How the NREMT Constructs its Tests and Questions

Unlike many of the tests we take throughout our formal education, the NREMT exam is adaptive, not standardized. This means that there is not a given set of questions that every student receives, but rather a pool of questions that the test can pull from based upon the strengths and weaknesses of the individual taking the exam. This exam will quickly determine the areas in which the candidate struggles, and hone in on that area in order to determine whether or not they have an adequate base-level understanding of that topic. If so, the test will move forward, and if not, the test will either continue to press into the topic or end early. This is the basic concept of an adaptive exam. This leads many people to write us and ask, “How is the NREMT exam scored?”

All of the questions on the NREMT exam are multiple choice. It is also important to note that many of the questions provide you with multiple answers that could be considered “correct”, however, there is always one “best” answer, which is the only answer for which a candidate can earn a point. The NREMT exam is designed around the concept of a 95% confidence range. This means that when the test determines with 95% confidence that a student has either mastered the content, or has failed to prove mastery, the test will end, and either a passing or failing score will be given (although it will take up to three days for the candidate to receive their score). For this reason, the exam has a range of 70-120 questions with a time allotment of 2 hours, and the more quickly a candidate demonstrates they are proficient (or not proficient) in the exam content, the sooner the test will end.

Often times students are confused because the content in their textbook, EMTprep questions, or study guides don’t line up with their local protocols. Many times we are asked, “Are the NREMT questions based on a specific textbook or set of protocols?”

The simple answer is no. The NREMT website is clear that the exam is not based on any one textbook or source, and questions are pulled from National EMS Educational Standards rather than state or local protocols. The answers candidates are meant to choose in order to pass are simply the “current accepted practices of EMS” (, 2018), which is typically what is written into all of the up-to-date EMT textbooks used in EMT programs. The NREMT also states that controversial topics - or those topics on which experts cannot agree on best practice - are avoided in the exam, and therefore should not be of concern to candidates. For more information on where we got this from, click HERE

Some people ask, “Are there any tools I can use on the exam?” Many times this is based on a candidate feeling like they need to memorize a specific chart or examination tool. Candidates are not allowed to bring anything into the exam. This means no electronic devices, paper products, pens, pencils, etc. However, the NREMT has now made an onscreen calculator available to candidates taking the exam. This calculator includes basic functions - addition, subtraction, multiplication, division, percentages, square root, reciprocals, and variable functions - which the candidates are able to use during the exam. This, however, will be the only “tool” available during the exam.

The NREMT exam is challenging and at times it can feel like they’re purposefully trying to trick you with a specific answer or group of answers. Their policies state that they don’t purposefully attempt to do that. So what can you do to empower yourself prior to test day? Learn as much as you can about the NREMT and the way they write their test questions, and then purchase a membership at This will give you the best chance of successfully preparing for this exam. Learn how EMTprep can help you prepare for the NREMT testing environment.