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Paramedic National Registry Exam ACTUAL QUESTIONS
AND ANSWERS LATEST UPDATE THIS YEAR
Paramedic National Registry Exam, followed by a summary of the exam coverage. The questions are
designed to be challenging and mirror the content and format of the actual exam.
Summarized Exam Coverage (Point Form)
• Airway, Respiration & Ventilation
o Airway anatomy and physiology.
o Techniques for airway management (BLS and ALS).
o Oxygenation and ventilation (bag-valve mask, CPAP, BiPAP).
o Capnography and pulse oximetry interpretation.
• Cardiology & Resuscitation
o ECG interpretation (ischemia, injury, infarct, blocks).
o Cardiac arrest management (ACLS algorithms).
o Acute Coronary Syndrome (ACS).
o Cardioversion and defibrillation.
• Medical Emergencies
o Respiratory emergencies (asthma, COPD, pulmonary edema).
o Neurological emergencies (stroke, seizure, altered mental status).
o Endocrine emergencies (diabetic ketoacidosis, hyperosmolar hyperglycemic state,
hypoglycemia).
o Toxicology and overdose management.
o Infectious diseases and sepsis.
o Anaphylaxis and allergic reactions.
• Trauma
o Blunt and penetrating trauma mechanisms.
o Hemorrhage control (tourniquets, hemostatic agents).
o Shock management (hypovolemic, obstructive, distributive, cardiogenic).
o Head and spinal trauma.
o Thoracic and abdominal trauma.
o Musculoskeletal trauma and burn management.
• Obstetrics & Pediatrics
o Normal and abnormal labor and delivery.
o Neonatal resuscitation.
o Pediatric airway and respiratory emergencies.
o Pediatric cardiac arrest and shock.
o Child abuse and neglect recognition.
• EMS Operations
o Incident command system (ICS) and multi-casualty incidents (MCI).
o Triage (START, SALT, JumpSTART).
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o Ambulance safety and operations.
o Hazardous materials awareness.
o Medical-legal issues (consent, confidentiality, advance directives).
1. You are evaluating a 45-year-old male with a history of hypertension and hyperlipidemia who
presents with substernal chest pressure radiating to his left jaw. He is diaphoretic and nauseous. His
blood pressure is 150/90 mmHg, heart rate is 110 bpm, and respiratory rate is 22/min. An ECG shows
ST-segment elevation in leads II, III, and aVF. What is the most likely diagnosis?
A. Acute pericarditis
B. Inferior wall ST-elevation myocardial infarction (STEMI)
C. Anterior wall ST-elevation myocardial infarction (STEMI)
D. Unstable angina
Answer: B. The presence of ST-segment elevation in the inferior leads (II, III, aVF) is diagnostic of an
inferior wall STEMI.
2. A 60-year-old female with a history of atrial fibrillation is found unresponsive with agonal respirations.
Her family reports she takes warfarin (Coumadin). Your primary assessment reveals her to be in cardiac
arrest. An ECG shows a wide-complex tachycardia without discernible P waves. What is the most likely
rhythm?
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A. Ventricular fibrillation
B. Ventricular tachycardia
C. Atrial fibrillation with aberrancy
D. Pulseless electrical activity (PEA)
Answer: B. Wide-complex tachycardia without P waves in a pulseless patient is consistent with
ventricular tachycardia. The history of atrial fibrillation and warfarin use suggests a possible embolic
event as the underlying cause.
3. A 25-year-old male is involved in a high-speed motor vehicle collision. He is complaining of severe
shortness of breath and right shoulder pain. On exam, you note decreased breath sounds on the right,
and his trachea is deviated to the left. His blood pressure is 80/50 mmHg and his heart rate is 130 bpm.
What is the most likely underlying pathology?
A. Simple pneumothorax
B. Tension pneumothorax
C. Hemothorax
D. Pericardial tamponade
Answer: B. Tension pneumothorax is a life-threatening condition that presents with respiratory distress,
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absent breath sounds, hypotension, and tracheal deviation away from the affected side. It requires
immediate needle decompression.
4. You are transporting a 30-year-old male with a history of asthma who is in severe respiratory distress.
He is barely able to speak and is using his accessory muscles. His peak expiratory flow rate is 150 L/min
(his personal best is 500 L/min). After two nebulized albuterol treatments, his condition has not
improved. What is the most appropriate next step?
A. Administer a third dose of albuterol
B. Administer nebulized ipratropium bromide
C. Administer magnesium sulfate IV
D. Administer epinephrine 1:1,000 IM
Answer: D. This patient is in severe, refractory status asthmaticus. Epinephrine 1:1,000 IM can be used
as a rescue agent. Nebulized ipratropium bromide and IV magnesium sulfate may also be considered, but
epinephrine is the most appropriate next step given the severity and failure of initial treatment.
5. A 6-year-old child is found to have a large-bore IV needle accidentally placed in his antecubital fossa.
The IV is actively infusing. What is the most immediate concern?
A. Air embolism
Paramedic National Registry Exam ACTUAL QUESTIONS
AND ANSWERS LATEST UPDATE THIS YEAR
Paramedic National Registry Exam, followed by a summary of the exam coverage. The questions are
designed to be challenging and mirror the content and format of the actual exam.
Summarized Exam Coverage (Point Form)
• Airway, Respiration & Ventilation
o Airway anatomy and physiology.
o Techniques for airway management (BLS and ALS).
o Oxygenation and ventilation (bag-valve mask, CPAP, BiPAP).
o Capnography and pulse oximetry interpretation.
• Cardiology & Resuscitation
o ECG interpretation (ischemia, injury, infarct, blocks).
o Cardiac arrest management (ACLS algorithms).
o Acute Coronary Syndrome (ACS).
o Cardioversion and defibrillation.
• Medical Emergencies
o Respiratory emergencies (asthma, COPD, pulmonary edema).
o Neurological emergencies (stroke, seizure, altered mental status).
o Endocrine emergencies (diabetic ketoacidosis, hyperosmolar hyperglycemic state,
hypoglycemia).
o Toxicology and overdose management.
o Infectious diseases and sepsis.
o Anaphylaxis and allergic reactions.
• Trauma
o Blunt and penetrating trauma mechanisms.
o Hemorrhage control (tourniquets, hemostatic agents).
o Shock management (hypovolemic, obstructive, distributive, cardiogenic).
o Head and spinal trauma.
o Thoracic and abdominal trauma.
o Musculoskeletal trauma and burn management.
• Obstetrics & Pediatrics
o Normal and abnormal labor and delivery.
o Neonatal resuscitation.
o Pediatric airway and respiratory emergencies.
o Pediatric cardiac arrest and shock.
o Child abuse and neglect recognition.
• EMS Operations
o Incident command system (ICS) and multi-casualty incidents (MCI).
o Triage (START, SALT, JumpSTART).
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o Ambulance safety and operations.
o Hazardous materials awareness.
o Medical-legal issues (consent, confidentiality, advance directives).
1. You are evaluating a 45-year-old male with a history of hypertension and hyperlipidemia who
presents with substernal chest pressure radiating to his left jaw. He is diaphoretic and nauseous. His
blood pressure is 150/90 mmHg, heart rate is 110 bpm, and respiratory rate is 22/min. An ECG shows
ST-segment elevation in leads II, III, and aVF. What is the most likely diagnosis?
A. Acute pericarditis
B. Inferior wall ST-elevation myocardial infarction (STEMI)
C. Anterior wall ST-elevation myocardial infarction (STEMI)
D. Unstable angina
Answer: B. The presence of ST-segment elevation in the inferior leads (II, III, aVF) is diagnostic of an
inferior wall STEMI.
2. A 60-year-old female with a history of atrial fibrillation is found unresponsive with agonal respirations.
Her family reports she takes warfarin (Coumadin). Your primary assessment reveals her to be in cardiac
arrest. An ECG shows a wide-complex tachycardia without discernible P waves. What is the most likely
rhythm?
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A. Ventricular fibrillation
B. Ventricular tachycardia
C. Atrial fibrillation with aberrancy
D. Pulseless electrical activity (PEA)
Answer: B. Wide-complex tachycardia without P waves in a pulseless patient is consistent with
ventricular tachycardia. The history of atrial fibrillation and warfarin use suggests a possible embolic
event as the underlying cause.
3. A 25-year-old male is involved in a high-speed motor vehicle collision. He is complaining of severe
shortness of breath and right shoulder pain. On exam, you note decreased breath sounds on the right,
and his trachea is deviated to the left. His blood pressure is 80/50 mmHg and his heart rate is 130 bpm.
What is the most likely underlying pathology?
A. Simple pneumothorax
B. Tension pneumothorax
C. Hemothorax
D. Pericardial tamponade
Answer: B. Tension pneumothorax is a life-threatening condition that presents with respiratory distress,
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absent breath sounds, hypotension, and tracheal deviation away from the affected side. It requires
immediate needle decompression.
4. You are transporting a 30-year-old male with a history of asthma who is in severe respiratory distress.
He is barely able to speak and is using his accessory muscles. His peak expiratory flow rate is 150 L/min
(his personal best is 500 L/min). After two nebulized albuterol treatments, his condition has not
improved. What is the most appropriate next step?
A. Administer a third dose of albuterol
B. Administer nebulized ipratropium bromide
C. Administer magnesium sulfate IV
D. Administer epinephrine 1:1,000 IM
Answer: D. This patient is in severe, refractory status asthmaticus. Epinephrine 1:1,000 IM can be used
as a rescue agent. Nebulized ipratropium bromide and IV magnesium sulfate may also be considered, but
epinephrine is the most appropriate next step given the severity and failure of initial treatment.
5. A 6-year-old child is found to have a large-bore IV needle accidentally placed in his antecubital fossa.
The IV is actively infusing. What is the most immediate concern?
A. Air embolism
