NREMT Exam and State EMT Tests


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"You will not find a more comprehensive online study guide for the NREMT Test than at My test scores proved it", Scott Hill, EMT-i85

EMT Certification, Licensing, Training and Examination Requirements by State


Taking the NREMT test or State EMT exam can be a painless experience if you are prepared with the
knowledge of the course material AND an understanding of what to expect of the NREMT test itself. We have
created this page to aid in answering some of the more common questions associated with taking NREMT and
state EMT certification tests. This includes facts and advice related to taking and passing the exams. It is
intended to aid the EMT candidate in his or her pursuit of certification and registration as an EMT, AEMT, or

Many states have adopted the NREMT cognitive exam as their state exam, however there are a few states that
still hold their own exam. The information given here is more specific for the NREMT Computer Adaptive Test
(CAT), however the test taking tips are useful for any exam. If you are not going to be taking the NREMT exam,
you should contact the state EMS office where you will be testing and see if they provide a study guide for their
exam. These study guides are very useful for state specific exams.

Over the years the NREMT exam format has changed from a linear exam (paper and pencil) to the CAT exam.
This is an adaptive exam and will vary in length. It is not graded like a traditional linear exam.

Facts you need to know about the NREMT Exam
Advice on how to take and pass the NREMT Exam
What materials to study for the NREMT Exam
Before taking the NREMT Exam
During the NREMT Exam
NREMT Question Breakdown
How The NREMT Exam and Questions are Constructed
NREMT Practical Exams


Facts you need to know about the NREMT Exam:


• NREMT test questions are multiple choice with 4 potential answers. A committee of 10-20 EMS experts, who
must all agree that the question is in line with the most current practice analysis study, creates all questions.
These EMS experts make sure that there is only one "best" or "correct" answer, and that "each incorrect
answer has some level of plausibility." Additionally, each question and answer must be easily found in
common text books used in teaching EMS classes.

• As of January 1, 2007 the NREMT has changed its exam formatting to a CBT (Computer Based Testing)
method. Exams will no longer be delivered via a paper test and completed with a pencil. All testing will be
performed at a computer workstation. PearsonVue testing centers all over the United States administer these

• The CBT that the NREMT is now utilizing is called CAT or (Computer Adaptive Testing) and each exam is
tailored specifically to the individual EMT candidate. This testing method is considered state of the art and
uses a theory called IRT (Item Response Theory). IRT is a statistical way to measure a person's ability based
on the fact that the probability of a person answering a question correctly is directly related to their ability and
the difficulty level of the question. Combining CAT with IRT should make NREMT exams more precise, fair,
and accurate. What does that mean? Basically each item (question) is given a weighted point value. This value
is based on the difficulty of the question. A harder question has a higher point value. An easier question has a
lower value.

• New CAT NREMT tests will deliver questions one at a time to the candidate and will NOT be randomly
chosen. They are rated along the same ability scale as the candidate is exhibiting proficiency. The first
questions on the exam are generally just below the passing standard. If a question is asked that is below the
candidate's level of ability, the probability is high for the candidate to answer the question correctly. If a
question asked is above a candidate's level of ability, they have a high probability of missing it. If the
candidate answers the question correctly then a slightly more difficult question will be delivered next. As the
difficulty of the questions increase, eventually the candidate will start to miss questions. The questions then
become slightly easier and the candidate will begin to answer correctly again. At this point in the exam the
application algorithm calculates an ability estimate for this candidate and begins delivering questions that are
slightly harder and slightly easier than the candidate's ability. As the CAT exam progresses, the ability
estimate gets more and more precise as the pattern of right to wrong answers stabilizes around the client's true
ability. The exam will end at the point when there is a 95% certainty that the candidate's true ability is above
or below the passing standard. It can also end if you run out of questions or time, however both of these
instances are rare.

• CAT and IRT match the question difficulty to the candidate's perceived level of ability, this limits the number
of questions delivered as well as increases accuracy.

• Exam fees can be paid online at the NREMT website, but you must first be registered and sign into your
account. You can pay by credit card, or with a payment voucher if your school provides one. You may also
mail in payment, however this will delay your ability to schedule your exam until the payment has cleared.

• If you do not pass the exam you may retake it after 14 days. This period is to provide you with time to study.

• NREMT test results are generally available within 1 to 2 business days on the NREMT website. Check your
exam results here

• You can find a NREMT test location on this page of



Advice on how to take and pass the NREMT exam and state EMT tests: Top of Page


This advice has been gleaned from dozens of sources. Information contained here has been compiled from interviews with EMTs and Paramedics who have taken and passed the tests multiple times. It has also been gathered from EMS related discussion forums and nationally recognized test-taking authorities.



What material to study for the NREMT exam: Top of Page


• Technically, you should know everything that was covered in the EMT course materials. There aren't any
secret methods or insights that can replace proper test preparation, but some things are common. The tests are
heavy in the basics. Know CPR and shock as well as all of the segment categories of the test itself i.e. Airway,
Ventilation and Oxygenation; Trauma; Cardiology; Medical; and Operations. Know the major components of
the airway and the normal ranges of respiration for adults and pediatric patients. Know diabetic emergencies
and the various causes of syncope. You will see about 15% of your questions related to pediatrics, and about
85% related to adults. These will be spread out through the 5 categories listed above.

• A large portion of the exam is related to operations and many students overlook this. Since September 11,
2001 a great effort has been made to incorporate more education about NIMS and ICS with regard to EMS.
Understand how these systems work and how they apply to a mass casualty and you will be a step ahead of
other candidates.

• The NREMT exam is NOT based upon the textbook you used in your class. The exam is based upon the
NREMT Practice Analysis done every five years. The exam questions are written to fall within the
Department of Transportation EMT Curriculum. EMT textbooks only give you their interpretation of those
standards. (NOTE: The new National EMS Education Standards are EMR (Emergency Medical Responder),
EMT, AEMT (Advanced EMT), and Paramedic.)

• Remember, although the NREMT exam looks for a minimum entry-level competency, nobody wants a "just
made it by the skin of their teeth" partner. Know your stuff. The more knowledge you have about EMS, the
shorter your test will be. If you are answering questions well above the competency line, your exam will end
closer to the minimum number of questions rather than the maximum number of questions.

• Obviously take advantage of the EMT and Paramedic Practice Tests here in this book and on the website.
There is detailed score tracking and exam review features that let you see your strong and weak areas while you continue to take exams and improve. Identify your strong and weak areas so you can study to improve all around. Use online information resources like Wikipedia to help broaden your subject knowledge and branch out from the knowledge of a single textbook.


Before taking the NREMT exam or state test: Top of Page


• Eat a well balanced diet and drink plenty of water the day before. Include B vitamin foods like bananas,
oatmeal, and raisins, and get plenty of rest. Reschedule if you are sick. Don't attempt the test if you aren't
feeling your best.

• Don't cram! If you don't know it the night before the test, you will most likely not know it for the test. Relax or
sleep instead of cramming.

• Don't consume a bunch of coffee or sugar before the exam it will only make your anxiety worse. Studies show
that consuming caffeine and/or sugar actually slows your brain down and results in lower grades on exams.

• Study regularly for a few weeks before you test. Use the resources from this website, and any other resources
you might have to study. Identify your weak areas and then focus your learning in those areas. If possible, you
should study for a couple of weeks after completing your EMS course, and then test. Don't wait a long time if
you have the ability to test sooner.

• Know exactly where the test center is and arrive early to eliminate the stress of being late. Remember, you
have to be signed up for the test. You cannot just walk in and take it. Bring your photo ID and a couple of
pencils. Scrap paper will be provided for you and it must be turned in with your exam.

• When you go to take the test dress in multiple layers so that you can shed what you do not need and still be
comfortable. Temperatures of testing centers can vary a great deal throughout the day especially if it is a rarely
used room or building. Being nervous will cause your vessels to constrict and you will feel colder than you
might normally feel. Shivering during a test is no fun!

• Go to the bathroom before the test. You are allowed to go during the exam, but take care of it sooner rather
than later. If you have to leave the testing room you will be required to take one form of ID with you while the
other stays within the testing center, and it will be verified each time you leave and enter.

• You must bring two forms of ID to the exam site, and at least one of them must have a photo ID.


During the NREMT exam or state test: Top of Page


• You CANNOT skip a question and come back to it later. The nature of the CAT exam requires that you
answer each question individually before any additional questions are delivered. The next question you get
delivered is based on how you answered the previous questions. This is why you must make a choice before
you can proceed.

• Look out for words like EXCEPT, ALWAYS, NEVER, MOST APPROPRIATE and other qualifiers.
Anything that puts limits on the potential answer should be a flag to slow down and read the question and all
answers very carefully.

• Read the whole question thoroughly at least a couple of times and formulate the answer in your head BEFORE
you look at the answer choices. If you look at the answer choices prior to understanding the question
completely, you can be lead to choose an incorrect answer. The test is timed, but by slowing down, you will
actually have a shorter test. Don't worry about the time, worry about making the correct choice.
Page 3 Copyright 2012 EMT-National-Training

• For each question there are 4 potential answers. All of the choices must have some plausibility to them. It is
possible that all 4 choices are correct, or that all 4 choices are wrong. You must choose the "most" correct
choice available, even if it is not what you would normally do first.

• Do not complicate the scenario or situation. Do not bring elements into the questions that are not there. This
will cause you to overlook the basics, which is probably what the question is testing for.

• Relax, and remember to breath adequately. Slow deep your breath by breathing in through your nose, and then
exhaling out through your mouth. Repeat. Do this as often as you find yourself hurrying, rushing, or getting

The NREMT's Newest Test Plan

The National Registry test plan changed on September 1, 2010. The new test plan now covers five topic areas:
Airway, Ventilation and Oxygenation; Trauma; Cardiology; Medical and Operations. This plan applies to all national EMS certification levels.

A total of 85% of the exam items cover adult patients and 15% cover pediatric patients. Former items that
covered OB are now part of the medical section of the exam. Examinations are not scored on the basis of topic
areas (sections). Passing an examination still requires successful demonstration of entry-level competency over
the entire domain of the test.

The changes in the test plan are the result of an NREMT research project that prioritized tasks all EMS providers
accomplish while providing care. The NREMT test plan is designed to cover the important tasks of the job. The
NREMT Board adopted this plan in November of 2009. Items in the test bank are the same items that were in
previous test banks. The emphasis is just different because the NREMT adjusted the emphasis of the test based upon EMS provider data.

Has between 80 and 110 questions. You have 1 hour and 45 minutes to complete the exam. Cost of the NREMT
EMR Exam is $65.00. The exam will cover the entire spectrum of EMS care including: Airway, Ventilation,
Oxygenation; Trauma; Cardiology; Medical; and EMS Operations. Items related to patient care are focused on
adult patients (85%) and pediatric patients (15%). In order to pass the exam, you must meet a standard level of competency. The passing standard is defined by the ability to provide safe and effective entry-level emergency
medical care.

Has between 70 and 120 questions. You have two hours to complete the test. Cost of the NREMT Exam is
$70.00. The exam will cover the entire spectrum of EMS care including: Airway, Ventilation, Oxygenation;
Trauma; Cardiology; Medical; and EMS Operations. Items related to patient care are focused on adult patients
(85%) and pediatric patients (15%). In order to pass the exam, you must meet a standard level of competency.
The passing standard is defined by the ability to provide safe and effective entry-level emergency medical care.

Is a Computer Based Test (CBT). There are 135 questions that each candidate must answer in 2 hours and 15 minutes. The exam will cover the entire spectrum of EMS care including: Airway, Respiration & Ventilation;
Cardiology & Resuscitation; Trauma; Medical & Obstetrics/Gynecology; and EMS Operations. Items related to patient care are focused on adult and geriatric patients (85%) and pediatric patients (15%). In order to pass the exam, you must meet a standard level of competency. The passing standard is defined by the ability to provide safe and effective entry-level advanced emergency medical care.

The NREMT Paramedic Exam
Has between 80 and 150 questions and you have 2 hours and 30 minutes to complete the exam. Cost of the
NREMT Paramedic Exam is $110.00. The exam will cover the entire spectrum of EMS care including: Airway,
Ventilation, Oxygenation; Trauma; Cardiology; Medical; and EMS Operations. Items related to patient care are
focused on adult patients (85%) and pediatric patients (15%). In order to pass the exam, you must meet a
standard level of competency. The passing standard is defined by the ability to provide safe and effective
entry-level emergency medical care.


How NREMT Exams and Questions are Constructed Top of Page


Most of the National exams given in the United States follow the formula below in developing questions. The NREMT is one of these tests. If you begin to understand what type of questions you are being asked it will allow you to begin to know how to apply the correct response. This is some deep reading, but has helped me a lot in my test taking. Read through the information then see if you can start to figure it out as you take practice tests. I’ll try to give a few examples at the end.

In 1956, Benjamin Bloom headed a group of educational psychologists who developed a classification of levels of intellectual behavior important in learning. Bloom found that over 95% of the test questions students encountered required them to think only at the lowest possible level...the recall of information.

Bloom identified six levels within the cognitive domain, from the simple recall or recognition of facts as the lowest level, through increasingly more complex and abstract mental levels, to the highest order which is classified as evaluation. Verb examples that represent intellectual activity on each level are listed here.

 1.       Knowledge: arrange, define, duplicate, label, list, memorize, name, order, recognize, relate, recall, repeat, reproduce, state.

2.       Comprehension: classify, describe, discuss, explain, express, identify, indicate, locate, recognize, report, restate, review, select, translate,

3.       Application: apply, choose, demonstrate, dramatize, employ, illustrate, interpret, operate, practice, schedule, sketch, solve, use, write.

4.       Analysis: analyze, appraise, calculate, categorize, compare, contrast, criticize, differentiate, discriminate, distinguish, examine, experiment, question, test.

5.       Synthesis: arrange, assemble, collect, compose, construct, create, design, develop, formulate, manage, organize, plan, prepare, propose, set up, write.

6.       Evaluation: appraise, argue, assess, attach, choose, compare, defend, estimate, judge, predict, rate, core, select, support, value, evaluate.

The chart below shows the increasing level of complexity of question construction.


The NREMT exam follows a similar formula in that it starts with the basic Knowledge then begins to increase the style of question to determine the candidate’s true grasp of a subject. This is why you will see similar questions during the test. Questions will be written in a slightly different way to see if you truly grasp the concept around it.

Questions given during your training are questions in the "knowledge" category 80% to 90% of the time. These questions are not bad, but using them all the time is. Instructors should try to utilize higher order level of questions. These questions require much more "brain power" and a more extensive and elaborate answer. Below are the six question categories as defined by Bloom. After each one is an example of how the question would be worded (started) so that you can begin to decipher at what level this question is being formed.


  • Remembering;
  • Memorizing;
  • Recognizing;
  • Recalling identification and
  • Recall of information
    • Who, what, when, where, how ...?
    • Describe


  • Interpreting;
  • Translating from one medium to another;
  • Describing in one's own words;
  • Organization and selection of facts and ideas
    • Retell...


  • Problem solving;
  • Applying information to produce some result;
  • Use of facts, rules, and principles
    • How example of...?
    • How is...related to...?
    • Why is...significant?        


  • Subdividing something to show how it is put together;
  • Finding the underlying structure of a communication;
  • Identifying motives;
  • Separation of a whole into component parts
    • What are the parts or features of...?
    • Classify...according to...
    • Outline/diagram...
    • How with...?
    • What evidence can you list for...?


  • Creating a unique, original product that may be in verbal form or may be a physical object;
  • Combination of ideas to form a new whole
    • What would you predict/infer from...?
    • What ideas can you add to...?
    • How would you create/design a new...?
    • What might happen if you combined...?
    • What solutions would you suggest for...?


  • Making value decisions about issues;
  • Resolving controversies or differences of opinion;
  • Development of opinions, judgments, or decisions
    • Do you agree...?
    • What do you think about...?
    • What is the most important...?
    • Place the following in order of priority...
    • How would you decide about...?
    • What criteria would you use to assess...?

This is the nuts and bolts of how an NREMT exam is built. Below is an example of how an NREMT question is constructed.  This will give you some insight into the thinking behind each question.

Steps to Question Writing

A well-designed multiple-choice item consists of three main components: a stem (asks a question or poses a statement which requires completion), key (the correct answer/s), and distracter(s) (incorrect option/s). The following section is designed to enhance the candidate’s understanding of the NREMT question writing process.

Step 1. Select an area of the test plan for the focus of the item

* Patient Assessment

Step 2. Select a subcategory from the chosen area of the test plan

* Multiple patient incidents

Step 3. Select an important concept within that subcategory

* Assess and triage among a group of patients to prioritize the order of care delivery

Step 4. Use the concept selected and write the stem

* The EMT arrives on scene of a vehicle accident.

Which is the most critical patient that should be transported first?

Step 5. Write a key to represent important information the entry-level EMT should know

* Altered Level of Consciousness

~ A patient who doesn’t remember the accident or what the day is.

Step 6. Identify common errors, misconceptions, or irrelevant information

* Distracting injuries

* Smell of alcohol

*  Lack of understanding of expected findings related to a specific clinical finding

Step 7. Use the previous information and write the distracters

~ A patient who has a large bleeding gash to the right arm

~ A patient who smells of alcohol and is having trouble walking

~ A patient with moderate Alzheimer’s disease (AD) who is asking to talk with the spouse who died several years ago

Step 8. Complete the item using the stem, key, and distracters

The EMT arrives on scene of a multiple vehicle accident. After assuring scene safety and assessing the patients, whom should the EMT transport first?

1. The patient who doesn’t remember the accident or what day it is. (Key)

2. The patient with a large bleeding gash to the right arm.

3. The patient who smells like alcohol and is having trouble walking straight.

4.  The patient, whose family states, has moderate Alzheimer’s disease and is asking to talk to a spouse who died several years ago.

In this example you can see that the question is asked at the Evaluation level of Bloom’s Taxonomy. That is the highest form of question. It requires you to know information about each answer option, and then weigh each against the other to determine an order of care.

In this sample question you can see that a patient with an altered level of consciousness would be the most critical given the information you have. A large bleeding gash is a distracting injury, easily treated with bandaging, and not requiring the most immediate transport. A patient who smells like alcohol and is possibly intoxicated does not in itself warrant immediate transport. This would probably be the second most critical due to mechanism and not being able to determine LOC as easily as others. The patient who is asking to speak to a dead spouse has a disease that would make this type of response normal. This is the type of question that the NREMT likes to give. It requires you to really think about each option and only use the information presented in the question and answers. would encourage every person to read all the available information on the NREMT website. They detail for you how their tests are constructed and administered. Knowing this information helps you be better prepared and more sure in your ability to test.



NREMT Practical Exams: Top of Page


The practical portion of the NREMT exam is not often given the attention that it deserves during EMT courses. Many times the instructor will only go over a practical skill once or twice in class. This does not provide the EMT student with adequate repetition to learn the skill well enough to pass an exam. Additionally some of the newest and most used text books still have the old NREMT skill sheets in them! Skills like Cardiac Arrest Management/AED have changed significantly and if you go into the exam and perform the skill according to old protocols you will fail the exam.

Here are links to the 15 potential EMT-B practical skill sheets and the 12 potential EMT-Paramedic practical skill sheets that you could be asked to perform. THESE ARE DIRECTLY FROM THE NREMT NOT AN OUTDATED BOOK.


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The NREMT Exam is written from the resources below.

National Emergency Medical Services Education Standards (NEMS ES)
Download EMR, EMT, AEMT, Paramedic

Current NREMT Skill Sheets: Download EMR, EMT, EMTI85, AEMT, Paramedic

AHA 2005 to 2010 Change Comparison Chart: Download AHA Changes 2005-2010



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