National Registry of Emergency Medical
Technicians (NREMT) Paramedic
Examination Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A 58-year-old male presents with chest pressure radiating to his jaw,
diaphoresis, and nausea. Vital signs: BP 148/92, HR 108, RR 22, SpO2 96%.
A 12-lead ECG reveals ST-segment elevation of 2 mm in leads II, III, and aVF.
Which intervention is the highest priority?
A. Administer nitroglycerin 0.4 mg sublingual
B. Administer aspirin 324 mg chewed
C. Obtain intravenous access and administer fentanyl for pain
D. Apply supplemental oxygen via non-rebreather mask
Answer: B
Rationale: Aspirin inhibits platelet aggregation by blocking thromboxane A2,
reducing mortality in acute myocardial infarction. In inferior STEMI (leads II, III,
aVF), right ventricular involvement is possible, making nitroglycerin and opioids
relatively contraindicated due to preload reduction and hypotension risk.
Oxygen is not indicated with SpO2 96%. Pain management is secondary to
antiplatelet therapy and reperfusion strategy. Early aspirin administration is a
Class I intervention that can be performed by paramedics without delay.
2. A paramedic is intubating a patient in cardiac arrest. After passing the
endotracheal tube, capnography shows a flat waveform with no detectable
CO2. Chest rise is minimal. Which action should be taken immediately?
, A. Advance the tube 2 cm and reassess
B. Remove the tube and ventilate with a bag-valve mask
C. Inflate the cuff with an additional 5 mL of air
D. Perform needle cricothyrotomy
Answer: B
Rationale: Absence of waveform capnography in a perfusing rhythm or after
initial placement indicates esophageal intubation until proven otherwise.
Minimal chest rise further supports misplacement. Immediate removal and bag-
valve-mask ventilation prevent hypoxia and gastric insufflation. Advancing the
tube blindly, overinflating the cuff, or performing a surgical airway without first
confirming dislodgement or esophageal placement is inappropriate and delays
adequate oxygenation.
3. A 20-year-old male sustains a gunshot wound to the left chest. He is
agitated, tachypneic, and has distended neck veins. Breath sounds are
absent on the left, and the trachea is shifted to the right. Heart sounds are
muffled. What is the most likely diagnosis?
A. Simple pneumothorax
B. Pericardial tamponade
C. Tension pneumothorax
D. Massive hemothorax
Answer: C
Rationale: The triad of unilateral breath sounds, tracheal deviation away from
the affected side, and distended neck veins in a hypotensive patient indicates
tension pneumothorax. Muffled heart sounds can occur due to mediastinal shift.
This is a life-threatening condition requiring immediate needle decompression.
Pericardial tamponade presents with Beck’s triad (muffled heart tones,
hypotension, JVD) without tracheal deviation. Simple pneumothorax lacks
hemodynamic compromise. Massive hemothorax would cause dullness to
percussion, not hyperresonance.
4. During a pediatric respiratory arrest, an 8-year-old child is intubated with a
6.0 mm cuffed endotracheal tube. Proper placement is confirmed. The cuff
, pressure should be maintained at what maximum level?
A. 15 cm H2O
B. 20 cm H2O
C. 30 cm H2O
D. 40 cm H2O
Answer: B
Rationale: Cuff pressure should be kept below 20 cm H2O in children and 25 cm
H2O in adults to prevent tracheal mucosal ischemia. Pediatric tracheal cartilage
is softer and more susceptible to pressure necrosis. Pressures above 20 cm H2O
can cause subglottic stenosis. The minimum occlusive volume technique should
be used to achieve a seal without exceeding safe pressures. Routine manometry
or minimal leak technique helps prevent iatrogenic airway injury.
5. A patient with a history of COPD is found unresponsive. ECG shows sinus
bradycardia at 38 bpm, BP 68/40. Capnography shows ETCO2 55 mmHg.
The patient is intubated and being ventilated at 10 breaths/min. What is the
most appropriate next pharmacologic intervention?
A. Atropine 0.5 mg IV
B. Epinephrine 1 mg IV push
C. Dopamine infusion 5-20 mcg/kg/min
D. Adenosine 6 mg rapid IV push
Answer: C
Rationale: Symptomatic bradycardia unresponsive to ventilation optimization
(elevated ETCO2 suggests hypoventilation, but rate is already 10/min, yet CO2
high—may need to increase rate, but given hypotension) requires a vasopressor.
In the setting of COPD and possible hypoxia-driven bradycardia, atropine may be
ineffective if vagal tone is not the cause. Dopamine provides chronotropic and
inotropic support. Epinephrine push is for cardiac arrest. Adenosine is for SVT.
After ensuring oxygenation/ventilation, dopamine is the appropriate second-line
pressor.
6. A 72-year-old female with CHF is in respiratory distress with pink, frothy
sputum. BP 220/118, HR 122, RR 40, SpO2 88%. Lung sounds reveal diffuse
, crackles. Which intervention is most beneficial?
A. Supine positioning and fluid bolus
B. Continuous positive airway pressure (CPAP)
C. Albuterol nebulization
D. High-flow nasal cannula at 15 L/min
Answer: B
Rationale: CPAP reduces preload and afterload, increases intrathoracic pressure,
and recruits collapsed alveoli, improving oxygenation and reducing work of
breathing in acute cardiogenic pulmonary edema. Nitrates and CPAP are
cornerstones. Supine position worsens dyspnea. Albuterol is for bronchospasm,
not cardiogenic edema, and may cause tachycardia. High-flow nasal cannula
provides oxygen but does not provide the same distending pressure as CPAP for
alveolar recruitment.
7. A 3-month-old infant presents with irritability, poor feeding, and a 2-day
history of vomiting. Blood glucose is 45 mg/dL. The infant is lethargic with
sunken fontanelles. Which fluid is most appropriate for initial volume
expansion?
A. D5W 20 mL/kg bolus
B. 0.45% normal saline 10 mL/kg bolus
C. Isotonic crystalloid 20 mL/kg bolus
D. 3% hypertonic saline 5 mL/kg bolus
Answer: C
Rationale: This infant shows signs of moderate dehydration with hypoglycemia.
Initial fluid resuscitation in pediatric hypovolemia uses isotonic crystalloid
(normal saline or lactated Ringer’s) at 20 mL/kg, repeated as needed. D5W is
hypotonic and not for volume expansion. 0.45% saline is hypotonic maintenance
fluid. Hypertonic saline is for symptomatic hyponatremia, not hypovolemia.
After bolus, blood glucose should be rechecked and corrected with dextrose if
needed.
8. A paramedic prepares to administer morphine sulfate to a patient with
acute chest pain unrelieved by nitroglycerin. Which finding requires the
Technicians (NREMT) Paramedic
Examination Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A 58-year-old male presents with chest pressure radiating to his jaw,
diaphoresis, and nausea. Vital signs: BP 148/92, HR 108, RR 22, SpO2 96%.
A 12-lead ECG reveals ST-segment elevation of 2 mm in leads II, III, and aVF.
Which intervention is the highest priority?
A. Administer nitroglycerin 0.4 mg sublingual
B. Administer aspirin 324 mg chewed
C. Obtain intravenous access and administer fentanyl for pain
D. Apply supplemental oxygen via non-rebreather mask
Answer: B
Rationale: Aspirin inhibits platelet aggregation by blocking thromboxane A2,
reducing mortality in acute myocardial infarction. In inferior STEMI (leads II, III,
aVF), right ventricular involvement is possible, making nitroglycerin and opioids
relatively contraindicated due to preload reduction and hypotension risk.
Oxygen is not indicated with SpO2 96%. Pain management is secondary to
antiplatelet therapy and reperfusion strategy. Early aspirin administration is a
Class I intervention that can be performed by paramedics without delay.
2. A paramedic is intubating a patient in cardiac arrest. After passing the
endotracheal tube, capnography shows a flat waveform with no detectable
CO2. Chest rise is minimal. Which action should be taken immediately?
, A. Advance the tube 2 cm and reassess
B. Remove the tube and ventilate with a bag-valve mask
C. Inflate the cuff with an additional 5 mL of air
D. Perform needle cricothyrotomy
Answer: B
Rationale: Absence of waveform capnography in a perfusing rhythm or after
initial placement indicates esophageal intubation until proven otherwise.
Minimal chest rise further supports misplacement. Immediate removal and bag-
valve-mask ventilation prevent hypoxia and gastric insufflation. Advancing the
tube blindly, overinflating the cuff, or performing a surgical airway without first
confirming dislodgement or esophageal placement is inappropriate and delays
adequate oxygenation.
3. A 20-year-old male sustains a gunshot wound to the left chest. He is
agitated, tachypneic, and has distended neck veins. Breath sounds are
absent on the left, and the trachea is shifted to the right. Heart sounds are
muffled. What is the most likely diagnosis?
A. Simple pneumothorax
B. Pericardial tamponade
C. Tension pneumothorax
D. Massive hemothorax
Answer: C
Rationale: The triad of unilateral breath sounds, tracheal deviation away from
the affected side, and distended neck veins in a hypotensive patient indicates
tension pneumothorax. Muffled heart sounds can occur due to mediastinal shift.
This is a life-threatening condition requiring immediate needle decompression.
Pericardial tamponade presents with Beck’s triad (muffled heart tones,
hypotension, JVD) without tracheal deviation. Simple pneumothorax lacks
hemodynamic compromise. Massive hemothorax would cause dullness to
percussion, not hyperresonance.
4. During a pediatric respiratory arrest, an 8-year-old child is intubated with a
6.0 mm cuffed endotracheal tube. Proper placement is confirmed. The cuff
, pressure should be maintained at what maximum level?
A. 15 cm H2O
B. 20 cm H2O
C. 30 cm H2O
D. 40 cm H2O
Answer: B
Rationale: Cuff pressure should be kept below 20 cm H2O in children and 25 cm
H2O in adults to prevent tracheal mucosal ischemia. Pediatric tracheal cartilage
is softer and more susceptible to pressure necrosis. Pressures above 20 cm H2O
can cause subglottic stenosis. The minimum occlusive volume technique should
be used to achieve a seal without exceeding safe pressures. Routine manometry
or minimal leak technique helps prevent iatrogenic airway injury.
5. A patient with a history of COPD is found unresponsive. ECG shows sinus
bradycardia at 38 bpm, BP 68/40. Capnography shows ETCO2 55 mmHg.
The patient is intubated and being ventilated at 10 breaths/min. What is the
most appropriate next pharmacologic intervention?
A. Atropine 0.5 mg IV
B. Epinephrine 1 mg IV push
C. Dopamine infusion 5-20 mcg/kg/min
D. Adenosine 6 mg rapid IV push
Answer: C
Rationale: Symptomatic bradycardia unresponsive to ventilation optimization
(elevated ETCO2 suggests hypoventilation, but rate is already 10/min, yet CO2
high—may need to increase rate, but given hypotension) requires a vasopressor.
In the setting of COPD and possible hypoxia-driven bradycardia, atropine may be
ineffective if vagal tone is not the cause. Dopamine provides chronotropic and
inotropic support. Epinephrine push is for cardiac arrest. Adenosine is for SVT.
After ensuring oxygenation/ventilation, dopamine is the appropriate second-line
pressor.
6. A 72-year-old female with CHF is in respiratory distress with pink, frothy
sputum. BP 220/118, HR 122, RR 40, SpO2 88%. Lung sounds reveal diffuse
, crackles. Which intervention is most beneficial?
A. Supine positioning and fluid bolus
B. Continuous positive airway pressure (CPAP)
C. Albuterol nebulization
D. High-flow nasal cannula at 15 L/min
Answer: B
Rationale: CPAP reduces preload and afterload, increases intrathoracic pressure,
and recruits collapsed alveoli, improving oxygenation and reducing work of
breathing in acute cardiogenic pulmonary edema. Nitrates and CPAP are
cornerstones. Supine position worsens dyspnea. Albuterol is for bronchospasm,
not cardiogenic edema, and may cause tachycardia. High-flow nasal cannula
provides oxygen but does not provide the same distending pressure as CPAP for
alveolar recruitment.
7. A 3-month-old infant presents with irritability, poor feeding, and a 2-day
history of vomiting. Blood glucose is 45 mg/dL. The infant is lethargic with
sunken fontanelles. Which fluid is most appropriate for initial volume
expansion?
A. D5W 20 mL/kg bolus
B. 0.45% normal saline 10 mL/kg bolus
C. Isotonic crystalloid 20 mL/kg bolus
D. 3% hypertonic saline 5 mL/kg bolus
Answer: C
Rationale: This infant shows signs of moderate dehydration with hypoglycemia.
Initial fluid resuscitation in pediatric hypovolemia uses isotonic crystalloid
(normal saline or lactated Ringer’s) at 20 mL/kg, repeated as needed. D5W is
hypotonic and not for volume expansion. 0.45% saline is hypotonic maintenance
fluid. Hypertonic saline is for symptomatic hyponatremia, not hypovolemia.
After bolus, blood glucose should be rechecked and corrected with dextrose if
needed.
8. A paramedic prepares to administer morphine sulfate to a patient with
acute chest pain unrelieved by nitroglycerin. Which finding requires the
