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10 Expert Tips to Pass the NREMT Cognitive Exam

Pass the Nremt Written Exam

10 Expert Tips to Pass the NREMT Cognitive Exam



1. Review the current AHA Guidelines for CPR and Emergency Cardiovascular Care.

This tip comes straight from the National Registry of EMT website. The NREMT doesn’t often recommend a specific text to study from, so it’s a good idea to listen when they do.


The NREMT cognitive exam will test on the AHA Guidelines for CPR and Emergency Cardiovascular Care up to the Basic EMT training level. Be familiar with the current American Heart Association guidelines.


2. There will be one BEST right answer.


According to the National Registry of EMT site, the EMT test is trying to determine how you will respond while providing patient care. Incorrect answers may include misunderstandings, common mistakes or inefficient approaches that represent less than optimal care


Each NREMT cognitive exam question will have 4 potential answers. It is possible that all 4 of the answers might be correct or all 4 can be wrong.


The test taker must choose the MOST correct of any 4 choices available, even if it’s not what your first choice would be.


3. Watch for signals that a situation is critical.


One signal that the NREMT cognitive exam scenario involves a critical situation is an altered mental status. This might be indicated by descriptive terms like anxiety, restlessness, unresponsive, etc.


Other indicators could be a rapid pulse and abnormal skin signs like cold and clammy. Often they are giving you clues that the patient is experiencing shock. (Keep in mind that a patient having anxiety or other non-critical situations can have similar symptoms.)  


→ Use the question for clues to determine whether it’s a critical situation.


If you determine there is a critical situation, it may mean you need to respond with a timely or urgent intervention.


This can help narrow down answers to those with more urgent responses. For example, if the situation is critical and the question asks what the next step is, it’s unlikely the answer will be to apply a splint.


More likely, the test taker will be required to answer with a more critical intervention like: ventilate the patient or administer oxygen. 


4. Read each question carefully.


Don’t skip through any part of the question. Read the entire question, the answer and take notice of words that change the meaning of an answer or question.


Some examples are words like “anterior” and “posterior” can make a significant difference when being asked about the Rule of Nines. (Extra Tip: Know the Rule of Nines


Other words like “never” “always” and “sometimes” make a difference and can trip you up if they are over-looked during the NREMT cognitive exam. Take the time to read each question and understand what is being asked, and then read each answer carefully.


5. Airway, Airway, Airway.


The NREMT cognitive exam will have 18% – 22% of the questions about Airway, Respiration and Ventilations. Of these questions 85% will be related to elderly and adult patients and 15% will be about pediatric patients. (If you don’t already know this, I recommend checking out our NREMT Exam page.)


There has long been problems around Airway, Ventilation, and Oxygenation decisions in the prehospital setting. The National Registry of EMT wants to ascertain that all certified Emergency Medical Technicians have undergone proper EMT training and demonstrate an understanding of proper patient care, especially in the basics – like the ABCs.


A common NREMT cognitive exam mix up is knowing when it’s appropriate to oxygenate a patient versus ventilate a patient.


If the patient is in respiratory failure or has inadequate respirations per minute, then ventilation is a priority. (They may also need oxygen, but the oxygen must be breathed in by the patient to do any good.) Also, keep in mind, in order to ventilate the patient the airway must be clear.


So for a question about an Apneic patient EMT training indicates  the following could be an appropriate answer. Manually open Airway, Ventilate with a BVM attached to oxygen at 15 L/min, at a rate of 10 – 12 Breaths per minute (1 ventilation every 5-6 seconds).


Mismanaging the airway can harm the patient, worsen conditions and cause legal issues for the EMT. For this reason the National Registry wants to make sure new candidates are competent and knowledgable in this area, so make sure you have studied the areas of Airway Management well.


6. NREMT tests National Standards.


Content tested on the NREMT cognitive exam will reflect National EMS Educational Standards, not state or local protocol EMT training. The NREMT cognitive exam will avoid questions on specifics that have regional differences.


This means if you are unsure of which answer is correct, go with the EMT National training standards over local rulings.


They also try to avoid some topics in EMS which are controversial, especially if experts disagree on the single best approach to those situations.


According to the National Registry of EMT website, the NREMT cognitive exam will avoid testing over controversial areas. They will stick with questions about basic EMT training that is standardized.

7. Be familiar with the CAT exam.


The EMT-B NREMT cognitive exam is administered via computer adaptive test (CAT). This testing style is a very specific algorithm and being familiar with it can help the candidate be more comfortable during testing.


Computer adaptive tests are likely not taught during EMT basic training, but there is information on the EMT national training website. (For information about the CAT test see our NREMT Exam or National Registry Paramedic pages.)


The most important things to know about the CAT are that you can’t skip a question, go back and change answers, or review your answers.


For this reason it’s important to answer every question to the best of your ability – at the time it is presented.


Cognitive Exam Schedule

8. Don’t study the night before.


The night before the scheduled NREMT cognitive exam isn’t a good time try to “cram” in EMT training for the test.


The night before is a good time to relax, let go of the anxiety that comes with studying, and get a good night’s sleep.


You want to eat a healthy dinner the night before, (not fast-food) just like how athletes eat healthy the night before a race or a game.


It’s important to relax the night before, but don’t get drunk or go out late with friends to relax. If you are like me, setting two alarms for the morning wake up will help with getting better sleep and getting rid of anxiety about oversleeping.


9. Bring two forms of valid ID to Testing Center.


Make sure you know what paperwork is required for entrance to the exam. Get the necessary identifications and documents together the night before so you don’t have to worry about it in the morning.


The National Registry of EMT requires two forms of valid, unexpired identification to take the test.


One must be a government-issued ID that includes a signature and permanently affixed photo (visible signature not required for millitary IDs).


NREMT Cognitive Exam Passport ID

The second ID must include your name and signature. If you have to bring an ATT form, first and last names on your identification must match exactly the first and last names on your Authorization to Test (ATT). (This is according to the National Registry of EMT website.)


10. Arrive Early for the Exam.


NREMT Cognitive Exam Alarm Clock

The National Registry of EMT site recommends candidates arrive at least 30 minutes early to the testing center. Getting there early will help reduce stress and give you time for unexpected delays.


Eat a good breakfast and leave yourself extra time for in case something comes up.


It’s also a good idea to map out the route to your testing center the night before so you don’t have to depend on GPS or having an internet connection to get there. 


NREMT Cognitive exam Believe


Do you need more help studying for the NREMT Cognitive Exam?

People often say that everything you need to know is in your text book, and that is true. However, it can be hard to figure out what items are important to study and what stuff is just filler.


If you want some guidance, the second edition EMT Crash Course Book is a great resource for under $20.


I highly recommend this book to anyone studying for the NREMT, but don’t take my word for it. Check out the reviews and see what other EMTs think of it!

In my opinion, it’s the best and easiest study guide out there for the price. 


Bonus Tip!

The National Registry of Emergency Medical Technicians has released an EMT Candidate Handbook for 2019. Section 4 of the handbook deals with the cognitive exam and has details about taking the test. It’s a short and I recommend reading through it before taking the NREMT written exam.


Want more tips? Check out our 7 tips for the Psychomotor Exam page.


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