Questions written the way the National Registry writes them — a scenario, four plausible options and a rationale that explains the whole answer, not just the letter. Below them, the exam you are actually sitting.
The EMR cognitive exam is a computer-adaptive test of 90–110 questions with up to 105 minutes. It is adaptive: after each answer it re-estimates your ability, picks the next question to match, and stops once it is confident you are above or below the passing standard. Emergency Medical Responder candidates are the first trained person on scene, often before an ambulance arrives.
Try six
Question 1 of 6
Under a hybrid SUV that has rolled over you see bright orange cables that have been torn. The correct response is to:
Answer: A. Orange cabling is the standard marking for high voltage in electric and hybrid cars, and torn cables can be live. The fire service shuts the car down. The crew's job is to keep everyone and everything away from the cables. Examination gloves give no electrical protection, and taping or pulling damaged high-voltage cable is not EMS work.
Question 2 of 6
A bystander says a man "had a seizure" for about 15 seconds right as he collapsed and now he is making occasional snorting gasps. What should you suspect first?
Answer: A. Brief jerking at the moment of collapse is a common result of sudden loss of blood flow to the brain, and occasional gasps are agonal breathing, not effective ventilation. Together they are a cardiac arrest until a pulse check proves otherwise. Calling it a postictal state is the trap: it delays compressions and defibrillation for a patient whose heart is not pumping.
Question 3 of 6
A nursing-home resident is confused. The single most useful question to ask the staff is:
Answer: A. Confusion only means something once you know the baseline, and the staff who see her every day are the only people on scene who can supply it. How long she has lived there and who her family are may be useful later for contact, but neither answers the one question that decides whether this is an emergency or her normal condition.
Question 4 of 6
An unresponsive patient started breathing better the moment you opened the airway with a jaw thrust. You should:
Answer: A. The improvement exists only for as long as the maneuver is held, which makes it a state to maintain rather than a task you have finished; letting go returns the tongue to exactly where it was. Repeating a maneuver already in place achieves nothing, and swapping technique for convenience trades the patient's airway for your hands.
Question 5 of 6
Which narrative entry is appropriate for a patient care report?
Answer: A. A direct quotation is an observation and survives scrutiny; a conclusion such as drunk is an opinion you cannot support without a test. Labels and sarcasm in a legal record damage your credibility on everything else you wrote, including the findings that actually mattered.
Question 6 of 6
The floor around your patient has become wet with spilled drink and vomit, and you are about to lift. You should:
Answer: A. A lift is the moment a crew has the least ability to recover from a slip, and the fix is seconds of toweling, a change of position or moving the patient a foot to dry floor. Lifting fast on a wet surface makes the slip more likely rather than less, dragging across the spill spreads it, and family standing in it puts more people where the footing is worst.
Keep the streak going with more questions like these, each with a full rationale.
The National Registry publishes the share of the exam each domain is worth. These are the current bands — the ones the EMR blueprint has used since the 2025 restructure, not the retired five-domain plan that much of the older material online still follows.
| Domain | Share of the exam | Free questions |
|---|---|---|
| Scene Size-Up & Safety | 19–23% | Practice scene size-up & safety |
| Primary Assessment | 37–41% | Practice primary assessment |
| Secondary Assessment | 4–8% | Practice secondary assessment |
| Patient Treatment & Transport | 20–24% | Practice patient treatment & transport |
| EMS Operations | 10–14% | Practice ems operations |
Study the weight, not the syllabus order. Primary Assessment is 37–41% of your exam. A weak domain that is also a heavy one is worth more of your week than everything else put together.
Everything below is free on this site, no account:
And the explainers: how the exam is scored, how the adaptive test decides, and the cheat sheets.
The EMR cognitive exam is adaptive: between 90 and 110 questions, including unscored pilot items, with a limit of 105 minutes. It ends when the exam is confident which side of the passing standard you are on.
Scene Size-Up & Safety 19–23%, Primary Assessment 37–41%, Secondary Assessment 4–8%, Patient Treatment & Transport 20–24%, EMS Operations 10–14%. The heaviest domain is where a retake is usually won or lost.
Neither. On an adaptive exam the length tells you how quickly the test became confident, not which way it decided. Candidates pass at the minimum length and fail at it.
Six attempts in total. After three unsuccessful attempts you must document remedial training before testing again, and after six you repeat a state-approved education program.
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