LATEST NRCME STUDY SHEET REAL EXAMS 2026/2027
QUESTIONS, ANSWERS and RATIONALES
TESTED and VERIFIED GRADE A+ FULLY COVERED
A+
1. A 57-year-old interstate driver has BP readings of 164/102, 166/100, and 162/98 taken
over 20 minutes. He is asymptomatic and states this is “white coat hypertension.” What is the
correct certification action?
A. Certify for 1 year
B. Certify for 2 years
C. Issue a one-time 3-month certificate
D. Disqualify permanently
RATIONALE:
CONSISTENT READINGS PLACE THE DRIVER IN STAGE 2 HYPERTENSION.
FMCSA ALLOWS A SINGLE 3-MONTH CERTIFICATE TO ACHIEVE CONTROL;
WHITE COAT CLAIMS DO NOT OVERRIDE DOCUMENTED READINGS.
2. A driver returns after a prior 3-month Stage 2 hypertension card. BP today is 148/92 on
medication. What is appropriate?
A. Renew 3-month card
B. Issue a 1-year certificate
C. Issue a 2-year certificate
D. Disqualify
Rationale:
Once BP is reduced to ≤140––99, certification may be extended to 1 year,
not 2.
,3. A driver has insulin-treated diabetes, reports no hypoglycemia, but the MCSA-5870 is
missing the treating clinician’s signature. What should the examiner do?
A. Certify based on verbal history
B. Issue a 3-month card
C. Do not certify until form is complete
D. Disqualify permanently
Rationale:
Certification cannot occur without a properly completed MCSA-5870. Verbal assurance
is insufficient.
4. A driver experienced severe hypoglycemia requiring assistance 5 months ago but has since
adjusted insulin dosing with no recurrence. What is correct?
A. Certify for 1 year
B. Disqualify until 12 months event-free
C. Certify for 3 months
D. Certify with restrictions
Rationale:
Severe hypoglycemic episodes require a minimum 12-month stability period before
certification.
5. A driver had an MI 7 months ago, EF 38%, asymptomatic, cleared by cardiology. What is
the correct action?
A. Certify for 2 years
B. Certify for 1 year
C. Certify for 3 months
D. Disqualify
,Rationale:
Post-MI drivers may be certified after 6 months if stable, but EF <40% limits certification
to 1 year due to increased sudden incapacitation risk.
6.
A driver with atrial fibrillation reports one episode of near-syncope 3 weeks ago. What is
correct?
A. Certify if anticoagulated
B. Issue a 3-month card
C. Disqualify until cause evaluated
D. Certify for 1 year
Rationale:
Recent syncope or near-syncope is disqualifying regardless of rhythm control.
7.
A driver with a pacemaker implanted 6 weeks ago for sick sinus syndrome reports no
symptoms. Recent interrogation shows normal function. What is appropriate?
A. Disqualify
B. Certify for 1 year
C. Certify for 2 years
D. Issue 3-month card
Rationale:
After the 1-month waiting period, pacemaker patients may be certified if asymptomatic and
device function is documented.
8.
A driver had a TIA 14 months ago, no residual deficits, normal neuro exam. What is correct?
A. Disqualify permanently
B. Issue 3-month card
, C. Certify for 1 year
D. Certify for 2 years
Rationale:
TIA requires 1-year waiting period; certification thereafter is annual, not 2 years.
9.
A driver reports untreated obstructive sleep apnea but denies sleepiness. BMI is 36, neck
circumference 19 inches. What should the examiner do?
A. Certify based on denial
B. Delay certification pending sleep evaluation
C. Issue 2-year card
D. Ignore risk factors
Rationale:
Objective risk factors override subjective denial. Untreated OSA is disqualifying until
evaluated and treated.
10.
A driver on CPAP presents compliance data showing 3.5 hours/night on 80% of nights. What
is correct?
A. Certify
B. Do not certify until compliant
C. Issue 3-month card
D. Certify with warning
Rationale:
Minimum compliance is ≥4 hours/night on ≥70% of nights. This driver does not meet
criteria.
11.
A driver admits using prescribed Adderall but cannot provide documentation of diagnosis or
prescribing provider. What is correct?
QUESTIONS, ANSWERS and RATIONALES
TESTED and VERIFIED GRADE A+ FULLY COVERED
A+
1. A 57-year-old interstate driver has BP readings of 164/102, 166/100, and 162/98 taken
over 20 minutes. He is asymptomatic and states this is “white coat hypertension.” What is the
correct certification action?
A. Certify for 1 year
B. Certify for 2 years
C. Issue a one-time 3-month certificate
D. Disqualify permanently
RATIONALE:
CONSISTENT READINGS PLACE THE DRIVER IN STAGE 2 HYPERTENSION.
FMCSA ALLOWS A SINGLE 3-MONTH CERTIFICATE TO ACHIEVE CONTROL;
WHITE COAT CLAIMS DO NOT OVERRIDE DOCUMENTED READINGS.
2. A driver returns after a prior 3-month Stage 2 hypertension card. BP today is 148/92 on
medication. What is appropriate?
A. Renew 3-month card
B. Issue a 1-year certificate
C. Issue a 2-year certificate
D. Disqualify
Rationale:
Once BP is reduced to ≤140––99, certification may be extended to 1 year,
not 2.
,3. A driver has insulin-treated diabetes, reports no hypoglycemia, but the MCSA-5870 is
missing the treating clinician’s signature. What should the examiner do?
A. Certify based on verbal history
B. Issue a 3-month card
C. Do not certify until form is complete
D. Disqualify permanently
Rationale:
Certification cannot occur without a properly completed MCSA-5870. Verbal assurance
is insufficient.
4. A driver experienced severe hypoglycemia requiring assistance 5 months ago but has since
adjusted insulin dosing with no recurrence. What is correct?
A. Certify for 1 year
B. Disqualify until 12 months event-free
C. Certify for 3 months
D. Certify with restrictions
Rationale:
Severe hypoglycemic episodes require a minimum 12-month stability period before
certification.
5. A driver had an MI 7 months ago, EF 38%, asymptomatic, cleared by cardiology. What is
the correct action?
A. Certify for 2 years
B. Certify for 1 year
C. Certify for 3 months
D. Disqualify
,Rationale:
Post-MI drivers may be certified after 6 months if stable, but EF <40% limits certification
to 1 year due to increased sudden incapacitation risk.
6.
A driver with atrial fibrillation reports one episode of near-syncope 3 weeks ago. What is
correct?
A. Certify if anticoagulated
B. Issue a 3-month card
C. Disqualify until cause evaluated
D. Certify for 1 year
Rationale:
Recent syncope or near-syncope is disqualifying regardless of rhythm control.
7.
A driver with a pacemaker implanted 6 weeks ago for sick sinus syndrome reports no
symptoms. Recent interrogation shows normal function. What is appropriate?
A. Disqualify
B. Certify for 1 year
C. Certify for 2 years
D. Issue 3-month card
Rationale:
After the 1-month waiting period, pacemaker patients may be certified if asymptomatic and
device function is documented.
8.
A driver had a TIA 14 months ago, no residual deficits, normal neuro exam. What is correct?
A. Disqualify permanently
B. Issue 3-month card
, C. Certify for 1 year
D. Certify for 2 years
Rationale:
TIA requires 1-year waiting period; certification thereafter is annual, not 2 years.
9.
A driver reports untreated obstructive sleep apnea but denies sleepiness. BMI is 36, neck
circumference 19 inches. What should the examiner do?
A. Certify based on denial
B. Delay certification pending sleep evaluation
C. Issue 2-year card
D. Ignore risk factors
Rationale:
Objective risk factors override subjective denial. Untreated OSA is disqualifying until
evaluated and treated.
10.
A driver on CPAP presents compliance data showing 3.5 hours/night on 80% of nights. What
is correct?
A. Certify
B. Do not certify until compliant
C. Issue 3-month card
D. Certify with warning
Rationale:
Minimum compliance is ≥4 hours/night on ≥70% of nights. This driver does not meet
criteria.
11.
A driver admits using prescribed Adderall but cannot provide documentation of diagnosis or
prescribing provider. What is correct?
