Page 1 of 110
NYS PARAMEDIC CERTIFICATION EXAM PREP – 300+ EXAM QUESTIONS 2026 EXAM
LATEST VERSION SOLVED QUESTIONS & ANSWERS VERIFIED 100 %
NYS Paramedic Certification Exam Prep – 300+ Practice Questions
1. A 45-year-old male is in respiratory distress with stridor and drooling. He cannot
lie flat. The most appropriate airway intervention is:
A. Oropharyngeal airway with BVM ventilation
B. Nasopharyngeal airway with high-flow oxygen via NRB
C. Awake, upright positioning with blow-by oxygen and immediate transport
D. Rapid sequence intubation in the supine position
Correct Answer: C
Rationale: Stridor + drooling + tripod positioning suggests epiglottitis or severe upper
airway obstruction. Laying the patient flat or manipulating the airway can cause
complete obstruction. Awake, upright positioning with minimal intervention and rapid
transport is preferred. RSI is high-risk without definitive surgical airway backup.
2. The primary advantage of video laryngoscopy over direct laryngoscopy is:
A. Lower cost and easier cleaning
B. Improved glottic visualization, especially in difficult airways
C. Eliminates the need for stylet use
D. Shorter time to intubation in all patients
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Correct Answer: B
Rationale: Video laryngoscopy provides an indirect view of the glottis, which is
particularly beneficial in patients with limited mouth opening, cervical spine
immobilization, or difficult anatomy. It does not eliminate the need for stylets or
guarantee faster intubation in all cases.
3. Which waveform capnography pattern is most consistent with bronchospasm
(e.g., asthma or COPD exacerbation)?
A. Normal rectangular waveform
B. Shark-fin (slow upsloping) waveform
C. Curare cleft waveform
D. Sudden loss of waveform
Correct Answer: B
Rationale: A shark-fin or slow upsloping waveform on capnography is characteristic of
bronchospasm due to uneven alveolar emptying. The waveform loses its normal
rectangular shape and shows a gradual upslope.
4. A patient in respiratory arrest is being ventilated via BVM. Capnography shows a
sudden loss of waveform. The most likely cause is:
A. Improved ventilation
B. Esophageal intubation or disconnection
C. Bronchospasm
D. Hyperventilation
Correct Answer: B
Rationale: Sudden loss of capnography waveform indicates either esophageal
intubation, tube disconnection, or complete airway obstruction. Immediate
assessment and correction are required.
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5. A paramedic is preparing for RSI on a 70 kg patient. Which induction agent and
paralytic combination is most appropriate?
A. Etomidate 0.3 mg/kg and succinylcholine 1.5 mg/kg
B. Midazolam 0.1 mg/kg and vecuronium 0.1 mg/kg
C. Ketamine 2 mg/kg and rocuronium 1.2 mg/kg
D. Propofol 2 mg/kg and pancuronium 0.1 mg/kg
Correct Answer: A
Rationale: Etomidate (0.3 mg/kg) provides hemodynamic stability, and succinylcholine
(1.5 mg/kg) provides rapid onset and short duration of paralysis. Ketamine and
rocuronium are alternatives but etomidate-succinylcholine is the classic RSI
combination.
6. A patient with a known difficult airway requires intubation. Which device should
the paramedic prepare first?
A. Macintosh blade
B. Miller blade
C. Video laryngoscope
D. Combitube
Correct Answer: C
Rationale: Video laryngoscopy is preferred for known or anticipated difficult airways
because it improves glottic visualization without requiring direct line of sight.
7. A paramedic is performing surgical cricothyrotomy. Which anatomical landmark
should be identified first?
A. Thyroid cartilage
B. Cricothyroid membrane
C. Cricoid cartilage
D. Hyoid bone
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Correct Answer: B
Rationale: The cricothyroid membrane, located between the thyroid and cricoid
cartilages, is the target for surgical cricothyrotomy. It is identified by palpating the
depression between these two structures.
8. A patient with a tracheostomy is in respiratory distress. The paramedic is unable
to pass a suction catheter. The most appropriate action is:
A. Remove the tracheostomy tube and ventilate via stoma
B. Increase suction pressure
C. Instill saline into the tracheostomy
D. Hyperventilate via the tracheostomy
Correct Answer: A
Rationale: If the tracheostomy is obstructed and suctioning fails, the tube should be
removed and the patient ventilated via the stoma or orally. Saline instillation and
increased suction are not recommended.
9. A 6-year-old child requires intubation. What is the appropriate uncuffed
endotracheal tube size?
A. 3.5 mm
B. 4.0 mm
C. 4.5 mm
D. 5.0 mm
Correct Answer: B
Rationale: The formula for uncuffed ETT size in children is (age in years ÷ 4) + 4 = (6 ÷ 4)
+ 4 = 1.5 + 4 = 5.5, but for a 6-year-old, a 4.0–4.5 mm uncuffed tube is typically
appropriate. Cuffed tubes are generally 0.5 mm smaller.
10. A paramedic is confirming ET tube placement. Which method is most reliable?
NYS PARAMEDIC CERTIFICATION EXAM PREP – 300+ EXAM QUESTIONS 2026 EXAM
LATEST VERSION SOLVED QUESTIONS & ANSWERS VERIFIED 100 %
NYS Paramedic Certification Exam Prep – 300+ Practice Questions
1. A 45-year-old male is in respiratory distress with stridor and drooling. He cannot
lie flat. The most appropriate airway intervention is:
A. Oropharyngeal airway with BVM ventilation
B. Nasopharyngeal airway with high-flow oxygen via NRB
C. Awake, upright positioning with blow-by oxygen and immediate transport
D. Rapid sequence intubation in the supine position
Correct Answer: C
Rationale: Stridor + drooling + tripod positioning suggests epiglottitis or severe upper
airway obstruction. Laying the patient flat or manipulating the airway can cause
complete obstruction. Awake, upright positioning with minimal intervention and rapid
transport is preferred. RSI is high-risk without definitive surgical airway backup.
2. The primary advantage of video laryngoscopy over direct laryngoscopy is:
A. Lower cost and easier cleaning
B. Improved glottic visualization, especially in difficult airways
C. Eliminates the need for stylet use
D. Shorter time to intubation in all patients
, Page 2 of 110
Correct Answer: B
Rationale: Video laryngoscopy provides an indirect view of the glottis, which is
particularly beneficial in patients with limited mouth opening, cervical spine
immobilization, or difficult anatomy. It does not eliminate the need for stylets or
guarantee faster intubation in all cases.
3. Which waveform capnography pattern is most consistent with bronchospasm
(e.g., asthma or COPD exacerbation)?
A. Normal rectangular waveform
B. Shark-fin (slow upsloping) waveform
C. Curare cleft waveform
D. Sudden loss of waveform
Correct Answer: B
Rationale: A shark-fin or slow upsloping waveform on capnography is characteristic of
bronchospasm due to uneven alveolar emptying. The waveform loses its normal
rectangular shape and shows a gradual upslope.
4. A patient in respiratory arrest is being ventilated via BVM. Capnography shows a
sudden loss of waveform. The most likely cause is:
A. Improved ventilation
B. Esophageal intubation or disconnection
C. Bronchospasm
D. Hyperventilation
Correct Answer: B
Rationale: Sudden loss of capnography waveform indicates either esophageal
intubation, tube disconnection, or complete airway obstruction. Immediate
assessment and correction are required.
, Page 3 of 110
5. A paramedic is preparing for RSI on a 70 kg patient. Which induction agent and
paralytic combination is most appropriate?
A. Etomidate 0.3 mg/kg and succinylcholine 1.5 mg/kg
B. Midazolam 0.1 mg/kg and vecuronium 0.1 mg/kg
C. Ketamine 2 mg/kg and rocuronium 1.2 mg/kg
D. Propofol 2 mg/kg and pancuronium 0.1 mg/kg
Correct Answer: A
Rationale: Etomidate (0.3 mg/kg) provides hemodynamic stability, and succinylcholine
(1.5 mg/kg) provides rapid onset and short duration of paralysis. Ketamine and
rocuronium are alternatives but etomidate-succinylcholine is the classic RSI
combination.
6. A patient with a known difficult airway requires intubation. Which device should
the paramedic prepare first?
A. Macintosh blade
B. Miller blade
C. Video laryngoscope
D. Combitube
Correct Answer: C
Rationale: Video laryngoscopy is preferred for known or anticipated difficult airways
because it improves glottic visualization without requiring direct line of sight.
7. A paramedic is performing surgical cricothyrotomy. Which anatomical landmark
should be identified first?
A. Thyroid cartilage
B. Cricothyroid membrane
C. Cricoid cartilage
D. Hyoid bone
, Page 4 of 110
Correct Answer: B
Rationale: The cricothyroid membrane, located between the thyroid and cricoid
cartilages, is the target for surgical cricothyrotomy. It is identified by palpating the
depression between these two structures.
8. A patient with a tracheostomy is in respiratory distress. The paramedic is unable
to pass a suction catheter. The most appropriate action is:
A. Remove the tracheostomy tube and ventilate via stoma
B. Increase suction pressure
C. Instill saline into the tracheostomy
D. Hyperventilate via the tracheostomy
Correct Answer: A
Rationale: If the tracheostomy is obstructed and suctioning fails, the tube should be
removed and the patient ventilated via the stoma or orally. Saline instillation and
increased suction are not recommended.
9. A 6-year-old child requires intubation. What is the appropriate uncuffed
endotracheal tube size?
A. 3.5 mm
B. 4.0 mm
C. 4.5 mm
D. 5.0 mm
Correct Answer: B
Rationale: The formula for uncuffed ETT size in children is (age in years ÷ 4) + 4 = (6 ÷ 4)
+ 4 = 1.5 + 4 = 5.5, but for a 6-year-old, a 4.0–4.5 mm uncuffed tube is typically
appropriate. Cuffed tubes are generally 0.5 mm smaller.
10. A paramedic is confirming ET tube placement. Which method is most reliable?
