The NREMT cognitive exam is a source of true anxiety for many EMT candidates, but it doesn’t have to be. Perhaps the first thing that you need to understand about the exam is that it is absolutely not designed to mess with your head. If anything, the Computer Adaptive Test is designed to offer each candidate a level playing field and test ability—not necessarily rote memorization.
It is fair to say, however, that the successful NREMT candidate not only has a handle on the material but also on how to approach the test questions. That is to say, you could have your EMT book completely memorized and still find the exam very challenging if you don’t know how to take the test.
- Please note: If you’re serious about passing the NREMT exam, you can find online EMT and Paramedic practice tests that will try to help you pass the examination on your first attempt. Just visit EMT-National-Training today for more information.
Why Does the Exam Feel So Difficult?
The NREMT exam is not exactly astrophysics. In fact, the test is written – as are most EMT textbooks – at about an eighth-grade reading level. What stands between EMT candidates and a successful NREMT exam is often a simple problem: the candidate is trying to be smarter than the test (and is failing miserably).
Here’s what I mean:
Your patient is a 60-year-old male who is unresponsive to painful stimuli. There is no sign of injury. He is lying supine with his head on a pillow and is making snoring respirations. What should you do first?
- Open his airway using a head-tilt chin-lift.
- Administer oxygen via non-rebreather mask at 12 lpm.
- Remove the pillow.
- Insert an oropharyngeal airway.
In this case, many EMT candidates would be tempted to choose either answer A or D, as they recognize that there is a need to open the airway in order to resolve the snoring respirations. However, what these candidates are missing is the fact that the question has offered a clue and a better answer.
The question itself offers what looks a lot like irrelevant information: the patient’s head is on a pillow. But it has also given the information that the patient’s airway needs to be opened.
All of the given answers could be correct, in theory. Similarly, all of them will probably be done for the patient in one variation or another at some point during their care. But that is not what the question is asking. What it is asking is: what should be done first?
- Are you going to administer oxygen to this patient? Probably, but not first.
- Are you going to insert an oropharyngeal airway? Probably, but you’re going to have to open that airway before you do that.
- Are you going to open the airway using a head-tilt chin-lift? Yes, of course you are. But…
- How are you going to open the airway using a head-tilt chin-lift without taking the pillow out from behind the patient’s head?
- The answer is C. You are going to do all of the rest of the answers at some point. But the step you have to take first is removing the pillow so that you can open the airway, insert an oral airway, administer oxygen, etc.
My point about trying to be smarter than the test is that many EMT candidates fail to read the test questions for exactly what they are. In some cases, students read too much into questions and get bogged down in details that simply are not there. In other cases, students don’t read the questions carefully enough.
Read the Questions Carefully
I’m going to repeat what your teachers told you in school: read every question and each possible answer carefully before you answer. The questions on the NREMT exam are not designed to catch you out, but they are designed to be read and considered carefully.
When we are in a hurry, either because of stress or over-confidence, it is easy to skip through a question and choose the answer based on what we assume the question is asking. This is test-taking disaster and is a problem that is so easily avoided.
An example might be:
Which vessel carries deoxygenated blood to the lungs?
- Pulmonary artery
- Pulmonary vein
- Vena cava
If you have an understanding of the anatomy of the heart and lungs and understand what type of blood flows through each vessel, you might fall into the trap of not reading this question carefully. It would be easy to trick your brain into seeing the word ‘oxygenated’ or ‘heart’ instead of ‘deoxygenated’ or ‘lungs.’ Right now, you might be thinking that this is a pretty straightforward question, but students make silly mistakes like that all the time.
Don’t be that student. Read the question and possible answers carefully.
(Incidentally, questions about the heart, lungs, and the flow of oxygenated versus deoxygenated blood come up on the NREMT exam frequently. If you don’t have that information memorized, then that’s a topic to add to your study list).
Understand What the Question is Asking
One area where NREMT candidates regularly get tripped up is in not understanding the question before they answer. This is partially tied up with reading the question carefully, but it also has to do with taking the time to consider carefully what the question is really asking.
I give you this question to ponder:
You are assisting a 28-year-old male who is experiencing respiratory distress. You are administering oxygen via bag-valve mask. How can you be sure that the artificial ventilation that you are providing is effective?
- The patient’s pulse returns to normal.
- You are administering high-flow oxygen at a rate of 15 lpm.
- The patient’s chest rises with every ventilation.
- You are achieving a compliant seal around the patient’s airway.
Your first reaction to this question may be to think that there are three possible correct answers. If that is the case, then I would encourage you to read the question again.
The question that is being asked is not how you can be sure that you are ventilating the patient correctly. The question that is being asked is how you know that what you are doing is working.
Answers B, C, and D all are indications that your ventilation technique is sound, but the only answer that indicates that you are making a positive change in your patient’s status is A. In this case, the pulse’s return to normal indicates that your patient is improving. Of course, there could be several other possibilities given in place of that answer:
- the patient’s skin color returns to normal
- the patient’s mental status improves
- the patient’s spontaneous respiratory rate slows to normal range
- the patient’s spontaneous breathing becomes easier or less noisy
- the patient’s SpO2 readings go up
No matter what option is given, the point is that you need to understand what the question is asking, not what you perceive it to be asking.
Should you find yourself facing a question like this on the exam – a question that makes you convinced that there are multiple correct answers – then be sure to read the question again to ensure that you understand what the question is really about. If you still think there are multiple correct answers, then choose the best one and move on.
Make the Odds More Favorable
You may have heard before that there is a way to make multiple-choice questions work a bit more in your favor. Obviously, if you have four possible answers in play and you do not know the answer, you have a 25% chance of choosing the correct answer if you guess.
However, if you are able to rule out a couple of options that are plainly not correct, then you can make the odds work for you. Therefore, if you do not know the answer to the question (or even if you do), it is a great strategy to try to narrow down the possibilities.
Let’s take the following example:
A pregnant patient is presenting with painless, bright red vaginal bleeding and a soft lower abdomen. You suspect the following:
- Ectopic pregnancy
- Placenta previa
- Spontaneous abortion
- Placental abruption
It is very common for EMT students to get confused when it comes to problems with pregnancy. However, let’s see if we can investigate this question and narrow down the options.
The first descriptor is the word ‘painless.’ Both ectopic pregnancy and spontaneous abortion are strongly associated with pain, so we can strike those out as being unlikely candidates. (Remember, the NREMT exam is not looking for exceptions to the rule; the exam will generally ask you about textbook signs and symptoms unless it indicates otherwise).
That leaves us with placenta previa (where the placenta has formed such that it covers or overlaps the cervix) and placental abruption (where the placenta tears or pulls away from the uterine wall). One of these two conditions is associated with painless, bright red bleeding and a soft uterus while the other is associated with painful, dark red bleeding and a hard uterus, but they are very frequently confused by EMT candidates.
At this stage, we have narrowed it down to two possibilities. Perhaps you will now be able to focus and remember which one is which, or perhaps now you will be forced to guess. If you have to guess, at least your chance of guessing correctly is now 50%.
The answer, by the way, is B, placenta previa. The placenta in this case has not suffered a traumatic tear and is thus not painful, but because of its proximity to the vaginal canal, the bleeding is bright red. It is, as is the case with placental abruption as well as ectopic pregnancy and spontaneous abortion, still an emergency.
Game the System
As I have mentioned before, the NREMT exam is both a test of your knowledge and your ability to take the test.
In order to attain the knowledge that you need to pass the test, you need to study the material. You will find that the NREMT exam focuses on the following content areas:
- Airway, Respiration & Ventilation
- Cardiology & Resuscitation
- EMS Operations
You will need to come to terms with these topics in order to be successful on the NREMT exam. I will talk about study strategies in another article.
You will also need to be able to interpret each question correctly and game the system in order to do well. The EMT candidate who understands how to read and answer the questions is the candidate who comes through the test with a pass. And in order to do that you have to practice taking the test and get good at it.
- If you’re ready to get serious about your test prep, sign up to get your Online EMT and Paramedic Practice Tests at EMT National Training.
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