NCOEMS EXAM STUDY SET 2026/2027 |
NORTH CAROLINA EMS CERTIFICATION
PREPARATION Patient Care, Trauma,
Cardiology & EMS Operations | Verified
Questions with Detailed Explanations
This comprehensive 400-question study set is designed for candidates preparing for the
North Carolina Office of Emergency Medical Services (NCOEMS) certification
examination for EMT and Paramedic levels. Each question includes the correct answer
(bolded) and a detailed clinical rationale based on current AHA guidelines, NC OEMS
protocols, and National Registry standards.
Important Note: Beginning January 1, 2026, North Carolina requires all EMS personnel
seeking credentialing or renewal to pass the National Registry of Emergency Medical
Technicians (NREMT) examination for their desired certification level
DOMAIN 1: AIRWAY MANAGEMENT & VENTILATION (50 Questions)
1. A 68-year-old male is unresponsive with snoring respirations at 6 breaths/min and an
SpO₂ of 82% on room air. What is your priority action?
A) Apply a non-rebreather mask at 15 L/min
B) Perform the jaw-thrust maneuver and begin BVM ventilation
C) Insert an oropharyngeal airway and apply a nasal cannula
D) Suction the oropharynx for 30 seconds
*Rationale: Snoring indicates partial airway obstruction by the tongue. The jaw-thrust
maneuver opens the airway without cervical spine movement. The patient is
hypoventilating (6/min) and hypoxic, requiring immediate positive pressure ventilation
with a Bag-Valve-Mask (BVM). An OPA can be inserted after the airway is opened.*
2. You intubate a cardiac arrest patient. According to North Carolina OEMS standards,
which is the most reliable confirmation of proper endotracheal (ET) tube placement in
the prehospital setting?
,A) Fogging visible inside the tube
B) 5-point auscultation and waveform capnography
C) Pulse oximetry reading of 95%
D) Symmetrical chest rise only
Rationale: NC OEMS mandates waveform capnography as the gold standard for
confirming ET tube placement, combined with bilateral breath sounds and epigastric
auscultation. Fogging and chest rise are unreliable secondary signs that can be
misleading.
3. A patient has a suspected cervical spine injury and is apneic. Which airway maneuver
is preferred?
A) Head-tilt chin-lift
B) Jaw-thrust without head extension
C) Insertion of a nasopharyngeal airway only
D) Supraglottic airway without positioning
Rationale: Jaw-thrust is the only maneuver that opens the airway without moving the
cervical spine. Head-tilt chin-lift is contraindicated in suspected spinal injury.
4. What is the correct tidal volume for an adult patient receiving BVM ventilation
without an advanced airway?
A) 300–400 mL
B) 500–600 mL
C) 700–800 mL
D) 1000 mL
*Rationale: Tidal volume of 500–600 mL (6–7 mL/kg ideal body weight) minimizes
gastric insufflation. Larger volumes increase aspiration risk and reduce venous return.*
5. A 45-year-old male is found unresponsive with snoring respirations after a suspected
opioid overdose. What is the priority action?
A) Administer intranasal naloxone
B) Insert an oropharyngeal airway and begin bag-valve-mask ventilation
C) Start an IV of normal saline
D) Check blood glucose level
Rationale: Airway and breathing are immediate priorities in an unresponsive patient with
snoring respirations (partial airway obstruction). While naloxone may be indicated,
securing the airway and providing ventilatory support takes precedence before further
interventions.
6. What is the maximum recommended suctioning time for an adult patient?
A) 5 seconds
B) 10 seconds
,C) 15 seconds
D) 30 seconds
Rationale: Suctioning should not exceed 15 seconds in adults (10 seconds in children, 5
seconds in infants) to prevent hypoxia, bradycardia, and increased intracranial pressure.
7. A 6-month-old infant presents with stridor, a barking cough, and retractions. What is
the most likely diagnosis and initial treatment?
A) Epiglottitis; immediate intubation
B) Croup; nebulized epinephrine
C) Foreign body; abdominal thrusts
D) Anaphylaxis; epinephrine IM
Rationale: The presentation is classic for croup (laryngotracheobronchitis). Nebulized
epinephrine reduces mucosal edema. Stridor is the key distinguishing symptom from lower
airway issues.
8. For a patient in respiratory distress with a history of COPD and an SpO₂ of 78% on 4
LPM nasal cannula, what is the next step?
A) Increase to 6 LPM nasal cannula
B) Switch to a non-rebreather at 15 LPM
C) Initiate BVM ventilation with 100% oxygen
D) Intubate immediately
Rationale: Severe hypoxemia (SpO₂ 78%) indicates failure of passive oxygenation. BVM
ventilation provides positive pressure and high FiO₂ to rapidly correct hypoxia and support
ventilation.
9. A patient with a tracheostomy tube is in respiratory distress. The tube is partially
dislodged and you cannot reinsert it. What is the next step?
A) Apply an oxygen mask over the stoma
B) Seal the stoma and ventilate via BVM over the mouth and nose
C) Insert a smaller endotracheal tube into the stoma
D) Perform needle cricothyrotomy
Rationale: If the tracheostomy tube cannot be reinserted, a smaller cuffed endotracheal
tube (e.g., 5.0 or 6.0) can be inserted into the stoma to secure the airway. Sealing the
stoma may cause an air leak or obstruction.
10. Which waveform on capnography indicates bronchospasm (e.g., asthma)?
A) Normal rectangular shape
B) Shark-fin (slow upslope) shape
C) Flat line
D) Cleft or notch on the plateau
Rationale: The "shark-fin" appearance indicates prolonged exhalation due to airway
, obstruction, characteristic of bronchospasm in asthma or COPD. Normal rectangular
shape indicates healthy lungs.
11. What is the preferred method for opening the airway in a non-trauma unresponsive
patient?
A) Jaw-thrust maneuver
B) Head-tilt, chin-lift
C) Modified jaw-thrust
D) Neck flexion
Rationale: In non-trauma patients without suspected cervical spine injury, the head-tilt
chin-lift maneuver is the preferred method to open the airway as it is most effective at
lifting the tongue from the posterior pharynx.
12. A patient has a stoma and requires BVM ventilation. How should you seal the
airway?
A) Place a mask over the mouth and nose and seal the stoma with a finger
B) Place a mask directly over the stoma only
C) Ventilate through the mouth and seal the stoma with gauze
D) Use a pediatric mask over the stoma
Rationale: A pediatric mask or specific tracheostomy mask placed directly over the stoma
creates an effective seal. Ventilating through the mouth will not work if the upper airway
is obstructed or disconnected from the stoma.
13. A 3-year-old child has a foreign body airway obstruction with severe coughing and
audible stridor. What should you do?
A) Abdominal thrusts
B) Back blows and chest thrusts
C) Do not interfere; encourage coughing
D) Blind finger sweep
Rationale: If the child has effective coughing and stridor, the airway is partially obstructed.
Do not interfere—encourage coughing. Only intervene if signs of ineffective cough (silent,
cyanosis, decreased consciousness) appear.
14. After intubation, ETCO₂ is 45 mmHg and waveform is normal. However, SpO₂ drops
to 85% over 2 minutes. What is the most likely cause?
A) Mainstem bronchus intubation
B) Esophageal intubation
C) Displaced tube
D) Equipment malfunction
*Rationale: Normal ETCO₂ rules out esophageal intubation. Right mainstem intubation
NORTH CAROLINA EMS CERTIFICATION
PREPARATION Patient Care, Trauma,
Cardiology & EMS Operations | Verified
Questions with Detailed Explanations
This comprehensive 400-question study set is designed for candidates preparing for the
North Carolina Office of Emergency Medical Services (NCOEMS) certification
examination for EMT and Paramedic levels. Each question includes the correct answer
(bolded) and a detailed clinical rationale based on current AHA guidelines, NC OEMS
protocols, and National Registry standards.
Important Note: Beginning January 1, 2026, North Carolina requires all EMS personnel
seeking credentialing or renewal to pass the National Registry of Emergency Medical
Technicians (NREMT) examination for their desired certification level
DOMAIN 1: AIRWAY MANAGEMENT & VENTILATION (50 Questions)
1. A 68-year-old male is unresponsive with snoring respirations at 6 breaths/min and an
SpO₂ of 82% on room air. What is your priority action?
A) Apply a non-rebreather mask at 15 L/min
B) Perform the jaw-thrust maneuver and begin BVM ventilation
C) Insert an oropharyngeal airway and apply a nasal cannula
D) Suction the oropharynx for 30 seconds
*Rationale: Snoring indicates partial airway obstruction by the tongue. The jaw-thrust
maneuver opens the airway without cervical spine movement. The patient is
hypoventilating (6/min) and hypoxic, requiring immediate positive pressure ventilation
with a Bag-Valve-Mask (BVM). An OPA can be inserted after the airway is opened.*
2. You intubate a cardiac arrest patient. According to North Carolina OEMS standards,
which is the most reliable confirmation of proper endotracheal (ET) tube placement in
the prehospital setting?
,A) Fogging visible inside the tube
B) 5-point auscultation and waveform capnography
C) Pulse oximetry reading of 95%
D) Symmetrical chest rise only
Rationale: NC OEMS mandates waveform capnography as the gold standard for
confirming ET tube placement, combined with bilateral breath sounds and epigastric
auscultation. Fogging and chest rise are unreliable secondary signs that can be
misleading.
3. A patient has a suspected cervical spine injury and is apneic. Which airway maneuver
is preferred?
A) Head-tilt chin-lift
B) Jaw-thrust without head extension
C) Insertion of a nasopharyngeal airway only
D) Supraglottic airway without positioning
Rationale: Jaw-thrust is the only maneuver that opens the airway without moving the
cervical spine. Head-tilt chin-lift is contraindicated in suspected spinal injury.
4. What is the correct tidal volume for an adult patient receiving BVM ventilation
without an advanced airway?
A) 300–400 mL
B) 500–600 mL
C) 700–800 mL
D) 1000 mL
*Rationale: Tidal volume of 500–600 mL (6–7 mL/kg ideal body weight) minimizes
gastric insufflation. Larger volumes increase aspiration risk and reduce venous return.*
5. A 45-year-old male is found unresponsive with snoring respirations after a suspected
opioid overdose. What is the priority action?
A) Administer intranasal naloxone
B) Insert an oropharyngeal airway and begin bag-valve-mask ventilation
C) Start an IV of normal saline
D) Check blood glucose level
Rationale: Airway and breathing are immediate priorities in an unresponsive patient with
snoring respirations (partial airway obstruction). While naloxone may be indicated,
securing the airway and providing ventilatory support takes precedence before further
interventions.
6. What is the maximum recommended suctioning time for an adult patient?
A) 5 seconds
B) 10 seconds
,C) 15 seconds
D) 30 seconds
Rationale: Suctioning should not exceed 15 seconds in adults (10 seconds in children, 5
seconds in infants) to prevent hypoxia, bradycardia, and increased intracranial pressure.
7. A 6-month-old infant presents with stridor, a barking cough, and retractions. What is
the most likely diagnosis and initial treatment?
A) Epiglottitis; immediate intubation
B) Croup; nebulized epinephrine
C) Foreign body; abdominal thrusts
D) Anaphylaxis; epinephrine IM
Rationale: The presentation is classic for croup (laryngotracheobronchitis). Nebulized
epinephrine reduces mucosal edema. Stridor is the key distinguishing symptom from lower
airway issues.
8. For a patient in respiratory distress with a history of COPD and an SpO₂ of 78% on 4
LPM nasal cannula, what is the next step?
A) Increase to 6 LPM nasal cannula
B) Switch to a non-rebreather at 15 LPM
C) Initiate BVM ventilation with 100% oxygen
D) Intubate immediately
Rationale: Severe hypoxemia (SpO₂ 78%) indicates failure of passive oxygenation. BVM
ventilation provides positive pressure and high FiO₂ to rapidly correct hypoxia and support
ventilation.
9. A patient with a tracheostomy tube is in respiratory distress. The tube is partially
dislodged and you cannot reinsert it. What is the next step?
A) Apply an oxygen mask over the stoma
B) Seal the stoma and ventilate via BVM over the mouth and nose
C) Insert a smaller endotracheal tube into the stoma
D) Perform needle cricothyrotomy
Rationale: If the tracheostomy tube cannot be reinserted, a smaller cuffed endotracheal
tube (e.g., 5.0 or 6.0) can be inserted into the stoma to secure the airway. Sealing the
stoma may cause an air leak or obstruction.
10. Which waveform on capnography indicates bronchospasm (e.g., asthma)?
A) Normal rectangular shape
B) Shark-fin (slow upslope) shape
C) Flat line
D) Cleft or notch on the plateau
Rationale: The "shark-fin" appearance indicates prolonged exhalation due to airway
, obstruction, characteristic of bronchospasm in asthma or COPD. Normal rectangular
shape indicates healthy lungs.
11. What is the preferred method for opening the airway in a non-trauma unresponsive
patient?
A) Jaw-thrust maneuver
B) Head-tilt, chin-lift
C) Modified jaw-thrust
D) Neck flexion
Rationale: In non-trauma patients without suspected cervical spine injury, the head-tilt
chin-lift maneuver is the preferred method to open the airway as it is most effective at
lifting the tongue from the posterior pharynx.
12. A patient has a stoma and requires BVM ventilation. How should you seal the
airway?
A) Place a mask over the mouth and nose and seal the stoma with a finger
B) Place a mask directly over the stoma only
C) Ventilate through the mouth and seal the stoma with gauze
D) Use a pediatric mask over the stoma
Rationale: A pediatric mask or specific tracheostomy mask placed directly over the stoma
creates an effective seal. Ventilating through the mouth will not work if the upper airway
is obstructed or disconnected from the stoma.
13. A 3-year-old child has a foreign body airway obstruction with severe coughing and
audible stridor. What should you do?
A) Abdominal thrusts
B) Back blows and chest thrusts
C) Do not interfere; encourage coughing
D) Blind finger sweep
Rationale: If the child has effective coughing and stridor, the airway is partially obstructed.
Do not interfere—encourage coughing. Only intervene if signs of ineffective cough (silent,
cyanosis, decreased consciousness) appear.
14. After intubation, ETCO₂ is 45 mmHg and waveform is normal. However, SpO₂ drops
to 85% over 2 minutes. What is the most likely cause?
A) Mainstem bronchus intubation
B) Esophageal intubation
C) Displaced tube
D) Equipment malfunction
*Rationale: Normal ETCO₂ rules out esophageal intubation. Right mainstem intubation
