NCOEMS Exam Study Set 2026/2027
North Carolina EMS Certification
Preparation | Patient Care Verified
Exam-Style Questions with Rationales
Aligns with NC OEMS Protocols & NREMT Standards
Question 1
A 60-year-old male is experiencing dyspnea with SpO₂ of 82%. What is your
priority action?
A) Apply non-rebreather mask at 15 LPM
B) Position the patient in a sitting or semi-Fowler's position
C) Insert an oropharyngeal airway
D) Suction the airway for 30 seconds
Correct Answer: B
Rationale: Positioning the patient upright improves lung expansion and
oxygenation. Oxygen should be applied immediately after positioning. Suctioning
is not indicated without visible secretions.
Question 2
You intubate a cardiac arrest patient. Which method confirms proper endotracheal
tube placement per 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 and chest rise.
,Question 3
A patient with a tracheostomy tube has partial dislodgment and 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 ET tube can be
inserted directly into the stoma. Needle cricothyrotomy is not indicated when an
existing stoma can be utilized.
Question 4
The oropharyngeal airway (OPA) is contraindicated in which patient?
A) Conscious patient with a gag reflex
B) Patient with copious secretions
C) Patient with known facial trauma
D) Patient under 3 years of age
Correct Answer: A
Rationale: An OPA is contraindicated in any patient with an intact gag reflex, as it
may induce vomiting and aspiration.
Question 5
After intubation, ETCO₂ is 45 mmHg with a normal waveform, but SpO₂ remains
85%. 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.
,Question 6
What is the correct tidal volume for an adult during 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: Adequate tidal volume is approximately 6-8 mL/kg, or 500-600 mL for
an average adult, enough to produce visible chest rise.
Question 7
A patient has snoring respirations after a fall. What is the first intervention?
A) Insert an OPA
B) Perform a jaw-thrust maneuver
C) Suction the oropharynx
D) Apply a cervical collar
Correct Answer: B
Rationale: Snoring indicates tongue obstruction. Jaw-thrust opens airway while
maintaining cervical spine precautions.
Question 8
What is the maximum suction time for an adult patient?
A) 5 seconds
B) 15 seconds
C) 30 seconds
D) 45 seconds
Correct Answer: B
Rationale: Suctioning should be limited to 10-15 seconds to prevent hypoxia and
bradycardia.
, Question 9
Which of the following is a contraindication to using a nasopharyngeal airway
(NPA)?
A) Gag reflex
B) Suspected basilar skull fracture
C) Age under 8 years
D) Conscious patient
Correct Answer: B
Rationale: NPA is contraindicated in suspected basilar skull fracture due to risk of
intracranial placement.
Question 10
A patient has stridor and respiratory distress after a bee sting. What is the most
likely cause?
A) Foreign body aspiration
B) Anaphylactic laryngeal edema
C) Asthma exacerbation
D) Pulmonary embolism
Correct Answer: B
Rationale: Stridor indicates upper airway obstruction, often from laryngeal edema
in anaphylaxis.
Question 11
What is the correct ventilation rate for an adult in cardiac arrest with an advanced
airway?
A) 6-8 breaths per minute
B) 10-12 breaths per minute
C) 16-20 breaths per minute
D) 24-30 breaths per minute
North Carolina EMS Certification
Preparation | Patient Care Verified
Exam-Style Questions with Rationales
Aligns with NC OEMS Protocols & NREMT Standards
Question 1
A 60-year-old male is experiencing dyspnea with SpO₂ of 82%. What is your
priority action?
A) Apply non-rebreather mask at 15 LPM
B) Position the patient in a sitting or semi-Fowler's position
C) Insert an oropharyngeal airway
D) Suction the airway for 30 seconds
Correct Answer: B
Rationale: Positioning the patient upright improves lung expansion and
oxygenation. Oxygen should be applied immediately after positioning. Suctioning
is not indicated without visible secretions.
Question 2
You intubate a cardiac arrest patient. Which method confirms proper endotracheal
tube placement per 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 and chest rise.
,Question 3
A patient with a tracheostomy tube has partial dislodgment and 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 ET tube can be
inserted directly into the stoma. Needle cricothyrotomy is not indicated when an
existing stoma can be utilized.
Question 4
The oropharyngeal airway (OPA) is contraindicated in which patient?
A) Conscious patient with a gag reflex
B) Patient with copious secretions
C) Patient with known facial trauma
D) Patient under 3 years of age
Correct Answer: A
Rationale: An OPA is contraindicated in any patient with an intact gag reflex, as it
may induce vomiting and aspiration.
Question 5
After intubation, ETCO₂ is 45 mmHg with a normal waveform, but SpO₂ remains
85%. 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.
,Question 6
What is the correct tidal volume for an adult during 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: Adequate tidal volume is approximately 6-8 mL/kg, or 500-600 mL for
an average adult, enough to produce visible chest rise.
Question 7
A patient has snoring respirations after a fall. What is the first intervention?
A) Insert an OPA
B) Perform a jaw-thrust maneuver
C) Suction the oropharynx
D) Apply a cervical collar
Correct Answer: B
Rationale: Snoring indicates tongue obstruction. Jaw-thrust opens airway while
maintaining cervical spine precautions.
Question 8
What is the maximum suction time for an adult patient?
A) 5 seconds
B) 15 seconds
C) 30 seconds
D) 45 seconds
Correct Answer: B
Rationale: Suctioning should be limited to 10-15 seconds to prevent hypoxia and
bradycardia.
, Question 9
Which of the following is a contraindication to using a nasopharyngeal airway
(NPA)?
A) Gag reflex
B) Suspected basilar skull fracture
C) Age under 8 years
D) Conscious patient
Correct Answer: B
Rationale: NPA is contraindicated in suspected basilar skull fracture due to risk of
intracranial placement.
Question 10
A patient has stridor and respiratory distress after a bee sting. What is the most
likely cause?
A) Foreign body aspiration
B) Anaphylactic laryngeal edema
C) Asthma exacerbation
D) Pulmonary embolism
Correct Answer: B
Rationale: Stridor indicates upper airway obstruction, often from laryngeal edema
in anaphylaxis.
Question 11
What is the correct ventilation rate for an adult in cardiac arrest with an advanced
airway?
A) 6-8 breaths per minute
B) 10-12 breaths per minute
C) 16-20 breaths per minute
D) 24-30 breaths per minute
