NCOEMS Exam Study Set 2026/2027 |
North Carolina EMS Certification
Preparation | Patient Care
EXAM
This document contains a comprehensive NCOEMS Exam study set for the
2026/2027 certification cycle, featuring 100 verified exam-style questions with
correc t answers and detailed rationales. It is designed to support Emergency
Medical Services (EMS) professionals preparing for certification under the North
Carolina Office of Emergency Medical Services (NCOEMS). The content aligns
with current NC EMS protocols and National Registry of Emergency Medical
Technicians (NREMT) standards. It covers key domains including patient
assessment and airway management, cardiology and resuscitation, trauma and
medical emergencies, EMS operations and North Carolina-specific protocols, and
pharmacology with IV therapy. The material provides structured review support
for prehospital care competency development and certification readiness.
Section 1: Airway Management & Respiratory Care (Questions 1-20)
Question 1
A 68-year-old male is unresponsive with snoring respirations at 6/min and SpO₂ of
82%. What is your priority action?
A) Apply non-rebreather mask at 15 LPM
B) Perform jaw-thrust maneuver and begin BVM ventilation
C) Insert an oropharyngeal airway and apply nasal cannula
D) Suction the airway for 30 seconds
Correct Answer: B
,Rationale: Snoring respirations indicate partial airway obstruction caused by the
tongue relaxing against the posterior pharynx. The jaw-thrust maneuver opens the
airway without cervical spine manipulation. BVM ventilation at 10-12 breaths per
minute with high-flow oxygen corrects the hypoxia (SpO₂ 82%). An OPA can be
inserted after the airway is opened, and suctioning should be limited to 15 seconds
to prevent hypoxia and bradycardia.
Question 2
You intubate a cardiac arrest patient. Which method confirms proper endotracheal
tube placement according to NC OEMS guidelines?
A) Fogging visible inside the tube
B) Five-point auscultation plus waveform capnography
C) Pulse oximetry improvement
D) Chest rise alone
Correct Answer: B
Rationale: NC OEMS mandates waveform capnography as the gold standard for
ET tube confirmation, combined with bilateral breath sounds, epigastric
auscultation, and chest rise. Fogging is unreliable as it occurs even with esophageal
intubation. Pulse oximetry responds too slowly, and chest rise alone does not rule
out esophageal placement. Continuous waveform capnography is also the standard
for monitoring CPR quality.
,Question 3
A patient with a tracheostomy tube has a partial dislodgment and is in respiratory
distress. You cannot reinsert the tube. What is your next action?
A) Apply an oxygen mask directly over the stoma
B) Seal the stoma and ventilate via BVM over mouth and nose
C) Insert a smaller endotracheal tube (5.0 or 6.0 cuffed) into the stoma
D) Perform needle cricothyrotomy
Correct Answer: C
Rationale: If a tracheostomy tube cannot be reinserted, a smaller cuffed
endotracheal tube can be inserted directly into the stoma. Sealing the stoma may
cause an air leak, and BVM over the face may not provide adequate ventilation if
the upper airway is obstructed. Needle cricothyrotomy is not indicated when an
existing stoma can be utilized.
Question 4
The oropharyngeal airway (OPA) is contraindicated in which of the following
patients?
A) Conscious patient with an intact gag reflex
B) Patient with suspected cervical spine injury
C) Patient with severe facial trauma
D) Patient under 8 years of age
Correct Answer: A
Rationale: An OPA in a conscious patient with an intact gag reflex can trigger
vomiting, aspiration, and laryngospasm. Cervical spine injury is not a
contraindication for OPA use; proper sizing and insertion technique are used.
, Facial trauma may require alternative airway management, but an OPA is not
absolutely contraindicated.
Question 5
After intubation, ETCO₂ is 45 mmHg with a normal waveform, but SpO₂ drops to
85% over 2 minutes. What is the most likely cause?
A) Right mainstem bronchus intubation
B) Esophageal intubation
C) Dislodged tube
D) Equipment malfunction
Correct Answer: A
Rationale: Normal ETCO₂ rules out esophageal intubation. Right mainstem
intubation causes hypoxemia due to single-lung ventilation but still produces
ETCO₂. Check breath sounds bilaterally and withdraw the tube 2-3 cm if right
mainstem intubation is suspected.
Question 6
What is the correct tidal volume for an adult receiving BVM ventilation without an
advanced airway?
A) 300-400 mL
B) 500-600 mL
C) 700-800 mL
D) 1000 mL
North Carolina EMS Certification
Preparation | Patient Care
EXAM
This document contains a comprehensive NCOEMS Exam study set for the
2026/2027 certification cycle, featuring 100 verified exam-style questions with
correc t answers and detailed rationales. It is designed to support Emergency
Medical Services (EMS) professionals preparing for certification under the North
Carolina Office of Emergency Medical Services (NCOEMS). The content aligns
with current NC EMS protocols and National Registry of Emergency Medical
Technicians (NREMT) standards. It covers key domains including patient
assessment and airway management, cardiology and resuscitation, trauma and
medical emergencies, EMS operations and North Carolina-specific protocols, and
pharmacology with IV therapy. The material provides structured review support
for prehospital care competency development and certification readiness.
Section 1: Airway Management & Respiratory Care (Questions 1-20)
Question 1
A 68-year-old male is unresponsive with snoring respirations at 6/min and SpO₂ of
82%. What is your priority action?
A) Apply non-rebreather mask at 15 LPM
B) Perform jaw-thrust maneuver and begin BVM ventilation
C) Insert an oropharyngeal airway and apply nasal cannula
D) Suction the airway for 30 seconds
Correct Answer: B
,Rationale: Snoring respirations indicate partial airway obstruction caused by the
tongue relaxing against the posterior pharynx. The jaw-thrust maneuver opens the
airway without cervical spine manipulation. BVM ventilation at 10-12 breaths per
minute with high-flow oxygen corrects the hypoxia (SpO₂ 82%). An OPA can be
inserted after the airway is opened, and suctioning should be limited to 15 seconds
to prevent hypoxia and bradycardia.
Question 2
You intubate a cardiac arrest patient. Which method confirms proper endotracheal
tube placement according to NC OEMS guidelines?
A) Fogging visible inside the tube
B) Five-point auscultation plus waveform capnography
C) Pulse oximetry improvement
D) Chest rise alone
Correct Answer: B
Rationale: NC OEMS mandates waveform capnography as the gold standard for
ET tube confirmation, combined with bilateral breath sounds, epigastric
auscultation, and chest rise. Fogging is unreliable as it occurs even with esophageal
intubation. Pulse oximetry responds too slowly, and chest rise alone does not rule
out esophageal placement. Continuous waveform capnography is also the standard
for monitoring CPR quality.
,Question 3
A patient with a tracheostomy tube has a partial dislodgment and is in respiratory
distress. You cannot reinsert the tube. What is your next action?
A) Apply an oxygen mask directly over the stoma
B) Seal the stoma and ventilate via BVM over mouth and nose
C) Insert a smaller endotracheal tube (5.0 or 6.0 cuffed) into the stoma
D) Perform needle cricothyrotomy
Correct Answer: C
Rationale: If a tracheostomy tube cannot be reinserted, a smaller cuffed
endotracheal tube can be inserted directly into the stoma. Sealing the stoma may
cause an air leak, and BVM over the face may not provide adequate ventilation if
the upper airway is obstructed. Needle cricothyrotomy is not indicated when an
existing stoma can be utilized.
Question 4
The oropharyngeal airway (OPA) is contraindicated in which of the following
patients?
A) Conscious patient with an intact gag reflex
B) Patient with suspected cervical spine injury
C) Patient with severe facial trauma
D) Patient under 8 years of age
Correct Answer: A
Rationale: An OPA in a conscious patient with an intact gag reflex can trigger
vomiting, aspiration, and laryngospasm. Cervical spine injury is not a
contraindication for OPA use; proper sizing and insertion technique are used.
, Facial trauma may require alternative airway management, but an OPA is not
absolutely contraindicated.
Question 5
After intubation, ETCO₂ is 45 mmHg with a normal waveform, but SpO₂ drops to
85% over 2 minutes. What is the most likely cause?
A) Right mainstem bronchus intubation
B) Esophageal intubation
C) Dislodged tube
D) Equipment malfunction
Correct Answer: A
Rationale: Normal ETCO₂ rules out esophageal intubation. Right mainstem
intubation causes hypoxemia due to single-lung ventilation but still produces
ETCO₂. Check breath sounds bilaterally and withdraw the tube 2-3 cm if right
mainstem intubation is suspected.
Question 6
What is the correct tidal volume for an adult receiving BVM ventilation without an
advanced airway?
A) 300-400 mL
B) 500-600 mL
C) 700-800 mL
D) 1000 mL
