EMT/NREMT Exam Flashcards

Q: What is the NREMT EMT exam pass rate?

The NREMT EMT exam has approximately a 70% first-time pass rate. The exam uses Computer Adaptive Testing (CAT), meaning the number of questions varies between 70-120 based on your performance. There is no set 'passing score'—the algorithm determines competency. You must demonstrate competence above the passing standard in each content area.

Q: How hard is the NREMT EMT exam?

The NREMT is considered moderately difficult. The CAT format means if you're answering correctly, questions get harder. Many candidates feel they failed because questions kept getting more difficult—this is actually a good sign. Focus areas: patient assessment (heaviest weight), airway/ventilation, cardiology, trauma, and medical/OB/GYN emergencies. Most failures occur in airway management and medical emergencies.

Q: How do I become an EMT?

Steps to become an EMT: (1) Complete a state-approved EMT education program (120-150 hours, typically 3-6 months), (2) Pass cognitive (written) and psychomotor (practical skills) exams, (3) Apply for NREMT certification, (4) Obtain state licensure. You must be 18+ (some states allow 16-17 with restrictions), have a high school diploma or GED, and hold a current CPR/BLS card.

Q: How long is NREMT certification valid?

NREMT EMT certification is valid for 2 years. To recertify, you must complete 40 hours of continuing education (including specific required topics) OR retake the cognitive exam. You must also maintain current CPR/BLS certification throughout. State licensure renewal requirements may differ from NREMT and must also be maintained separately.

Q: What topics are on the NREMT EMT exam?

The NREMT EMT exam covers: Airway, Respiration & Ventilation (18-22%), Cardiology & Resuscitation (20-24%), Trauma (14-18%), Medical/OB/GYN & Behavioral (27-31%), and EMS Operations (10-14%). Questions are scenario-based and test your ability to apply knowledge to patient care situations, not just memorize facts.

Q: Can I retake the NREMT if I fail?

Yes, you can retake the NREMT after a 15-day waiting period. You have 6 attempts within 2 years of completing your EMT course. After 3 failed attempts, you must complete a 24-hour remedial training program before your 4th attempt. After 6 failures, you must repeat the entire EMT course. Each retake costs approximately $80.

Question 1

Primary Assessment (ABCDE)

Accepted Answer

A = Airway (with C-spine protection), B = Breathing (rate, quality, sounds), C = Circulation (pulse, bleeding, skin), D = Disability (neurological status, AVPU/GCS), E = Expose (remove clothing to assess injuries). Performed on every patient.

Question 2

AVPU Scale

Accepted Answer

Rapid neurological assessment: A = Alert (oriented), V = responds to Verbal stimuli, P = responds to Painful stimuli, U = Unresponsive. Used in primary assessment. More detailed than but quicker than Glasgow Coma Scale.

Question 3

Glasgow Coma Scale (GCS)

Accepted Answer

Neurological scoring: Eye Opening (1-4), Verbal Response (1-5), Motor Response (1-6). Total range: 3-15. Score ≤8 = severe (intubate), 9-12 = moderate, 13-15 = mild. Best predictor of outcome in traumatic brain injury.

Question 4

SAMPLE History

Accepted Answer

S = Signs/Symptoms, A = Allergies, M = Medications, P = Past medical history, L = Last oral intake, E = Events leading to the incident. Collected during secondary assessment from patient or bystanders.

Question 5

OPQRST (Pain Assessment)

Accepted Answer

O = Onset (what were you doing?), P = Provocation/Palliation (what makes it better/worse?), Q = Quality (sharp, dull, crushing?), R = Radiation (does it move?), S = Severity (1-10 scale), T = Time (when did it start?).

Question 6

Vital Signs: Normal Adult Ranges

Accepted Answer

Heart rate: 60-100 bpm. Respiratory rate: 12-20 breaths/min. Blood pressure: 90/60-140/90 mmHg. SpO2: 95-100%. Temperature: 97.8-99.1°F (36.5-37.3°C). Pupils: PERRL (equal, round, reactive to light).

Question 7

Head-Tilt Chin-Lift

Accepted Answer

Basic airway maneuver for unresponsive patients WITHOUT suspected spinal injury. One hand tilts forehead back, other lifts chin forward. Opens airway by moving tongue away from posterior pharynx. Contraindicated if cervical spine injury suspected.

Question 8

Jaw-Thrust Maneuver

Accepted Answer

Airway opening technique for patients WITH suspected spinal injury. Place fingers behind the angle of the mandible and push jaw forward. Maintains neutral C-spine alignment. Preferred in trauma patients.

Question 9

Oropharyngeal Airway (OPA)

Accepted Answer

Rigid airway adjunct inserted into the mouth. Sizing: corner of mouth to earlobe or angle of jaw. Insert upside-down, rotate 180° (adults). Used ONLY in unresponsive patients with NO gag reflex. Prevents tongue from blocking airway.

Question 10

Nasopharyngeal Airway (NPA)

Accepted Answer

Flexible rubber airway inserted through the nostril. Sizing: tip of nose to earlobe. Lubricate with water-soluble lubricant. Can be used in patients WITH a gag reflex. Contraindicated in suspected basilar skull fracture.

Question 11

Bag-Valve-Mask (BVM) Ventilation

Accepted Answer

Manual ventilation device. Deliver over 1 second per breath. Adult: 500-600 mL per breath. Rate: 10-12 breaths/min (adults), 12-20 (peds). Connect to high-flow O2 at 15 L/min. Two-person technique preferred for proper seal.

Question 12

Suctioning Techniques

Accepted Answer

Oropharyngeal: rigid (Yankauer) catheter, suction no longer than 15 seconds. Measure catheter like OPA. Do not insert past base of tongue. Logroll patient and suction if vomiting. Pre-oxygenate before suctioning.

Question 13

Acute Coronary Syndrome (ACS)

Accepted Answer

Spectrum of conditions from unstable angina to STEMI. Symptoms: chest pain/pressure, dyspnea, diaphoresis, nausea, radiation to arm/jaw. EMT treatment: oxygen if SpO2 <94%, aspirin 324 mg (chewed), nitroglycerin (if prescribed), rapid transport.

Question 14

Cardiac Arrest Chain of Survival

Accepted Answer

1) Early recognition and activation of EMS, 2) Early CPR, 3) Early defibrillation, 4) Early advanced cardiac life support, 5) Post-cardiac arrest care, 6) Recovery. Each link must be strong for best patient outcome.

Question 15

CPR: Adult Compression Guidelines

Accepted Answer

Rate: 100-120 compressions/min. Depth: at least 2 inches (5 cm) but no more than 2.4 inches. Full chest recoil between compressions. Minimize interruptions (<10 seconds). Ratio: 30:2 (compressions to ventilations). Switch compressors every 2 minutes.

Question 16

AED (Automated External Defibrillator) Use

Accepted Answer

Power on, attach pads (right clavicle, left axilla). Analyze rhythm—ensure no one is touching patient. Shockable rhythms: V-fib, pulseless V-tach. Deliver shock if advised, immediately resume CPR for 2 minutes. Reanalyze after each cycle.

Question 17

Signs of Shock (Hypoperfusion)

Accepted Answer

Early: anxiety, restlessness, tachycardia, pale/cool/clammy skin. Late: hypotension, altered mental status, weak/thready pulse, cyanosis, delayed capillary refill (>2 sec). Treat cause, position supine, keep warm, high-flow O2, rapid transport.

Question 18

Hemorrhage Control Priority

Accepted Answer

1) Direct pressure (most effective for external bleeding), 2) Tourniquet (extremity, life-threatening bleeding—apply high and tight), 3) Hemostatic agents, 4) Wound packing. Do NOT remove dressings once applied; add more on top.

Question 19

Types of Bleeding

Accepted Answer

Arterial: bright red, spurting, pulsatile—most dangerous. Venous: dark red, steady flow. Capillary: oozing, slow—usually self-limiting. Arterial bleeding is life-threatening and requires immediate tourniquet or direct pressure.

Question 20

Spinal Motion Restriction (SMR)

Accepted Answer

Indicated for mechanism of injury with suspected spinal trauma: falls >3 feet, diving injuries, MVA, penetrating trauma near spine. Manual stabilization, apply cervical collar, secure to long backboard. Maintain neutral alignment.

Question 21

Pneumothorax (Types)

Accepted Answer

Simple: air in pleural space, lung partially collapses. Tension: air accumulates with no exit, compresses heart/great vessels—life-threatening. Signs of tension: tracheal deviation, JVD, absent breath sounds, hypotension. Treat: needle decompression (ALS).

Question 22

Burns: Rule of Nines (Adult)

Accepted Answer

Head: 9%. Each arm: 9%. Chest: 18%. Back: 18%. Each leg: 18%. Groin: 1%. Patient's palm = ~1% BSA. Critical burns: >25% BSA, face/airway/hands/feet/genitalia, circumferential, chemical/electrical, with inhalation injury.

Question 23

Flail Chest

Accepted Answer

Two or more adjacent ribs fractured in two or more places, creating a free-floating segment. Paradoxical movement: segment moves inward during inspiration, outward during expiration. Treat with positive pressure ventilation and stabilize the segment.

Question 24

Stroke Assessment (Cincinnati Prehospital Stroke Scale)

Accepted Answer

Three tests: (1) Facial droop—have patient smile, (2) Arm drift—extend both arms, eyes closed, (3) Speech—repeat a phrase clearly. Any ONE abnormality = 72% probability of stroke. Note time of symptom onset (critical for treatment decisions).

Question 25

Diabetic Emergencies: Hypo vs. Hyperglycemia

Accepted Answer

Hypoglycemia (BGL <60): rapid onset, cool/clammy skin, altered mental status, seizures. Treat: oral glucose if conscious. Hyperglycemia (BGL >300): gradual onset, warm/dry skin, Kussmaul breathing, fruity breath odor. Both need rapid transport.

Question 26

Anaphylaxis

Accepted Answer

Severe allergic reaction causing airway swelling, bronchospasm, and vasodilation. Signs: hives, wheezing, stridor, hypotension, tachycardia, facial swelling. Treatment: epinephrine auto-injector (0.3 mg adult IM, lateral thigh), high-flow O2, rapid transport.

Question 27

Seizure Management

Accepted Answer

During seizure: protect from injury, do NOT restrain or place anything in mouth, time the seizure. Post-ictal: maintain airway (recovery position), suction if needed, high-flow O2. Status epilepticus: seizure >5 min or repeated without regaining consciousness—emergency.

Question 28

Asthma vs. COPD

Accepted Answer

Asthma: reversible airway constriction, wheezing, younger patients, triggered by allergens/exercise. COPD: chronic, irreversible airway disease (emphysema/chronic bronchitis), older patients, smoking history. Both: bronchodilator (assist prescribed MDI), O2, position of comfort.

Question 29

Overdose/Poisoning: General Management

Accepted Answer

Scene safety first (hazmat?). Identify substance if possible. Contact Poison Control (1-800-222-1222). Assess ABCs, monitor vital signs. Naloxone (Narcan) for opioid overdose: 2 mg IN or IM. Do NOT induce vomiting. Bring containers/medications to hospital.

Question 30

EMT Medication Administration

Accepted Answer

EMTs can administer: oral glucose (hypoglycemia), aspirin (ACS), epinephrine auto-injector (anaphylaxis), naloxone (opioid OD), albuterol via nebulizer (some states). Can ASSIST with: nitroglycerin, metered-dose inhalers (patient's prescribed medications).

Question 31

Nitroglycerin

Accepted Answer

Vasodilator for chest pain. Dose: 0.4 mg sublingual, may repeat every 5 min up to 3 doses. Contraindications: SBP <100 mmHg, head injury, ED medications (sildenafil) in last 24-48 hours, right ventricular infarction. Side effects: headache, hypotension.

Question 32

Epinephrine Auto-Injector

Accepted Answer

For severe allergic reaction/anaphylaxis. Adult: 0.3 mg (EpiPen). Pediatric: 0.15 mg (EpiPen Jr, for <30 kg). Inject into lateral mid-thigh through clothing if needed. Hold for 10 seconds. May repeat in 5-15 minutes. Side effects: tachycardia, anxiety.

Question 33

Pediatric Assessment Triangle (PAT)

Accepted Answer

Rapid visual assessment from the doorway: (1) Appearance—tone, interactiveness, consolability, look/gaze, speech/cry (TICLS), (2) Work of Breathing—nasal flaring, retractions, positioning, (3) Circulation to Skin—pallor, mottling, cyanosis.

Question 34

Pediatric CPR Differences

Accepted Answer

Compression depth: 1/3 AP diameter (infant: 1.5 inches, child: 2 inches). Rate: 100-120/min. Ratio: 30:2 (single rescuer), 15:2 (2 healthcare providers). Infant technique: two-finger or two-thumb encircling. Most pediatric arrests are respiratory in origin.

Question 35

Croup vs. Epiglottitis

Accepted Answer

Croup: viral, gradual onset, barking/seal-like cough, low-grade fever, steeple sign on X-ray, ages 6mo-3yr. Epiglottitis: bacterial (H. influenzae), rapid onset, drooling, tripod position, high fever, thumb sign on X-ray, do NOT examine throat—airway emergency.

Question 36

Normal Delivery Procedure

Accepted Answer

Support head as it delivers, check for nuchal cord (slip over head or clamp/cut), suction mouth then nose, deliver anterior shoulder (gentle downward traction), then posterior shoulder. Dry and stimulate newborn. Clamp cord at 6 inches and 9 inches from baby.

Question 37

APGAR Score

Accepted Answer

Assess at 1 and 5 minutes after birth. Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), Respirations. Each scored 0-2. Total 7-10: normal. 4-6: moderately depressed. 0-3: severely depressed, needs aggressive resuscitation.

Question 38

Triage: START System

Accepted Answer

Simple Triage And Rapid Treatment. Walk? → Minor (Green). Breathing? No → reposition airway → still no → Expectant (Black). Respiratory rate >30? → Immediate (Red). Radial pulse absent or CRT >2s? → Immediate (Red). Follows commands? No → Immediate (Red). Yes → Delayed (Yellow).

Question 39

Incident Command System (ICS)

Accepted Answer

Standardized management for emergencies. Key roles: Incident Commander (overall authority), Operations (tactical), Planning (strategy), Logistics (resources/supplies), Finance/Admin (costs). Unified command for multi-agency incidents. Span of control: 3-7 (optimal 5).

Question 40

EMS Levels of Certification

Accepted Answer

EMR (Emergency Medical Responder): basic first aid, CPR, AED. EMT (Emergency Medical Technician): BLS, airway management, medications. AEMT: IV, some medications. Paramedic: ALS, intubation, cardiac monitoring, IV medications, surgical airways.

Question 41

Implied vs. Expressed Consent

Accepted Answer

Expressed: competent adult verbally or in writing agrees to treatment. Implied: assumed for unconscious or incapacitated patients (life-threatening situations). Minors: consent from parent/guardian except for emancipated minors or emergencies (implied consent applies).

Question 42

Hypothermia Management

Accepted Answer

Mild (90-95°F): shivering, confusion—passive rewarming (blankets, warm environment). Moderate (82-90°F): loss of shivering, decreased LOC—active rewarming (warm packs to core). Severe (<82°F): unresponsive, V-fib risk—handle gently, no rough movements, limit to one defibrillation if <86°F.

Question 43

Heat Emergencies: Exhaustion vs. Stroke

Accepted Answer

Heat exhaustion: heavy sweating, cool/moist skin, normal/slightly elevated temp, weakness, nausea. Treat: cool environment, fluids. Heat stroke: NO sweating, hot/dry/red skin, temp >104°F, altered mental status—LIFE THREATENING. Treat: rapid cooling, ice packs to neck/axillae/groin.

Question 44

Drowning/Submersion Emergency

Accepted Answer

Assume cervical spine injury (diving, unknown mechanism). Begin rescue breathing ASAP (even in water if trained). CPR on firm surface. Focus on ventilation (drowning is primarily a respiratory emergency). Suction as needed. All submersion patients require hospital evaluation.

Question 45

Behavioral Emergency Management

Accepted Answer

Ensure scene safety (request law enforcement if needed). Use calm, non-threatening approach. Maintain safe distance. Do NOT make sudden movements. Never leave patient alone. Assess for medical causes (hypoglycemia, hypoxia, head injury). Document thoroughly.

Question 46

Excited Delirium Syndrome

Accepted Answer

Potentially fatal condition: extreme agitation, paranoia, superhuman strength, hyperthermia, imperviousness to pain. Often associated with stimulant use or psychiatric crisis. High risk for sudden cardiac arrest. Request ALS, prepare for chemical sedation, continuous monitoring.

Question 47

HIPAA in EMS

Accepted Answer

Health Insurance Portability and Accountability Act protects patient health information (PHI). EMTs may share PHI only for treatment, payment, or healthcare operations. Minimum necessary standard applies. Violations can result in fines up to $250,000 and imprisonment.

Question 48

Negligence (Four Elements)

Accepted Answer

Must prove all four: (1) Duty to act—EMT had an obligation, (2) Breach of duty—deviated from standard of care, (3) Causation—breach caused the injury, (4) Damages—patient suffered actual harm. Absence of any element = no negligence.

Question 49

Do Not Resuscitate (DNR) Orders

Accepted Answer

Legal document directing EMS not to perform CPR/resuscitation. Must be verified as valid (signed by physician, current). If validity is uncertain, begin resuscitation. DNR applies to cardiac arrest only—still treat other conditions. Follow local protocols.

Question 50

Mandatory Reporting Requirements

Accepted Answer

EMTs are mandated reporters for: suspected child abuse/neglect, elder abuse, domestic violence (varies by state), gunshot wounds, stab wounds, animal bites, certain infectious diseases. Report to appropriate authorities. Document objectively—do not accuse.

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