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8 habits for NREMT exam success

These habits have helped hundreds of EMT and paramedic students pass the NREMT cognitive exam on their first attempt


The blue Star of Life is a uniform symbol representing EMS.

Many EMS students believe that the National Registry of EMT cognitive exam is an extremely challenging test, filled with poorly worded questions that seem to be missing lots of information needed to answer it. Even the answers seem strange — often there is more than one “right” answer.

The fact is, like every other EMS exam, the NREMT cognitive exam is only challenging if you are not prepared to take it. With planning and practice, the NREMT written test can be very straightforward. Here are eight habits I have taught to and observed in hundreds of successful students who passed the NREMT cognitive exam on their first attempt.

Habit 1: Preparation begins early.

If you know that the NREMT exam is waiting for you at the end of your class, keeping that in mind while you’re still in the class will help create a mindset that prepares you for first time success. Pay attention to the topics your instructor presents — they are likely the more critical ones to master. Review your in class exam results so you better understand why you chose the wrong answers. Ask about topics that are difficult for you. There are truly no dumb questions except the ones you don’t ask and regret not doing so later.

Habit 2: Study right.

While studying with friends and coworkers can be helpful, your brain does need some quiet time to process all of that information. Treat study time like class time. Each week set aside specific times to spend reviewing your notes and the reading. For example, schedule your Friday afternoons to be in the library from 1 to 5 p.m. Prep your study materials so that you don’t waste time pulling everything together at the last minute. Reduce or eliminate distraction — those earbuds fill your brain with music, not knowledge (unless you’re listening to recorded lectures or the Inside EMS podcast, of course!)

Habit 3: Give your brain a break.

Too much studying can be less than helpful. It’s probably better to study over four, two-hour sessions spread throughout the week, rather than trying to read nonstop for eight hours. Like any other muscle, the brain can only absorb so much without having to take a break to process.

Habit 4: Know what to expect.

Any multiple choice exam item consists of the same parts. The first “question” part is called the stem. The best choice is the answer. The remaining choices are called distractors.

There are several distinguishing traits that separate NREMT exam questions from the ones you may have seen in class. First, the stem does contain all of the information you need to answer it correctly. You may need to infer certain pieces of information from what you read. For example, an anxious patient with cool pale and diaphoretic skin may be hypotensive. Second, the difficulty of the question is really set in the quality of the choices. Notice that you are choosing the best answer, not the right one on an NREMT exam. That’s because there may be more than one right answer, depending on how you interpret the stem (that’s why they are called distractors). One will be the most correct, under the circumstances being described in the stem.

Habit 5: Answer the question first, then look at the answers.

You probably have heard of this test taking tip before and it’s helpful. If you really understand the stem, you should be able to formulate a response before you look at the choices. If your initial response does not match the choices, then re-read the stem to make sure you understand its intent.

Habit 6: Be confident.

The NREMT exam is designed to feel hard. That’s because it’s adaptive, meaning that if you answer one question correctly, the computer will give you another question in the same content area that is harder. If you get that one right, you’ll receive another question that’s even more challenging. This continues until the computer determines that your knowledge base is at a level deemed entry level competent in that area before it moves on to the next section. That’s why students who take the exam say that’s a very challenging test. The questions push against your level of proficiency. Don’t let that wreck your confidence. You got this! A positive attitude keeps you relaxed and focused, no different than playing sports or mastering a new hobby.

Habit 7: Let go after each question.

The NREMT exam does not let you go back to a question once you’ve answered it. That means no regret on your part. Once you have answered the question, move on. Don’t dwell on the question.

If you aren’t able to choose the best response right away, eliminate the ones that are clearly wrong. This technique increases your chances of making a correct educated guess from 25 percent to 33 percent or even 50 percent.

Habit 8: Practice for success.

Taking a multiple choice exam is a skill, just like applying a splint or starting an IV. The more times you take tests, the better you will be at understanding stems and choosing the best answer. There are a variety of online and book-based test prep solutions; if you are not a confident test taker, these materials are worth the investment.

By focusing on a few key areas, your confidence in passing the NREMT exam will improve. The investment you make now will pay off in getting you one step closer to achieving your career goal!

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of “EMT Exam for Dummies,” has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at and connect with him on Facebook or Twitter.

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