• 64 questions

NC Paramedic Practice Test

Unofficial questions for North Carolina's Paramedic state exam, in its six blueprint domains, plus the state's own EMS law.

Above which lactate level does the Shock guideline call the result abnormal?

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Unofficial practice questions, not affiliated with the North Carolina Office of Emergency Medical Services. Bank checked October 12, 2026.

The real exam, as North Carolina's Office of EMS describes it

Time limit
120 minutes
Retakes
Three attempts within six months of the course graded date. After three failures the educational program is repeated.
Length
100 multiple-choice questions on a computer.
Form
A linear exam: all candidates at a level take the same domain blueprint. Forms have roughly 50% of their questions in common.
Result
Pass or fail, with the percent correct in each domain and no cumulative score. The pass point is set for each exam form.
Deadline
The written examination is completed within 90 days of the course graded date.
Who gives it
The Office of EMS, through the Meazure Learning testing system.
Credential
Valid for four years.

Checked October 12, 2026 against NC OEMS Candidate Handbook (November 14, 2023), the state's Exam Information pages and 10A NCAC 13P .0502 and .0503. Rules change, so confirm with the agency itself before your test.

The Office of EMS education and exam information page

Next step National Registry paramedic practice testNC EMT practice test

All 64 questions

Operations 5

  • A crew is in the hot zone of an active threat. What does the High Threat guideline say about medical care there? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), High Threat Considerations/Active Shooter Scenario guideline
  • A crew is weighing termination of resuscitation for a 15-year-old. What does the Termination of Resuscitative Efforts guideline recommend? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Termination of Resuscitative Efforts guideline
  • A patient contaminated with radioactive material has a life-threatening injury. What takes priority, by the Radiation Exposure guideline? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Radiation Exposure guideline
  • How does the High Threat guideline define the warm zone? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), High Threat Considerations/Active Shooter Scenario guideline
  • Where local protocol lets EMS remove the barbed darts of a conducted electrical weapon, which areas does the guideline except? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Conducted Electrical Weapon Injury guideline
Show all 64 questions (59 more)

Airway, respiration, ventilation 9

  • A child with croup has stridor at rest. Which nebulized treatment does the Croup guideline give? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Pediatric Respiratory Distress (Croup) guideline
  • A patient on CPAP for severe respiratory distress also needs a bronchodilator. How does the Respiratory Distress guideline say to give it? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Respiratory Distress guideline
  • An adult in acute pulmonary edema has a systolic pressure of 180 mmHg. Which sublingual nitroglycerin dose does the Respiratory Distress guideline give? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Respiratory Distress guideline
  • An adult with pulmonary edema from acute heart failure has a systolic pressure of 84 mmHg. What does the Respiratory Distress guideline give? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Respiratory Distress guideline
  • What does the Respiratory Distress guideline say about invasive airways in a patient with bronchospasm? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Respiratory Distress guideline
  • When does the Respiratory Distress guideline give IM epinephrine to a patient with bronchospasm? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Respiratory Distress guideline
  • Which IV or IM steroid does the Respiratory Distress guideline list for a critically ill patient with bronchospasm? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Respiratory Distress guideline
  • Which magnesium sulfate dose does the Respiratory Distress guideline give for severe bronchoconstriction with impending respiratory failure? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Respiratory Distress guideline
  • Which of these does the Respiratory Distress guideline say not to give for bronchospasm, because no patient benefit has been shown? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Respiratory Distress guideline

Cardiovascular emergencies 9

  • A patient with chest pain took a phosphodiesterase inhibitor such as sildenafil. Within how long of that dose should nitrates be avoided, by the Chest Pain guideline? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Chest Pain/Acute Coronary Syndrome/STEMI guideline
  • After return of circulation the 12-lead shows a STEMI. Where should the patient preferably be taken, by the Adult Post-ROSC Care guideline? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Adult Post-ROSC Care guideline
  • The diagnosis is an inferior STEMI. What does the Chest Pain guideline say about nitroglycerin? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Chest Pain/Acute Coronary Syndrome/STEMI guideline
  • How does the Adult Post-ROSC Care guideline define hypotension in an adult? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Adult Post-ROSC Care guideline
  • When does the Cardiac Arrest guideline say to give epinephrine? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Cardiac Arrest guideline
  • Which amiodarone dose does the Cardiac Arrest guideline give for VF or pulseless VT that has not responded to CPR, defibrillation and a vasopressor? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Cardiac Arrest guideline
  • Which drug does the Cardiac Arrest guideline list as an alternative to amiodarone for VF or pulseless VT that does not respond to CPR, defibrillation and a vasopressor? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Cardiac Arrest guideline
  • Why does the Adult Post-ROSC Care guideline call for serial 12-lead ECGs? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Adult Post-ROSC Care guideline
  • Why does the Chest Pain guideline urge caution with morphine in unstable angina or non-STEMI? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Chest Pain/Acute Coronary Syndrome/STEMI guideline

Medical emergencies 8

  • A patient in shock takes long-term steroids for adrenal insufficiency. Which drug does the Shock guideline list as preferred? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Shock guideline
  • Above which lactate level does the Shock guideline call the result abnormal? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Shock guideline
  • By the guideline, what is the primary antidote in organophosphate, carbamate or nerve agent exposure? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Acetylcholinesterase Inhibitors Exposure guideline
  • For which patients does the Nausea-Vomiting guideline say ondansetron is contraindicated? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Nausea-Vomiting guideline
  • In anaphylaxis, when does the guideline say to consider an IV epinephrine drip? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Anaphylaxis and Allergic Reaction guideline
  • What should early hospital notification for a suspected stroke include, by the Suspected Stroke guideline? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Suspected Stroke/Transient Ischemic Attack guideline
  • Which fluid bolus size does the Shock guideline give a child in cardiogenic shock? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Shock guideline
  • Which vasopressor does the Shock guideline prefer in neurogenic and septic causes of distributive shock? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Shock guideline

Traumatic emergencies 7

  • A 6-year-old with a head injury needs bag-valve-mask ventilation. Which rate does the Head Injury guideline give? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Head Injury guideline
  • A blast victim may have a thermal burn of the airway. What does the Blast Injuries guideline call vital? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Blast Injuries guideline
  • A patient's globe is avulsed from the socket. What does the Facial/Dental Trauma guideline say? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Facial/Dental Trauma guideline
  • A tooth has been knocked out. Which storage medium does the Facial/Dental Trauma guideline give? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Facial/Dental Trauma guideline
  • A tourniquet is in place and the limb is still bleeding. What does the Extremity Trauma guideline say to do next? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Extremity Trauma/External Hemorrhage Management guideline
  • In a head injury, endotracheal intubation or a supraglottic airway is only for systems equipped with what, by the Head Injury guideline? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Head Injury guideline
  • While packing a deep wound you meet bone fragments. What does the Extremity Trauma guideline say? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Extremity Trauma/External Hemorrhage Management guideline

Special patient populations 4

  • The baby's head delivers and the delivery then fails to progress. What does the Childbirth guideline attempt? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Childbirth guideline
  • The umbilical cord is prolapsed. What does the Childbirth guideline say to do? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Childbirth guideline
  • Which dexamethasone dose does the Croup guideline give for a child with suspected croup? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Pediatric Respiratory Distress (Croup) guideline
  • Which IV or IO epinephrine dose does the Neonatal Resuscitation guideline give when the heart rate stays under 60? National Model EMS Clinical Guidelines, Version 3.0 (NASEMSO, March 2022), Neonatal Resuscitation guideline

North Carolina EMS law and exam facts 22

  • A paramedic asks to renew as an EMT instead. What does 10A NCAC 13P .0504(d) allow? North Carolina Administrative Code, 10A NCAC 13P .0504(d), Renewal of Credentials
  • A paramedic credentialed in another state applies under legal recognition, but took the initial course at an approved North Carolina institution. What does 10A NCAC 13P .0502(b) require? North Carolina Administrative Code, 10A NCAC 13P .0502(b), Initial Credentialing Requirements
  • A paramedic in the chemical addiction or abuse recovery program seeks an encumbered credential. For how long must the paramedic have complied with the treatment program, under 10A NCAC 13P .1403? North Carolina Administrative Code, 10A NCAC 13P .1403, Conditions for Restricted Practice with Limited Privileges
  • A paramedic is credentialed in North Carolina by legal recognition under G.S. 131E-159(c). For how long is that credential valid? North Carolina General Statutes, G.S. 131E-159(c), Credentialing requirements
  • About how much do the forms of one level's state examination have in common, by the Office of EMS? North Carolina Office of EMS, NC OEMS Exam Information, "How are the North Carolina Office of EMS state credentialing examinations structured?"
  • An EMS System changes one of its treatment protocols. How far ahead of the change must it go to the OEMS Medical Director for review and approval, under 10A NCAC 13P .0405(b)? North Carolina Administrative Code, 10A NCAC 13P .0405(b), Requirements for Adult and Pediatric Treatment Protocols
  • By the definition in 10A NCAC 13P .0102, what must a paramedic have to staff a Specialty Care Transport Program? North Carolina Administrative Code, 10A NCAC 13P .0102(44), Definitions
  • For how long may a temporary EMS credential be valid under G.S. 131E-159(e)? North Carolina General Statutes, G.S. 131E-159(e), Credentialing requirements
  • How does G.S. 131E-161 class the operation of an ambulance without the credentialed staffing the law requires? North Carolina General Statutes, G.S. 131E-161, Violation declared misdemeanor
  • How far ahead of the intended exam date must a request for testing accommodations be submitted, by the candidate handbook? NC OEMS Candidate Handbook (November 14, 2023), Requesting Special Testing Accommodations
  • How long is North Carolina's Paramedic written examination, by the candidate handbook? NC OEMS Candidate Handbook (November 14, 2023), Examination Information
  • How often must an EMS System's Peer Review Committee meet under 10A NCAC 13P .0408? North Carolina Administrative Code, 10A NCAC 13P .0408, EMS Peer Review Committee for EMS Systems
  • How soon are state examination results typically posted in the candidate's Continuum account, by the candidate handbook? NC OEMS Candidate Handbook (November 14, 2023), Examination Results
  • In the state's exam blueprint, which domain has the highest maximum number of questions? North Carolina Office of EMS, NC OEMS Exam Information, "How are the North Carolina Office of EMS state credentialing examinations developed?"
  • On a ground ambulance transport between hospitals, who decides which level of caregiver manages the patient, under 10A NCAC 13P .0221? North Carolina Administrative Code, 10A NCAC 13P .0221, Patient Transportation Between Hospitals
  • Once a candidate receives the Notice to Schedule from the testing vendor, for how long is it valid, by the candidate handbook? NC OEMS Candidate Handbook (November 14, 2023), Examination Registration
  • What does 10A NCAC 13P .0102 call an EMS System's use of credentialed personnel with additional training to meet community needs beyond 911 response and transport? North Carolina Administrative Code, 10A NCAC 13P .0102(9), Definitions
  • What is the minimum crew of an ambulance that is transporting a patient, under G.S. 131E-158(a)? North Carolina General Statutes, G.S. 131E-158(a), Credentialed personnel required
  • What must a candidate bring to the test site, by the candidate handbook? NC OEMS Candidate Handbook (November 14, 2023), Examination Day
  • Which of these is a ground for action against an EMS credential under 10A NCAC 13P .1507(b)? North Carolina Administrative Code, 10A NCAC 13P .1507(b)(31), EMS Personnel Credentials
  • Who may deviate from written treatment protocols when giving on-line medical direction, under 10A NCAC 13P .0401? North Carolina Administrative Code, 10A NCAC 13P .0401, Components of Medical Oversight for EMS Systems
  • Who may suspend a paramedic temporarily from participation in an EMS System, pending review, under 10A NCAC 13P .0403(c)? North Carolina Administrative Code, 10A NCAC 13P .0403(c), Responsibilities of the Medical Director for EMS Systems

How this list was compiled: Our own questions, written to the exam blueprint the North Carolina Office of Emergency Medical Services publishes under "NC OEMS Exam Information" on https://oems.nc.gov/education/ ("How are the North Carolina Office of EMS state credentialing examinations developed?", https://oems.nc.gov/how-are-the-north-carolina-office-of-ems-state-credentialing-examinations-developed/; read 2026-10-12). The blueprint gives a minimum and a maximum number of questions for each domain: Operations 6 to 12, Airway, Respiration, Ventilation 11 to 22, Cardiovascular Emergencies 11 to 23, Medical Emergencies 10 to 20, Traumatic Emergencies 8 to 18, Special Patient Populations 4 to 10. The bank holds 5, 9, 9, 8, 7 and 4 questions in those domains (42), each share inside the blueprint's range for a 100-question exam, plus 22 on North Carolina's own EMS law and exam facts, which the blueprint does not list as a domain. Clinical facts were read on 2026-10-12 in the National Model EMS Clinical Guidelines, Version 3.0 (National Association of State EMS Officials, March 2022; https://nasemso.org/docs.ashx?id=1444322). State facts were read the same day in Title 10A, Subchapter 13P of the North Carolina Administrative Code (the copy of the Office of Administrative Hearings, linked from https://info.ncdhhs.gov/dhsr/EMS/rules.html), Article 7 of Chapter 131E of the North Carolina General Statutes (https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_131E/Article_7.html), the NC OEMS Candidate Handbook of November 14, 2023 (https://oems.nc.gov/wp-content/uploads/2023/12/NCOEMS-Candidate-Handbook_11052023_DHSR.pdf) and the Exam Information pages. Licence: Own work. Every question, wrong choice and explanation was written for this site from the public source it names. Nothing is copied, reworded or reconstructed from a North Carolina credentialing examination or from any other practice test.

How it works

This free NC paramedic practice test has 64 questions of our own for North Carolina's Paramedic state credentialing exam. It is unofficial and not affiliated with or endorsed by the North Carolina Office of Emergency Medical Services.

Read the full guide

What the paramedic state exam covers

The state's blueprint, read October 12, 2026, sets a question range for each of six domains. Cardiovascular emergencies is the largest at 11 to 23 and special patient populations the smallest at 4 to 10. Forty-two questions here keep those shares at paramedic depth: drug doses, post-arrest care, shock, newborns.

North Carolina EMS law for paramedics

Twenty-two more ask what only this state sets: who may give on-line medical direction, the Medical Director's power to suspend, specialty care transport, community paramedicine, legal recognition and ambulance staffing under G.S. 131E-158.

Where the clinical answers come from

Each clinical answer cites the public National Model EMS Clinical Guidelines. On the job, your EMS System's protocols and the North Carolina Medical Board's scope of practice come first.

  • State results come as percent correct by domain, so study your weakest domain first.

Questions and answers

How many questions are on the NC paramedic state exam?

100 multiple-choice questions in two hours, taken on a computer through the Meazure Learning system, by the NC OEMS Candidate Handbook of November 14, 2023.

What is the passing score for the NC paramedic exam?

The state publishes no percent. A panel of subject-matter experts rates each question, and the cut score varies with the form: an easier form needs more correct answers.

How many times can you take the NC paramedic exam?

Three times within six months, with the examination completed within 90 days of the course graded date (10A NCAC 13P .0502). After a third failure the paramedic program has to be repeated.

Can I get a North Carolina paramedic credential with the NREMT?

G.S. 131E-159(c) allows legal recognition of a current National Registry or approved other-state credential. If your initial course was at a North Carolina institution, rule .0502(b) still requires the state exam.

Are these the real NC paramedic exam questions?

No. Each was written for this page from a public source it names. Rule .1507 treats copying or reconstructing state exam questions as a ground to deny or revoke a credential, and none appears here.

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