2026/2027
NREMT Paramedic Prep Exam
2026/2027 Professional Study Guide
for National Registry EMS
Certification, Final Review, Practice
Assessments, and Exam Success
Strategies
Question 1:
When assessing the work of breathing in a pediatric patient, which assessment
findings are most appropriate?
A. Chest expansion, skin color, and wheezes or stridor
B. Inspection, palpation, percussion, and auscultation of chest
C. Breath sounds bilaterally, ventilation rate, quality, and volume
D. Airway sounds, positioning, retractions, and nasal flaring
Correct Answer: D. Airway sounds, positioning, retractions, and nasal flaring
Rationale:
In pediatric respiratory assessment, the work of breathing is best evaluated by
observing visible signs of respiratory distress such as airway noise (e.g., stridor),
abnormal positioning (tripod or head tilt), nasal flaring, and intercostal or subcostal
retractions. These findings reflect increased respiratory effort and early respiratory
compromise. Option A includes useful findings but is less focused on work of
breathing. Option B represents a full physical examination technique rather than
work-of-breathing assessment. Option C evaluates ventilation but does not
specifically capture early distress indicators like retractions and nasal flaring.
Question 2:
During CPR on an adult patient where you are assigned airway management, what is
the most appropriate ventilation technique?
A. Ventilate once after every 30 compressions
B. Use a two-person bag-valve-mask (BVM) technique
C. Use a BVM that refills in 3 seconds
D. Ventilate every 15 seconds with BVM
Correct Answer: B. Use a two-person bag-valve-mask (BVM) technique
,2026/2027
Rationale:
A two-person BVM technique is the most effective method during CPR because it
ensures a proper mask seal and delivers adequate tidal volume, improving
oxygenation and ventilation. Option A reflects incorrect ventilation timing for adult
CPR. Option C is not a recognized clinical standard. Option D reflects outdated or
incorrect ventilation intervals that are not appropriate for adult CPR protocols.
Question 3:
A 20-year-old male develops sudden chest pain and difficulty breathing after
basketball. He is alert, with decreased breath sounds on the left. What is the most
likely condition?
A. Tension pneumothorax
B. Simple pneumothorax
C. Heat exhaustion
D. Heat stroke
Correct Answer: B. Simple pneumothorax
Rationale:
A spontaneous or simple pneumothorax presents with sudden chest pain, dyspnea, and
decreased breath sounds on one side without severe hemodynamic instability. Tension
pneumothorax typically causes severe distress, hypotension, and tracheal deviation.
Heat-related illnesses (options C and D) do not cause unilateral decreased breath
sounds.
Question 4:
A tall, thin 21-year-old male develops worsening shortness of breath during exercise
with neck swelling and subcutaneous emphysema. What is the most likely diagnosis?
A. Pulmonary embolism
B. Spontaneous pneumothorax
C. Pernicious anemia
D. Cardiomegaly
Correct Answer: B. Spontaneous pneumothorax
Rationale:
Spontaneous pneumothorax is common in tall, thin young males and presents with
dyspnea, chest discomfort, and subcutaneous emphysema (air under skin causing
“crackling” sensation). Pulmonary embolism typically presents with pleuritic chest
pain and hypoxia. The other options do not match respiratory collapse findings.
Question 5:
,2026/2027
Which patient shows the most severe signs of hypoxia?
A. Restless 72-year-old female with tachycardia
B. Pale, clammy 68-year-old male with stable vitals
C. Sleepy, confused 69-year-old male with cyanotic nail beds
D. Tachypneic 73-year-old female with headache
Correct Answer: C. Sleepy, confused 69-year-old male with cyanotic nail beds
Rationale:
Late hypoxia presents with altered mental status, confusion, and cyanosis due to
inadequate oxygen delivery to tissues. Restlessness occurs earlier in hypoxia.
Tachypnea and headache are early compensatory signs. Cyanosis with confusion
indicates decompensated respiratory failure.
Question 6:
A 2-year-old child has a barking cough, inspiratory stridor, and mild respiratory
distress with normal oxygen saturation. What should you prepare for?
A. Respiratory arrest
B. Sepsis
C. Vomiting
D. Airway obstruction
Correct Answer: D. Airway obstruction
Rationale:
These symptoms are classic for croup, which causes upper airway narrowing and
potential obstruction due to inflammation. Although oxygen saturation is normal,
progression may lead to obstruction. Respiratory arrest is a late complication, not
immediate. Sepsis and vomiting are unrelated.
Question 7:
An unconscious patient has a gag reflex when attempting airway insertion. What
airway should you use?
A. Nasopharyngeal airway (NPA)
B. Oropharyngeal airway (OPA)
C. Suction device
D. Head tilt-chin lift
Correct Answer: A. Nasopharyngeal airway (NPA)
Rationale:
An NPA is appropriate when a gag reflex is present because it is better tolerated in
semi-conscious or responsive patients. An OPA is contraindicated due to gag reflex
, 2026/2027
stimulation. Suctioning and positioning are supportive but do not provide airway
patency.
Question 8:
A child with fever, tripod positioning, drooling, and sore throat most likely has:
A. Rubeola
B. Pertussis
C. Epiglottitis
D. Esophagitis
Correct Answer: C. Epiglottitis
Rationale:
Epiglottitis presents with sudden airway obstruction signs including drooling, tripod
positioning, and sore throat. It is a medical emergency. Pertussis presents with
coughing fits. Rubeola is measles. Esophagitis does not cause airway obstruction.
Question 9:
A 3-month-old infant had apnea but is now stable after stimulation. What should you
do first?
A. Give oxygen
B. Check apnea monitor function
C. Determine prehospital care provided
D. Assist ventilations
Correct Answer: C. Determine prehospital care provided
Rationale:
Assessment begins with gathering history of events and interventions to guide care.
Oxygen and ventilation may not be immediately necessary since the infant is stable.
Device checks are secondary after patient assessment.
Question 10:
A 71-year-old female awoke with shortness of breath and SpO₂ of 91%. What is your
first action?
A. Administer oxygen via NRB
B. Ask about nitroglycerin use
C. Lay patient flat
D. Auscultate lungs
Correct Answer: A. Administer oxygen via NRB
NREMT Paramedic Prep Exam
2026/2027 Professional Study Guide
for National Registry EMS
Certification, Final Review, Practice
Assessments, and Exam Success
Strategies
Question 1:
When assessing the work of breathing in a pediatric patient, which assessment
findings are most appropriate?
A. Chest expansion, skin color, and wheezes or stridor
B. Inspection, palpation, percussion, and auscultation of chest
C. Breath sounds bilaterally, ventilation rate, quality, and volume
D. Airway sounds, positioning, retractions, and nasal flaring
Correct Answer: D. Airway sounds, positioning, retractions, and nasal flaring
Rationale:
In pediatric respiratory assessment, the work of breathing is best evaluated by
observing visible signs of respiratory distress such as airway noise (e.g., stridor),
abnormal positioning (tripod or head tilt), nasal flaring, and intercostal or subcostal
retractions. These findings reflect increased respiratory effort and early respiratory
compromise. Option A includes useful findings but is less focused on work of
breathing. Option B represents a full physical examination technique rather than
work-of-breathing assessment. Option C evaluates ventilation but does not
specifically capture early distress indicators like retractions and nasal flaring.
Question 2:
During CPR on an adult patient where you are assigned airway management, what is
the most appropriate ventilation technique?
A. Ventilate once after every 30 compressions
B. Use a two-person bag-valve-mask (BVM) technique
C. Use a BVM that refills in 3 seconds
D. Ventilate every 15 seconds with BVM
Correct Answer: B. Use a two-person bag-valve-mask (BVM) technique
,2026/2027
Rationale:
A two-person BVM technique is the most effective method during CPR because it
ensures a proper mask seal and delivers adequate tidal volume, improving
oxygenation and ventilation. Option A reflects incorrect ventilation timing for adult
CPR. Option C is not a recognized clinical standard. Option D reflects outdated or
incorrect ventilation intervals that are not appropriate for adult CPR protocols.
Question 3:
A 20-year-old male develops sudden chest pain and difficulty breathing after
basketball. He is alert, with decreased breath sounds on the left. What is the most
likely condition?
A. Tension pneumothorax
B. Simple pneumothorax
C. Heat exhaustion
D. Heat stroke
Correct Answer: B. Simple pneumothorax
Rationale:
A spontaneous or simple pneumothorax presents with sudden chest pain, dyspnea, and
decreased breath sounds on one side without severe hemodynamic instability. Tension
pneumothorax typically causes severe distress, hypotension, and tracheal deviation.
Heat-related illnesses (options C and D) do not cause unilateral decreased breath
sounds.
Question 4:
A tall, thin 21-year-old male develops worsening shortness of breath during exercise
with neck swelling and subcutaneous emphysema. What is the most likely diagnosis?
A. Pulmonary embolism
B. Spontaneous pneumothorax
C. Pernicious anemia
D. Cardiomegaly
Correct Answer: B. Spontaneous pneumothorax
Rationale:
Spontaneous pneumothorax is common in tall, thin young males and presents with
dyspnea, chest discomfort, and subcutaneous emphysema (air under skin causing
“crackling” sensation). Pulmonary embolism typically presents with pleuritic chest
pain and hypoxia. The other options do not match respiratory collapse findings.
Question 5:
,2026/2027
Which patient shows the most severe signs of hypoxia?
A. Restless 72-year-old female with tachycardia
B. Pale, clammy 68-year-old male with stable vitals
C. Sleepy, confused 69-year-old male with cyanotic nail beds
D. Tachypneic 73-year-old female with headache
Correct Answer: C. Sleepy, confused 69-year-old male with cyanotic nail beds
Rationale:
Late hypoxia presents with altered mental status, confusion, and cyanosis due to
inadequate oxygen delivery to tissues. Restlessness occurs earlier in hypoxia.
Tachypnea and headache are early compensatory signs. Cyanosis with confusion
indicates decompensated respiratory failure.
Question 6:
A 2-year-old child has a barking cough, inspiratory stridor, and mild respiratory
distress with normal oxygen saturation. What should you prepare for?
A. Respiratory arrest
B. Sepsis
C. Vomiting
D. Airway obstruction
Correct Answer: D. Airway obstruction
Rationale:
These symptoms are classic for croup, which causes upper airway narrowing and
potential obstruction due to inflammation. Although oxygen saturation is normal,
progression may lead to obstruction. Respiratory arrest is a late complication, not
immediate. Sepsis and vomiting are unrelated.
Question 7:
An unconscious patient has a gag reflex when attempting airway insertion. What
airway should you use?
A. Nasopharyngeal airway (NPA)
B. Oropharyngeal airway (OPA)
C. Suction device
D. Head tilt-chin lift
Correct Answer: A. Nasopharyngeal airway (NPA)
Rationale:
An NPA is appropriate when a gag reflex is present because it is better tolerated in
semi-conscious or responsive patients. An OPA is contraindicated due to gag reflex
, 2026/2027
stimulation. Suctioning and positioning are supportive but do not provide airway
patency.
Question 8:
A child with fever, tripod positioning, drooling, and sore throat most likely has:
A. Rubeola
B. Pertussis
C. Epiglottitis
D. Esophagitis
Correct Answer: C. Epiglottitis
Rationale:
Epiglottitis presents with sudden airway obstruction signs including drooling, tripod
positioning, and sore throat. It is a medical emergency. Pertussis presents with
coughing fits. Rubeola is measles. Esophagitis does not cause airway obstruction.
Question 9:
A 3-month-old infant had apnea but is now stable after stimulation. What should you
do first?
A. Give oxygen
B. Check apnea monitor function
C. Determine prehospital care provided
D. Assist ventilations
Correct Answer: C. Determine prehospital care provided
Rationale:
Assessment begins with gathering history of events and interventions to guide care.
Oxygen and ventilation may not be immediately necessary since the infant is stable.
Device checks are secondary after patient assessment.
Question 10:
A 71-year-old female awoke with shortness of breath and SpO₂ of 91%. What is your
first action?
A. Administer oxygen via NRB
B. Ask about nitroglycerin use
C. Lay patient flat
D. Auscultate lungs
Correct Answer: A. Administer oxygen via NRB
