How can you prepare for the NREMT cognitive and practical exam?


In order to become a nationally certified EMT, as registered by the NREMT, you need to pass both their written and the practical exam.

This article is not meant to be negative and to cause you apprehension before taking the exam, it is designed to help give you an idea of what to expect.   This article alone will not adequately prepare you for anything, it is just some helpful advice written by someone who prepared for, took the exam and passed it.

The Practical Exam

When you first start the class, it might seem like there are a lot of skills to learn.  The practical stations are a series of simple steps.  You need to memorize them and understand the order.  Get a copy of the skill sheets you and memorize them.  While medical and trauma assessments require some critical thinking, the rest of the stations are pretty much acting out a series of steps.  For the assessments, you need a wide body of knowledge on life threats, how to address them and the treatments you are able to provide.

Make sure that you know your stations in and out.  From the very beginning of class, focus on memorizing those sheets.  Take advantage of all of the time you have in class to practice.  If you are still messing up a station, go in and practice it more.  After you repeat doing something enough times, it should become part of your “muscle memory” where you don’t even have to think about it to perform the required actions.

The stations you need to pass may vary by state.  In Wisconsin, the stations are as follows:

Medical Assessment
Trauma Assessment
Advanced Airway
Spinal Immobilization Seated/Supine

Using a study guide can help you prepare by having a nice sheet summarizing all of the steps that you can easily carry with you.

The Cognitive Exam

The order in which you learn to do the steps for the practical exam can also be important with respect to the cognitive exam.  Know your primary and secondary assessments.  Does a step fall into the secondary?  Then don’t do it while there are still life threats to be addressed.  When you are given a bunch of information about a patient, there are probably a lot of things you might consider doing.  What do you do first?  Is giving oxygen important? Probably.  If there is a choice to check the airway, you probably want to check the airway before beginning oxygen delivery.  The order of the practical exam stations is one of the most important aspects of providing proper basic life support (BLS).

This is not an easy test.  It is unlike most other tests in that each person taking it gets a different experience.  Many people that take and pass the test walk out feeling very unsure.

They say that the test is based on making sure you understand important topics up to a certain confidence interval.  There are supposedly different levels of questions ranging from easy to hard.  There is some level of knowledge that you are required to have relating to each particular topic or area.  If you miss really hard questions, that might be ok, it could just follow up with easier questions.  If you miss easy questions, you might be ok as well by getting some harder ones.  The hard questions could have just been a test of a new question, or just there to make you feel terrible.  Who knows?

You should probably read the current instructions on the NREMT site in their entirety before you look into this further.  There should not be any confusion with regards to the instructions and testing policies.

In our experience in testing for certification, and re-testing for renewal, it seems like the questions from Study Tools by FISDAP are the close to the questions you will see on the actual exam.  Their EMT Study Tools package lets you take practice quizzes and tests.  When you take their actual test, it breaks it down into each area.  They have some stats that show people who do above a certain percent in each category of their questions have something like a 95% pass rate on the actual NREMT exam.  They might be worth checking out for your preparation before taking the NREMT exam.

Upon accepting the agreement to take the test, you are specifically prohibited from disclosing the questions you had, so you will not find any questions here.  In fact it would be hard to list questions as they were not simple knowledge questions.  Upon answering them, it is hard to know which answers were correct.  The only questions that stick out in our heads are the ones that we definitely answered wrong and kept us up the night after taking the test while waiting for the pass/fail.

According to many people who comment about the test on different web sites, it is quite common to walk out feeling awful about it and then find out you passed.

Be ready for the test to end abruptly and with no warning. There are discussions on the internet about how many questions a person ends with.  You can end at 70 or end at 120, or anywhere in between.  You could fail at 70 or pass at 120.  It all depends on when the test decides it is confident that you understand the necessary topics.  There are discussions spread around the internet on all sorts of forums that feature people commenting about their experience taking the test.  There is even a hundred something page discussion out there of people saying what question they ended on and if they passed or not.  From what most people say, ending at 70 is a good thing unless you completely fail it.

It is possible to have 120 questions and have gotten them all correct, they sometimes do that as a control group.  They will ask questions that have no effect on your pass/fail, just to see what portion of the people taking the test would get them correct.  It is not expected for you to know why you are getting particular questions.  There is definitely some crazy science that goes on behind the scenes to make this test adaptive.  While you are taking it, you are providing them with data to use in creation of their future tests.

How to Study
Don’t just think you can blow off class and then study the week or two before the NREMT exam.  This is not the kind of test you can cram for.  It isn’t about memorizing tons of stuff, it is about critical thinking.  You need to learn the material and be able to apply it.

Read your entire book during the course of class.  If you have access to additional online resources, like interactive lectures or audio books, use them.  People learn in different ways, some people do not learn just from listening to content.  Even if you do not learn from hearing alone, will listening to the chapter hurt you?  Doubtful.  Take advantage of all tests and quizzes provided with your book, online sites and in your class.  

There is a set of basic knowledge that everyone should know.  Looking at study sheets like the AABCD or PSG from EMS Alpha might help you.  In fact, if someone were to start studying those before they even start taking their class they would be way ahead of everyone else.  Many people do not have them fully memorized even after taking the class.  They really are excellent tools for studying.

There are a lot of services and apps, both paid and unpaid, which offer you test questions.  JB Navigate Test Prep has lots of great questions to test you on your knowledge.  Getting a 100% percent on an exam at JB test prep is great, but you will not pass the NREMT exam if all you can do is recite information or memorize questions.

Types of Questions
Some questions might be simple knowledge that you can recite or think through.  Those are the “easy” type questions.  You need to have that basic level of knowledge, and then be able to apply it.

Know your vitals.  If some vital is out of whack, think about what causes it.  Know about heat, cold, diabetes and dehydration and how various conditions would affect your vitals.  You might be given a set of patient vitals, and nothing more, and be asked to choose between 4 conditions.  How do you know which condition or issue the patient is experiencing?  You don’t, but there might be something in those vitals which indicates something important is going on.

You need to have some level of understanding of all of the topic areas from your class and book as you never know what you will be questioned on.

The questions do not seem designed to trick you, just to cause you to extrapolate.  Critical thinking skills seem to be the desired skill.  That can not be stated enough.  You might not know the answer, just use what you know to try to figure out the correct choice.

General Tips
Try to get enough sleep before the exam.  Don’t do a bunch of studying the morning before you take it.  Walk in there with a clear mind.  Use breathing exercises, meditate, whatever works for you.

This author did a 599 question JB Test prep exam the day before the test.  It took 4 hours.  After taking a break for a few hours, doing a 120 question exam resulted in only missing two.  Memorizing questions might be great for class tests, but will not help you on the NREMT exam.  You do need the general knowledge from the book, just don’t expect that alone to get you through this.

Bring proper identification.  They will not accept your fishing license as a second form of identification.  Make sure to read the instructions you are given with respect to the Pearson VUE testing center and what they require you to do.

Stick to your order.  Whether primary, secondary, on scene, ..... BLS is important.  If you could only read one last thing before taking the NREMT exam, read the BLS manual and make sure you know the order.  Airway, breathing, circulation.  It is all about the ABC’s.  BLS is the foundation of prehospital care.

Don’t pay attention to the clock.  Even if you end up having to do all 120 questions you will have 1 minute per question.  Take your time and read each question.  Don’t fly through the test.  Read each question and read each response carefully.  Sometimes they all seem correct, sometimes they all seem incorrect.  Choose which one is best based on what you know.  You should think about your answer, because once you confirm it there is no going back.  You only see one question at a time, so only focus on your current question, not the time, not the question number.

Getting Your Results
You need to log in to the NREMT site and “Check the status of your initial entry application”.  It may take a couple business days before your results are available.  The results could also be in by the time you get home.  Don’t take the test late on a Friday unless you want to worry all weekend.  Log in a couple times a day until you see your results.

Supposedly, if you take the test over, you will not see any of the same questions.  If you feel like you were being asked a lot of questions over and over about the same topic, you might want to look into that topic and figure out why.  Some places say that if you do not pass you are provided with a breakdown of the general categories of the test and which sections to work on.  If you have that data, you should make sure to focus on those areas.

Know that many people fail and end up passing on a later date.  The NREMT cognitive exam is not designed to be an easy test.  Do not let a failure shatter your confidence.


The NREMT exam is definitely unique in the fact that it is adaptive and requires you to think outside of the knowledge you have memorized.  Simple information recall will not be enough to pass.

Be ready to think critically and answer some questions you have never seen before.  Be ready to take some educated guesses.

Try to relax and go in confident.  If you have worked hard to get to this point you should be able to go in feeling good about yourself and the exam.  Good luck.

About the author

Bob Lindquist is an expert consultant with extensive experience building web sites, databases and performing internet marketing work for his clients.  He has over 20 years of experience working with clients from a wide variety of industries along with a degree in Computer Science.  Bob is a professional member of the Association for Computing Machinery.

In his free time, Bob is a volunteer Firefighter / EMT and has served on the boards of several not-for-profit groups.

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