You are dispatched to a rolled-over tanker truck. Dispatch reports a placarded tank leaking an unknown liquid, with a vapor cloud drifting across the highway. How should you plan your approach?

Approach from upwind and uphill, stay out of low areas, and stage at a safe distance until the material is identified

You need to suction a patient who is vomiting large amounts of blood. You already have gloves on. What else does CDC infection-control guidance call for?

Protective eyewear and a mask, or a face shield, to protect your eyes, nose and mouth

At a single-car crash, the only person you find is the driver, who is dazed and cannot answer questions clearly. In the back seat there is an empty rear-facing infant car seat with a blanket and a bottle beside it. What should you do?

Search the vehicle and the area around it for a possible infant patient, and call for more help if needed

Your ambulance is first to arrive at a bus crash with about 25 injured passengers. What should you do first?

Declare a mass casualty incident, request additional resources, and begin triage

You use the pediatric assessment triangle as you walk up to a sick child. Which three things does it look at?

Appearance, work of breathing, and circulation to the skin

A man found on a park bench does not respond when you speak loudly to him, but he groans and pulls away when you squeeze his trapezius muscle. What is his level of responsiveness on the AVPU scale?

P (responds to painful stimulus)

A worker fell from a ladder and is unresponsive with a cut on his forehead. You need to open his airway. Which technique should you try first?

Jaw thrust without extending the head

A 60-year-old man collapsed at a gym. He is unresponsive and takes a slow, irregular gasp about every 10 seconds. You cannot feel a definite carotid pulse within 10 seconds. What should you do?

Start chest compressions and attach the AED

Bright red blood keeps spurting from a deep cut in the middle of a patient's forearm despite firm direct pressure and a pressure dressing. What is the next step?

Apply a commercial tourniquet 2 to 3 inches above the wound, not over a joint, and tighten until the bleeding stops

A 24-year-old was stung by a bee 10 minutes ago. She has hives across her chest, is wheezing and short of breath, and her blood pressure is 118/76. How should you classify this?

Anaphylaxis, because skin signs are paired with breathing trouble; epinephrine is the first-line treatment

On a hot afternoon a roofer is found confused and combative. His skin is hot and flushed. You have no thermometer. What is the most likely problem and the priority?

Heat stroke; move him to a cool place and begin rapid active cooling

A 72-year-old fell from standing at home. Which finding, on its own, meets a red (high-risk) criterion in the National Guideline for the Field Triage of Injured Patients?

Systolic blood pressure of 104 mmHg

You suspect a stroke in a patient with new facial droop and arm weakness. Which piece of history is most important to get and pass on?

The time the patient was last known to be well

You are transporting a stable patient with an ankle injury on a 25-minute trip. Which plan for vital signs follows the national model guideline?

At least two sets of vital signs during care and transport

An adult has a strong carotid pulse but is not breathing. How often should you give breaths with the bag-valve mask?

1 breath every 6 seconds (10 per minute)

A man was stabbed in the side of the neck. He is alert, moves all four limbs normally, and the bleeding is controlled with direct pressure. How should you manage his spine?

Do not apply a cervical collar or spinal precautions; watch his airway closely

A 61-year-old with chest pain has his own prescribed nitroglycerin tablets, and your protocol lets you help him take them. His blood pressure is 138/84. He says he took tadalafil (Cialis) last night. What should you do about the nitroglycerin?

Do not give it, because he took a phosphodiesterase-5 inhibitor within the last 48 hours

An 8-month-old is choking on food. She is awake but cannot cry or cough. What should you do?

Give repeated cycles of 5 back blows and 5 chest thrusts

At the emergency department you give the nurse a full verbal report. Which statement about the patient care report (PCR) is correct?

The verbal report does not replace the complete written or electronic PCR

During your shift check you attach a regulator to a full oxygen cylinder. How should you open the cylinder valve?

Slowly, with the valve pointed away from yourself and anyone else

While restocking you check the epinephrine auto-injectors. One is within its expiration date, but the solution in the window looks pinkish-brown. What should you do?

Take it out of service and replace it

You apply a tourniquet to a patient's thigh. What must be recorded prominently on the patient and in the patient care report?

The time the tourniquet was applied

Under the federal OSHA bloodborne pathogens standard, which of these is an exposure incident?

A splash of the patient's blood into your eye

Built on the 2025 NREMT EMT test plan

Free NREMT EMT Practice Test (2026)

30 questions weighted like the National Registry EMT cognitive exam, built on the test plan that took effect on April 7, 2025. Instant answers, plain explanations, and a score by domain at the end.

Questions

Domains, real weights

100%

Answers sourced

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How this test is weighted

Scene Size-up and Safety	15-19% of the NREMT	5 questions here
Primary Assessment	39-43% of the NREMT	12 questions here
Secondary Assessment	5-9% of the NREMT	2 questions here
Patient Treatment and Transport	20-24% of the NREMT	7 questions here
Operations	10-14% of the NREMT	4 questions here

Click an answer to check it. Each question shows why the answer is right and the public source it comes from (AHA 2025 CPR guidelines, NASEMSO model EMS guidelines, the national field triage guideline).

Q1 · Scene Size-up and Safety

You are dispatched to a rolled-over tanker truck. Dispatch reports a placarded tank leaking an unknown liquid, with a vapor cloud drifting across the highway. How should you plan your approach?

The answer is B. Hazardous materials guidance tells responders to stay upwind, uphill and/or upstream, and warns that many vapors are heavier than air and collect in low areas. Approaching from downwind or downhill puts the crew in the path of the vapor or liquid, and rushing in makes the crew part of the problem.

Source: PHMSA Emergency Response Guidebook 2024 (ERG2024), guide pages via NIH PubChem, Public Safety: stay upwind, uphill and/or upstream; vapors collect in low or confined areas
Q2 · Scene Size-up and Safety

You need to suction a patient who is vomiting large amounts of blood. You already have gloves on. What else does CDC infection-control guidance call for?

The answer is C. CDC's core infection-prevention practices say to use protective eyewear and a mask, or a face shield, during procedures that could generate splashes or sprays of blood or body fluids. Suctioning a bleeding airway is exactly that kind of procedure; gloves, gowns or extra gloves do not protect the mucous membranes of the face.

Source: CDC: Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings, Standard Precautions: personal protective equipment
Q3 · Scene Size-up and Safety

At a single-car crash, the only person you find is the driver, who is dazed and cannot answer questions clearly. In the back seat there is an empty rear-facing infant car seat with a blanket and a bottle beside it. What should you do?

The answer is A. Determining the number of patients is part of the scene size-up. An infant seat with fresh items beside it suggests a child may have been in the car and could have been thrown or carried away; a confused driver cannot reliably rule that out, so the scene must be searched now.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Universal Care Guideline, Assessment 1(c): determine number of patients
Q4 · Scene Size-up and Safety

At a mass casualty incident you are using START triage. An adult cannot walk, is breathing on their own at 34 breaths per minute, has a radial pulse and follows simple commands. Which category do you assign?

The answer is D. In START, a patient who cannot walk and is breathing is next checked for respiratory rate. A rate of 30 or more per minute sends the patient straight to Immediate (red) without checking perfusion or mental status further.

Source: HHS ASPR CHEMM: START Adult Triage Algorithm, Algorithm: Respiratory rate <30/min? No -> Immediate
Q5 · Scene Size-up and Safety

Your ambulance is first to arrive at a bus crash with about 25 injured passengers. What should you do first?

The answer is A. Size-up includes determining the number of patients, requesting additional resources, and considering declaration of a mass casualty incident. When patients outnumber resources, the first crew sorts patients by triage rather than spending its time on one patient or leaving the scene.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Universal Care Guideline, Assessment 1(c), 1(e), 1(f); Trauma Mass Casualty Incident guideline
Q6 · Primary Assessment

You use the pediatric assessment triangle as you walk up to a sick child. Which three things does it look at?

The answer is B. The pediatric assessment triangle is a from-the-doorway general impression of appearance, work of breathing and circulation (skin color). It is done before hands-on checks such as pulse, blood pressure or capillary refill.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Universal Care Guideline, Notes/Educational Pearls 1(b)
Q7 · Primary Assessment

A man found on a park bench does not respond when you speak loudly to him, but he groans and pulls away when you squeeze his trapezius muscle. What is his level of responsiveness on the AVPU scale?

The answer is C. AVPU: A = alert, V = responds to voice, P = responds to painful stimulus, U = no response at all. He does not respond to voice but does react to pain, so he is P.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Appendix VI, Neurologic Status Assessment: AVPU
Q8 · Primary Assessment

After a fall, an adult opens her eyes when you speak to her, answers in sentences but is confused about where she is, and reaches up to push your hand away when you apply pressure (she does not follow commands). What is her Glasgow Coma Scale score?

The answer is C. Eyes open to voice = 3, confused speech = 4, localizes pain = 5. 3 + 4 + 5 = 12.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Appendix VI, Neurologic Status Assessment: Glasgow Coma Score table
Q9 · Primary Assessment

An unresponsive patient with snoring respirations gags as soon as you start to insert an oropharyngeal airway. Which airway adjunct is most appropriate?

The answer is B. Oropharyngeal airways are for patients without a gag reflex; nasopharyngeal airways are for patients who still have one. Forcing any oral airway past an active gag reflex can cause vomiting and aspiration.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Airway Management guideline, Treatment 3(c)(i)-(ii)
Q10 · Primary Assessment

A worker fell from a ladder and is unresponsive with a cut on his forehead. You need to open his airway. Which technique should you try first?

The answer is D. With head or neck trauma, trained rescuers should open the airway with a jaw thrust without head extension because it moves the neck less. If a jaw thrust and an airway adjunct do not open the airway, a head tilt-chin lift is then used, because an open airway takes priority.

Source: AHA 2025 Guidelines for CPR and ECC, Part 7: Adult Basic Life Support, Opening the Airway: recommendations for head and neck trauma
Q11 · Primary Assessment

A 60-year-old man collapsed at a gym. He is unresponsive and takes a slow, irregular gasp about every 10 seconds. You cannot feel a definite carotid pulse within 10 seconds. What should you do?

The answer is A. Gasping (agonal breathing) is not normal breathing. An unresponsive adult with absent or only gasping breaths and no definite pulse after a check of no more than 10 seconds should be treated as being in cardiac arrest.

Source: AHA 2025 Guidelines for CPR and ECC, Part 7: Adult Basic Life Support, Recognition of Cardiac Arrest, recommendations 1-2
Q12 · Primary Assessment

Bright red blood keeps spurting from a deep cut in the middle of a patient's forearm despite firm direct pressure and a pressure dressing. What is the next step?

The answer is D. When direct pressure and a pressure dressing fail on a limb wound, a commercial tourniquet goes 2 to 3 inches proximal to (above) the wound, not over a joint, tightened until bleeding stops and the distal pulse is gone. Do not remove dressings to check for bleeding.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Extremity Trauma/External Hemorrhage Management, Treatment 1(a)-(b)
Q13 · Primary Assessment

A 24-year-old was stung by a bee 10 minutes ago. She has hives across her chest, is wheezing and short of breath, and her blood pressure is 118/76. How should you classify this?

The answer is B. Anaphylaxis includes skin or mucosal involvement together with respiratory compromise, even with a normal blood pressure. Low blood pressure is only one of the ways it can present. When anaphylaxis is suspected, epinephrine is the first-line treatment.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Anaphylaxis and Allergic Reaction, Assessment 4(a); Key Considerations 1
Q14 · Primary Assessment

On a hot afternoon a roofer is found confused and combative. His skin is hot and flushed. You have no thermometer. What is the most likely problem and the priority?

The answer is A. Without a thermometer, heat stroke is distinguished from heat exhaustion by altered mental status, seizures or coma. Heat stroke with altered mental status calls for active cooling; ice-water immersion cools fastest.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Hyperthermia/Heat Exposure: Definitions 3; Treatment 1, 7
Q15 · Primary Assessment

A 58-year-old with diabetes is confused and has slurred speech. Which test should you do early in your assessment?

The answer is A. Check a blood glucose level in any patient with altered mental status or suspected stroke. Low blood sugar can look like a stroke, and it can be treated in the field.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Universal Care Guideline, Assessment 5(d)(iii) and 8(c)
Q16 · Primary Assessment

A 6-year-old was struck by a car. Under the National Guideline for the Field Triage of Injured Patients, a systolic blood pressure below what value meets a red (high-risk) criterion for this child?

The answer is C. For ages 0 to 9 years, the red criterion is a systolic pressure below 70 + (2 x age in years). For a 6-year-old: 70 + 12 = 82 mmHg. The 90 mmHg cut-off is for ages 10 to 64.

Source: ACS Committee on Trauma: National Guideline for the Field Triage of Injured Patients, Red criteria, Mental Status & Vital Signs: Age 0-9 years, SBP < 70 mmHg + (2 x age in years)
Q17 · Primary Assessment

A 72-year-old fell from standing at home. Which finding, on its own, meets a red (high-risk) criterion in the National Guideline for the Field Triage of Injured Patients?

The answer is D. For patients 65 and older, a systolic pressure below 110 mmHg (or a heart rate higher than the systolic pressure) is a red criterion. Anticoagulant use is an EMS-judgment risk factor, not a red criterion; a respiratory rate of 24 is within 10 to 29; and a heart rate of 96 is lower than a systolic of 128.

Source: ACS Committee on Trauma: National Guideline for the Field Triage of Injured Patients, Red criteria, Mental Status & Vital Signs: Age >= 65 years; EMS Judgment risk factors
Q18 · Secondary Assessment

You suspect a stroke in a patient with new facial droop and arm weakness. Which piece of history is most important to get and pass on?

The answer is B. The time of symptom onset or last known well is critical: it decides whether the patient may be eligible for clot-busting drugs (under about 4.5 hours) or mechanical thrombectomy (under 24 hours), and so where the patient should go.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Suspected Stroke/Transient Ischemic Attack: Assessment 3(a); Treatment 1; Key Considerations 2
Q19 · Secondary Assessment

You are transporting a stable patient with an ankle injury on a 25-minute trip. Which plan for vital signs follows the national model guideline?

The answer is C. Stable patients should have at least two sets of pertinent vital signs; critical patients need them monitored more often. One set is not enough, and waiting for the patient to report feeling worse misses silent changes.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Universal Care Guideline, Assessment 8(d)-(e)
Q20 · Patient Treatment and Transport

An adult has a strong carotid pulse but is not breathing. How often should you give breaths with the bag-valve mask?

The answer is B. For adults who have a pulse but are not breathing normally, give 1 breath every 6 seconds, which is 10 breaths per minute. The faster rates are for infants and children; slower rates under-ventilate an adult.

Source: AHA 2025 Guidelines for CPR and ECC, Part 7: Adult Basic Life Support, Top 10 Take-Home Messages, item 7
Q21 · Patient Treatment and Transport

You and your partner are doing CPR on a 5-year-old in cardiac arrest. No advanced airway is in place. What compression-to-ventilation ratio should you use?

The answer is D. For infants and children without an advanced airway, one rescuer uses 30:2 and two rescuers use 15:2. A 3:1 ratio is for newborns.

Source: AHA/AAP 2025 Guidelines for CPR and ECC, Part 6: Pediatric Basic Life Support, Components of high-quality CPR, recommendation 9
Q22 · Patient Treatment and Transport

A man was stabbed in the side of the neck. He is alert, moves all four limbs normally, and the bleeding is controlled with direct pressure. How should you manage his spine?

The answer is A. Patients with penetrating neck injuries should not be placed in a cervical collar or other spinal precautions, with or without neurologic symptoms. A collar can hide an expanding hematoma or airway problem and has been associated with higher mortality.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Spinal Care guideline, Treatment and Interventions 2
Q23 · Patient Treatment and Transport

A 61-year-old with chest pain has his own prescribed nitroglycerin tablets, and your protocol lets you help him take them. His blood pressure is 138/84. He says he took tadalafil (Cialis) last night. What should you do about the nitroglycerin?

The answer is C. Nitrates should be avoided in anyone who has used a phosphodiesterase inhibitor such as sildenafil, vardenafil or tadalafil in the past 48 hours. The combination can drop blood pressure sharply. A normal blood pressure does not override this.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Chest Pain/ACS/STEMI, Treatment 7(a)-(b)
Q24 · Patient Treatment and Transport

An 8-month-old is choking on food. She is awake but cannot cry or cough. What should you do?

The answer is D. For infants with severe airway obstruction, the 2025 guidelines call for repeated cycles of 5 back blows and 5 chest thrusts until the object comes out or the infant becomes unresponsive. Abdominal thrusts are not recommended in infants (back blows with abdominal thrusts is the method for children).

Source: AHA/AAP 2025 Guidelines for CPR and ECC, Part 6: Pediatric Basic Life Support, Top take-home messages 4-5; Foreign-body airway obstruction recommendations 2-3
Q25 · Patient Treatment and Transport

A woman with diabetes had a seizure caused by low blood sugar. After oral glucose she is fully alert, her repeat glucose is 110 mg/dL, and her husband is with her. Which fact makes the national model guideline recommend hospital transport for her anyway?

The answer is B. Hypoglycemic patients who have had a seizure should be transported to the hospital regardless of their mental status and response to therapy. A glucose above 80, insulin use and a reliable adult at home are all conditions that support release without transport in patients who did not seize.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Hypoglycemia, Treatment 3 (Disposition) (b)-(c)
Q26 · Patient Treatment and Transport

At the emergency department you give the nurse a full verbal report. Which statement about the patient care report (PCR) is correct?

The answer is A. Ideally the completed medical record is handed over at transfer. If not, a verbal report and an abbreviated written report are given, but these do not replace or remove the requirement for a complete electronic or written record of the care provided.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Universal Care Guideline, Transfer of Care 2-5
Q27 · Operations

During your shift check you attach a regulator to a full oxygen cylinder. How should you open the cylinder valve?

The answer is A. NIOSH reported fire flashes from oxygen regulators that injured firefighters, EMTs and health care workers. Its advice: point the cylinder valve away from the operator and other people, and open it slowly and completely once the regulator is attached.

Source: NIOSH: Warns Workers and Employers of Risk From Aluminum Regulators in High-Pressure Oxygen Systems (Feb 17, 1999), NIOSH suggested precautions
Q28 · Operations

While restocking you check the epinephrine auto-injectors. One is within its expiration date, but the solution in the window looks pinkish-brown. What should you do?

The answer is C. The EpiPen label says the solution should be clear and colorless, and the auto-injector should be replaced if the solution is discolored (pinkish or brown), cloudy or has particles. The label also says not to refrigerate it.

Source: DailyMed: EpiPen and EpiPen Jr (epinephrine injection) auto-injector label, Instructions for use / How supplied: storage and handling
Q29 · Operations

You apply a tourniquet to a patient's thigh. What must be recorded prominently on the patient and in the patient care report?

The answer is B. Mark the time of tourniquet placement prominently on the patient and in the patient care report. The tourniquet should stay visible (not covered by clothing or dressings) and should not be loosened to relieve pain.

Source: NASEMSO National Model EMS Clinical Guidelines, Version 3.0 (March 2022; copy hosted by Iowa HHS), Extremity Trauma/External Hemorrhage Management, Patient Safety Considerations 2-3
Q30 · Operations

Under the federal OSHA bloodborne pathogens standard, which of these is an exposure incident?

The answer is D. OSHA defines an exposure incident as eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials during work. Intact skin, gloves and clothing are not exposure routes. After an exposure incident the employer must offer post-exposure evaluation and follow-up.

Source: OSHA 29 CFR 1910.1030, Bloodborne Pathogens, 1910.1030(b) definition of Exposure Incident; 1910.1030(f)(1)(i)

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The NREMT at a glance

70 to 120 questions in up to 2 hours. The test is computer-adaptive: it stops as soon as it can make a pass or fail decision with 95% confidence, so the length varies. Ten of the questions are unscored pilot items.
$104 per attempt, paid to the National Registry. You test at a Pearson VUE center or online with OnVUE remote proctoring.
New exam since April 7, 2025. Questions now follow the call (scene size-up, primary assessment, secondary assessment, treatment and transport, operations) instead of topics like airway, cardiology and trauma, and pediatric care is woven throughout. Besides multiple choice, expect multiple-response, options-table, build-list and drag-and-drop items.

From National Registry of Emergency Medical Technicians's official EMT examination specifications. CertOutlook is not affiliated with National Registry of Emergency Medical Technicians. Practice questions are original and are not taken from the exam.

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