Cognitive Tips

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All exam items evaluate your ability to apply knowledge from your course and textbook to the types of tasks and situations that are expected of entry-level EMS professionals. Questions that are answered incorrectly on the exam mean you could choose the wrong assessment or treatment in the field. There are some general concepts to remember about the cognitive exam:

  • There is only one best answer. The items are written to determine how you would respond when providing patient care. Incorrect responses may be misunderstandings, common mistakes or inefficient approaches that represent less-than-optimal care.
  • Examination content reflects the National EMS Educational Standards, not local or state protocols. The National Registry avoids questions on specific details that have regional differences. Some topics in EMS are controversial, and experts disagree on the single best approach to some situations. The National Registry avoids testing over controversial areas.
  • National Registry exams focus on what providers should do in the field. The exam is not taken from any single textbook or source. The exams are intended to reflect the current accepted practices of EMS. Fortunately, most textbooks are up-to-date and written to a similar standard; however, no single source thoroughly prepares you for the exam. You are encouraged to consult multiple references, especially in areas in which you are having difficulty.
  • You do not need to be an experienced computer user or be able to type to take the computer based exam. The computer testing system has been designed so that it can be used by those with even minimal computer experience and typing skills. A tutorial is available to each candidate at the testing center prior to taking the examination.


Preparing for the exam:

Here are a few simple suggestions that will help you to perform to the best of your ability on the examination:

  • Study your textbook thoroughly and consider using the accompanying workbooks to help you master the material.
  • Thoroughly review the current American Heart Association’s Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. You will be tested on this material at the level of the exam you are taking.
  • The National Registry does not recommend a particular study guide but recognizes that they can be useful. Study guides may help you identify your weaknesses, but should be used carefully. Some study guides have many easy questions leading some candidates to believe that they are prepared for the exam when more study is warranted. If you choose to use a study guide, we suggest that you do so a few weeks before your actual exam. You can obtain these from your local bookstore or library. Use the score to identify your areas of strength and weakness. Re-read and study your notes and materials for the areas you did not do well in.
  • The National Registry is not able to provide candidates information about their specific deficiencies.

The Night Before The Exam

  • Do not try to study the night before the exam. If you come across a topic you do not think you know well, there will not be enough time to study. This will only create a stressful situation.
  • Get a good night’s sleep

The Day of the Exam

  • Eat a well-balanced meal.
  • Arrive at the test center at least 30 minutes before the scheduled testing time. The identification and examination preparation process takes time. You may also need this time to review the tutorial on taking a computer based test. Arriving early will reduce stress.
  • Be sure to have the proper identification as outlined in your confirmation materials before you head to the test center
  • You will not be able to take the exam if you do not have the proper form of identification.
  • Relax, thorough preparation and confidence are the best ways to reduce test anxiety

During the Exam

  • Take your time and read each question carefully. The exam is constructed so most people will have plenty of time to finish. Most successful candidates spend about 30 – 60 seconds per item reading each question carefully and thinking it through.
  • Less than 1% of the candidates are unable to finish the exam. Your risk of misreading a question is far greater than your risk of running out of time.
  • Don’t get frustrated. Because of the adaptive nature of the exam, everyone will think their exam is difficult. The CAT algorithm is adjusting the exam to your maximum ability level, so you may feel that all the items are difficult. Focus on one question at a time, do your best on that question and move on.

After The Exam

  • Examination results are not released at the test center or over the telephone.
  • Your examination results will be posted to your National Registry account usually within 2 business days following the completion of the examination provided you have met all other requirements of registration.
  • Log into your account and click on “Dashboard” or “My Application -> Application Status” to view your exam results.


Example Items

To help you understand what to expect from exam questions, we have provided examples of the types of questions entry level providers are expected to answer on the exam. These three questions range in difficulty but are all either at the passing standard or above the passing standard.

  1. Your patient fell while skateboarding and has a painful, swollen, deformed lower arm. You are unable to palpate the radial pulse. You should immediately
    1. apply cold packs.
    2. align the arm with gentle traction.
    3. splint the arm in the position found. 
    4. ask the patient to try moving the arm.
  2. Your patient is a disoriented 86 year old male who has a history of terminal brain cancer. He fell out of bed and complains of severe right hip pain. His wife called 9-1-1 for assistance in putting him back to bed. She tells you that he has DNR orders and that she does not want him transported. You should initially
    1. explain why he needs to be transported. 
    2. ask to see the DNR orders
    3. have her sign a refusal form.
    4. call for law enforcement back-up.
  3. You are called to a scene where law enforcement officers have detained a man who they thought was drunk. They called you because he has a history of diabetes. You administer oral glucose and within a minute the patient becomes unresponsive. You should
    1. remain at the scene under law enforcement authority and request ALS back-up. 
    2. leave the glucose in place, complete a primary survey and transport.
    3. open his airway with an oropharyngeal airway and ventilate him.
    4. suction his mouth and begin transport.