NREMT PARAMEDIC EXAM |ACTUAL QUESTIONS &
VERIFIED ANSWERS 2026-2027 UPDATED EDITION
|GRADED A+
Question 1
A 56-year-old male with chest pain states it began 30 minutes ago while watching TV. He
describes a "heavy pressure" radiating to his left arm and jaw, rated 8/10. He appears
pale, diaphoretic, and nauseous, with cool, clammy skin. His respiratory rate is 18, SpO₂ is
93% on room air, heart rate is 88 bpm, and BP is 142/86 mmHg. He has a history of
hypertension and diabetes, taking lisinopril, metformin, and daily aspirin. You administer
high-flow oxygen and 324 mg of aspirin. A 12-lead ECG reveals ST-elevation in leads II, III,
and aVF.
What is your next step?
A. Perform a right-sided ECG to rule out right ventricular involvement before nitroglycerin
B. Administer nitroglycerin and alert the hospital of a STEMI
C. Give a second aspirin dose and transport rapidly
D. Transport immediately without further treatment
CORRECT ANSWER
Correct Answer: A. Perform a right-sided ECG to rule out right ventricular involvement
before nitroglycerin
Explanation:
A is correct because ST-elevation in leads II, III, and aVF suggests an inferior STEMI, often
involving the right ventricle. Nitroglycerin can reduce preload and cause hemodynamic
collapse if right ventricular involvement is present. A right-sided ECG confirms this before
further treatment.
B is incorrect because giving nitroglycerin without ruling out right-sided MI risks
destabilizing the patient.
C is incorrect because 324 mg is the standard prehospital aspirin dose.
1
@THE STUDY VAULT
,D is incorrect because delaying essential assessments like a right-sided ECG risks
inappropriate treatment.
Question 2
You respond to a 22-year-old female complaining of severe shortness of breath and chest
tightness. She is sitting upright, visibly anxious, and using accessory muscles to breathe.
She speaks in two- to three-word sentences. Her respiratory rate is 28, her heart rate is
116 bpm, BP is 128/82 mmHg, and SpO₂ is 89% on room air. She tells you she has asthma,
triggered today by a neighbor's cigarette smoke. She takes albuterol as needed but hasn't
used it yet today.
You place her on high-flow oxygen via nonrebreather and note diffuse wheezing on
auscultation. She shows no signs of cyanosis or altered mental status.
What is your next step?
A. Administer an albuterol nebulizer and monitor for improvement
B. Administer epinephrine 0.3 mg IM and transport rapidly
C. Initiate CPAP to assist with breathing and oxygenation
D. Provide oxygen only and reassess in 5 minutes
CORRECT ANSWER
Correct Answer: A. Administer an albuterol nebulizer and monitor for improvement
Explanation:
A is correct because the patient's symptoms indicate an acute asthma exacerbation, and
the first-line treatment is a beta-agonist like albuterol to relax bronchial smooth muscle.
Monitoring for response to treatment is essential.
B is incorrect because epinephrine is reserved for severe exacerbations with signs of
impending respiratory failure, such as cyanosis or altered mental status, which this patient
does not exhibit.
C is incorrect because CPAP is not indicated unless there is severe hypoxia or failure to
oxygenate adequately after initial treatments.
D is incorrect because oxygen alone does not address bronchospasm, the underlying cause
of the exacerbation.
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@THE STUDY VAULT
, Question 3
You are called to a 72-year-old male with a sudden onset of right-sided weakness and
slurred speech. His wife reports the symptoms began about 45 minutes ago while he was
watching TV. He is alert but has difficulty forming words. On assessment, his BP is 180/98
mmHg, heart rate is 92 bpm, respiratory rate is 18, and SpO₂ is 96% on room air. His right-
sided facial droop and weakness in his arm and leg are evident. He is unable to raise his
right arm fully. He has a history of hypertension, hyperlipidemia, and smoking. He is on
lisinopril and atorvastatin.
What is your next step?
A. Administer 324 mg of aspirin and transport to the nearest stroke center
B. Perform a Cincinnati Prehospital Stroke Scale (CPSS) assessment and initiate transport
C. Administer IV fluids to manage hypertension and transport
D. Transport immediately to a facility equipped for thrombolysis
CORRECT ANSWER
Correct Answer: B. Perform a Cincinnati Prehospital Stroke Scale (CPSS) assessment and
initiate transport
Explanation:
B is correct because performing a CPSS is a critical first step in determining the likelihood
of a stroke. This includes assessing facial droop, arm drift, and speech. Rapid identification
and transport to a stroke center are necessary for further evaluation and possible
thrombolysis.
A is incorrect because aspirin is contraindicated in ischemic stroke until the type of stroke
is confirmed. Administering aspirin before confirming the stroke type could worsen
hemorrhagic stroke if present.
C is incorrect because IV fluids are not indicated for stroke management unless the patient
shows signs of dehydration or hypotension. Hypertension can be managed later by
medical control.
3
@THE STUDY VAULT
VERIFIED ANSWERS 2026-2027 UPDATED EDITION
|GRADED A+
Question 1
A 56-year-old male with chest pain states it began 30 minutes ago while watching TV. He
describes a "heavy pressure" radiating to his left arm and jaw, rated 8/10. He appears
pale, diaphoretic, and nauseous, with cool, clammy skin. His respiratory rate is 18, SpO₂ is
93% on room air, heart rate is 88 bpm, and BP is 142/86 mmHg. He has a history of
hypertension and diabetes, taking lisinopril, metformin, and daily aspirin. You administer
high-flow oxygen and 324 mg of aspirin. A 12-lead ECG reveals ST-elevation in leads II, III,
and aVF.
What is your next step?
A. Perform a right-sided ECG to rule out right ventricular involvement before nitroglycerin
B. Administer nitroglycerin and alert the hospital of a STEMI
C. Give a second aspirin dose and transport rapidly
D. Transport immediately without further treatment
CORRECT ANSWER
Correct Answer: A. Perform a right-sided ECG to rule out right ventricular involvement
before nitroglycerin
Explanation:
A is correct because ST-elevation in leads II, III, and aVF suggests an inferior STEMI, often
involving the right ventricle. Nitroglycerin can reduce preload and cause hemodynamic
collapse if right ventricular involvement is present. A right-sided ECG confirms this before
further treatment.
B is incorrect because giving nitroglycerin without ruling out right-sided MI risks
destabilizing the patient.
C is incorrect because 324 mg is the standard prehospital aspirin dose.
1
@THE STUDY VAULT
,D is incorrect because delaying essential assessments like a right-sided ECG risks
inappropriate treatment.
Question 2
You respond to a 22-year-old female complaining of severe shortness of breath and chest
tightness. She is sitting upright, visibly anxious, and using accessory muscles to breathe.
She speaks in two- to three-word sentences. Her respiratory rate is 28, her heart rate is
116 bpm, BP is 128/82 mmHg, and SpO₂ is 89% on room air. She tells you she has asthma,
triggered today by a neighbor's cigarette smoke. She takes albuterol as needed but hasn't
used it yet today.
You place her on high-flow oxygen via nonrebreather and note diffuse wheezing on
auscultation. She shows no signs of cyanosis or altered mental status.
What is your next step?
A. Administer an albuterol nebulizer and monitor for improvement
B. Administer epinephrine 0.3 mg IM and transport rapidly
C. Initiate CPAP to assist with breathing and oxygenation
D. Provide oxygen only and reassess in 5 minutes
CORRECT ANSWER
Correct Answer: A. Administer an albuterol nebulizer and monitor for improvement
Explanation:
A is correct because the patient's symptoms indicate an acute asthma exacerbation, and
the first-line treatment is a beta-agonist like albuterol to relax bronchial smooth muscle.
Monitoring for response to treatment is essential.
B is incorrect because epinephrine is reserved for severe exacerbations with signs of
impending respiratory failure, such as cyanosis or altered mental status, which this patient
does not exhibit.
C is incorrect because CPAP is not indicated unless there is severe hypoxia or failure to
oxygenate adequately after initial treatments.
D is incorrect because oxygen alone does not address bronchospasm, the underlying cause
of the exacerbation.
2
@THE STUDY VAULT
, Question 3
You are called to a 72-year-old male with a sudden onset of right-sided weakness and
slurred speech. His wife reports the symptoms began about 45 minutes ago while he was
watching TV. He is alert but has difficulty forming words. On assessment, his BP is 180/98
mmHg, heart rate is 92 bpm, respiratory rate is 18, and SpO₂ is 96% on room air. His right-
sided facial droop and weakness in his arm and leg are evident. He is unable to raise his
right arm fully. He has a history of hypertension, hyperlipidemia, and smoking. He is on
lisinopril and atorvastatin.
What is your next step?
A. Administer 324 mg of aspirin and transport to the nearest stroke center
B. Perform a Cincinnati Prehospital Stroke Scale (CPSS) assessment and initiate transport
C. Administer IV fluids to manage hypertension and transport
D. Transport immediately to a facility equipped for thrombolysis
CORRECT ANSWER
Correct Answer: B. Perform a Cincinnati Prehospital Stroke Scale (CPSS) assessment and
initiate transport
Explanation:
B is correct because performing a CPSS is a critical first step in determining the likelihood
of a stroke. This includes assessing facial droop, arm drift, and speech. Rapid identification
and transport to a stroke center are necessary for further evaluation and possible
thrombolysis.
A is incorrect because aspirin is contraindicated in ischemic stroke until the type of stroke
is confirmed. Administering aspirin before confirming the stroke type could worsen
hemorrhagic stroke if present.
C is incorrect because IV fluids are not indicated for stroke management unless the patient
shows signs of dehydration or hypotension. Hypertension can be managed later by
medical control.
3
@THE STUDY VAULT
