PARAMEDIC NATIONAL REGISTRY PRACTICE ULTIMATE EXAM
Instructions: Choose the best answer for each of the following questions. This
comprehensive practice exam is designed for candidates preparing for the NREMT
Paramedic (NRP) Certification Examination. The actual exam is administered through
Computerized Adaptive Testing (CAT) format with a minimum of 110 questions and a 3.5-
hour time limit. This practice exam contains 200 scenario-based questions covering all six
domains: Airway, Respiration & Ventilation; Cardiology & Resuscitation; Trauma;
Medical/OB/GYN; EMS Operations; and Clinical Judgment.
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SECTION 1: AIRWAY, RESPIRATION & VENTILATION (Questions 1-35)
Question 1:
A 45-year-old male is found unresponsive in a restaurant after choking on food. He is
cyanotic and has no audible breath sounds. After opening the airway with a head-tilt/chin-
lift, you visualize a foreign body. Your immediate action should be:
A) Perform abdominal thrusts
B) Attempt to remove the object with Magill forceps
C) Initiate bag-valve-mask ventilation
D) Perform a surgical cricothyrotomy
Answer: A)
Explanation: In a conscious choking victim who becomes unresponsive, the first step is to
perform abdominal thrusts (Heimlich maneuver). If the object is visualized and accessible,
Magill forceps may be used, but abdominal thrusts are the initial intervention.
Question 2:
What is the primary advantage of using a bougie during endotracheal intubation?
A) It allows for blind nasal intubation
B) It provides a stylet for difficult airways with poor glottic visualization
,C) It eliminates the need for a laryngoscope
D) It confirms proper tube placement
Answer: B)
Explanation: A bougie is a useful adjunct in difficult airways when the glottis is not well
visualized. It is passed blindly into the trachea, and the tube is then railroaded over it. A
"clicks" or "holds up" sign is felt as it passes through the tracheal rings.
Question 3:
Which waveform capnography pattern is most consistent with severe bronchospasm?
A) Normal rectangular waveform
B) Shark-fin or sloping ascending waveform
C) Sudden drop to zero
D) Elevated baseline with a plateau
Answer: B)
Explanation: A "shark-fin" pattern with a prolonged ascending phase is indicative of
bronchospasm, as seen in asthma or COPD exacerbations. The normal waveform has a
sharp upstroke and a plateau.
Question 4:
A 68-year-old male with COPD is receiving oxygen via a non-rebreather mask. He becomes
lethargic and his respiratory rate drops from 22 to 8 breaths per minute. The most likely
cause is:
A) Oxygen toxicity
B) Loss of hypoxic drive
C) Hypercarbia
D) Pulmonary embolism
Answer: C)
,Explanation: Patients with chronic CO2 retention rely on a hypoxic drive to breathe.
Administering high-flow oxygen can suppress this drive, leading to hypoventilation,
increased CO2 levels, and respiratory acidosis (hypercarbia). This can cause lethargy and
altered mental status.
Question 5:
The proper size for an oropharyngeal airway (OPA) is determined by measuring from:
A) The corner of the mouth to the angle of the mandible
B) The tip of the nose to the earlobe
C) The center of the incisors to the angle of the jaw
D) The corner of the mouth to the tragus of the ear
Answer: A)
Explanation: The correct OPA size is measured from the corner of the patient's mouth to
the angle of the mandible. An OPA that is too large can obstruct the airway, while one that
is too small may push the tongue back.
Question 6:
Which of the following is a contraindication to nasotracheal intubation?
A) Apnea
B) Facial trauma
C) Suspected cervical spine injury
D) Trismus
Answer: A)
Explanation: Nasotracheal intubation requires a spontaneously breathing patient. It is
contraindicated in apneic patients. Facial trauma and suspected basilar skull fractures are
also contraindications due to the risk of intracranial placement.
Question 7:
, A patient's end-tidal CO2 (EtCO2) reading drops from 40 mmHg to 20 mmHg during
transport. This is most concerning for:
A) Hypoventilation
B) Hyperventilation
C) Esophageal intubation or tube displacement
D) Sepsis
Answer: C)
Explanation: A sudden drop in EtCO2 in an intubated patient is a classic sign of
esophageal intubation or tube displacement. Confirmation with waveform capnography
and auscultation is critical.
Question 8:
Which medication is used to facilitate awake fiberoptic intubation by providing topical
anesthesia and vasoconstriction?
A) Lidocaine
B) Benzocaine
C) Phenylephrine
D) Ketamine
Answer: A)
Explanation: Lidocaine (viscous or nebulized) provides topical anesthesia and mild
vasoconstriction. Benzocaine provides anesthesia but not vasoconstriction. Phenylephrine
provides vasoconstriction only.
Question 9:
A 6-year-old with a suspected epiglottitis is in severe respiratory distress. The preferred
airway management is:
A) Orotracheal intubation in the OR
B) Nasotracheal intubation
C) Needle cricothyrotomy
Instructions: Choose the best answer for each of the following questions. This
comprehensive practice exam is designed for candidates preparing for the NREMT
Paramedic (NRP) Certification Examination. The actual exam is administered through
Computerized Adaptive Testing (CAT) format with a minimum of 110 questions and a 3.5-
hour time limit. This practice exam contains 200 scenario-based questions covering all six
domains: Airway, Respiration & Ventilation; Cardiology & Resuscitation; Trauma;
Medical/OB/GYN; EMS Operations; and Clinical Judgment.
---
SECTION 1: AIRWAY, RESPIRATION & VENTILATION (Questions 1-35)
Question 1:
A 45-year-old male is found unresponsive in a restaurant after choking on food. He is
cyanotic and has no audible breath sounds. After opening the airway with a head-tilt/chin-
lift, you visualize a foreign body. Your immediate action should be:
A) Perform abdominal thrusts
B) Attempt to remove the object with Magill forceps
C) Initiate bag-valve-mask ventilation
D) Perform a surgical cricothyrotomy
Answer: A)
Explanation: In a conscious choking victim who becomes unresponsive, the first step is to
perform abdominal thrusts (Heimlich maneuver). If the object is visualized and accessible,
Magill forceps may be used, but abdominal thrusts are the initial intervention.
Question 2:
What is the primary advantage of using a bougie during endotracheal intubation?
A) It allows for blind nasal intubation
B) It provides a stylet for difficult airways with poor glottic visualization
,C) It eliminates the need for a laryngoscope
D) It confirms proper tube placement
Answer: B)
Explanation: A bougie is a useful adjunct in difficult airways when the glottis is not well
visualized. It is passed blindly into the trachea, and the tube is then railroaded over it. A
"clicks" or "holds up" sign is felt as it passes through the tracheal rings.
Question 3:
Which waveform capnography pattern is most consistent with severe bronchospasm?
A) Normal rectangular waveform
B) Shark-fin or sloping ascending waveform
C) Sudden drop to zero
D) Elevated baseline with a plateau
Answer: B)
Explanation: A "shark-fin" pattern with a prolonged ascending phase is indicative of
bronchospasm, as seen in asthma or COPD exacerbations. The normal waveform has a
sharp upstroke and a plateau.
Question 4:
A 68-year-old male with COPD is receiving oxygen via a non-rebreather mask. He becomes
lethargic and his respiratory rate drops from 22 to 8 breaths per minute. The most likely
cause is:
A) Oxygen toxicity
B) Loss of hypoxic drive
C) Hypercarbia
D) Pulmonary embolism
Answer: C)
,Explanation: Patients with chronic CO2 retention rely on a hypoxic drive to breathe.
Administering high-flow oxygen can suppress this drive, leading to hypoventilation,
increased CO2 levels, and respiratory acidosis (hypercarbia). This can cause lethargy and
altered mental status.
Question 5:
The proper size for an oropharyngeal airway (OPA) is determined by measuring from:
A) The corner of the mouth to the angle of the mandible
B) The tip of the nose to the earlobe
C) The center of the incisors to the angle of the jaw
D) The corner of the mouth to the tragus of the ear
Answer: A)
Explanation: The correct OPA size is measured from the corner of the patient's mouth to
the angle of the mandible. An OPA that is too large can obstruct the airway, while one that
is too small may push the tongue back.
Question 6:
Which of the following is a contraindication to nasotracheal intubation?
A) Apnea
B) Facial trauma
C) Suspected cervical spine injury
D) Trismus
Answer: A)
Explanation: Nasotracheal intubation requires a spontaneously breathing patient. It is
contraindicated in apneic patients. Facial trauma and suspected basilar skull fractures are
also contraindications due to the risk of intracranial placement.
Question 7:
, A patient's end-tidal CO2 (EtCO2) reading drops from 40 mmHg to 20 mmHg during
transport. This is most concerning for:
A) Hypoventilation
B) Hyperventilation
C) Esophageal intubation or tube displacement
D) Sepsis
Answer: C)
Explanation: A sudden drop in EtCO2 in an intubated patient is a classic sign of
esophageal intubation or tube displacement. Confirmation with waveform capnography
and auscultation is critical.
Question 8:
Which medication is used to facilitate awake fiberoptic intubation by providing topical
anesthesia and vasoconstriction?
A) Lidocaine
B) Benzocaine
C) Phenylephrine
D) Ketamine
Answer: A)
Explanation: Lidocaine (viscous or nebulized) provides topical anesthesia and mild
vasoconstriction. Benzocaine provides anesthesia but not vasoconstriction. Phenylephrine
provides vasoconstriction only.
Question 9:
A 6-year-old with a suspected epiglottitis is in severe respiratory distress. The preferred
airway management is:
A) Orotracheal intubation in the OR
B) Nasotracheal intubation
C) Needle cricothyrotomy
