PARAMEDIC CERTIFICATION
(NREMT-P LEVEL) EXAM BANK –
COMPREHENSIVE EXAM WITH
ANSWERS AND RATIONALES
1. The first-line medication for symptomatic
bradycardia (heart rate 40 bpm with hypotension) is:
A) Epinephrine 1 mg IV push
B) Atropine 0.5 mg IV
C) Dopamine 5 mcg/kg/min
D) Transcutaneous pacing (TCP)
Correct answer: B
Rationale: Atropine (0.5 mg IV q3-5 min, max 3 mg) is
first-line for symptomatic bradycardia; TCP if
atropine fails; dopamine or epinephrine infusion as
alternatives.
2. Which of the following rhythms requires
synchronized cardioversion in a stable patient?
A) Ventricular fibrillation (VF)
B) Unstable supraventricular tachycardia (SVT) with
hypotension
,C) Stable monomorphic ventricular tachycardia (VT)
with pulse
D) Atrial fibrillation with rapid ventricular response
(stable)
Correct answer: C
Rationale: Stable monomorphic VT (with pulse)
requires synchronized cardioversion (100 J
biphasic). Unstable SVT/VT requires immediate
unsynchronized cardioversion. Stable atrial
fibrillation may be rate-controlled.
3. The correct dose of adenosine for supraventricular
tachycardia (SVT) in an adult is:
A) 6 mg rapid IV push followed by 12 mg if needed
B) 12 mg slow IV push
C) 1 mg IV push
D) 0.1 mg/kg IV
Correct answer: A
Rationale: Adenosine 6 mg rapid IV push (followed by
saline flush) then 12 mg if no conversion; repeat 12
mg once. Causes transient asystole.
,4. A patient with ventricular fibrillation (VF) receives
three stacked shocks without conversion. The next
appropriate action is:
A) Resume CPR for 2 minutes then administer
epinephrine 1 mg
B) Administer amiodarone 300 mg IV push
C) Administer lidocaine 1.5 mg/kg IV
D) Synchronized cardioversion
Correct answer: A
Rationale: After defibrillation, resume CPR
immediately for 2 minutes; administer epinephrine (1
mg IV/IO) after second shock (or immediately if
refractory VF).
5. The endotracheal tube (ETT) depth at the teeth for
an average adult is approximately:
A) 16-18 cm (for female) or 20-22 cm (for male)
B) 10-12 cm
C) 25-28 cm
D) 30-35 cm
Correct answer: A
, Rationale: ETT depth: 21-23 cm at teeth for males; 20-
22 cm for females (approximately 3 × ETT size). Verify
with capnography and auscultation.
6. Which of the following is the most reliable method
to confirm endotracheal tube placement?
A) Auscultation of bilateral breath sounds and
epigastric sounds
B) Pulse oximetry
C) Continuous waveform capnography (ETCO2)
D) Chest rise and fall
Correct answer: C
Rationale: Continuous waveform capnography
(ETCO2) is gold standard for confirming ETT
placement; sustained ETCO2 after 6 breaths
indicates tracheal placement.
7. A patient in cardiac arrest has an initial rhythm of
pulseless electrical activity (PEA). The most common
cause to consider is:
A) Tension pneumothorax
B) Hypovolemia (including hemorrhage)
C) Cardiac tamponade
(NREMT-P LEVEL) EXAM BANK –
COMPREHENSIVE EXAM WITH
ANSWERS AND RATIONALES
1. The first-line medication for symptomatic
bradycardia (heart rate 40 bpm with hypotension) is:
A) Epinephrine 1 mg IV push
B) Atropine 0.5 mg IV
C) Dopamine 5 mcg/kg/min
D) Transcutaneous pacing (TCP)
Correct answer: B
Rationale: Atropine (0.5 mg IV q3-5 min, max 3 mg) is
first-line for symptomatic bradycardia; TCP if
atropine fails; dopamine or epinephrine infusion as
alternatives.
2. Which of the following rhythms requires
synchronized cardioversion in a stable patient?
A) Ventricular fibrillation (VF)
B) Unstable supraventricular tachycardia (SVT) with
hypotension
,C) Stable monomorphic ventricular tachycardia (VT)
with pulse
D) Atrial fibrillation with rapid ventricular response
(stable)
Correct answer: C
Rationale: Stable monomorphic VT (with pulse)
requires synchronized cardioversion (100 J
biphasic). Unstable SVT/VT requires immediate
unsynchronized cardioversion. Stable atrial
fibrillation may be rate-controlled.
3. The correct dose of adenosine for supraventricular
tachycardia (SVT) in an adult is:
A) 6 mg rapid IV push followed by 12 mg if needed
B) 12 mg slow IV push
C) 1 mg IV push
D) 0.1 mg/kg IV
Correct answer: A
Rationale: Adenosine 6 mg rapid IV push (followed by
saline flush) then 12 mg if no conversion; repeat 12
mg once. Causes transient asystole.
,4. A patient with ventricular fibrillation (VF) receives
three stacked shocks without conversion. The next
appropriate action is:
A) Resume CPR for 2 minutes then administer
epinephrine 1 mg
B) Administer amiodarone 300 mg IV push
C) Administer lidocaine 1.5 mg/kg IV
D) Synchronized cardioversion
Correct answer: A
Rationale: After defibrillation, resume CPR
immediately for 2 minutes; administer epinephrine (1
mg IV/IO) after second shock (or immediately if
refractory VF).
5. The endotracheal tube (ETT) depth at the teeth for
an average adult is approximately:
A) 16-18 cm (for female) or 20-22 cm (for male)
B) 10-12 cm
C) 25-28 cm
D) 30-35 cm
Correct answer: A
, Rationale: ETT depth: 21-23 cm at teeth for males; 20-
22 cm for females (approximately 3 × ETT size). Verify
with capnography and auscultation.
6. Which of the following is the most reliable method
to confirm endotracheal tube placement?
A) Auscultation of bilateral breath sounds and
epigastric sounds
B) Pulse oximetry
C) Continuous waveform capnography (ETCO2)
D) Chest rise and fall
Correct answer: C
Rationale: Continuous waveform capnography
(ETCO2) is gold standard for confirming ETT
placement; sustained ETCO2 after 6 breaths
indicates tracheal placement.
7. A patient in cardiac arrest has an initial rhythm of
pulseless electrical activity (PEA). The most common
cause to consider is:
A) Tension pneumothorax
B) Hypovolemia (including hemorrhage)
C) Cardiac tamponade
