National Registry of Emergency Medical
Technicians (NREMT) Advanced EMT
Certification Practice Examination
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. A 47-year-old male with a history of type 2 diabetes presents with profuse
diaphoresis, confusion, and a heart rate of 118 beats per minute. His blood
glucose level reads 42 mg/dL. He is unable to swallow safely. Which of the
following is the most appropriate initial pharmacologic intervention?
A. Oral glucose gel
B. Glucagon 1 mg intravenous
C. Dextrose 50% 50 mL intravenous
D. Subcutaneous insulin
Answer: B
Rationale: The patient is hypoglycemic with an altered mental status and an
unsafe gag reflex, making oral glucose contraindicated. While dextrose 50%
(D50) is effective, glucagon 1 mg IV is the preferred first-line agent when
intravenous access is challenging or when the patient is a known diabetic with
depleted glycogen stores. Glucagon stimulates hepatic glycogenolysis, raising
blood glucose within 5-10 minutes. D50 is also acceptable but requires a patent
IV; however, in this scenario, glucagon's mechanism is appropriate. Insulin is
contraindicated as it would worsen hypoglycemia. Oral glucose is unsafe due to
aspiration risk.
, 2. A 32-year-old female is in active labor with a visible prolapsed umbilical
cord. The presenting part is not yet engaged. The mother is in a semi-Fowler
position. What is the immediate priority for this patient?
A. Administer oxygen via non-rebreather at 15 L/min
B. Place the mother in a knee-chest position
C. Prepare for immediate vaginal delivery
D. Push the cord back into the vagina
Answer: B
Rationale: A prolapsed cord is a true obstetric emergency because cord
compression can lead to fetal hypoxia and death. The immediate priority is to
relieve pressure on the cord by positioning the mother in a knee-chest
(Trendelenburg) or extreme pelvic tilt position, which uses gravity to move the
presenting part away from the cord. Oxygen administration is supportive but
not the first action. The mother should not deliver vaginally until in a controlled
setting; pushing the cord back is contraindicated and may cause further prolapse
or infection.
3. A 60-year-old male complains of sudden, severe tearing chest pain radiating
to his back, accompanied by a blood pressure of 210/110 mmHg in the left
arm and 160/90 mmHg in the right arm. He appears pale and diaphoretic.
Which of the following conditions is most likely?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C
Rationale: The hallmark presentation of aortic dissection includes sudden,
severe, tearing or ripping chest pain that radiates to the back, accompanied by a
significant blood pressure differential between the right and left arms (greater
than 20 mmHg). The pain is often described as migrational. Hypertension is a
major predisposing factor. While acute MI can cause chest pain, it rarely
produces a blood pressure differential. Pulmonary embolism typically presents
,with pleuritic pain and dyspnea. Pericarditis pain is usually positional and sharp,
worsened by inspiration.
4. During the primary assessment of a 22-year-old male involved in a high-
speed MVC, you note that he is responding to verbal stimuli but has a
patent airway. His respiratory rate is 26 breaths/min with adequate depth,
and his radial pulse is strong and regular. Which component of the primary
assessment is the next priority?
A. Airway assessment
B. Breathing assessment
C. Circulation assessment
D. Level of consciousness
Answer: C
Rationale: The primary assessment follows the ABCD (Airway, Breathing,
Circulation, Disability) sequence. The patient already has a patent airway and
adequate breathing (rate and depth). Circulation is the next priority, which
involves assessing for signs of shock, such as skin color, temperature, and
capillary refill, and checking for major external bleeding. Level of consciousness
is assessed under Disability, which follows circulation in the sequence.
5. A 45-year-old female presents with dyspnea, tachypnea, and a productive
cough with pink, frothy sputum. Breath sounds reveal coarse crackles
bilaterally. She has a history of heart failure and is taking lisinopril and
furosemide. Her SpO2 is 88% on room air. Which of the following is the
most appropriate initial pharmacologic treatment?
A. Albuterol nebulizer
B. Epinephrine 0.3 mg intramuscular
C. Nitroglycerin 0.4 mg sublingual
D. Amiodarone 300 mg intravenous
Answer: C
Rationale: This patient presents with acute decompensated heart failure (ADHF)
characterized by pulmonary edema. The primary goal is to reduce preload and
afterload. Nitroglycerin 0.4 mg sublingual is a vasodilator that decreases venous
, return (preload) and arterial resistance (afterload), thereby reducing pulmonary
congestion. Albuterol is for bronchospasm, not heart failure. Epinephrine
increases heart rate and afterload, worsening the condition. Amiodarone is an
antiarrhythmic used for ventricular dysrhythmias.
6. You are evaluating a 15-year-old male who was stung by a bee 10 minutes
ago. He now presents with generalized urticaria, stridor, and a systolic blood
pressure of 80 mmHg. After ensuring a patent airway and administering
high-flow oxygen, which medication should be administered immediately?
A. Diphenhydramine 50 mg intravenous
B. Methylprednisolone 125 mg intravenous
C. Epinephrine 0.3 mg intramuscular
D. Albuterol 2.5 mg nebulized
Answer: C
Rationale: This patient is in anaphylactic shock with airway compromise (stridor)
and hypotension. Epinephrine is the first-line treatment for anaphylaxis and is
the only medication that reverses both bronchospasm and vasodilation. The
dose for an adult (and adolescent) is 0.3 mg IM (1:1000) in the anterolateral
thigh. Diphenhydramine and corticosteroids are adjunctive therapies that take
effect too slowly for this acute emergency. Albuterol addresses bronchospasm
but does not correct hypotension.
7. A 28-year-old male is found unresponsive in a bathtub with a water heater
set to 140°F. He is not breathing and has a weak carotid pulse. You perform
endotracheal intubation and confirm placement with capnography. The
endotracheal tube is positioned at 22 cm at the teeth. After attaching the
bag-valve device, you note that breath sounds are absent on the left side
and present on the right. What is the most likely cause of this finding?
A. The tube is in the right mainstem bronchus
B. The tube is in the right mainstem bronchus
C. A tension pneumothorax has developed
D. The tube is in the esophagus
Technicians (NREMT) Advanced EMT
Certification Practice Examination
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. A 47-year-old male with a history of type 2 diabetes presents with profuse
diaphoresis, confusion, and a heart rate of 118 beats per minute. His blood
glucose level reads 42 mg/dL. He is unable to swallow safely. Which of the
following is the most appropriate initial pharmacologic intervention?
A. Oral glucose gel
B. Glucagon 1 mg intravenous
C. Dextrose 50% 50 mL intravenous
D. Subcutaneous insulin
Answer: B
Rationale: The patient is hypoglycemic with an altered mental status and an
unsafe gag reflex, making oral glucose contraindicated. While dextrose 50%
(D50) is effective, glucagon 1 mg IV is the preferred first-line agent when
intravenous access is challenging or when the patient is a known diabetic with
depleted glycogen stores. Glucagon stimulates hepatic glycogenolysis, raising
blood glucose within 5-10 minutes. D50 is also acceptable but requires a patent
IV; however, in this scenario, glucagon's mechanism is appropriate. Insulin is
contraindicated as it would worsen hypoglycemia. Oral glucose is unsafe due to
aspiration risk.
, 2. A 32-year-old female is in active labor with a visible prolapsed umbilical
cord. The presenting part is not yet engaged. The mother is in a semi-Fowler
position. What is the immediate priority for this patient?
A. Administer oxygen via non-rebreather at 15 L/min
B. Place the mother in a knee-chest position
C. Prepare for immediate vaginal delivery
D. Push the cord back into the vagina
Answer: B
Rationale: A prolapsed cord is a true obstetric emergency because cord
compression can lead to fetal hypoxia and death. The immediate priority is to
relieve pressure on the cord by positioning the mother in a knee-chest
(Trendelenburg) or extreme pelvic tilt position, which uses gravity to move the
presenting part away from the cord. Oxygen administration is supportive but
not the first action. The mother should not deliver vaginally until in a controlled
setting; pushing the cord back is contraindicated and may cause further prolapse
or infection.
3. A 60-year-old male complains of sudden, severe tearing chest pain radiating
to his back, accompanied by a blood pressure of 210/110 mmHg in the left
arm and 160/90 mmHg in the right arm. He appears pale and diaphoretic.
Which of the following conditions is most likely?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C
Rationale: The hallmark presentation of aortic dissection includes sudden,
severe, tearing or ripping chest pain that radiates to the back, accompanied by a
significant blood pressure differential between the right and left arms (greater
than 20 mmHg). The pain is often described as migrational. Hypertension is a
major predisposing factor. While acute MI can cause chest pain, it rarely
produces a blood pressure differential. Pulmonary embolism typically presents
,with pleuritic pain and dyspnea. Pericarditis pain is usually positional and sharp,
worsened by inspiration.
4. During the primary assessment of a 22-year-old male involved in a high-
speed MVC, you note that he is responding to verbal stimuli but has a
patent airway. His respiratory rate is 26 breaths/min with adequate depth,
and his radial pulse is strong and regular. Which component of the primary
assessment is the next priority?
A. Airway assessment
B. Breathing assessment
C. Circulation assessment
D. Level of consciousness
Answer: C
Rationale: The primary assessment follows the ABCD (Airway, Breathing,
Circulation, Disability) sequence. The patient already has a patent airway and
adequate breathing (rate and depth). Circulation is the next priority, which
involves assessing for signs of shock, such as skin color, temperature, and
capillary refill, and checking for major external bleeding. Level of consciousness
is assessed under Disability, which follows circulation in the sequence.
5. A 45-year-old female presents with dyspnea, tachypnea, and a productive
cough with pink, frothy sputum. Breath sounds reveal coarse crackles
bilaterally. She has a history of heart failure and is taking lisinopril and
furosemide. Her SpO2 is 88% on room air. Which of the following is the
most appropriate initial pharmacologic treatment?
A. Albuterol nebulizer
B. Epinephrine 0.3 mg intramuscular
C. Nitroglycerin 0.4 mg sublingual
D. Amiodarone 300 mg intravenous
Answer: C
Rationale: This patient presents with acute decompensated heart failure (ADHF)
characterized by pulmonary edema. The primary goal is to reduce preload and
afterload. Nitroglycerin 0.4 mg sublingual is a vasodilator that decreases venous
, return (preload) and arterial resistance (afterload), thereby reducing pulmonary
congestion. Albuterol is for bronchospasm, not heart failure. Epinephrine
increases heart rate and afterload, worsening the condition. Amiodarone is an
antiarrhythmic used for ventricular dysrhythmias.
6. You are evaluating a 15-year-old male who was stung by a bee 10 minutes
ago. He now presents with generalized urticaria, stridor, and a systolic blood
pressure of 80 mmHg. After ensuring a patent airway and administering
high-flow oxygen, which medication should be administered immediately?
A. Diphenhydramine 50 mg intravenous
B. Methylprednisolone 125 mg intravenous
C. Epinephrine 0.3 mg intramuscular
D. Albuterol 2.5 mg nebulized
Answer: C
Rationale: This patient is in anaphylactic shock with airway compromise (stridor)
and hypotension. Epinephrine is the first-line treatment for anaphylaxis and is
the only medication that reverses both bronchospasm and vasodilation. The
dose for an adult (and adolescent) is 0.3 mg IM (1:1000) in the anterolateral
thigh. Diphenhydramine and corticosteroids are adjunctive therapies that take
effect too slowly for this acute emergency. Albuterol addresses bronchospasm
but does not correct hypotension.
7. A 28-year-old male is found unresponsive in a bathtub with a water heater
set to 140°F. He is not breathing and has a weak carotid pulse. You perform
endotracheal intubation and confirm placement with capnography. The
endotracheal tube is positioned at 22 cm at the teeth. After attaching the
bag-valve device, you note that breath sounds are absent on the left side
and present on the right. What is the most likely cause of this finding?
A. The tube is in the right mainstem bronchus
B. The tube is in the right mainstem bronchus
C. A tension pneumothorax has developed
D. The tube is in the esophagus
