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NREMT Paramedic Cognitive Exam practice questions

217 free questions with answers and explanations.

Practice test
  1. 101.A 35-year-old female presents with sudden onset of severe, tearing chest pain radiating to her back. She is diaphoretic and anxious. Her blood pressure is 190/110 mmHg in the right arm and 140/90 mmHg in the left arm. Heart rate is 104 bpm, and respirations are 20 breaths/min. Distal pulses are palpable but diminished in the left arm. What is the MOST likely underlying condition?Medical
  2. 102.A 10-year-old child presents with a sudden high fever (103°F/39.4°C), severe sore throat, drooling, and inspiratory stridor. He is sitting upright, leaning forward, and appears anxious. His immunizations are incomplete. What is the most appropriate initial action?Medical
  3. 103.A 50-year-old female presents with acute onset of severe, sharp, right upper quadrant abdominal pain radiating to her right shoulder. She reports the pain started after eating a fatty meal. She is nauseated and has vomited once. Her skin is warm and dry, and she has no fever. What is the MOST likely cause of her pain?Medical
  4. 104.A 30-year-old female with a history of systemic lupus erythematosus (SLE) presents with generalized weakness, fatigue, and a 'butterfly rash' across her face. She also reports joint pain in her hands and knees. Her vital signs are stable. Which of the following is the most appropriate prehospital management?Medical
  5. 105.A 6-year-old child presents with a sudden onset of high fever (103.5°F/39.7°C), severe sore throat, drooling, and inspiratory stridor. The child is sitting in a 'tripod' position and appears anxious. Auscultation reveals diminished breath sounds bilaterally. Which of the following is the most appropriate initial intervention?Medical
  6. 106.A 30-year-old female with a history of systemic lupus erythematosus (SLE) presents with generalized weakness, fatigue, and a 'butterfly rash' across her face. She also reports joint pain in her hands and wrists. Her vital signs are stable. What is the most important aspect of prehospital care for this patient?Medical
  7. 107.A 68-year-old male presents with sudden onset of severe, unilateral headache, photophobia, and a stiff neck. He describes the headache as 'the worst headache of my life.' His Glasgow Coma Scale (GCS) is 14 (E4, V4, M6). Vital signs are BP 160/90 mmHg, HR 70 bpm, RR 16 bpm, SpO2 97% on room air. Which of the following conditions is most consistent with this presentation?Medical
  8. 108.A 35-year-old female presents with sudden onset of severe, tearing chest pain radiating to her back, described as 'the worst pain of my life.' She has a history of uncontrolled hypertension. Her vital signs are BP 180/110 mmHg (right arm), 140/80 mmHg (left arm), HR 110 bpm, RR 20 bpm. Her ECG shows sinus tachycardia with no ischemic changes. What is the most likely diagnosis?Medical
  9. 109.A 48-year-old male is found unconscious in an unheated garage. His skin is cold to the touch, and he is shivering uncontrollably. His core body temperature is measured at 92°F (33.3°C). His vital signs are BP 100/60 mmHg, HR 58 bpm, RR 10 bpm. Which rewarming method is most appropriate at this time?Medical
  10. 110.A 5-year-old child ingested an unknown quantity of caustic drain cleaner approximately 15 minutes ago. On arrival, the child is crying, has significant oral burns, and is drooling profusely. Which of the following is the most appropriate initial action?Medical
  11. 111.A 6-month-old infant presents with a history of poor feeding, irritability, and a bulging fontanelle. The mother reports the infant has been lethargic and has had a fever (102°F/38.9°C) for the past 12 hours. There are no signs of rash. Which of the following conditions is most likely causing these symptoms?Medical
  12. 112.A 45-year-old male presents with acute onset of severe, colicky right flank pain radiating to his groin. He is restless, diaphoretic, and reports nausea. His vital signs are stable. He denies fever or dysuria. What is the MOST appropriate initial management?Medical
  13. 113.A 55-year-old female with a history of type 2 diabetes is found unresponsive. Her blood glucose level is 30 mg/dL. She is cool, pale, and diaphoretic. Her vital signs are BP 100/60 mmHg, HR 110 bpm, RR 20 bpm, SpO2 96% on room air. She has an established IV line. What is the most appropriate initial treatment?Medical
  14. 114.A 16-year-old female is found unconscious in her bedroom after her friends reported she had been 'huffing' from an aerosol can. She has pinpoint pupils, is apneic, and has a weak, thready pulse of 40 bpm. Which of the following is the most critical initial intervention?Medical
  15. 115.A 40-year-old male presents with sudden-onset severe right flank pain radiating to his groin, accompanied by nausea and vomiting. He denies fever or dysuria. His vital signs are stable. On examination, he is restless and unable to find a comfortable position. His abdomen is soft and non-tender to palpation. What is the most likely diagnosis?Medical
  16. 116.A 16-year-old female is found unconscious in her bedroom after her friends reported she had been 'huffing' from an aerosol can. On assessment, she has a strong chemical odor on her breath, is unresponsive to verbal stimuli, and has a heart rate of 140 bpm with occasional premature ventricular contractions (PVCs). Her blood pressure is 100/60 mmHg, and respiratory rate is 8 bpm. Which of the following is the most critical immediate intervention?Medical
  17. 117.A 50-year-old female presents with acute onset of severe, sharp, right upper quadrant abdominal pain that radiates to her right shoulder. The pain began shortly after eating a fatty meal and is accompanied by nausea and vomiting. She denies fever. Her vital signs are stable. On palpation, she has tenderness in the right upper quadrant. Which of the following is the most likely diagnosis?Medical
  18. 118.A 22-year-old male presents with acute onset of severe testicular pain, swelling, and redness. He denies any recent trauma or fever. On examination, the affected testis is elevated, and the cremasteric reflex is absent on the affected side. What is the most likely diagnosis?Medical
  19. 119.A 28-year-old female presents with severe abdominal pain, nausea, and vomiting. She states her last menstrual period was 8 weeks ago and she had a positive home pregnancy test. On examination, she is pale, diaphoretic, and her abdomen is tender to palpation in the lower quadrants, particularly on the left. Her vital signs are BP 90/60 mmHg, HR 120 bpm, RR 22 breaths/min. What is the MOST critical immediate intervention?Medical
  20. 120.A 62-year-old male with a history of hypertension and hyperlipidemia presents with sudden onset of right-sided weakness, facial droop, and slurred speech that began 45 minutes ago. His blood glucose is 98 mg/dL. What is the most critical prehospital intervention for this patient?Medical
  21. 121.A 72-year-old female is found by family members to be confused and agitated. She has a history of dementia and atrial fibrillation. Her temperature is 101.5°F (38.6°C), BP 130/80 mmHg, HR 98 bpm, RR 22 bpm. Her skin is warm and dry. She complains of generalized weakness. What is the most likely underlying cause of her acute mental status change?Medical
  22. 122.A 22-year-old male presents with sudden onset of severe, excruciating pain in his right testicle. He reports the pain started abruptly an hour ago and is accompanied by nausea and mild swelling of the scrotum. On examination, the right testicle is high-riding and exquisitely tender to touch. What is the MOST likely diagnosis?Medical
  23. 123.A 28-year-old male presents with sudden onset of difficulty breathing, wheezing, and hives after eating shrimp. He states he has a known shellfish allergy. His blood pressure is 80/40 mmHg, heart rate 120 bpm, respiratory rate 28 bpm, and SpO2 90% on room air. Lung sounds reveal diffuse wheezing. Which of the following is the most appropriate initial intervention?Medical
  24. 124.A 40-year-old male presents with sudden onset of severe headache, described as 'the worst headache of my life.' He is alert but reports photophobia and neck stiffness. His vital signs are stable, and neurological examination is non-focal. What condition should be HIGHLY suspected?Medical
  25. 125.A 50-year-old female presents with acute onset of severe, sharp, right upper quadrant abdominal pain that radiates to her right shoulder. The pain began after eating a fatty meal and is accompanied by nausea and vomiting. She is afebrile. Her vital signs are stable. What is the most likely diagnosis?Medical
  26. 126.A 78-year-old female resident of a nursing home is found by staff to be lethargic, disoriented, and incontinent of urine. She has a history of dementia and frequent urinary tract infections. Her temperature is 101.5°F (38.6°C), HR 98 bpm, BP 100/70 mmHg, RR 20 breaths/min. Her blood glucose is 120 mg/dL. What is the MOST likely cause of her altered mental status?Medical
  27. 127.A 6-month-old infant presents with a history of poor feeding, irritability, and a bulging fontanelle. The parents report a fever of 102°F (38.9°C) and a recent upper respiratory infection. On assessment, the infant is lethargic and has a high-pitched cry. Which of the following conditions should be highly suspected?Medical
  28. 128.A 45-year-old female presents with acute severe abdominal pain, described as a 'tearing' sensation radiating to her back. She has a history of poorly controlled hypertension. Her vital signs are BP 190/110 mmHg, HR 120 bpm, RR 20 bpm, SpO2 97%. Her skin is cool and clammy. Upon palpation, her abdomen is diffusely tender but soft. Distal pulses are palpable but weak. What is the most likely diagnosis?Medical
  29. 129.A 45-year-old male presents with sudden onset of severe, tearing pain in his back that radiates to his abdomen. He has a history of poorly controlled hypertension. On assessment, his blood pressure is 190/110 mmHg in the right arm and 140/90 mmHg in the left arm, and his pulse is 110 bpm. Distal pulses are diminished in the left lower extremity. Which of the following is the most likely diagnosis?Medical
  30. 130.A 72-year-old female resident of a nursing home is found by staff to be lethargic, disoriented, and has a temperature of 100.8°F (38.2°C) with a history of recent indwelling urinary catheter placement. Her blood pressure is 90/58 mmHg, heart rate 110 bpm, respiratory rate 24 bpm. Her skin is warm and flushed. Which of the following conditions should the paramedic most suspect?Medical
  31. 131.A 72-year-old female is found unresponsive, pulseless, and apneic. CPR is immediately initiated. The cardiac monitor shows ventricular fibrillation (VF). What is the MOST appropriate next action?Cardiology & Resuscitation
  32. 132.A 50-year-old male presents with sudden onset of severe chest pain, diaphoresis, and nausea. His ECG shows ST elevation in leads II, III, and aVF. His blood pressure is 90/60 mmHg, and heart rate is 50 bpm. Which of the following medications is contraindicated in this patient?Cardiology & Resuscitation
  33. 133.A 60-year-old male presents with acute onset of severe substernal chest pain that began 30 minutes ago. He is pale, diaphoretic, and states he feels 'terrible'. His vital signs are BP 88/50 mmHg, HR 50 bpm, RR 18 bpm, SpO2 94% on room air. The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Which of the following medications is CONTRAINDICATED in this patient?Cardiology & Resuscitation
  34. 134.A 60-year-old male presents with sudden onset of dizziness, weakness, and syncope. His ECG shows a regular rhythm with a heart rate of 30 bpm, wide QRS complexes, and no discernible P waves. He is hypotensive with a blood pressure of 80/50 mmHg. Which of the following is the most appropriate initial intervention?Cardiology & Resuscitation
  35. 135.A 50-year-old male presents with acute onset of severe substernal chest pain that began 30 minutes ago. He is diaphoretic and anxious. His ECG shows ST elevation in leads V2-V4. His blood pressure is 130/80 mmHg, HR 90 bpm, RR 18 bpm, SpO2 97% on room air. What is the MOST appropriate initial medication to administer for pain relief, assuming no contraindications?Cardiology & Resuscitation
  36. 136.A 68-year-old male presents with acute onset of shortness of breath, orthopnea, and bilateral crackles on auscultation. His blood pressure is 180/100 mmHg, heart rate 110 bpm, and SpO2 is 88% on room air. He has a history of congestive heart failure. Which of the following is the most appropriate initial pharmacological intervention?Cardiology & Resuscitation
  37. 137.A 35-year-old female presents with sudden onset of dizziness and weakness. Her skin is cool and clammy. Vital signs are BP 80/50 mmHg, HR 120 bpm, RR 20 bpm, SpO2 96%. Her ECG shows a narrow-complex tachycardia at 120 bpm, but she appears to be in compensated shock. What is the MOST immediate intervention?Cardiology & Resuscitation
  38. 138.A 58-year-old male presents with sudden onset of crushing substernal chest pain radiating to his left arm and jaw. He is pale, diaphoretic, and complains of shortness of breath. His vital signs are BP 100/60 mmHg, HR 110 bpm, RR 22 bpm, SpO2 92% on room air. An ECG shows ST-segment elevation in leads II, III, and aVF. Which of the following interventions should be prioritized for this patient?Cardiology & Resuscitation
  39. 139.A 65-year-old male with a history of hypertension and diabetes presents with discomfort in his left arm and jaw, accompanied by nausea and diaphoresis. His ECG shows ST depression in leads V3-V5 and T-wave inversions in leads II, III, and aVF. Cardiac enzymes are pending. What is the MOST likely diagnosis?Cardiology & Resuscitation
  40. 140.A 45-year-old male presents with sudden onset of severe palpitations. He denies chest pain or shortness of breath. His vital signs are BP 128/84 mmHg, HR 180 bpm, RR 16 bpm, SpO2 98%. The ECG shows a regular, narrow-complex tachycardia. He is alert and oriented with no signs of hypoperfusion. What is the MOST appropriate initial treatment for this patient?Cardiology & Resuscitation
  41. 141.A 70-year-old male with a history of heart failure is found unresponsive. CPR is in progress. The cardiac monitor shows a regular rhythm at a rate of 70 bpm, but no palpable pulse. What is the most likely cardiac arrest rhythm?Cardiology & Resuscitation
  42. 142.A 28-year-old male collapses during a basketball game. CPR is initiated immediately by bystanders. Upon paramedic arrival, the patient is pulseless, and the monitor shows a wide, regular tachycardia at 200 bpm. What is the MOST appropriate immediate action?Cardiology & Resuscitation
  43. 143.A 65-year-old male with a history of heart failure complains of sudden onset of severe shortness of breath, orthopnea, and a productive cough with pink, frothy sputum. His vital signs are BP 160/90 mmHg, HR 115 bpm, RR 30 bpm with crackles bilaterally, and SpO2 88% on room air. Which of the following medications is indicated to improve this patient's condition?Cardiology & Resuscitation
  44. 144.A 70-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with new onset of atrial fibrillation with rapid ventricular response (AFib with RVR). His heart rate is 160 bpm, and he is complaining of palpitations but is otherwise hemodynamically stable. Which of the following medications is generally preferred for rate control in this patient?Cardiology & Resuscitation
  45. 145.A 58-year-old male is experiencing crushing substernal chest pain radiating to his left arm. He is pale, diaphoretic, and complaining of nausea. His ECG shows ST elevation in leads V2-V4. Which of the following is the most appropriate dose of Aspirin to administer?Cardiology & Resuscitation
  46. 146.A 45-year-old male presents with sudden onset of palpitations. He is alert and oriented, blood pressure 130/80 mmHg, heart rate 180 bpm, respirations 18 bpm, SpO2 98%. The ECG shows a regular narrow-complex tachycardia with no discernible P waves. What is the MOST appropriate initial intervention?Cardiology & Resuscitation
  47. 147.A 55-year-old male presents with sudden onset of severe, tearing chest pain radiating to his back. He has a history of uncontrolled hypertension. His blood pressure is 180/100 mmHg in the right arm and 140/90 mmHg in the left arm. His heart rate is 110 bpm. Which of the following is the most appropriate initial management for this patient?Cardiology & Resuscitation
  48. 148.A 40-year-old male collapses during a basketball game. Bystanders initiated CPR immediately. Upon arrival, you find the patient is unresponsive, pulseless, and apneic. The cardiac monitor shows a wide, irregular QRS complex rhythm with no discernible P waves, at a rate of 180 bpm. What is the most appropriate next intervention?Cardiology & Resuscitation
  49. 149.A 72-year-old male is in cardiac arrest. CPR is ongoing. The cardiac monitor shows a rhythm with organized electrical activity at a rate of 70 bpm, but no palpable pulse is detected. What is the MOST appropriate next action?Cardiology & Resuscitation
  50. 150.A 75-year-old female is found unresponsive and pulseless. CPR is in progress. After 2 minutes of high-quality CPR, the rhythm check reveals a flat line on the cardiac monitor. What is the MOST appropriate next intervention?Cardiology & Resuscitation