20 free NREMT Paramedic practice questions

Correct answer: C · Continuous waveform capnography, used together with clinical assessment

The 2025 AHA adult advanced life support guideline recommends continuous waveform capnography, in addition to clinical assessment, as the most reliable method of confirming and monitoring correct endotracheal tube placement in adults in cardiac arrest. Misting inside the tube and chest rise with the first breaths are spot checks made by eye; repeating them still leaves gaps between checks, and the guideline names capnography, not either of these, as the most reliable method. A pulse oximetry reading tracks oxygen saturation rather than where the tube sits, and waiting minutes for it to climb delays confirmation. Capnography gives a continuous reading, so it both confirms the tube and keeps monitoring it.

Look for this next time: In adult cardiac arrest, confirm and keep monitoring an endotracheal tube with continuous waveform capnography plus clinical assessment.

Correct answer: A · Keep her upright with her parent, do not look in her throat, and prepare airway support for transport

This combination suggests a threatened upper airway, including possible epiglottitis. Keep the child calm in her preferred position with her parent, avoid a provocative throat examination, and prepare airway support and urgent transport. Forcing her flat, deep oral suctioning, or making her walk may worsen distress. The Royal Children's Hospital acute upper-airway guideline supports minimal disturbance and early airway expertise.

Look for this next time: With suspected epiglottitis, let the child stay upright, do not inspect the throat, and prepare airway support for transport.

Correct answer: D · As soon as feasible, now that the IV line is in place

Asystole is a nonshockable rhythm. The 2025 AHA adult guideline says that for adults in cardiac arrest with a nonshockable rhythm it is reasonable to give epinephrine as soon as feasible, and the new IV line makes it feasible now. Waiting for the second rhythm check postpones the drug with no shock to wait for; the later timing, after initial defibrillation attempts have failed, is the one for shockable rhythms. The timing recommendation is not tied to an advanced airway, so placing one first only adds delay. The guideline recommends trying IV access first and calls intraosseous access reasonable when IV attempts fail or are not feasible, so replacing a working IV line reverses that order.

Look for this next time: In adult cardiac arrest with a nonshockable rhythm, give epinephrine as soon as feasible, using IV access first.

Correct answer: B · Synchronized cardioversion, because he is hemodynamically unstable

Low blood pressure, new confusion, and cool, pale skin show that this regular narrow-complex tachycardia is making him hemodynamically unstable. The 2025 AHA adult guideline recommends synchronized cardioversion for hemodynamically unstable narrow-complex tachycardia. Vagal maneuvers are recommended for regular narrow-complex tachycardia, but trying them and waiting minutes to reassess delays the treatment an unstable patient needs. Unsynchronized defibrillation is the shock for pulseless ventricular fibrillation or ventricular tachycardia and for sustained polymorphic ventricular tachycardia; a fast rate alone does not call for it. Transporting him without treatment until he loses a pulse leaves the instability in place.

Look for this next time: A hemodynamically unstable narrow-complex tachycardia calls for synchronized cardioversion, not a trial of vagal maneuvers.

Correct answer: B · A red criterion is met, since 78 is below the limit of 82 for her age

For children aged 0 to 9, the 2021 guideline's red vital-sign criterion is a systolic pressure below 70 mm Hg plus twice the age in years. For a 6-year-old that is 70 + 12 = 82, and her 78 is below it. Meeting any one red criterion means transport to the highest-level trauma center available within the regional trauma system, and the guideline adds that children should be triaged preferentially to pediatric-capable centers. Calling 78 normal for her age ignores that threshold. The yellow fall criterion is a fall from more than 10 feet, so 5 feet does not meet it. Being alert and following commands rules out the motor-score criterion, but one red criterion is enough.

Look for this next time: For ages 0 to 9, a systolic pressure below 70 plus twice the age in years is a red field-triage criterion.

Correct answer: D · Her fall and her anticoagulant are risk factors, so a trauma center is preferred

The guideline's EMS judgment box lists low-level falls in adults 65 and older with significant head impact, and anticoagulant use, among the risk factors to consider. Those are yellow criteria, and a patient who meets a yellow criterion but no red one should be preferentially transported to a trauma center, which need not be the highest level. She meets no red criterion: for age 65 and older the vital-sign limits are a systolic pressure below 110 or a heart rate above the systolic pressure, her breathing rate and oxygen saturation do not reach the red limits, and no red injury pattern was found. Saying no criteria apply ignores both risk factors. Leaving her at home ignores them too, and the guideline says that if you are concerned, you take the patient to a trauma center.

Look for this next time: In an older adult, a low-level fall with significant head impact or anticoagulant use is a yellow risk factor that favors a trauma center.

Correct answer: A · Ventilate him with a bag-mask device and give naloxone

With a definite pulse but no breathing, this adult needs immediate ventilation and naloxone for suspected opioid respiratory arrest. Compressions are not indicated while a definite pulse remains; monitoring or applying pads alone cannot replace ventilation. Waiting for naloxone or delaying for another assessment leaves the patient without breaths. Continue reassessment and start CPR if cardiac arrest develops.

Look for this next time: In suspected opioid overdose with respiratory arrest and a definite pulse, ventilate and give naloxone; compressions are for a patient without a pulse.

Correct answer: C · Intramuscular epinephrine in the lateral thigh, given right away

Hives, wheezing, lightheadedness, and low blood pressure minutes after eating peanuts point to anaphylaxis. The 2024 AHA and American Red Cross First Aid Guidelines call intramuscular epinephrine the mainstay of immediate treatment for anaphylaxis and describe strong consensus for early intramuscular epinephrine in the lateral thigh as the primary treatment, whatever the trigger. The same guideline notes that some patients also need advanced care such as intravenous fluids, so fluids can be added to epinephrine but do not replace it. An oral antihistamine with observation, and an IV corticosteroid given first, both put another drug ahead of the treatment the guideline names as primary. Doses and later steps follow your protocol.

Look for this next time: Give intramuscular epinephrine promptly for anaphylaxis. Airway support and fluids may proceed alongside it; antihistamines or steroids must not delay it.

Correct answer: D · Start ice-water immersion now and keep monitoring her core temperature

Confusion and a core temperature above 40 °C point to life-threatening hyperthermia. The 2025 AHA guidelines recommend starting active cooling together with resuscitation, prefer immersion in ice water over other cooling methods, and aim for cooling of at least 0.15 °C per minute, stopping active cooling when the core temperature reaches 38.6 °C, which is why her temperature must be watched. Cold packs, fanning and misting, and tepid sponging are methods the guideline ranks below ice-water immersion, and each one either waits for transport or stops when she feels better instead of at a measured temperature. Immersion in tepid water is the guideline's fallback only when ice water is not available, and here it is.

Look for this next time: For heat stroke with a core temperature above 40 °C, start ice-water immersion when it is available and stop active cooling at 38.6 °C.

Correct answer: A · Manually displace her uterus to the left during compressions

The 2025 AHA guidelines recommend manual left lateral uterine displacement during chest compressions for a pregnant patient in cardiac arrest when the fundal height is at or above the umbilicus, as it is here. The same guidelines say airway management should be prioritized during the resuscitation of a pregnant patient, so holding it until after delivery reverses that priority. Pausing compressions to reposition her interrupts CPR, while manual displacement is done with compressions running. Leaving pregnancy-specific care to the hospital gives up an action the crew can take now; the guidelines' separate target for delivering the fetus does not replace displacement during compressions.

Look for this next time: In cardiac arrest late in pregnancy, with the fundus at or above the umbilicus, manually displace the uterus to the left during compressions and prioritize the airway.

Correct answer: C · 21% oxygen, then adjusted to the pulse oximetry targets

The 2025 AHA neonatal guidance says the initial oxygen concentration when providing ventilation is 21% for term and late preterm newborns of 35 weeks or more, with the concentration then titrated to pulse oximetry targets. A term newborn who needs ventilation therefore starts at 21%, and the oximeter guides any change. Starting at 100% and lowering it by skin color, or starting at the highest concentration on hand until the baby cries, begins well above the recommended starting point and adjusts by signs other than oximetry. A fixed 40% for the whole resuscitation neither starts at 21% nor adjusts to the oximetry targets.

Look for this next time: Ventilation for a term newborn starts at 21% oxygen and is then adjusted to pulse oximetry targets.

Correct answer: B · Use the device for the stair carry and drive, where manual CPR is hard to keep up

The 2025 AHA guidelines do not recommend routine use of mechanical CPR devices, but say one may be considered when high-quality CPR cannot be maintained or for the safety of healthcare professionals, such as during transport to a hospital. A long stair carry and a 20-minute drive are those conditions. Using the device on every arrest is the routine use the guidelines advise against, rated as no benefit. Stopping compressions for the drive leaves the patient without CPR for 20 minutes. Manual CPR from a compressor standing unbelted in a moving ambulance is hard to keep at high quality and puts the crew at risk, which is the safety concern the guidelines name.

Look for this next time: Mechanical CPR is not for routine use, but it may be considered when high-quality manual CPR cannot be maintained or crew safety is at risk, such as during transport.

Correct answer: A · Identify herself, help without using advanced skills, and hand off to the local crew

The National EMS Scope of Practice Model says a person may perform only the skills they are educated, certified, licensed, and credentialed to perform, and it gives this kind of case as an example: an off-duty paramedic at an incident outside their jurisdiction usually is not credentialed to perform advanced skills, so doing so would violate scope of practice. The National Registry also says its certification does not grant the right to practice; a state license does. That rules out placing an advanced airway on the strength of national certification, and taking charge of a crew that is credentialed there when she is not. The credentialing limit concerns advanced skills and does not require her to leave, so she can identify herself, help within that limit, and hand off when the local crew arrives.

Look for this next time: National certification and a home-state license do not credential a paramedic to use advanced skills outside their jurisdiction.

Correct answer: D · The time she was last known to be normal, from the daughter's call

Word-finding trouble and a new arm drift are stroke cues, and the 2026 AHA/ASA stroke guideline lists determination of the last-known-well time among proposed prehospital quality measures, along with a stroke screen, a glucose check, a scene time of 15 minutes or less, and prenotification of the hospital. Here the last time she was known to be normal is the daughter's call 50 minutes ago; finding her 10 minutes ago marks when the symptoms were noticed, not when they began. Gathering a complete medication list before moving her stretches the scene time. Insurance details and past surgeries are not among the time-critical items the guideline names and can wait for the hospital.

Look for this next time: Recognize cues (scene): in suspected stroke, the last-known-well time is the history detail to pin down and report first.

Correct answer: C · Activate the PCI-capable center from the field and transport him there

The 2025 ACC/AHA guideline says patients with STEMI identified before hospital arrival should preferentially be transported to a PCI-capable hospital, with a goal of 90 minutes or less from first medical contact to first device, and that activating the catheterization laboratory from the field has been associated with lower short- and long-term mortality. Calling ahead from the field and driving to the PCI-capable center does both. Going to the closer hospital first adds a transfer before he can reach PCI. The guideline asks for at least one 12-lead ECG, and this one already meets STEMI criteria, so repeating it before choosing a destination only delays the decision. Driving in without notice gives up field activation.

Look for this next time: Take action (post scene): for a STEMI found in the field, activate the PCI-capable center from the field and transport the patient there.

Correct answer: B · Return of spontaneous circulation

The 2025 AHA adult guideline says an abrupt increase in end-tidal CO2 may be used to detect return of spontaneous circulation during chest compressions, and that a sudden rise of more than 10 mm Hg may indicate it. This reading rose by about 25 mm Hg while compressions and ventilation stayed the same, so returning circulation is the best explanation, and the crew looks for an organized rhythm and a pulse at the next check. A tube that slipped into the esophagus would make exhaled CO2 fall, not jump. The stem rules out a change in ventilation rate. Dismissing the rise as a sensor fault ignores the very sign the guideline says can detect circulation returning.

Look for this next time: Define hypothesis (scene): an abrupt rise in ETCO2 during CPR, with technique unchanged, points first to return of spontaneous circulation.

Correct answer: D · Immediate defibrillation, given as an unsynchronized shock

Wide complexes that keep changing shape and size describe polymorphic ventricular tachycardia, and this run is sustained. New in 2025, the AHA adult guideline recommends that all adult patients with sustained polymorphic VT receive immediate defibrillation. The same guideline says adenosine should not be given for polymorphic wide-complex tachycardia, so using it to identify the rhythm is ruled out. Synchronized cardioversion is the guideline's treatment for unstable wide-complex tachycardia in general, but sustained polymorphic VT is singled out for immediate defibrillation instead. Vagal maneuvers are recommended for regular narrow-complex tachycardia, which this is not, so they only delay the shock.

Look for this next time: Generate solutions (scene): sustained polymorphic VT in an adult calls for immediate defibrillation, not adenosine or synchronized cardioversion.

Correct answer: A · Switch compressors during this rhythm check and keep the pulse check to 10 seconds or less

The 2025 AHA adult BLS guidelines call for compressions at least 2 inches (5 cm) deep at 100 to 120 per minute, say it is reasonable to switch compressors about every 2 minutes, and limit the pulse check to no more than 10 seconds. The rhythm check at the end of this cycle is the planned pause, so the leader uses it to bring in a fresh compressor without adding time off the chest. Keeping the tired compressor for another cycle accepts two more minutes of shallow compressions. Stretching the pause to change pads and recheck the airway adds time without compressions. Lowering the rate to about 90 per minute falls below the recommended 100 to 120.

Look for this next time: Take action, leadership (scene): use the planned rhythm check to switch a tiring compressor, and keep the pulse check to 10 seconds or less.

Correct answer: C · Support his breathing and reconsider the destination, since he now meets red criteria

The new respiratory findings meet red triage criteria. Support breathing and reassess the destination under the regional plan rather than treating the original decision as fixed. The stem allows safe transport to the highest-level center without a prolonged delay, so automatic diversion to the nearest emergency department is not the best choice here. In actual extremis, such as an airway that cannot be managed, severe shock or traumatic arrest, initial stabilization at the closest hospital may be needed.

Look for this next time: Evaluation (post scene): recheck the triage criteria as findings change, because a patient who develops a red criterion during transport needs the destination re-evaluated.

Correct answer: B · A 12-lead ECG, to look for a STEMI that would change the destination

The 2025 AHA guidelines say a 12-lead ECG should be performed for adults after return of spontaneous circulation, and the 2025 ACC/AHA acute coronary syndrome guideline says EMS should preferentially take patients who are comatose after cardiac arrest, have ROSC, and show STEMI on the ECG to a primary PCI center. The 12-lead is the assessment that sorts these cues toward a treatable cardiac cause and the right destination. A head-to-toe exam may find injuries from the fall, but it does not look for the cause of the arrest. Estimating neurologic recovery from the pupils predicts an outcome instead of identifying a cause to treat. Putting off all assessment until the hospital wastes a finding that could change where he goes.

Look for this next time: Analyze cues (post scene): after ROSC in an adult, a 12-lead ECG looks for a STEMI that can change the destination.