Preparing for the NREMT certifying (cognitive) exam can be daunting, given the breadth and depth of knowledge required. However, with the right strategies, you can optimize your study time and improve your performance. 

Here are some effective study tips to help you excel and feel more confident for the exam!

1. Understand the exam format

Before diving into your studies, familiarize yourself with the exam format. Medical exams often test not only your knowledge but also your critical thinking and problem-solving skills. Knowing the structure, including the number of questions, types of questions, and time allotted, will help you tailor your study approach.


For the cognitive exams, the questions are all multiple choice and focus on your knowledge of patient care, but not specific regional protocols since those may differ depending on location and agency. The questions don’t come from any specific textbook or source, and are instead created by many teams and staff – just one question can take almost $2,000 and a full year to create.


Many questions are focused on the order of care following the skill sheets – here’s an example question from the NREMT (the correct answer is in bold):


An 86-year-old patient with terminal brain cancer is disoriented after a fall. The patient reports severe right hip pain. The spouse tells the EMT that the patient has DNR orders and does not want the patient transported. What should the EMT do next?


A. Explain the risks of refusal of transport.

B. Ask to see the patient’s DNR orders.

C. Have the patient sign a refusal form.

D. Request law enforcement intervention.


The exam is adaptive, so it’s not one set of questions for every candidate. Instead, it adapts based on your ability to answer questions and may become harder or easier based on your progress.


Generally, candidates may see anywhere from 60 to 120 questions, but the number of questions they receive doesn’t indicate whether they passed or failed. The exam is also timed, with most candidates spending 30-60 seconds on each question.


If you get concerned about the time limit, note that the NREMT states that less than 1% of candidates fail based on running out of time.

2. Create a study schedule

Organization is key. Develop a study schedule that breaks down your study material into manageable chunks. Allocate specific times for each subject or topic, ensuring you cover all areas without cramming. Consistent, daily study sessions are more effective than last-minute marathon sessions.


Create a plan for how long you want to study for your exam – we always recommend taking the exam within one month of completing your EMT initial course. Sooner is better, since knowledge lapses over time, even with studying.


Based on that timeline, set out time to study, preferably each day for an hour or so, to keep up your knowledge and ability. Avoid spending 12 hour days studying to cram in just a couple days before the exam – this might lead to exhaustion and not remembering everything properly.

3. Focus on specific topics

The cognitive exam tests specific topic areas in EMS:


  • Airway, Respiration & Ventilation

  • Cardiology & Resuscitation

  • Trauma

  • Medical/Obstetrics/Gynecology

  • EMS Operations

Tailor your studying to these areas – this helps break all the information into manageable chunks instead of trying to review everything all at once.

4. Utilize active learning techniques

Passive reading is less effective than active learning. Engage with the material by:


  • Practice Questions: Regularly complete practice questions to test your understanding and identify weak areas (recommendations for study apps are at the end of this post!).


  • Flashcards: Use flashcards for memorization, especially for key terms (such as anatomy, physiology, and pharmacology) and definitions. Hand-writing your own notecards can also be a helpful memorization technique for visual and kinesthetic learners.


  • Teach Others: Explaining concepts to a study partner or someone you live with can reinforce your understanding. If you can explain it to someone, then you understand the concept!

5. Master test-taking strategies

Effective test-taking strategies can significantly impact your performance. Here are a few to consider:


  • Read Carefully: Ensure you understand each question and all answer choices before selecting an answer. Some questions may ask the negative, which is what should you not do? Make sure to know what the question is actually asking before looking at the answers. Read the last sentence of the question an extra time to be sure you understand.


  • Eliminate Wrong Answers: Narrow down your choices by eliminating clearly incorrect options.


  • Time Management: Keep an eye on the clock to ensure you have enough time to address all questions. Practice pacing yourself during mock exams.

6. Take care of your health

Your physical and mental well-being play a crucial role in your study effectiveness. Ensure you:

Get Enough Sleep: Aim for 7-8 hours of quality sleep each night to enhance memory and cognitive function. Put down your phone an hour before bed, or at least once you get into bed, to ensure higher quality sleep. 


Eat Well: Maintain a balanced diet to keep your energy levels stable.

Exercise Regularly: Physical activity can reduce stress and improve concentration. You may even find studying while on a stationary bike or treadmill can help increase your retainment of knowledge!

7. Stay positive and confident!

Maintaining a positive attitude and confidence in your abilities can reduce exam anxiety. Practice relaxation techniques while studying and anytime you feel nervous about the exam, such as deep breathing, meditation, or visualization to keep calm and focused.

Recommended Study Tools

Here are some of the study tools we recommend to our EMT initial students and RN to EMT students – the best way to study is practicing applying your knowledge on new multiple choice questions (not just studying old exams).


Please note that we are not affiliated with or sponsored by any of these companies – we just like to help guide our students to helpful resources!


  • Limmer Education YouTube Channel (free)

    • Hosts NREMT cognitive exam jeopardy games

    • Review questions

    • Approaches on dissecting NREMT exam questions

    • Provides updates on any exam changes

  • LC Ready (pricing varies – we are able to offer a 15% discount if you email us at [email protected]!)

    • EMT lecture series

    • EMT review

    • NREMT prep crash course

    • Options for multiple ways of studying

  • FISDAP ($20-30)

    • Study tools for both EMT and EMR NREMT cognitive exam

    • Test prep questions and review 

  • EMT Pocket Prep (free to download app – check your phone’s app store)

    • EMR or EMT practice questions

    • One of many phone app options for NREMT study prep!


Preparing for a multiple-choice medical exam requires a combination of strategic planning, active learning, and self-care. By understanding the exam format, focusing on high-yield topics, using effective study techniques, and maintaining a healthy lifestyle, you can enhance your performance and achieve success.


Remember, consistency and perseverance are key. Good luck!