive but may be required to have more
frequent monitoring of this potentially progressive disease.A 37-year-male CMV driver presents for
examination. He has the fourth finger missing from his right hand. He provides a medical report
confirming a strong right-hand grasp. Does this person require a Skill Performance Evaluation (SPE)
Certificate by FMCSA to complete the qualifying procedure under CFR 391.41, and why?
a. No, as long as there is a medical report confirming no interference with hand grasp power an SPE
certificate is not required for impairment/ loss of a finger.
b. Yes, a medical report confirming a strong right-hand grasp does not exempt from an SPE certificate.
c. Yes, an impaired or missing finger requires an SPE certificate regardless of whether it affects hand
grasp power or not.
d. No,thispersonismedicallynotqualifiedtobeaCMVdriver.ANSWERCorrect answer is "A". This is the
correct answer because according to CFR 391.41, persons with an impairment of a hand or finger that
does not interfere with prehension and grasping power may be qualified. In this case, the presence of a
medical report confirming the prehension power is valid evidence for the medical examiner and does
not prompt for a SPE certificate.A 41-year-old male presents for examination. He has a history of
thoracic aortic aneurysm which is reported by his treating cardiovascular specialist to be 2.9 cm. How
would you handle this case and what is the medical certification period for this medical history?
a. Request a cardiologist report; biennial certification.
b. Query and evaluate digestive system disorders; annual certification.
c. Disqualify the person.
d. Query and evaluate other associated cardiovascular diseases; annual certification.ANSWERCorrect
answer is "D". Per FMCSA's guidelines, persons with a thoracic aortic aneurysm of less than 3.5 cm may
be certified annually after thorough evaluation and ruling out of any associated cardiovascular
diseases.A 43-year old male driver reports for a re-certification examination. His previous certification
was good for 2 years. His history is benign. Further questioning reveals an appendectomy 8 years ago,
and no current medications. His examination is as follows:
,NRCME QUESTIONS AND MULTIPLE
CHOICE CORRECT ANSWERS 2025(108
PAGES EXAM), Exams of Nursing
Visual Acuity: 20/30 left; 20/20 right; 20/20 both
Able to distinguish signal red, amber, green
Lateral Horizontal Vision: 80 degrees left, 80 degrees right.
Whisper test: 5 ft. right; 4 ft. left
BP 148/88; pulse: 86
UA: Specific Gravity: 1.010; Protein: trace; Blood: Negative; Sugar: Negative. The rest of the examination
is unremarkable. The examiners best decision would be to:
a. Disqualify the driver.•
b. Certify the driver with a 1-time 3-month certificate.
c. Certify the driver for 1 year.
d. Certify the driver for 2 years.ANSWERCorrect answer is "B". The driver suffers from Stage 1
hypertension. There is no previous history of hypertension, the driver may be certified for 1 year.A 44-
year-old male presents for examination. He has undergone a surgery for repair of a 5.0 cm abdominal
aortic aneurysm 1 year ago. He provides a clearance report by a cardiovascular specialist indicating he is
asymptomatic. Is this person qualified? If yes, for how long?
a. Yes, for 6 months.
b. No.
c. Yes, for one year.
d. Yes, for two years.ANSWERCorrect answer is "C". Per FMCSA's guidelines, persons with an abdominal
aortic aneurysm of ≥ 5.0 cm may be certified annually if more than three months have passed since
surgery, they're asymptomatic, and are cleared by a cardiovascular specialist.A 48-year-old male driver
presents for a certification examination. He reports in his history a back injury that had occurred 4 years
earlier. He states that he was out of work following back surgery for over a year, but since has returned
to driving and his last certification was good for 2 years. He lists as his only medication Oxycodone,
which he takes only as needed. He reports seeing his "pain doctor" every few months for evaluation. He
also reports he has had a steroid injection (series of 3) about a year ago, which "helped a lot." The
examiner should:
a. Request medical clearance.
b. Certify the driver for 1 year.
c. Certify the driver for 2 years.
, NRCME QUESTIONS AND MULTIPLE
CHOICE CORRECT ANSWERS 2025(108
PAGES EXAM), Exams of Nursing
d. Disqualify the driver.ANSWERCorrect answer is "A". The driver suffers a chronic pain condition which
may inhibit his ability to perform all essential functions associated with driving a CMV. He is also taking a
narcotic medication. Both of these will need clearance from a treating provider prior to making a
decision regarding certification.A 50-year-old male CMV driver has chronic kidney failure for which is
undergoes hemodialysis three times each week. His treating physician provided him with a medical
report indicating that he can work normally except on the days he is undergoing dialysis. He is also
suffering from hypertension. This CMV driver would be:
a. Qualified normally for 2 years.
b. Disqualified.
c. Qualifiedfor1year.
d. Qualified for 6 months.ANSWERCorrect answer is "B". According to the FMCSA, drivers with stage 5
chronic kidney disease, requiring dialysis, must be disqualified. The hypertension condition of the driver
in this case does not imply any exemption, because of the severity of the kidney disease. In general,
persons who undergo dialysis are prone to fatigue and sleepiness, which jeopardize their ability to drive
safely.A 56-year-old male driver applying for a new certificate admitted that he suffered a myocardial
infarction 3 months before. He provides you with a clearance certificate by a cardiologist. He also
informs you that he is not feeling any chest pain post-MI. Is this information sufficient to determine his
health history?
a. No, need information on post-MI LVEF, ETT, ECG, and tolerance to the medication.
b. No, need information on ECG and on tolerance to medication.
c. Yes, no other information is needed.
d. No, need information on post-MI ETT and tolerance to medication.ANSWERCorrect answer is "A".
According to FMCSA guidelines a person who has had an MI at least 2 months before and who is
asymptomatic, must still demonstrate an LVEF > 40%, normal ETT, no ischemic changes on ECG and
good tolerance to medications before she/he can be certified.A 60-year-old male presents for
examination. He admits to taking Sinemet tablets 3 times per day. What is the health condition of this
person and what is the decision regarding his certification?
a. Myocardial infarction; Qualified annually
b. Blepharospasm (involuntary closing of the eyelids); Qualified normally
c. Parkinson's disease/syndrome; Disqualified
d. Meningitis;DisqualifiedANSWERCorrect answer is "C". Sinemet (Levodopa-Carbidopa) is used in the
treatment of Parkinson's disease, which is a disqualifying health condition according to FMCSA
guidelines. Parkinson's disease impairs the ability to drive as it results in motor function disorders such
as prolonged motor and premotor reaction times, slowness of execution of movement, frequent
CHOICE CORRECT ANSWERS 2025(108
PAGES EXAM), Exams of Nursing
A 20-year-old person approaches you and asks you to perform a medical examination for him as he is
planning to apply for an interstate CMV driver job advertised by a local transportation company.
According to the FMCSA standards, a person under 21 is not eligible to work as an interstate CMV driver;
however, you can still perform the examination because:
a. The person is only applying for the job and not yet employed.
b. There's no indication that he intends to work as an interstate CMV driver.
c. It is not your responsibility to ensure that the person meets the age requirements.
d. From his physical appearance he seems quite healthy.ANSWERCorrect answer is "C" - It is not your
responsibility to ensure that the person meets the age requirements. Per the FMCSA, it is the
responsibility of the motor carrier to ensure that their interstate CMV drivers meet the age
requirements. As a certified medical examiner, you can perform the driver physical examination for any
person who requests it.A 25-year-old driver denies a history of any medical problems. She is a
nonsmoker who exercises regularly without symptoms. The medical examiner auscultates bilateral
wheezes during the examination. The driver's SpO2 is 90 percent in the medical examiner's office. The
rest of the examination is normal. The driver should be:
a. Temporarily disqualified pending results of a cardiac workup.
b. Qualified since she has no cardiac symptoms.
c. Temporarily disqualified until further evaluation.
d. Qualified because her O2 saturation exceeds the minimum.ANSWERCorrect Answer "C". This is the
correct response because the driver has a non-diagnosed respiratory or thoracic illness that might
interfere with the ability to safely operate a CMV. The driver should not be certified until the etiology is
confirmed and treatment has been shown to be effective, safe, and stable. Also, according to FMCSA
medical guidelines, a SpO2 of less than 92 percent warrants obtaining an arterial blood gas analysis.A 26
year-old driver presents for a first-time certification. He has a long-standing history of ADHD and is
taking methylphenidate. You have verified his diagnosis and obtained clearance from his treating
psychiatrist. As the certified examiner, you:
a. Should disqualify the driver, explaining that use of such stimulants is cause for disqualification.
b. May certify for a maximum of 6 months.
c. May certify for a maximum of 12 months.
d. May certify for a maximum of 2 years.ANSWERc. May certify for a maximum of 12 months.A 35-year-
old right-handed female driver reports for a recertification. She reports in her history that she has
recently been diagnosed with Carpal Tunnel Syndrome in her left wrist. Additionally, she reports using a
brace at night, taking NSAIDS as needed, and seeing her PCP and a physical therapist for treatment. She
,NRCME QUESTIONS AND MULTIPLE
CHOICE CORRECT ANSWERS 2025(108
PAGES EXAM), Exams of Nursing
has no current restrictions from work. Her grip strength in her right and left hand is 5/5. The rest of her
examination is unremarkable. The best next step is:
a. Disqualify the driver and require her to apply for an SPE.
b. Certify the driver but require more frequent monitoring.
c. Disqualify the driver pending an orthopedic evaluation.
d. Order a Nerve Conduction Test to determine severity.ANSWERCorrect answer is "B". An SPE is not
available for this driver because CTS is not a "Fixed Deficit". If the driver can meet the functions of a
CMV driver involving hand strength, s/he should be certified to drive but may be required to have more
frequent monitoring of this potentially progressive disease.A 37-year-male CMV driver presents for
examination. He has the fourth finger missing from his right hand. He provides a medical report
confirming a strong right-hand grasp. Does this person require a Skill Performance Evaluation (SPE)
Certificate by FMCSA to complete the qualifying procedure under CFR 391.41, and why?
a. No, as long as there is a medical report confirming no interference with hand grasp power an SPE
certificate is not required for impairment/ loss of a finger.
b. Yes, a medical report confirming a strong right-hand grasp does not exempt from an SPE certificate.
c. Yes, an impaired or missing finger requires an SPE certificate regardless of whether it affects hand
grasp power or not.
d. No,thispersonismedicallynotqualifiedtobeaCMVdriver.ANSWERCorrect answer is "A". This is the
correct answer because according to CFR 391.41, persons with an impairment of a hand or finger that
does not interfere with prehension and grasping power may be qualified. In this case, the presence of a
medical report confirming the prehension power is valid evidence for the medical examiner and does
not prompt for a SPE certificate.A 41-year-old male presents for examination. He has a history of
thoracic aortic aneurysm which is reported by his treating cardiovascular specialist to be 2.9 cm. How
would you handle this case and what is the medical certification period for this medical history?
a. Request a cardiologist report; biennial certification.
b. Query and evaluate digestive system disorders; annual certification.
c. Disqualify the person.
d. Query and evaluate other associated cardiovascular diseases; annual certification.ANSWERCorrect
answer is "D". Per FMCSA's guidelines, persons with a thoracic aortic aneurysm of less than 3.5 cm may
be certified annually after thorough evaluation and ruling out of any associated cardiovascular
diseases.A 43-year old male driver reports for a re-certification examination. His previous certification
was good for 2 years. His history is benign. Further questioning reveals an appendectomy 8 years ago,
and no current medications. His examination is as follows:
,NRCME QUESTIONS AND MULTIPLE
CHOICE CORRECT ANSWERS 2025(108
PAGES EXAM), Exams of Nursing
Visual Acuity: 20/30 left; 20/20 right; 20/20 both
Able to distinguish signal red, amber, green
Lateral Horizontal Vision: 80 degrees left, 80 degrees right.
Whisper test: 5 ft. right; 4 ft. left
BP 148/88; pulse: 86
UA: Specific Gravity: 1.010; Protein: trace; Blood: Negative; Sugar: Negative. The rest of the examination
is unremarkable. The examiners best decision would be to:
a. Disqualify the driver.•
b. Certify the driver with a 1-time 3-month certificate.
c. Certify the driver for 1 year.
d. Certify the driver for 2 years.ANSWERCorrect answer is "B". The driver suffers from Stage 1
hypertension. There is no previous history of hypertension, the driver may be certified for 1 year.A 44-
year-old male presents for examination. He has undergone a surgery for repair of a 5.0 cm abdominal
aortic aneurysm 1 year ago. He provides a clearance report by a cardiovascular specialist indicating he is
asymptomatic. Is this person qualified? If yes, for how long?
a. Yes, for 6 months.
b. No.
c. Yes, for one year.
d. Yes, for two years.ANSWERCorrect answer is "C". Per FMCSA's guidelines, persons with an abdominal
aortic aneurysm of ≥ 5.0 cm may be certified annually if more than three months have passed since
surgery, they're asymptomatic, and are cleared by a cardiovascular specialist.A 48-year-old male driver
presents for a certification examination. He reports in his history a back injury that had occurred 4 years
earlier. He states that he was out of work following back surgery for over a year, but since has returned
to driving and his last certification was good for 2 years. He lists as his only medication Oxycodone,
which he takes only as needed. He reports seeing his "pain doctor" every few months for evaluation. He
also reports he has had a steroid injection (series of 3) about a year ago, which "helped a lot." The
examiner should:
a. Request medical clearance.
b. Certify the driver for 1 year.
c. Certify the driver for 2 years.
, NRCME QUESTIONS AND MULTIPLE
CHOICE CORRECT ANSWERS 2025(108
PAGES EXAM), Exams of Nursing
d. Disqualify the driver.ANSWERCorrect answer is "A". The driver suffers a chronic pain condition which
may inhibit his ability to perform all essential functions associated with driving a CMV. He is also taking a
narcotic medication. Both of these will need clearance from a treating provider prior to making a
decision regarding certification.A 50-year-old male CMV driver has chronic kidney failure for which is
undergoes hemodialysis three times each week. His treating physician provided him with a medical
report indicating that he can work normally except on the days he is undergoing dialysis. He is also
suffering from hypertension. This CMV driver would be:
a. Qualified normally for 2 years.
b. Disqualified.
c. Qualifiedfor1year.
d. Qualified for 6 months.ANSWERCorrect answer is "B". According to the FMCSA, drivers with stage 5
chronic kidney disease, requiring dialysis, must be disqualified. The hypertension condition of the driver
in this case does not imply any exemption, because of the severity of the kidney disease. In general,
persons who undergo dialysis are prone to fatigue and sleepiness, which jeopardize their ability to drive
safely.A 56-year-old male driver applying for a new certificate admitted that he suffered a myocardial
infarction 3 months before. He provides you with a clearance certificate by a cardiologist. He also
informs you that he is not feeling any chest pain post-MI. Is this information sufficient to determine his
health history?
a. No, need information on post-MI LVEF, ETT, ECG, and tolerance to the medication.
b. No, need information on ECG and on tolerance to medication.
c. Yes, no other information is needed.
d. No, need information on post-MI ETT and tolerance to medication.ANSWERCorrect answer is "A".
According to FMCSA guidelines a person who has had an MI at least 2 months before and who is
asymptomatic, must still demonstrate an LVEF > 40%, normal ETT, no ischemic changes on ECG and
good tolerance to medications before she/he can be certified.A 60-year-old male presents for
examination. He admits to taking Sinemet tablets 3 times per day. What is the health condition of this
person and what is the decision regarding his certification?
a. Myocardial infarction; Qualified annually
b. Blepharospasm (involuntary closing of the eyelids); Qualified normally
c. Parkinson's disease/syndrome; Disqualified
d. Meningitis;DisqualifiedANSWERCorrect answer is "C". Sinemet (Levodopa-Carbidopa) is used in the
treatment of Parkinson's disease, which is a disqualifying health condition according to FMCSA
guidelines. Parkinson's disease impairs the ability to drive as it results in motor function disorders such
as prolonged motor and premotor reaction times, slowness of execution of movement, frequent
