1
NRCME DOT Certification Exam Actual
Exam 2026/2027 | Complete National
Registry of Certified Medical Examiners
Prep with Verified Questions and Answers |
FMCSA-Aligned | A+ Graded
SECTION 1: FMCSA REGULATIONS & GUIDELINES
Q1: Under FMCSA regulations, which of the following blood pressure readings would qualify a
commercial driver for a 2-year medical certificate without additional monitoring?
• A. 138/88 mm Hg [CORRECT]
• B. 142/92 mm Hg
• C. 152/96 mm Hg
• D. 162/98 mm Hg
Correct Answer: A Rationale: FMCSA guidelines allow a 2-year certification for drivers with
blood pressure ≤140/90 mm Hg (A). BP 141-150/91-100 (B) qualifies for 1-year certification. BP
151-160/101-110 (C) qualifies for 1-year certification with close monitoring. BP >160/110 (D) is
disqualifying.
Q2: A medical examiner is reviewing a driver's application and notices the driver is currently
taking a Schedule I controlled substance prescribed by their physician for chronic pain.
According to 49 CFR Part 391, what is the appropriate certification determination?
• A. Issue a 2-year certificate with annual monitoring
• B. Issue a 1-year certificate with restriction for daytime driving only
• C. Disqualify the driver from certification [CORRECT]
• D. Issue a 3-month temporary certificate pending specialist clearance
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Correct Answer: C Rationale: FMCSA regulations under 49 CFR Part 391.41(b)(12) explicitly
disqualify drivers who use Schedule I drugs, regardless of prescription status or state legality.
Schedule I substances have high abuse potential with no accepted medical use in treatment,
making them incompatible with CMV operation safety.
Q3: Which of the following is a mandatory requirement for initial medical examiner certification
with the FMCSA National Registry?
• A. Completion of a 4-year medical residency in occupational medicine
• B. Completion of an FMCSA-approved training program and passing the NRCME
certification examination [CORRECT]
• C. Board certification in internal medicine or family practice
• D. Minimum 5 years of clinical practice experience
Correct Answer: B Rationale: To become a certified medical examiner, healthcare providers
must complete an FMCSA-approved training program covering specific CMV driver health
standards and pass the NRCME certification exam. Board certification or residency training in
specific specialties is not required, though clinical practice experience is expected.
Q4: A driver presents for examination with a blood pressure of 158/104 mm Hg on initial
screening. According to FMCSA hypertension staging guidelines, what certification period is
appropriate if the driver has no other disqualifying conditions?
• A. 2-year certification
• B. 1-year certification [CORRECT]
• C. 3-month temporary certification
• D. Disqualification from certification
Correct Answer: B Rationale: FMCSA categorizes BP 151-160/101-110 mm Hg as Stage 2
hypertension, which qualifies for 1-year certification with recommendation for re-evaluation and
treatment. The driver is not disqualified (which requires >160/110) but does not qualify for 2-
year certification (requires ≤140/90).
Q5: Under 49 CFR Part 391.43, which of the following healthcare professionals is NOT eligible
to become a certified medical examiner listed on the National Registry?
• A. Doctor of Medicine (MD)
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• B. Doctor of Osteopathic Medicine (DO)
• C. Physician Assistant (PA) working under physician supervision
• D. Registered Nurse (RN) with advanced practice certification [CORRECT]
Correct Answer: D Rationale: FMCSA regulations specify that only MDs, DOs, PAs,
Chiropractors (DCs), and Advanced Practice Nurses (APNs/NPs) may become certified medical
examiners. Registered Nurses (RNs), even with advanced certifications, are not eligible unless
they hold NP licensure. The professional must have prescribing authority in their state.
Q6: A medical examiner completes a DOT physical examination and determines the driver meets
all standards but requires annual monitoring due to controlled hypertension. How should the
medical examiner's certificate (MEC) be completed?
• A. Mark "Qualified" and specify expiration date 24 months from examination
• B. Mark "Qualified" and specify expiration date 12 months from examination
[CORRECT]
• C. Mark "Determination Pending" and issue a 3-month temporary certificate
• D. Mark "Disqualified" with instructions to return after blood pressure control
Correct Answer: B Rationale: When a driver meets standards but requires monitoring for a
medical condition like controlled hypertension (Stage 1: 140-159/90-99 mm Hg), the examiner
marks "Qualified" on the MEC but sets the expiration date to 12 months from the examination
date, not the standard 24 months.
Q7: Which of the following actions by a certified medical examiner would violate FMCSA
regulations regarding the Medical Examination Report (MER) Form, MCSA-5875?
• A. Retaining a copy of the completed MER in the driver's medical file for 3 years
• B. Transmitting the completed MER to FMCSA within 24 hours of examination
• C. Allowing the driver to take the original MER form to their employer instead of the
medical examiner's certificate [CORRECT]
• D. Documenting all abnormal physical findings in Section 3 of the form
Correct Answer: C Rationale: The original MER Form MCSA-5875 must remain with the
medical examiner; the driver receives only the Medical Examiner's Certificate (MEC) Form
MCSA-5876. Allowing the driver to take the MER violates FMCSA documentation requirements
and compromises medical privacy and examination integrity.
, 4
Q8: According to the FMCSA Medical Examiner Handbook, how often must certified medical
examiners complete periodic training to maintain their National Registry status?
• A. Every 2 years
• B. Every 3 years
• C. Every 5 years [CORRECT]
• D. Every 10 years
Correct Answer: C Rationale: Certified medical examiners must complete periodic training
every 5 years and pass a recertification examination every 10 years to maintain active status on
the National Registry. Failure to complete these requirements results in removal from the registry
and inability to perform DOT physicals.
Q9: A driver with insulin-treated diabetes mellitus presents for examination. The driver does not
have a federal insulin exemption. What is the appropriate certification determination under
current FMCSA guidelines?
• A. Issue a 1-year certificate with endocrinologist clearance
• B. Issue a 2-year certificate with quarterly glucose monitoring
• C. Disqualify from interstate commerce; may qualify for intrastate with state variance
[CORRECT]
• D. Issue a 6-month temporary certificate pending exemption application
Correct Answer: C Rationale: Insulin-treated diabetes disqualifies drivers from interstate CMV
operation unless they hold a valid FMCSA insulin exemption. Some states offer intrastate
variances, but interstate commerce requires either the federal exemption or disqualification. The
examiner cannot certify without the exemption documentation.
Q10: Which of the following vision standards is REQUIRED for a driver to qualify for interstate
commerce under 49 CFR Part 391.41(b)(10)?
• A. Visual acuity of 20/20 in both eyes without correction
• B. Visual acuity of at least 20/40 in each eye with or without correction, and field of
vision of at least 70° [CORRECT]
• C. Visual acuity of 20/30 in the better eye with or without correction
NRCME DOT Certification Exam Actual
Exam 2026/2027 | Complete National
Registry of Certified Medical Examiners
Prep with Verified Questions and Answers |
FMCSA-Aligned | A+ Graded
SECTION 1: FMCSA REGULATIONS & GUIDELINES
Q1: Under FMCSA regulations, which of the following blood pressure readings would qualify a
commercial driver for a 2-year medical certificate without additional monitoring?
• A. 138/88 mm Hg [CORRECT]
• B. 142/92 mm Hg
• C. 152/96 mm Hg
• D. 162/98 mm Hg
Correct Answer: A Rationale: FMCSA guidelines allow a 2-year certification for drivers with
blood pressure ≤140/90 mm Hg (A). BP 141-150/91-100 (B) qualifies for 1-year certification. BP
151-160/101-110 (C) qualifies for 1-year certification with close monitoring. BP >160/110 (D) is
disqualifying.
Q2: A medical examiner is reviewing a driver's application and notices the driver is currently
taking a Schedule I controlled substance prescribed by their physician for chronic pain.
According to 49 CFR Part 391, what is the appropriate certification determination?
• A. Issue a 2-year certificate with annual monitoring
• B. Issue a 1-year certificate with restriction for daytime driving only
• C. Disqualify the driver from certification [CORRECT]
• D. Issue a 3-month temporary certificate pending specialist clearance
,2
Correct Answer: C Rationale: FMCSA regulations under 49 CFR Part 391.41(b)(12) explicitly
disqualify drivers who use Schedule I drugs, regardless of prescription status or state legality.
Schedule I substances have high abuse potential with no accepted medical use in treatment,
making them incompatible with CMV operation safety.
Q3: Which of the following is a mandatory requirement for initial medical examiner certification
with the FMCSA National Registry?
• A. Completion of a 4-year medical residency in occupational medicine
• B. Completion of an FMCSA-approved training program and passing the NRCME
certification examination [CORRECT]
• C. Board certification in internal medicine or family practice
• D. Minimum 5 years of clinical practice experience
Correct Answer: B Rationale: To become a certified medical examiner, healthcare providers
must complete an FMCSA-approved training program covering specific CMV driver health
standards and pass the NRCME certification exam. Board certification or residency training in
specific specialties is not required, though clinical practice experience is expected.
Q4: A driver presents for examination with a blood pressure of 158/104 mm Hg on initial
screening. According to FMCSA hypertension staging guidelines, what certification period is
appropriate if the driver has no other disqualifying conditions?
• A. 2-year certification
• B. 1-year certification [CORRECT]
• C. 3-month temporary certification
• D. Disqualification from certification
Correct Answer: B Rationale: FMCSA categorizes BP 151-160/101-110 mm Hg as Stage 2
hypertension, which qualifies for 1-year certification with recommendation for re-evaluation and
treatment. The driver is not disqualified (which requires >160/110) but does not qualify for 2-
year certification (requires ≤140/90).
Q5: Under 49 CFR Part 391.43, which of the following healthcare professionals is NOT eligible
to become a certified medical examiner listed on the National Registry?
• A. Doctor of Medicine (MD)
,3
• B. Doctor of Osteopathic Medicine (DO)
• C. Physician Assistant (PA) working under physician supervision
• D. Registered Nurse (RN) with advanced practice certification [CORRECT]
Correct Answer: D Rationale: FMCSA regulations specify that only MDs, DOs, PAs,
Chiropractors (DCs), and Advanced Practice Nurses (APNs/NPs) may become certified medical
examiners. Registered Nurses (RNs), even with advanced certifications, are not eligible unless
they hold NP licensure. The professional must have prescribing authority in their state.
Q6: A medical examiner completes a DOT physical examination and determines the driver meets
all standards but requires annual monitoring due to controlled hypertension. How should the
medical examiner's certificate (MEC) be completed?
• A. Mark "Qualified" and specify expiration date 24 months from examination
• B. Mark "Qualified" and specify expiration date 12 months from examination
[CORRECT]
• C. Mark "Determination Pending" and issue a 3-month temporary certificate
• D. Mark "Disqualified" with instructions to return after blood pressure control
Correct Answer: B Rationale: When a driver meets standards but requires monitoring for a
medical condition like controlled hypertension (Stage 1: 140-159/90-99 mm Hg), the examiner
marks "Qualified" on the MEC but sets the expiration date to 12 months from the examination
date, not the standard 24 months.
Q7: Which of the following actions by a certified medical examiner would violate FMCSA
regulations regarding the Medical Examination Report (MER) Form, MCSA-5875?
• A. Retaining a copy of the completed MER in the driver's medical file for 3 years
• B. Transmitting the completed MER to FMCSA within 24 hours of examination
• C. Allowing the driver to take the original MER form to their employer instead of the
medical examiner's certificate [CORRECT]
• D. Documenting all abnormal physical findings in Section 3 of the form
Correct Answer: C Rationale: The original MER Form MCSA-5875 must remain with the
medical examiner; the driver receives only the Medical Examiner's Certificate (MEC) Form
MCSA-5876. Allowing the driver to take the MER violates FMCSA documentation requirements
and compromises medical privacy and examination integrity.
, 4
Q8: According to the FMCSA Medical Examiner Handbook, how often must certified medical
examiners complete periodic training to maintain their National Registry status?
• A. Every 2 years
• B. Every 3 years
• C. Every 5 years [CORRECT]
• D. Every 10 years
Correct Answer: C Rationale: Certified medical examiners must complete periodic training
every 5 years and pass a recertification examination every 10 years to maintain active status on
the National Registry. Failure to complete these requirements results in removal from the registry
and inability to perform DOT physicals.
Q9: A driver with insulin-treated diabetes mellitus presents for examination. The driver does not
have a federal insulin exemption. What is the appropriate certification determination under
current FMCSA guidelines?
• A. Issue a 1-year certificate with endocrinologist clearance
• B. Issue a 2-year certificate with quarterly glucose monitoring
• C. Disqualify from interstate commerce; may qualify for intrastate with state variance
[CORRECT]
• D. Issue a 6-month temporary certificate pending exemption application
Correct Answer: C Rationale: Insulin-treated diabetes disqualifies drivers from interstate CMV
operation unless they hold a valid FMCSA insulin exemption. Some states offer intrastate
variances, but interstate commerce requires either the federal exemption or disqualification. The
examiner cannot certify without the exemption documentation.
Q10: Which of the following vision standards is REQUIRED for a driver to qualify for interstate
commerce under 49 CFR Part 391.41(b)(10)?
• A. Visual acuity of 20/20 in both eyes without correction
• B. Visual acuity of at least 20/40 in each eye with or without correction, and field of
vision of at least 70° [CORRECT]
• C. Visual acuity of 20/30 in the better eye with or without correction
