My NREMT Exam Experience 2025

I recently took the NREMT paramedic exam. It was a good experience, and I saw the new format with technology-enhanced items, clinical judgment scenarios, and an expanded minimum number of questions. The last time I took the exam, there were a minimum of 80 questions and none of the new item formats.

I got the minimum number of questions. Despite my experience as a paramedic, educator, EMT textbook author and owner of an NREMT test prep company – I was nervous going in.

Fortunately, I passed.

I’d like to share a few takeaways from the 2025 NREMT. These will benefit you whether you’re taking the EMT, AEMT or paramedic exam.

Take your time on each question.

I got 110 questions, and I took almost two full hours. That is about a minute per question. I read each question twice before I looked at the choices. This helped me in two ways:

• By not rushing and staying focused, I didn’t miss careless things. I caught myself going in the wrong direction more than once.

• The other thing this did was prepare me for more challenging questions where I really needed to know information from the question to rule in or rule out choices.

The NREMT is a long exam. Have a plan to manage your time.

I knew I would be in the exam longer than the last time I took it. I was mentally prepared for that. But I didn’t obsess about the clock. I planned regular check-ins against the clock every 30 questions. Why 30 questions? Because if about 30 minutes had come off the clock since the last time I looked, I knew I was on track.

I also told myself that if the exam continued past 110 questions, I wouldn’t be shaken by that. It just means I have to answer a few more.

When you prepare for any level NREMT exam, be sure to do a full practice exam in one sitting. Do this more than once. You need to feel the time you will be in that seat and practice your focus and concentration over that time.

• Paramedic exam is 110-150 questions with a 3.5 hour time limit.

• AEMT exam is exactly 135 questions with a 3 hour time limit.

• EMT exam is 70-120 questions with a 2 hour time limit.

Test prep like the PASS apps and Review Plus apps include simulated exams with an on-screen timer. The questions are very similar to the NREMT’s questions.

Details matter more than ever in the new NREMT question styles.

The clinical judgment scenarios take time—and the NREMT has added to the available time for the examination. I got four clinical judgment scenarios, including two scenarios as my first 20+ questions. I found that I would occasionally want to look back to earlier parts of the question. For example, If I was on scene or post-scene and I wanted to look back on the size-up portion of the call, I could do that. I should do that. I have the time.

There were a lot of multiple response items, about 25-30% of the exam. You choose 2 of 5 or 3 of 6 correct answers in these. Some were straightforward. Others required me to go back to the question and look for assessment findings or other facts to help me rule choices in or out. Multiple response items can appear individually or within clinical judgment scenarios.

The “best answer” format is gone, but the questions are still challenging.

I remember the days of the best-answer question. All answers were allegedly right, but one was more right. Those days appear to be gone. These questions were more straightforward.

That doesn’t mean that the questions are easy. As an educator, I loved the way the questions were crafted. As a test taker, I recognized the challenge.

I am not allowed to tell any content from the exam. I can say generally, there were situations where I read a multiple response item, and I thought to myself, “I know what the two answers should be.” But I only found one of those choices. I had to go through the remaining four, referring back to the question and relying on some pathophysiology knowledge, to determine the other correct choice.

When the answer you want isn’t one of the choices given: Reread the question carefully and lean on your pathophysiology knowledge.

Remember, you don’t get a lot of throwaway choices. All the choices have something attractive about them. This makes a question challenging—and different from some of the exams you get in class and on inferior exam preparation products.

The new NREMT exam really tested my paramedic knowledge.

I liked the clinical judgment scenarios and the TEI items. They broke up the monotony of the random, challenging NREMT items. The multiple response items were voluminous and time-consuming. But when I got out, I felt the distribution of material from around the paramedic knowledge base was fair and representative. I think 20% of the questions, especially operations questions, could easily have been on an EMT or AEMT exam.

The exam was challenging and fair. My message to you is to not build up the exam or any parts or question types as a burden or hindrance to your passing.

The advice I give every exam prep class I lead is the same advice I followed: Prepare well. Then, answer each question to the best of your ability and move on. Don’t ruminate on questions that have already gone by. The one on your screen is the most important.

Limmer Education does NREMT prep the right way.

I can confirm that Limmer Education’s test prep closely matches the current version of the NREMT. There are plenty of NREMT prep companies that make a product, put it on the market and barely ever touch it again. They continue to sell that product even as it slowly becomes out of date and irrelevant. With Limmer Education, you never run that risk.

Our products are constantly updated to keep up with changing best practices, AHA guidelines, and NREMT blueprints and question styles. Our content is written and vetted by former NREMT personnel and NREMT item writers. And our practice exam questions are very much like the NREMT’s questions. Find specific recommendations below.

We walk the walk to make your journey easier.

If you’ve recently taken the exam, we’d love to hear your thoughts (please don’t share specifics). Limmer Education is here for you when it is your time to prepare.