NRCME STUDY SHEET REAL EXAMS 2026/2027 QUESTIONS,
ANSWERS and RATIONALES
TESTED and VERIFIED GRADE A+
1.
A 54-year-old commercial driver presents for a Department of Transportation physical
examination. He reports a history of coronary artery disease and had a myocardial infarction 7
months ago. He underwent stent placement and states he feels “back to normal.” He denies chest
pain but has not followed up with cardiology or completed a stress test since hospital discharge.
What is the most appropriate certification decision?
A. Certify for 2 years
B. Issue a 6-month certificate
C. Defer certification until cardiology clearance and functional testing are completed
D. Permanently disqualify
Rationale:
Drivers with a history of myocardial infarction are at increased risk for sudden cardiac events,
including arrhythmias and recurrent ischemia, which could cause sudden incapacitation while
driving. FMCSA guidelines require a minimum waiting period and objective evidence of cardiac
stability, including stress testing and cardiology clearance. Even if the driver feels asymptomatic,
subjective improvement does not guarantee adequate cardiac reserve or absence of ischemia.
Deferring certification protects both the driver and the public by ensuring that the driver can
safely perform the physical and cognitive demands of commercial driving.
2.
A 46-year-old driver presents for recertification and reports a diagnosis of epilepsy. He
experienced a generalized seizure 4 months ago after missing doses of his prescribed medication.
He has since resumed treatment but has not seen a neurologist. What is the correct action?
A. Certify for 1 year
B. Issue a short-term card
C. Disqualify until seizure-free period and neurologist clearance are documented
D. Certify with restrictions
Rationale:
Epilepsy poses a significant risk for sudden loss of consciousness. FMCSA standards require
drivers to demonstrate a seizure-free period and compliance with treatment, verified by a
neurologist. Because this driver recently experienced a seizure, he does not meet safety criteria.
,Even though he has resumed medication, there is no guarantee of immediate stability.
Certification would expose the public to unacceptable risk if another seizure occurred while
driving.
3.
A 59-year-old driver reports excessive daytime sleepiness, loud snoring, and his spouse has
observed apneic episodes during sleep. His BMI is 42 and neck circumference is 19 inches. He
refuses a sleep study, stating it is “too expensive.” What is the correct certification decision?
A. Certify for 1 year
B. Issue a 3-month card
C. Disqualify until objective evaluation for obstructive sleep apnea is completed
D. Certify without restrictions
Rationale:
This driver has multiple high-risk indicators for obstructive sleep apnea, a condition strongly
associated with motor vehicle accidents due to microsleeps, impaired attention, and delayed
reaction time. FMCSA guidelines require objective testing to confirm or rule out OSA. Refusal
of testing prevents assessment of fitness to drive. Without confirmation of diagnosis and
treatment compliance, certification is unsafe and inappropriate.
4.
A 51-year-old driver reports using hydrocodone daily for chronic back pain. He admits he feels
“slightly drowsy” in the afternoons but says he can still drive. What is the appropriate action?
A. Certify
B. Issue short-term card
C. Disqualify until opioid use is discontinued and alertness verified
D. Certify with restrictions
Rationale:
Opioids impair cognition, reaction time, and judgment even at prescribed doses. Commercial
driving requires sustained vigilance and rapid response to hazards. FMCSA considers active
opioid use disqualifying unless the medication is discontinued and the driver demonstrates full
alertness. Allowing certification while experiencing drowsiness poses unacceptable safety risks.
5.
,A 62-year-old driver experienced a transient ischemic attack 6 months ago. He reports full
recovery but has not followed up with neurology. What is the correct certification decision?
A. Certify immediately
B. Issue short-term card
C. Disqualify until one-year waiting period and neurologist clearance are completed
D. Certify with restrictions
Rationale:
A TIA is a warning sign of future stroke and indicates vascular instability. FMCSA requires a
minimum one-year waiting period following a TIA, along with neurologist documentation
confirming no residual deficits and low recurrence risk. Premature certification could result in
catastrophic outcomes if a stroke occurs while driving.
6.
A 48-year-old driver reports anxiety treated with clonazepam twice daily. He admits feeling
groggy during morning driving shifts. What is the correct action?
A. Certify
B. Issue short-term card
C. Disqualify until sedating medication is discontinued and alertness confirmed
D. Certify with restrictions
Rationale:
Benzodiazepines cause sedation, delayed reaction time, and impaired judgment. FMCSA
prohibits certification while drivers are impaired by sedating medications. Even if prescribed, the
presence of grogginess demonstrates functional impairment. Certification would violate safety
standards.
7.
A 55-year-old driver with type 1 diabetes reports frequent hypoglycemic episodes during long
trips because he skips meals. What is the correct action?
A. Certify
B. Short-term card
C. Defer certification until glucose control is stabilized and documented
D. Permanently disqualify
Rationale:
Hypoglycemia can cause confusion, seizures, and loss of consciousness. FMCSA requires stable
, glycemic control and proper self-management. This driver demonstrates unsafe practices,
creating immediate risk. Certification must be deferred until control is proven.
8.
A 60-year-old driver has glaucoma with documented peripheral visual field loss. He reports
difficulty noticing cars in adjacent lanes. What is the correct decision?
A. Certify
B. Short-term card
C. Defer until ophthalmology confirms functional vision meets standards
D. Permanently disqualify
Rationale:
Peripheral vision is essential for hazard detection and lane awareness. FMCSA requires specialist
evaluation when deficits are present. Without confirmation of adequate vision, certification is
unsafe.
9.
A 50-year-old driver uses zolpidem nightly for insomnia and reports morning drowsiness. What
is correct?
A. Certify
B. Short-term card
C. Disqualify until medication is stopped and alertness verified
D. Certify with restrictions
Rationale:
Sedative-hypnotics impair vigilance and reaction time. Morning drowsiness demonstrates
residual drug effect, making commercial driving unsafe.
10.
A 57-year-old driver with COPD has resting oxygen saturation of 88%. He reports fatigue during
long drives. What is correct?
A. Certify
B. Short-term card
ANSWERS and RATIONALES
TESTED and VERIFIED GRADE A+
1.
A 54-year-old commercial driver presents for a Department of Transportation physical
examination. He reports a history of coronary artery disease and had a myocardial infarction 7
months ago. He underwent stent placement and states he feels “back to normal.” He denies chest
pain but has not followed up with cardiology or completed a stress test since hospital discharge.
What is the most appropriate certification decision?
A. Certify for 2 years
B. Issue a 6-month certificate
C. Defer certification until cardiology clearance and functional testing are completed
D. Permanently disqualify
Rationale:
Drivers with a history of myocardial infarction are at increased risk for sudden cardiac events,
including arrhythmias and recurrent ischemia, which could cause sudden incapacitation while
driving. FMCSA guidelines require a minimum waiting period and objective evidence of cardiac
stability, including stress testing and cardiology clearance. Even if the driver feels asymptomatic,
subjective improvement does not guarantee adequate cardiac reserve or absence of ischemia.
Deferring certification protects both the driver and the public by ensuring that the driver can
safely perform the physical and cognitive demands of commercial driving.
2.
A 46-year-old driver presents for recertification and reports a diagnosis of epilepsy. He
experienced a generalized seizure 4 months ago after missing doses of his prescribed medication.
He has since resumed treatment but has not seen a neurologist. What is the correct action?
A. Certify for 1 year
B. Issue a short-term card
C. Disqualify until seizure-free period and neurologist clearance are documented
D. Certify with restrictions
Rationale:
Epilepsy poses a significant risk for sudden loss of consciousness. FMCSA standards require
drivers to demonstrate a seizure-free period and compliance with treatment, verified by a
neurologist. Because this driver recently experienced a seizure, he does not meet safety criteria.
,Even though he has resumed medication, there is no guarantee of immediate stability.
Certification would expose the public to unacceptable risk if another seizure occurred while
driving.
3.
A 59-year-old driver reports excessive daytime sleepiness, loud snoring, and his spouse has
observed apneic episodes during sleep. His BMI is 42 and neck circumference is 19 inches. He
refuses a sleep study, stating it is “too expensive.” What is the correct certification decision?
A. Certify for 1 year
B. Issue a 3-month card
C. Disqualify until objective evaluation for obstructive sleep apnea is completed
D. Certify without restrictions
Rationale:
This driver has multiple high-risk indicators for obstructive sleep apnea, a condition strongly
associated with motor vehicle accidents due to microsleeps, impaired attention, and delayed
reaction time. FMCSA guidelines require objective testing to confirm or rule out OSA. Refusal
of testing prevents assessment of fitness to drive. Without confirmation of diagnosis and
treatment compliance, certification is unsafe and inappropriate.
4.
A 51-year-old driver reports using hydrocodone daily for chronic back pain. He admits he feels
“slightly drowsy” in the afternoons but says he can still drive. What is the appropriate action?
A. Certify
B. Issue short-term card
C. Disqualify until opioid use is discontinued and alertness verified
D. Certify with restrictions
Rationale:
Opioids impair cognition, reaction time, and judgment even at prescribed doses. Commercial
driving requires sustained vigilance and rapid response to hazards. FMCSA considers active
opioid use disqualifying unless the medication is discontinued and the driver demonstrates full
alertness. Allowing certification while experiencing drowsiness poses unacceptable safety risks.
5.
,A 62-year-old driver experienced a transient ischemic attack 6 months ago. He reports full
recovery but has not followed up with neurology. What is the correct certification decision?
A. Certify immediately
B. Issue short-term card
C. Disqualify until one-year waiting period and neurologist clearance are completed
D. Certify with restrictions
Rationale:
A TIA is a warning sign of future stroke and indicates vascular instability. FMCSA requires a
minimum one-year waiting period following a TIA, along with neurologist documentation
confirming no residual deficits and low recurrence risk. Premature certification could result in
catastrophic outcomes if a stroke occurs while driving.
6.
A 48-year-old driver reports anxiety treated with clonazepam twice daily. He admits feeling
groggy during morning driving shifts. What is the correct action?
A. Certify
B. Issue short-term card
C. Disqualify until sedating medication is discontinued and alertness confirmed
D. Certify with restrictions
Rationale:
Benzodiazepines cause sedation, delayed reaction time, and impaired judgment. FMCSA
prohibits certification while drivers are impaired by sedating medications. Even if prescribed, the
presence of grogginess demonstrates functional impairment. Certification would violate safety
standards.
7.
A 55-year-old driver with type 1 diabetes reports frequent hypoglycemic episodes during long
trips because he skips meals. What is the correct action?
A. Certify
B. Short-term card
C. Defer certification until glucose control is stabilized and documented
D. Permanently disqualify
Rationale:
Hypoglycemia can cause confusion, seizures, and loss of consciousness. FMCSA requires stable
, glycemic control and proper self-management. This driver demonstrates unsafe practices,
creating immediate risk. Certification must be deferred until control is proven.
8.
A 60-year-old driver has glaucoma with documented peripheral visual field loss. He reports
difficulty noticing cars in adjacent lanes. What is the correct decision?
A. Certify
B. Short-term card
C. Defer until ophthalmology confirms functional vision meets standards
D. Permanently disqualify
Rationale:
Peripheral vision is essential for hazard detection and lane awareness. FMCSA requires specialist
evaluation when deficits are present. Without confirmation of adequate vision, certification is
unsafe.
9.
A 50-year-old driver uses zolpidem nightly for insomnia and reports morning drowsiness. What
is correct?
A. Certify
B. Short-term card
C. Disqualify until medication is stopped and alertness verified
D. Certify with restrictions
Rationale:
Sedative-hypnotics impair vigilance and reaction time. Morning drowsiness demonstrates
residual drug effect, making commercial driving unsafe.
10.
A 57-year-old driver with COPD has resting oxygen saturation of 88%. He reports fatigue during
long drives. What is correct?
A. Certify
B. Short-term card
