NCOEMS EXAM / NORTH CAROLINA OFFICE OF
EMERGENCY MEDICAL SERVICE ACTUAL EXAM
2026/2027 QUESTIONS AND A NEW UPDATED STUDY
GUIDE ACCURATE EXAM COMPLETE APPROVED
QUESTIONS AND CORRECT VERIFIED ANSWERS
WITH DETAILED RATIONALES | NEWEST UPDATED
VERSION 2026 EDITION | GUARANTEED SUCCESS A+
(BRAND NEW!) FULL REVISED NCOEMS EXAM
Q1. A 68-year-old male is unresponsive with snoring respirations at 6 breaths/min
and an SpO₂ of 82% on room air. What is your priority action?
A) Apply a non-rebreather mask at 15 L/min
B) Perform the jaw-thrust maneuver and begin BVM ventilation
C) Insert an oropharyngeal airway and apply a nasal cannula
D) Suction the oropharynx for 30 seconds
Correct answer: B
Rationale: Snoring indicates partial airway obstruction from the tongue. The jaw-
thrust maneuver opens the airway without moving the cervical spine. The patient is
hypoventilating (6 breaths/min) and hypoxic (SpO₂ 82%); therefore, positive
pressure ventilation with a Bag-Valve-Mask (BVM) is required immediately.
Q2. You intubate a cardiac arrest patient. According to North Carolina OEMS
standards, which is the most reliable confirmation of proper endotracheal (ET) tube
placement in the prehospital setting?
A) Fogging visible inside the tube
B) 5-point auscultation and waveform capnography
C) Pulse oximetry reading of 95%
D) Symmetrical chest rise only
Correct answer: B
Rationale: NCOEMS mandates waveform capnography as the gold standard for
confirming ET tube placement, combined with bilateral breath sounds and
epigastric auscultation. Fogging and chest rise are unreliable secondary signs.
,Q3. A patient has a suspected cervical spine injury and is apneic. Which airway
maneuver is preferred?
A) Head-tilt chin-lift
B) Jaw-thrust without head extension
C) Insertion of a nasopharyngeal airway only
D) Supraglottic airway without positioning
Correct answer: B
Rationale: The jaw-thrust maneuver is the only airway-opening technique that
does not require extending the cervical spine. Head-tilt chin-lift is contraindicated
in suspected spinal injury.
Q4. Which waveform on capnography indicates bronchospasm (e.g., asthma)?
A) Normal rectangular shape
B) Shark-fin (slow upslope) shape
C) Flat line
D) Cleft or notch on the plateau
Correct answer: B
Rationale: The "shark-fin" appearance (slow upslope) indicates prolonged
exhalation due to airway obstruction, characteristic of bronchospasm in asthma or
COPD. Normal rectangular shape indicates healthy lungs; flat line indicates
esophageal intubation or cardiac arrest.
Q5. 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
Correct answer: B
Rationale: Tidal volume of 500–600 mL (6–7 mL/kg ideal body weight)
minimizes gastric insufflation. Larger volumes increase the risk of aspiration and
reduce venous return.
,Q6. The maximum recommended suctioning time for an adult patient is:
A) 5 seconds
B) 10 seconds
C) 15 seconds
D) 30 seconds
Correct answer: C
Rationale: Suctioning should not exceed 15 seconds in adults (10 seconds for
children, 5 seconds for infants) to prevent hypoxia, bradycardia, and increased
intracranial pressure.
Q7. A patient with a tracheostomy tube is in respiratory distress. The tube is
partially dislodged and you cannot reinsert it. What is the next step?
A) Apply an oxygen mask over the stoma
B) Seal the stoma and ventilate via BVM over the mouth and nose
C) Insert a smaller endotracheal tube into the stoma
D) Perform needle cricothyrotomy
Correct answer: C
Rationale: If the tracheostomy tube cannot be reinserted, a smaller cuffed
endotracheal tube (e.g., 5.0 or 6.0) can be inserted into the stoma to secure the
airway. Sealing the stoma may cause an air leak or obstruction.
Q8. A 6-month-old infant presents with stridor, a barking cough, and retractions.
What is the most likely diagnosis and initial treatment?
A) Epiglottitis; immediate intubation
B) Croup; nebulized epinephrine
C) Foreign body; abdominal thrusts
D) Anaphylaxis; epinephrine IM
Correct answer: B
Rationale: The presentation is classic for croup (laryngotracheobronchitis).
Nebulized epinephrine reduces mucosal edema. Stridor is the key distinguishing
symptom. Epiglottitis presents with drooling, tripod positioning, and absence of
cough.
, Q9. An EMT is using a pocket mask. What is true regarding this device?
A) Direct contact occurs between rescuer and patient’s mouth
B) Oxygen cannot be connected to the mask
C) A one-way valve prevents exhaled air from contacting the rescuer
D) It is only for use on children
Correct answer: C
Rationale: A pocket mask includes a one-way valve that diverts exhaled air away
from the rescuer, reducing infection risk. Oxygen can be connected via a port. It is
used for all ages.
Q10. A 45-year-old male is found unresponsive with a respiratory rate of 8 and
shallow breathing. You are unable to open his airway with a jaw thrust. What is
your next action?
A) Perform a head-tilt chin-lift despite possible spine injury
B) Insert a nasopharyngeal airway and begin BVM
C) Use a supraglottic airway device immediately
D) Apply an oropharyngeal airway and then head-tilt
Correct answer: A
Rationale: Airway is the priority. If jaw-thrust fails to open the airway, a head-tilt
chin-lift is acceptable even with suspected spine injury because oxygenation
outweighs the risk of spinal movement.
Q11. Which of the following is a contraindication to the use of an oropharyngeal
airway (OPA)?
A) Gag reflex present
B) Unconscious patient
C) Snoring respirations
D) Suspected cervical injury
Correct answer: A
Rationale: An OPA should only be used in unresponsive patients without a gag
reflex; a conscious or semi-conscious patient may vomit or laryngospasm. Snoring
and cervical injury are not contraindications.
EMERGENCY MEDICAL SERVICE ACTUAL EXAM
2026/2027 QUESTIONS AND A NEW UPDATED STUDY
GUIDE ACCURATE EXAM COMPLETE APPROVED
QUESTIONS AND CORRECT VERIFIED ANSWERS
WITH DETAILED RATIONALES | NEWEST UPDATED
VERSION 2026 EDITION | GUARANTEED SUCCESS A+
(BRAND NEW!) FULL REVISED NCOEMS EXAM
Q1. A 68-year-old male is unresponsive with snoring respirations at 6 breaths/min
and an SpO₂ of 82% on room air. What is your priority action?
A) Apply a non-rebreather mask at 15 L/min
B) Perform the jaw-thrust maneuver and begin BVM ventilation
C) Insert an oropharyngeal airway and apply a nasal cannula
D) Suction the oropharynx for 30 seconds
Correct answer: B
Rationale: Snoring indicates partial airway obstruction from the tongue. The jaw-
thrust maneuver opens the airway without moving the cervical spine. The patient is
hypoventilating (6 breaths/min) and hypoxic (SpO₂ 82%); therefore, positive
pressure ventilation with a Bag-Valve-Mask (BVM) is required immediately.
Q2. You intubate a cardiac arrest patient. According to North Carolina OEMS
standards, which is the most reliable confirmation of proper endotracheal (ET) tube
placement in the prehospital setting?
A) Fogging visible inside the tube
B) 5-point auscultation and waveform capnography
C) Pulse oximetry reading of 95%
D) Symmetrical chest rise only
Correct answer: B
Rationale: NCOEMS mandates waveform capnography as the gold standard for
confirming ET tube placement, combined with bilateral breath sounds and
epigastric auscultation. Fogging and chest rise are unreliable secondary signs.
,Q3. A patient has a suspected cervical spine injury and is apneic. Which airway
maneuver is preferred?
A) Head-tilt chin-lift
B) Jaw-thrust without head extension
C) Insertion of a nasopharyngeal airway only
D) Supraglottic airway without positioning
Correct answer: B
Rationale: The jaw-thrust maneuver is the only airway-opening technique that
does not require extending the cervical spine. Head-tilt chin-lift is contraindicated
in suspected spinal injury.
Q4. Which waveform on capnography indicates bronchospasm (e.g., asthma)?
A) Normal rectangular shape
B) Shark-fin (slow upslope) shape
C) Flat line
D) Cleft or notch on the plateau
Correct answer: B
Rationale: The "shark-fin" appearance (slow upslope) indicates prolonged
exhalation due to airway obstruction, characteristic of bronchospasm in asthma or
COPD. Normal rectangular shape indicates healthy lungs; flat line indicates
esophageal intubation or cardiac arrest.
Q5. 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
Correct answer: B
Rationale: Tidal volume of 500–600 mL (6–7 mL/kg ideal body weight)
minimizes gastric insufflation. Larger volumes increase the risk of aspiration and
reduce venous return.
,Q6. The maximum recommended suctioning time for an adult patient is:
A) 5 seconds
B) 10 seconds
C) 15 seconds
D) 30 seconds
Correct answer: C
Rationale: Suctioning should not exceed 15 seconds in adults (10 seconds for
children, 5 seconds for infants) to prevent hypoxia, bradycardia, and increased
intracranial pressure.
Q7. A patient with a tracheostomy tube is in respiratory distress. The tube is
partially dislodged and you cannot reinsert it. What is the next step?
A) Apply an oxygen mask over the stoma
B) Seal the stoma and ventilate via BVM over the mouth and nose
C) Insert a smaller endotracheal tube into the stoma
D) Perform needle cricothyrotomy
Correct answer: C
Rationale: If the tracheostomy tube cannot be reinserted, a smaller cuffed
endotracheal tube (e.g., 5.0 or 6.0) can be inserted into the stoma to secure the
airway. Sealing the stoma may cause an air leak or obstruction.
Q8. A 6-month-old infant presents with stridor, a barking cough, and retractions.
What is the most likely diagnosis and initial treatment?
A) Epiglottitis; immediate intubation
B) Croup; nebulized epinephrine
C) Foreign body; abdominal thrusts
D) Anaphylaxis; epinephrine IM
Correct answer: B
Rationale: The presentation is classic for croup (laryngotracheobronchitis).
Nebulized epinephrine reduces mucosal edema. Stridor is the key distinguishing
symptom. Epiglottitis presents with drooling, tripod positioning, and absence of
cough.
, Q9. An EMT is using a pocket mask. What is true regarding this device?
A) Direct contact occurs between rescuer and patient’s mouth
B) Oxygen cannot be connected to the mask
C) A one-way valve prevents exhaled air from contacting the rescuer
D) It is only for use on children
Correct answer: C
Rationale: A pocket mask includes a one-way valve that diverts exhaled air away
from the rescuer, reducing infection risk. Oxygen can be connected via a port. It is
used for all ages.
Q10. A 45-year-old male is found unresponsive with a respiratory rate of 8 and
shallow breathing. You are unable to open his airway with a jaw thrust. What is
your next action?
A) Perform a head-tilt chin-lift despite possible spine injury
B) Insert a nasopharyngeal airway and begin BVM
C) Use a supraglottic airway device immediately
D) Apply an oropharyngeal airway and then head-tilt
Correct answer: A
Rationale: Airway is the priority. If jaw-thrust fails to open the airway, a head-tilt
chin-lift is acceptable even with suspected spine injury because oxygenation
outweighs the risk of spinal movement.
Q11. Which of the following is a contraindication to the use of an oropharyngeal
airway (OPA)?
A) Gag reflex present
B) Unconscious patient
C) Snoring respirations
D) Suspected cervical injury
Correct answer: A
Rationale: An OPA should only be used in unresponsive patients without a gag
reflex; a conscious or semi-conscious patient may vomit or laryngospasm. Snoring
and cervical injury are not contraindications.
