NREMT EMR Exam Flashcards

Q: What is on the NREMT EMR exam in 2026?

The 2025-2026 NREMT EMR exam follows the April 2025 BLS redesign and tests five assessment-flow domains: Scene Size-Up and Safety (19-23%), Primary Assessment (37-41%), Secondary Assessment (4-8%), Patient Treatment and Transport (20-24%), and Operations (10-14%). Pediatric content is integrated throughout rather than appearing as a separate section. The exam is computer-adaptive (CAT) with 90-110 items in 1 hour 45 minutes, including 30 unscored pilot items, delivered through Pearson VUE test centers or OnVUE online proctoring.

Q: How many questions are on the NREMT EMR exam and how long is it?

The NREMT EMR cognitive exam uses computerized adaptive testing (CAT) with 90-110 total items, including 30 unscored pilot items, in a 1 hour 45 minute window. The CAT engine stops once it can determine with high confidence whether the candidate meets the EMR entry-level competency standard. Results are normally posted to your National Registry account within two business days, provided all certification requirements are met.

Q: What is the NREMT EMR pass rate and passing score?

NREMT's 2024 annual certification data reports an EMR cognitive examination pass percentage of 69%. The exam is scored pass/fail based on the entry-level EMR competency standard; NREMT also reports performance on a 100-1500 scaled score with 950 as the published passing reference. There is no traditional percentage cut-score because the test is computer-adaptive.

Q: How much does the NREMT EMR exam cost and what is the retake policy?

The NREMT EMR examination fee is $88 per attempt. Failed candidates must wait 15 days after results post before retesting. EMR candidates are allowed three total attempts; after three failed attempts the candidate must complete a full state-approved EMR refresher or initial education program before testing again. The Authorization to Test (ATT) is valid for 90 days from issue.

Q: Do I need a sponsor or employer to take the NREMT EMR exam?

No. EMR candidates self-register through their NREMT.org account after completing a state-approved EMR education program that meets or exceeds the National EMS Education Standards. The Program Director verifies course completion in the National Registry system. Initial candidates must have completed the EMR course within the past two years and must also meet a State EMS Office approved BLS skills competency requirement separate from the cognitive exam.

Q: How long is NREMT EMR certification valid?

NREMT EMR certification is valid for 2 years from issue. Recertification requires either the National Continued Competency Program (NCCP) model with 16 hours of approved continuing education (8 National, 4 Local/State, 4 Individual) plus current CPR/BLS, or passing the cognitive examination again. EMRs must hold current healthcare-provider-level CPR throughout the certification cycle.

Question 1

Scene size-up (5 components)

Accepted Answer

The EMR's first action on arrival: (1) BSI/standard precautions, (2) scene safety, (3) mechanism of injury or nature of illness, (4) number of patients, (5) additional resources needed. Never enter an unsafe scene to reach a patient.

Question 2

Standard precautions (BSI)

Accepted Answer

Treat every patient's blood and body fluids as infectious. Minimum PPE for routine patient contact is gloves; add eye protection and mask whenever splash or airborne exposure is possible, and a gown for heavy contamination.

Question 3

Hazmat 'Rule of Thumb'

Accepted Answer

Hold your thumb at arm's length toward the scene. If the thumb does not fully cover the hazardous area, you are too close. Stay uphill, upwind, and upstream and wait for trained hazmat teams.

Question 4

START triage

Accepted Answer

Simple Triage And Rapid Treatment for adult MCIs. Categories: Green (walking/minor), Yellow (delayed), Red (immediate), Black (deceased/expectant). Decision points: respirations, perfusion (radial pulse or capillary refill), mental status (can follow commands).

Question 5

JumpSTART triage (pediatrics)

Accepted Answer

Pediatric MCI triage tool for patients who appear under 8. Key difference from START: if a child is apneic but has a pulse, give 5 rescue breaths before tagging Black. Restored breathing tags Red.

Question 6

Incident Command System (ICS) span of control

Accepted Answer

One supervisor should manage 3-7 subordinates, with 5 being optimal. EMRs working at a multi-casualty scene report to the EMS branch under the Operations Section and never freelance.

Question 7

Mechanism of injury (MOI) red flags

Accepted Answer

Significant MOI in adults includes falls >20 ft, ejection from a vehicle, death of an occupant, unrestrained rollover, motorcycle crash >20 mph, and penetrating trauma to head/neck/torso. Any of these triggers full spinal precautions and rapid transport.

Question 8

General impression

Accepted Answer

First step of the Primary Assessment: a 'doorway' look at appearance, work of breathing, and circulation (skin color) to decide sick vs not sick within seconds of approaching the patient.

Question 9

AVPU scale

Accepted Answer

Quick mental-status check: Alert, responds to Verbal stimulus, responds to Painful stimulus, Unresponsive. Used during the Primary Assessment before formal GCS or detailed neuro exam.

Question 10

Head-tilt/chin-lift vs jaw-thrust

Accepted Answer

Head-tilt/chin-lift is the preferred airway maneuver for a medical, non-trauma patient. Jaw-thrust is the airway maneuver of choice whenever cervical spine injury is suspected because it opens the airway without extending the neck.

Question 11

Oropharyngeal airway (OPA) sizing and use

Accepted Answer

Measure from the corner of the mouth to the angle of the jaw or earlobe. Insert ONLY in patients with no gag reflex. If the patient gags or coughs, remove immediately to prevent vomiting and aspiration.

Question 12

Nasopharyngeal airway (NPA) sizing and contraindication

Accepted Answer

Measure from the tip of the nose to the earlobe; lubricate with water-based lubricant and insert with bevel toward the septum. Avoid in patients with suspected basilar skull fracture or significant facial trauma (CSF leak/raccoon eyes/Battle sign).

Question 13

Adult respiratory rate ranges

Accepted Answer

Normal adult resting rate: 12-20 breaths/min. <12 is bradypnea and >20 is tachypnea; either is abnormal and demands ventilatory support consideration. Below 8 or above 30 in an adult is an immediate life threat.

Question 14

Pediatric respiratory rate ranges (BLS)

Accepted Answer

Infant (<1 yr): 30-60; Toddler (1-3): 24-40; Preschool (3-6): 22-34; School age (6-12): 18-30; Adolescent (12-18): 12-20. Sustained tachypnea in a child often precedes respiratory failure.

Question 15

Bag-valve-mask ventilation rate (adult, with pulse)

Accepted Answer

Ventilate an apneic adult with a pulse at 1 breath every 6 seconds (about 10/min). Each breath should be delivered over about 1 second with just enough volume to see visible chest rise; over-ventilation causes gastric distention and lowers cardiac output.

Question 16

BVM ventilation rate (infant/child, with pulse)

Accepted Answer

Ventilate an apneic infant or child with a pulse at 1 breath every 2-3 seconds (about 20-30/min) per the 2020 AHA update. Use the smallest BVM that delivers visible chest rise and avoid excessive volume.

Question 17

Pulse oximetry SpO2 target

Accepted Answer

Normal SpO2 is 94-100% on room air. Apply supplemental oxygen when SpO2 drops below 94% or when the patient has signs of inadequate perfusion or respiratory distress; titrate to 94-99% to avoid hyperoxia.

Question 18

Non-rebreather mask flow rate

Accepted Answer

10-15 L/min, delivering roughly 90% FiO2. Inflate the reservoir bag before placing on the patient. Use for spontaneously breathing patients with severe hypoxia, significant trauma, or carbon monoxide exposure.

Question 19

Nasal cannula flow range

Accepted Answer

1-6 L/min, delivering roughly 24-44% FiO2. Use for stable patients with mild hypoxia or who cannot tolerate a mask. Above 6 L/min dries nasal mucosa without meaningfully increasing FiO2.

Question 20

Adult pulse check site for unresponsive patient

Accepted Answer

Carotid artery for adult and child >1 year. Take no more than 10 seconds; if no definite pulse is felt, begin CPR. Use the brachial artery for infants under 1 year.

Question 21

Capillary refill use

Accepted Answer

Press a nail bed or fleshy area for 2 seconds and release; normal refill is under 2 seconds. Most reliable as a perfusion indicator in children under 6; environmental cold and adult age make it less reliable in adults.

Question 22

Adult high-quality CPR (C-A-B)

Accepted Answer

Compressions first: rate 100-120/min, depth at least 2 inches (no more than 2.4 in), allow full chest recoil, minimize interruptions <10 sec. Compression-to-ventilation ratio 30:2 for one or two rescuers without advanced airway.

Question 23

Child CPR compression depth and ratio

Accepted Answer

Depth: about 2 inches (one-third the AP chest diameter). One rescuer 30:2; two rescuers 15:2. Rate remains 100-120/min. Use heel of one or two hands depending on the child's size.

Question 24

Infant CPR technique

Accepted Answer

Two-finger technique (single rescuer) or two-thumb encircling hands (two rescuers). Depth about 1.5 inches (one-third AP). Ratio 30:2 single rescuer, 15:2 two rescuers. Brachial pulse check, max 10 seconds.

Question 25

AED use in adults

Accepted Answer

Apply adult pads as soon as available, even during pregnancy. Stop CPR only for rhythm analysis and shock; resume compressions immediately for 2 minutes after each shock or 'no shock advised' before reanalyzing.

Question 26

AED pad selection in children

Accepted Answer

Use pediatric pads/dose attenuator for children under 8 years or under 25 kg when available. If unavailable, use adult pads but place one anterior and one posterior to avoid contact. Never delay defibrillation to find pediatric pads.

Question 27

Conscious adult choking (severe airway obstruction)

Accepted Answer

Perform abdominal thrusts (Heimlich) until the object is expelled or the patient becomes unresponsive. If unresponsive, lower to the ground, begin CPR starting with compressions, and look in the mouth before each set of breaths.

Question 28

Conscious infant choking

Accepted Answer

Alternate 5 back slaps (between scapulae, head down) and 5 chest thrusts (two-finger compressions over the lower sternum) until the object is dislodged or the infant becomes unresponsive. Never perform abdominal thrusts on an infant under 1.

Question 29

External bleeding control sequence

Accepted Answer

Direct pressure first. If life-threatening extremity bleeding cannot be controlled by pressure, apply a commercial tourniquet 2-3 inches proximal to the wound (never over a joint), tighten until bleeding stops, and record the application time on the device.

Question 30

Hemostatic dressing use

Accepted Answer

Indicated for junctional or anatomic-site bleeding where a tourniquet cannot be applied (groin, axilla, neck). Pack the wound tightly to the source of bleeding and hold firm direct pressure for at least 3 minutes before securing with a pressure dressing.

Question 31

Signs and stages of shock (hypoperfusion)

Accepted Answer

Compensated shock: anxiety, tachycardia, tachypnea, pale/cool/clammy skin, narrowing pulse pressure, normal BP. Decompensated shock: falling BP, altered mental status, weak central pulses. Irreversible: organ failure despite resuscitation.

Question 32

Shock position (current EMR guidance)

Accepted Answer

Place the patient supine and keep them warm; routine head-down Trendelenburg is NOT recommended because it does not improve perfusion and may worsen breathing and ICP. Treat the cause, give oxygen if hypoxic, and transport rapidly.

Question 33

Burn rule of nines (adult)

Accepted Answer

Head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%. For irregular burns, the patient's palm (including fingers) equals about 1% BSA. Pediatric rule shifts more BSA to the head (18%) and less to the legs.

Question 34

Chemical burn management

Accepted Answer

Brush off dry powder first, then flush with copious water for at least 20 minutes. Remove contaminated clothing during irrigation. Do NOT attempt to neutralize an acid with a base or vice versa - the reaction releases heat and worsens injury.

Question 35

Sucking chest wound

Accepted Answer

Apply a vented (3-sided) occlusive dressing over an open pneumothorax to let air escape on exhalation while preventing entry on inhalation. Monitor for tension pneumothorax - if it develops, briefly lift the dressing to release trapped air.

Question 36

Manual spinal motion restriction

Accepted Answer

Apply manual in-line stabilization in a neutral position as soon as spine injury is suspected and maintain it until full restriction is in place or injury is ruled out. Do not pull traction; just neutralize movement of the head and neck.

Question 37

Recovery position (when to use)

Accepted Answer

Use for unresponsive patients who are breathing adequately, have a pulse, and are NOT suspected of spinal injury. Roll as a unit onto the left side to keep the airway open and let secretions drain.

Question 38

SAMPLE history

Accepted Answer

Signs/Symptoms, Allergies, Medications, Pertinent past history, Last oral intake, Events leading up. Standard mnemonic for the focused history taken during the Secondary Assessment.

Question 39

OPQRST pain assessment

Accepted Answer

Onset, Provocation/Palliation, Quality, Region/Radiation, Severity (0-10), Time/duration. Used to characterize chest pain, abdominal pain, or any focused complaint during the Secondary Assessment.

Question 40

Reassessment intervals

Accepted Answer

Reassess vital signs and the primary survey every 5 minutes for unstable patients and every 15 minutes for stable patients, and after every intervention. Document changes and trends - a deteriorating trend matters more than a single value.

Question 41

Stroke assessment (Cincinnati Prehospital Stroke Scale)

Accepted Answer

Three-item screen: facial droop, arm drift, abnormal speech. Any one positive finding suggests a 72% likelihood of stroke. Note exact time last known well - this drives eligibility for thrombolytics or thrombectomy.

Question 42

Hypoglycemia signs and EMR action

Accepted Answer

Cool/pale/diaphoretic skin, tachycardia, altered mental status, weakness, hunger; blood glucose <70 mg/dL. If the patient is alert and can swallow, give oral glucose (15 g); if unresponsive, manage airway and request ALS.

Question 43

Anaphylaxis recognition and epinephrine

Accepted Answer

Hives plus airway swelling, wheezing, or hypotension after exposure. EMRs trained and authorized may assist with the patient's own epinephrine auto-injector: adult 0.3 mg IM into the lateral thigh, pediatric 0.15 mg, and request ALS.

Question 44

Suspected opioid overdose

Accepted Answer

Triad: pinpoint pupils, depressed respirations, decreased mental status. Support ventilation with BVM and supplemental oxygen first, then administer intranasal naloxone (typically 4 mg IN) if trained and authorized; repeat every 2-3 minutes as needed.

Question 45

Generalized (tonic-clonic) seizure care

Accepted Answer

Protect from injury, do not restrain or place anything in the mouth, time the seizure. Post-ictal: position to protect airway, give oxygen for hypoxia, check glucose, and transport. A seizure >5 minutes or recurrent seizures without recovery = status epilepticus and requires ALS.

Question 46

Heat stroke vs heat exhaustion

Accepted Answer

Heat exhaustion: heavy sweating, normal-to-elevated core temp, normal mental status - rest, cool, oral fluids if alert. Heat stroke: hot dry OR sweaty skin, core >104 F, altered mental status - active rapid cooling and rapid transport. Mental status change is the key differentiator.

Question 47

Imminent delivery signs (crowning)

Accepted Answer

Visible crowning, contractions <2 minutes apart lasting 60-90 seconds, urge to push, or sensation of bowel movement signal imminent delivery. Prepare to deliver on scene rather than transport; support the head, suction is no longer routine for vigorous infants.

Question 48

Newborn APGAR scoring

Accepted Answer

Assess at 1 and 5 minutes after birth: Appearance, Pulse, Grimace, Activity, Respirations. Each 0-2 points (max 10). Score <7 at 5 minutes indicates the need for continued resuscitation and ALS support.

Question 49

Patient refusal documentation requirements

Accepted Answer

Document mental status/competence, that risks of refusal were explained (including possible death), the patient's verbatim refusal, signatures of patient and a witness, and that EMS would return if they change their mind. Refusal must be informed and from a competent adult.

Question 50

Critical Incident Stress Management (CISM)

Accepted Answer

Post-incident support for responders after high-stress calls (pediatric death, MCI, line-of-duty death). Includes defusing (within hours), debriefing (24-72 hours), and follow-up. Self-care is required to prevent burnout and PTSD across an EMS career.

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