Paramedic NRP Exam Prep practice questions and answers 2026. Tap an option to test yourself — you'll see the correct answer and a plain-English explanation for every question. Free, no login.
Q21You are treating an elderly patient who suddenly complains of shortness of breath and is becoming increasingly anxious. Upon examination, you notice a significant swelling under the skin around the neck and upper chest area that crackles when palpated. What is this abnormal finding?
✓ Correct answer: B. Subcutaneous emphysema
Answer: Subcutaneous emphysema. Subcutaneous emphysema happens when air escapes from the lungs or airways into the subcutaneous tissues, often due to a trauma or underlying lung pathology. When palpated, it feels like pockets of air under the skin that produce a crackling sensation. Cellulitis is a bacterial skin infection that causes redness, swelling, and warmth, but does not produce a crackling sensation. Lymphadenopathy refers to swollen or enlarged lymph nodes, and thoracic outlet syndrome involves compression of nerves or blood vessels near the neck, neither of which mimic subcutaneous emphysema.
Q22A patient presents with rapid breathing, a whistling sound heard during exhalation, and visible use of accessory muscles for breathing. Which of the following conditions is most likely occurring?
✓ Correct answer: A. Asthma
Answer: Asthma Asthma is characterized by episodes of widespread but variable airflow obstruction, which is often reversible either spontaneously or with treatment. The classic signs and symptoms include rapid breathing (tachypnea), wheezing (a whistling sound during exhalation), and visible use of accessory muscles for breathing. These indicators strongly point towards an asthma attack. Pneumothorax, pulmonary embolism, and heart failure may present with some breathing difficulties but they do not typically include wheezing or the visible use of accessory muscles.
Q23You are preparing to intubate an adult patient who is 45 years old and weighs 70 kg. Which of the following endotracheal tube sizes would be most appropriate for this patient?
✓ Correct answer: A. An 8.0 mm ET tube with a balloon cuff
Answer: An 8.0 mm ET tube with a balloon cuff. When choosing an appropriately sized ET tube for an adult, the general rule is to use a tube of approximately the same size for males and females based on approximate weight ranges. In this case, an 8.0 mm tube would be most appropriate. It is important to use an ET tube with a balloon cuff to seal the airway adequately. ET tubes that are too small or without a cuff may not provide effective ventilation and can lead to complications.
Q24Identify the respiratory pattern that is characterized by progressively deeper and faster breathing, followed by a gradual decrease leading to a temporary stop in breathing (apnea), often observed in patients with heart failure or brain injury.
✓ Correct answer: B. Cheyne-Stokes respiratory pattern
Answer: Cheyne-Stokes respiratory pattern Cheyne-Stokes respiration is characterized by a cycle of progressively deeper and faster breathing, followed by a gradual decrease resulting in a period of apnea. This pattern is often observed in patients with heart failure or brain injuries. Kussmaul's respirations are regular, rapid, and deep, typically associated with metabolic acidosis conditions such as Diabetic Ketoacidosis (DKA). Ataxic respiratory pattern involves completely irregular breathing with random periods of apnea, commonly seen in brainstem injury. Biot's respirations are irregular with varying depth and periods of apnea, lacking repetitiveness and often irregular.
Q25A 60-year-old patient presents with sudden-onset shortness of breath and chest pain after a long international flight. He has a history of chronic venous insufficiency. Based on these symptoms and history, which of the following conditions should you suspect until proven otherwise?
✓ Correct answer: A. Pulmonary embolus
Answer: Pulmonary embolus A pulmonary embolus (PE) occurs when a blood clot, usually from the deep veins of the legs, travels to the lungs and obstructs a pulmonary artery. This condition is particularly common in individuals with a history of venous disease or in those who have been immobilized for long periods, such as during a long flight. Symptoms of a PE can include sudden-onset shortness of breath, chest pain, and in some cases, diaphoresis (sweating). An air embolus typically results from medical procedures that introduce air into the venous system, such as improper IV insertion. A pneumothorax involves air in the pleural space causing lung collapse, which would present with different clinical signs like unilateral chest movement and absent breath sounds on the affected side. A myocardial infarction, or heart attack, usually presents with chest pain but does not typically cause sudden-onset shortness of breath and chest pain together in the same context as a PE.
Q26Which of the following injuries fall under the classification of a Zone III neck injury? Select the 3 answer options which are correct.
✓ Correct answer: D. Internal jugular veins
Zone III of the neck is the area between the angle of the mandible and the base of the skull. The following structures are located here: Internal jugular veins Vertebral arteries Spinal cord The aortic arch is found in Zone I of the neck. The Trachea and Esophagus are found in Zone II of the neck.
Q27Which of the following would most likely be present in a trauma patient with blood loss in a Class III hemorrhage? Select the three answer options which are correct.
✓ Correct answer: A. Rapid breathing
A trauma patient with blood loss in a Class III hemorrhage will present as seriously ill with: • A rapid, thready pulse (> 120) • Hypotension • Delayed cap refill • Tachypnea (> 28) • Cold, pale, moist skin • Confusion/anxiousness The pulse will not be bounding in this stage of hemorrhage due to hypotension and blood loss.
Q28Your patient has sustained a pelvic fracture from a high-impact car accident. The injury site shows signs of significant bruising and swelling, but there is no external bleeding. How much blood could be lost internally, if a closed pelvic fracture is present?
✓ Correct answer: D. 1,500-2,000 mL
Answer: 1,500-2,000 mL. It is possible for a patient suffering from a closed pelvic fracture to lose as much as 1,500-2,000 mL of blood in the compartments around the bone. This amount of blood loss is significant enough to cause hypovolemic shock in patients. A closed tib/fib fracture usually results in a blood loss of approximately 250-500 mL, while a closed femur fracture could cause a blood loss of around 1,000-1,500 mL. A hemorrhage of over 2,500 mL would likely cause severe hypovolemic shock and could only occur in extreme cases of abdominal or chest injuries with major hemorrhage.
Q29You arrive first at the scene of a multi-vehicle collision on a highway. There are several vehicles involved, and you see multiple people with apparent injuries. What should your first course of action be?
✓ Correct answer: A. Establish command and request additional resources, such as fire rescue and additional ambulances.
Correct answer: Establish command and request additional resources, such as fire rescue and additional ambulances. When arriving at the scene of a major incident, it is essential to quickly assess the situation (scene size-up) to determine what additional resources will be needed. Establishing command helps ensure a coordinated response. It's critical to request necessary resources to manage the scene effectively. Starting immediate patient care without assessing the scene and requesting additional resources could compromise safety and lead to mismanagement of the incident. There is also no guarantee that the necessary resources will be dispatched without explicit communication. Contacting medical control or notifying the trauma center are important steps but should occur after ensuring adequate resources are en route.
Q30While decontaminating your ambulance after transporting a patient with a suspected infectious disease, which of the following contaminated items should not be placed in a plastic biohazard bag?
✓ Correct answer: B. Used scalpel blade
Answer: Used scalpel blade Used scalpel blades are sharp and pose a puncture hazard. They should be placed in a puncture-proof sharps container, not a plastic biohazard bag. Items like contaminated gloves, used surgical masks, and blood-soaked bandages can be safely placed in plastic biohazard bags as they generally do not pose a puncture risk.
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