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NREMT STUDY GUIDE 2026
1. Where does gas exchange of oxygen and carbon dioxide occur?
a. larynx
b. bronchioles
c. alveoli
d. main stem bronchi: Alveoli
The alveoli are where the lungs and the blood exchange oxygen and carbon dioxide during the process of breathing in and breathing out. Oxygen breathed in from the air passes through the alveoli and into the blood and travels to the tissues throughout the body.
2. What is the primary role of the epiglottis?
a. bringing oxygen into circulation
b. aids in food digestion
c. assist air flow to the larynx
d. prevent aspiration while eating: Prevent aspiration while eating
The main job of the epiglottis is to close over the trachea while you're eating to prevent food entering your airway.
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3. What is the PRIMARY role of the mediastinum?
a. Protects vital structures of the chest
b. Protects your diaphragm from collapse
c. Protects your lungs from collapse
d. Surrounds the heart's four chambers: protects vital structures of the chest
The mediastinum protects many vital structures including the heart, large vessels, the trachea, and critical nerves.
4. You respond to a 8 year old male who states he is having trouble breathing. His respiratory
rate is 44 breaths/min and you notice accessory muscle use on exam. You can hear an audible wheeze present. What should your initial step be?
a. Start BVM ventilations
b. Attempt a head tilt-chin lift
c. Obtain his oxygen saturation
d. Gather a SAMPLE history: Obtain his oxygen saturation
This patient is able to speak so the airway is patent, we don't have any oxygen data so we need that before we can go ahead with oxygen administration. This will give the final piece of info to start assessing his current status.
5. You are called to the home of a 4 year old female patient. The patient has a persistent
4 / 253 e. use blow-by oxygen
7. You are about to place an airway adjunct into your patient. Which situation would you NOT
place a nasopharyngeal airway?
a. A semiconscious child who just had a seizure
b. A patient with ecchymosis behind one ear
c. An unconscious patient with an intact gag reflex
d. An semiconscious adult who cannot maintain their own airway: a patient with ecchymosis behind one
ear Bruising behind one ear is known as the "Battle sign" and an indication of a basilar skull fracture, which is a severe head injury. Use of a nasopharyngeal airway with severe head injuries is contraindicated.
8. You are transporting a 53 year-old male who complains of shortness of breath, dizziness,
numbness in his hands, and a dry mouth. His vital signs are: blood pressure 118/80 mmHg, HR 120, RR of 32, SpO2 99%, and ETCO2 of 26 mmHg. What do you suspect?
a. Hypokalemia
b. Hypoventilation syndrome
c. Pneumothorax
d. Hyperventilation syndrome: Hyperventilation syndrome
5 / 253 This patient is hyperventilating as demonstrated by his increased respiratory rate and low end-tidal reading levels. A high respiratory rate increases the amount of carbon dioxide exhaled, accounting for the low end-tidal reading. His heart rate is also a little elevated, possibly due to anxiety.
9. A 78 year old female is found lying on her bathroom floor unconscious. Her caregiver
reports finding her like this upon arrival and is unsure what happened. You hear gurgling sounds on inspiration. What is the next best step?
a. Suction her airway
b. Begin ventilations with a bag-valve mask
c. Insert an oropharyngeal airway
d. Provide nasal cannula at 2 L/min: suction her airway
The gurgling sounds on inspiration suggest her airway needs to be cleared. You want to make sure you suction and clear her airway before proceeding with treatment.
10. You assess a 23 year-old male who was struck in the right chest wall with an airbag after
a motor vehicle accident. The patient complains of pain on in- spiration and shortness of breath. You gather the following from your physical assessment: unequal chest wall rise and absent lungs sounds on the right side. What do you suspect?
a. Flail chest
b. Cardiac tamponade
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d. Titrate oxygen flow rate on nasal cannula to 6L/min: Provide oxygen by non-rebreather mask
The non-rebreather mask is correct as a higher concentration of oxygen can be administered than via the nasal cannula, especially since the patient has stated his symptoms are getting worse.
13. A 21 year-old male was shot in the left chest, below the clavicle. Where should you
place the stethoscope to best hear his lung sounds?
a. Anterior chest, below xiphoid process
b. Anterior chest, above suprasternal notch
c. Posterior, above occiput
d. Posterior, below the scapula: Posterior, below the scapula
Below our scapula is a large area of the lungs to auscultate breath sounds.
14. A 10 year-old boy complains of sore throat and pain when swallowing. He presents in
the tripod position and has a fever of 101 degrees F. His parents state he went to bed fine and woke up suddenly with symptoms. You suspect:
a. Croup
b. Epiglottitis
c. Bacterial Tracheitis
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d. Bronchiolitis: Epiglottitis
The patient presents with the hallmark symptoms of epiglottitis, sudden sore throat and pain when swallowing. It is also common for children to wake up the next day suddenly with these symptoms. He is also demonstrating signs of respiratory distress as he presents in the tripod position.
15. You arrive on scene to a patient with a history of COPD having an exacerba- tion. He
requires rapid transport to the emergency department. What is the best position for the patient to be transported on the stretcher?
a. Trendelenburg position
b. Supine position
c. Prone position
d. Fowler's position: Fowler's position
This position is where the head of the stretcher is elevated 45-60 degrees, so the patient is sitting upright. This position is typically the most comfortable for patients with diflculty breathing.
16. You and your partner arrive on scene to a 7 year-old male who has tripped and fell
into a pool, hitting his head. You find he has no respirations and no pulse. What is the next best step in the management of this patient?
a. Provide manual stabilization of cervical spine and gather additional rescuers to perform 2-
rescuer CPR at a 15:2 ratio.
b. Apply cervical collar and deliver 2-rescuer CPR at 30:2 ratio.
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c. Bluish discoloration of the skin
d. Yellow tinge of the skin: Bluish discoloration of the skin.
This is known as cyanosis, which is due to poor oxygenation and/or circulation of the blood. It is commonly first seen around the lips and nail beds of a patient.
19. A 72 year old male presents with sudden onset shortness of breath. He has a previous
history of a heart attack 6 months ago. His vital signs are as follows: BP 100/82, HR 98, RR of 22, and SpO2 86% on room air. On auscultation of lung sounds you hear rales bilaterally. What is the next best step?
a. Initiate CPR
b. Administer ventilations with bag-valve mask at 12-20 breaths/min
c. Rapid transport in Trendelenburg position
d. Administer supplemental oxygen to increase SpO2 to 94% or higher: Administer supplemental oxygen to
increase SpO2 to 94% or higher This patient requires supplemental oxygen as his oxygen saturation level is low. He does not require ventilations via BVM at this time and transport via Trendelenburg position would increase his breathing diflculty. CPR is not needed as this patient has a pulse and is breathing.
20. What is the most common cause of an airway blockage?
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a. Food obstruction
b. The tongue
c. Vomit
d. Throat swelling: The tongue
When a patient becomes unconscious, their throat muscles relax which can cause the tongue to fall back and block the airway.
21. What is the physical process of moving air into and out of the lungs?
a. Inspiration
b. Oxygenation
c. Ventilation
d. Diffusion: Ventilation
The process of ventilation is the physical act of moving air into and out of the lungs.
22. A 38 year-old female presents restless on her couch with shortness of breath and
accessory muscle use. From your assessment you find an open and clear airway. What is the next best step?
a. Assess skin color and mental status
b. Obtain oxygen saturation
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b. 78 year-old male with a history of previous myocardial infarction
c. 6-month old infant
d. 31 year-old female who is 8 months pregnant
e. 17 year-old male with history of asthma: a. 48 year-old male weighing 375 pounds
Chest thrusts are indicated in obese patients as it may be diflcult to get your arms properly around patient's abdomen c. 6-month old infant Chest thrusts are indicated in any child under 1 year old d. 31 year-old female who is 8 months pregnant Chest thrusts are indicated in pregnant patients as it may be diflcult to get your arms properly around the patient's abdomen
25. You arrive on scene to a 12 year-old boy in respiratory distress. His mother states she is
trying to get him to use his inhaler but he is "not there". You see the child sitting in the tripod position, and he stares ahead of you with a disoriented look. He is taking very shallow breaths. You suspect:
a. Respiratory Acidosis
b. Respiratory Alkalosis
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c. Metabolic Acidosis
d. Metabolic Alkalosis: Respiratory Acidosis
26. A 82 year old male with a history of smoking presents on scene unable to speak and
taking shallow breaths. He is unable to lift his head upright. His vital signs are as follows: BP 102/76, HR 100, RR 28 and shallow, SpO2 74% on oxygen by nasal cannula at 3L/min. What is the next best step?
a. Titrate home oxygen to 6L/min by nasal cannula
b. Administer oxygen with non-rebreather mask
c. Intubate with ET tube
d. Begin ventilations with bag-valve mask: Begin ventilations with bag-valve mask
This patient is entering respiratory failure and requires ventilatory assistance to breath. His respiratory rate is high, his oxygen saturation is low, he cannot speak and has labored breathing. Providing higher concentration oxygen will not work as his ventilations is the underlying problem in this situation.
27. What are Cheyne-Stokes respirations?
a. Rapid, deep breaths commonly seen in patients with severe metabolic aci- dosis
b. Periods of rapid and slow breathing followed by periods of apnea, commonly seen in patients
with head injuries
16 / 253 started getting more tired as practice went on. His chest wall expansion is normal and he does not complain of chest pain. Upon auscultation you heard diminished breath sounds in the upper left chest. His vital signs are as follows: BP 118/78, HR of 112 beats, RR of 16, and SpO2 90% on room air. What condition do you suspect?
a. Pulmonary embolism
b. Spontaneous pneumothorax
c. Tension pneumothorax
d. Pleuritis: Spontaneous pneumothorax
Spontaneous pneumothorax is common in young, thin, tall males who exercise. The diminished breath sounds on one side of the lungs is another clue of this condition.
30. Which structure is considered the divide between the upper and lower res- piratory
tracts?
a. Trachea
b. Bronchi
c. Epiglottis
d. Larynx: Larynx
This is the point where the upper respiratory tracts separate into the lower respiratory tract. The ditterence is the upper respiratory tracts carries both
17 / 253 food/fluid and air, whereas the lower respiratory tract just carries air.
31. You placed a non-rebreather mask on a patient in respiratory distress, how- ever, the
reservoir bag collapsed when the patient inhaled. You should...
a. Tell the patient to exhale harder
b. Coach the patient on how to inhale deeper
c. Switch to a nasal cannula on 6L/min
d. Increase oxygen flow rate so reservoir bag remains at least 2/3 full when patient breathes in: Increase
oxygen flow rate so reservoir bag remains at least 2/3 full when patient breathes in The non-rebreather mask should also be inflated, even when the patient inhales. If it is not at least 2/3 full, adjust oxygen flow rate.
32. A 48 year-old male reports sudden onset shortness of breath. He complains of left-sided
chest pain as well. He states it might be pneumonia as he just flew home from Australia yesterday and thinks he got something there. His vital signs are as follows: BP 104/82, HR 114, RR of 20, SpO2 82% room air. What do you suspect?
a. Pneumonia
b. Myocardial infarction
c. Pulmonary embolism
d. Asthma attack: Pulmonary embolism
19 / 253 The next best step would be to reposition the head to make sure the tongue is not blocking the airway and try again with the BVM. If there is still no chest rise or fall, then placing an NPA or OPA would be the next step.
35. You arrive on scene to a 29 year-old female having an asthma attack. You determine
she requires ventilatory assistance. At the EMT level, how can you promote bronchodilation with ventilations?
a. Ventilate patient in Fowler's position on stretcher
b. Administer ventilations with bag valve mask and albuterol with a nebulizer device
c. Administer patient's inhaler after 20 breaths from the bag-valve mask
d. Administer oral Benadryl then provide BVM ventilations: Administer ventilations with bag valve mask and
albuterol with a nebulizer device An EMT can administer albuterol through a nebulizer mask to help with bronchodilation.
36. What chemical does the body produce to prevent atelectasis?
a. Carbon dioxide
b. Cerebrospinal fluid
c. Oxytocin
d. Surfactant: Surfactant
20 / 253 Surfactant are chemical compounds produced in the lungs to decrease surface tension in the alveoli to prevent collapse of the alveoli at expiration.
37. What is the average tidal volume in an adult?
a. 200 mL
b. 500 mL
c. 1500 mL
d. 6000 mL: 500 mL
The average tidal volume in an adult is 500 mL.
38. A 65 year-old patient presents in respiratory distress. You find he also has a stoma
partially occluded by secretions. To administer oxygen, which of the following actions should you perform?
a. Suction secretions in stoma then ventilate stoma with a pediatric bag-valve mask
b. Do NOT suction the stoma. Ventilate the stoma with a pediatric bag-valve mask
c. Contact medical control for further assistance
d. Do NOT suction the stoma. Ventilate patient's nose/mouth with bag-valve mask.: Suction secretions in
stoma then ventilate stoma with a pediatric bag-valve mask Suction the secretions in the stoma to clear it. Then ventilate stoma with a pediatric BVM. If this does not work, try ventilating the patient's
