- Scene Size-Up and Safety 17.2%
- Primary Assessment 41.4%
- Secondary Assessment 7.1%
- Patient Treatment and Transport 22.2%
- Operations 12.1%
Free · 2026 · 12.1% of the NREMT EMT NREMT Operations practice questions
Operations is 12.1% of the NREMT EMT. Answer 10 questions (6 on Operations) and see your score by domain, with every answer explained. Free, no sign-up.
You arrive to find a 30-year-old man with known epilepsy who had a generalized seizure and was unresponsive when you began care. Fifteen minutes later he is alert and oriented to person, place, time and event. He has no injuries and says he took his medication late. He now clearly declines transport. Which statement best describes your legal position?
Tap an answer, or press A to D
Equipment and oxygen checks, supplies, patient care reports, consent, refusal and other legal issues, infection control and responder safety.
What the NREMT EMT exam tests in Operations
- Ensure equipment is in proper working order: daily vehicle and equipment checks, AED and suction checks, oxygen cylinders and regulators, cleaning, disinfection and sterilization of equipment and the ambulance
- Ensure sufficient inventory of medications and supplies used in patient care: restocking, expiration dates, oxygen supply duration calculations, medication storage
- Ensure proper documentation is completed: patient care report contents and purpose, objective writing and pertinent negatives, correcting errors, refusals of care, MCI documentation, confidentiality and HIPAA, legal and ethical issues (scope of practice, consent, refusal, abandonment, negligence, advance directives and DNR/POLST, mandatory reporting, crime scenes)
- Ensure the well-being of self and other responders: stress, resilience and grief, infection control and exposure reporting, vaccinations, safe lifting and body mechanics, emergency vehicle operation and roadway safety, scene violence, rehab
High-yield operations facts
- Start-of-shift checks cover the vehicle (fuel, fluids, tires, lights, siren) and the equipment: AED (battery, pads, self-test), suction (power, vacuum), O2 (cylinder pressure, spares, regulators), BVMs in all sizes, stretcher, radios, PPE, medications (quantity, expiration), splints, OB kit, glucometer.
- Cleaning removes visible soil. Low-level disinfection (EPA-registered) is for surfaces such as the stretcher. High-level disinfection is for reusables that touch mucous membranes. Sterilization is for items that enter tissue.
- Clean after every call wearing PPE, and bag contaminated linen. Sharps go straight into a sharps container; never recap.
- O2 cylinders: full ≈2,000 psi; safe residual 200 psi. Store secured and away from heat, with no oil or grease on fittings.
- Inventory: restock after every call, rotate stock (oldest first), check expirations (aspirin, oral glucose, epinephrine, naloxone, nebulized drugs), and store medications at label temperature and protected from light as required.
- PCR purposes: continuity of care, legal record, billing, quality improvement, research and education. Data follow the NEMSIS national standard.
| Cylinder | Constant | Worked example |
|---|---|---|
| D | 0.16 | 1,000 psi at 4 L/min: (800 x 0.16) ÷ 4 = 32 min |
| E | 0.28 | 2,000 psi at 15 L/min: (1,800 x 0.28) ÷ 15 = 33.6 min |
| M | 1.56 | 2,000 psi at 15 L/min: (1,800 x 1.56) ÷ 15 = 187.2 min |
| G | 2.41 | Same formula |
| H/K | 3.14 | Same formula |
The full NREMT High-Yield Cram Sheet comes with full prep.
Common operations traps
- Negligence requires all four elements; no harm means no negligence.
- Handing a patient to a lower level of care is abandonment.
- Implied consent applies only when the patient can't consent; a competent refusal overrides it.
- Non-emancipated minors and suicidal patients can't refuse care.
- DNR means no resuscitation, not no treatment; if in doubt, resuscitate.
- Correct a PCR with a single line, initials and date; never obliterate, and use an addendum after submission.
- HIPAA permits full information sharing with the receiving hospital for treatment.
- Good Samaritan laws don't protect gross negligence.
Free NREMT operations practice questions
Question 1
A 16-year-old girl who is not emancipated has an obviously deformed forearm after a bicycle crash. She is alert and insists she does not want treatment or transport. Her mother arrives, has legal custody, and asks you to treat and transport her daughter. You should:
- AHonor the patient's refusal, because she is alert and old enough to decide
- BTreat and transport her based on her mother's consent
- CHave the patient sign a refusal form, with her mother as witness
- DTreat her under implied consent, since the mother's consent is not needed
Show answer and explanation
Answer: B. An unemancipated minor cannot legally refuse care, and the parent's consent authorizes treatment and transport.
Why not A: Being alert does not give an unemancipated minor legal authority to refuse care. That authority belongs to the parent or guardian.
Why not C: A minor's signature on a refusal form has no legal effect, and it would document a refusal the minor cannot make.
Why not D: Implied consent applies to patients unable to consent in an emergency. Here a parent is present and gives expressed consent.
Remember: An unemancipated minor cannot refuse care; the consent or refusal of a parent or legal guardian governs.
Question 2
Under standard infection-control classification, a reusable piece of equipment that contacts a patient's mucous membranes but does not penetrate skin or tissue must receive, at a minimum, which level of decontamination?
- ACleaning with soap and water to remove visible soil
- BLow-level disinfection with an EPA-registered surface disinfectant
- CSterilization that destroys all microorganisms, including spores
- DHigh-level disinfection that kills nearly all microorganisms
Show answer and explanation
Answer: D. Items that contact mucous membranes but do not enter tissue require at least high-level disinfection after cleaning.
Why not A: Cleaning removes dirt and organic matter but does not reliably kill microorganisms on items that touch mucous membranes.
Why not B: Low-level disinfection is for items that touch only intact skin or environmental surfaces, such as the stretcher.
Why not C: Sterilization is required for items that enter tissue or the bloodstream; it exceeds the minimum for mucous-membrane contact.
Remember: Skin and surfaces need low-level disinfection, mucous-membrane items need high-level disinfection, and items that enter tissue need sterilization.
Question 3
On a hot afternoon, an EMT checks the agency's epinephrine auto-injectors. The ambulance sat in direct sun with a failed compartment cooling system. The viewing window on one auto-injector shows a brownish solution, though it is not expired. What should the EMT do?
- AKeep it for use only if no other auto-injector is available
- BRemove it from service and restock with a properly stored device
- CChill it in the refrigerator to restore the drug's potency
- DKeep it in service, since the expiration date has not passed
Show answer and explanation
Answer: B. Epinephrine should be clear, and discoloration after heat exposure means the dose may be degraded and should not be used.
Why not A: A degraded drug may fail during anaphylaxis; it should be replaced, not held as a backup.
Why not C: Cooling cannot reverse degradation, and epinephrine auto-injectors are not meant to be refrigerated.
Why not D: An in-date expiration does not guarantee potency when the drug has been stored outside its labeled conditions and looks abnormal.
Remember: Store medications as their labels direct, and replace any drug that is discolored or was exposed to extreme temperatures, even if not expired.
Question 4
An on-duty EMT splints a patient's fractured forearm but forgets to recheck distal pulse, motor function and sensation afterward. At the hospital the arm is found to have normal circulation and nerve function, and the patient recovers fully. The patient later files a negligence claim. Why is the claim most likely to fail?
- AThere was no causation because the original fall caused the fracture
- BThere were no damages because the patient suffered no harm from the omission
- CThere was no breach because the splint itself was applied correctly
- DThere was no duty because the patient never signed a written consent form
Show answer and explanation
Answer: B. Negligence requires duty, breach, damages and causation, and without actual harm the damages element is missing.
Why not A: Causation asks whether the breach caused harm, not what caused the original injury. Here the real gap is that no harm occurred.
Why not C: Failing to reassess PMS after splinting departs from the standard of care, so a breach likely did occur.
Why not D: Duty to act arose when the on-duty EMT responded and began care. A signed form is not required to create duty.
Remember: Negligence requires all four elements (duty, breach, damages and causation), and if any one is missing, the claim fails.
Question 5
You are called to a bar for a man who fell. He is awake, has a small forehead abrasion, and repeatedly asks you to leave. Which narrative entry is most appropriate for the patient care report?
- AOdor of alcoholic beverage on breath, slurred speech, unsteady gait; pt states "I had six beers."
- BPt is drunk and will likely become combative if transported.
- CPt appears to be a chronic alcoholic who frequently falls at this bar.
- DPt is intoxicated and uncooperative; refused to answer most questions.
Show answer and explanation
Answer: A. It records observed findings and quotes the patient's own words without drawing conclusions.
Why not B: This mixes a label with a prediction. Neither is an objective finding.
Why not C: This is speculation about history the EMT did not observe. It is a subjective judgment.
Why not D: "Intoxicated" and "uncooperative" are conclusions, not observations. They could be challenged legally.
Remember: Document what you see, hear and smell, and quote key patient statements, rather than writing labels such as "drunk" or "combative."
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