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AEMT and paramedic candidates will start seeing new question styles on the NREMT. The questions are not harder, but they look different than what you’re probably used to. Most of the exam will still be the multiple choice style questions you’re used to. Only a few questions will be in a different format.

NREMT Scenario Questions

The biggest change you’ll see in NREMT question style is performance scenario questions. The exam presents a scenario, and you answer questions about that scenario from start to finish. The questions test your clinical judgment, but they will also test your leadership and communication abilities! Watch the NREMT’s video about the new question type

simplified version of NREMT graphic overview of NREMT Performance Scenario Questions on ALS Exams

Below is a quick example of a performance scenario question. To answer the second question, you have to think about the context of the scenario presented in the first question.

As a paramedic in a first response vehicle you are called to a 75 year old female who is experiencing malaise and abdominal pain. She responds to you appropriately and appears oriented. 1. Which of the following actions would you perform first based on the patient presentation? a. Observe skin color and condition b. Administer oxygen c. Attach ECG electrodes d. Check for airway swelling or obstruction 2. Which early finding would give you the best indication of the patient’s overall level of criticality? a. Mental status b. Pulse oximetry c. Lung sounds d. Severity of abdominal pain

Answers at the bottom of this page.

Again, these questions are not harder than regular NREMT questions. They do a good job recreating the experience of a real call, where you must make many related decisions–big and small–for each patient.

Where Can I Get Practice for NREMT Scenario Questions?

screenshot of LC-Ready app (paramedic review plus) showing two new butttons in the testing menu. Buttons say "NREMT Performance Scenario"Four of our ALS apps include complete performance scenarios: AEMT PASS, AEMT Review, Paramedic PASS and Paramedic Review Plus. Each app has unique scenarios, written and reviewed by a team of NREMT experts.

In any of these apps, go to the main menu, select the “Test” module and you’ll see the performance scenario tests at the bottom of the testing menu. In each AEMT app, there is one scenario consisting of 10-12 questions. In each paramedic app, there are two scenarios consisting of 10-12 questions each.

Note: If you already own one of these apps, the performance scenario updates were automatically rolled out on June 1, 2023. All our apps are regularly updated to keep up with AHA guidelines, NREMT changes, and EMS best practices. 

About the Apps:

AEMT PASSAEMT PASS logo/icon:  525 ultra-challenging questions will determine your readiness and help you focus your study. When you complete the practice questions, take the simulated NREMT exams and the performance scenario exam. Our PASS Predictor tells you if you’re ready for the real deal!

AEMT ReviewAEMT Review logo/icon:  Get a comprehensive review of your AEMT class while studying for the NREMT! 1,400 items are included in study cards, review questions, and practice tests. Great for brushing up on things you missed in class while getting a solid foundation of NREMT prep.

Paramedic PASSparamedic pass app logo:  The 500 practice questions in this app are famously difficult. But we guarantee they will make you think, make you learn, and prepare you for the NREMT. When you finish the practice questions, take the simulated tests and the performance scenario exam. The PASS Predictor tells you how ready you are for the National Registry.

Paramedic Review PlusEMT Review Plus logo/icon:  The topical reviews in this app will give you a deep dive into the paramedic curriculum. After review, practice with four, 100-question NREMT-style exams. The exams were all updated in 2022, followed by two full-length performance scenario exams in 2023 – so you know you’re getting the most up-to-date content. Includes bonus sections covering ECG interpretation and medical calculations!


What questions do you have about the NREMT’s addition of performance scenario questions on ALS exams? Let us know in the comments!

Answers to example scenario question: 1.) A,  2.) A

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