# 3rd NREMTB attempt



## DSemt54 (Mar 13, 2010)

Hey Everyone,

I failed the NR twice, I came really close both attempts.
Can someone please refer me to a NR study book I can purchase at a local Barnes n nobles that will adequately prepare me for the NR.
(Kaplan sucks.)
And also if you know any good websites that offer situational questions like the NR please let me know :3

Your help is very appreciated, I do not want to fail again, I feel very stupid already. :sad:

Regards,
D h34r:


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## SanDiegoEmt7 (Mar 13, 2010)

Where did you go to EMT school?  Can they provide you with more practice tests to hone your skills?  

What book did you use?  Perhaps a buying a different book that is more tailored to the NR, if yours wasn't. And utilize the study or workbook that comes with the textbook.


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## DSemt54 (Mar 13, 2010)

I actually went to a very good EMT program in Walnut, Ca.

Right now I'm even embarrassed to apply for the 3rd attempt, I wouldn't want to go back and ask for help.

After failing the first time I went and purchased a book written by Kaplan, I read and studied the entire book, And failed my 2nd attempt at 120questions.

I'm feeling really down atm, I just want a book that will adequately prepare me for the situational based questions. =/


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## SanDiegoEmt7 (Mar 13, 2010)

So here are my tips then,

1) Do not be embarrassed.  Just because you are having a hard time on the test doesn't mean that you can't be a good EMT.  Usually you are just overthinking the questions.  

2) You need to know all of the numbers and ranges etc. in your book (basic vitals ranges, normal findings etc.) but a summary book is also a good addition to your study materials.  A lot of times the workbooks say the same ideas in less words, so its easier wrap your head around topics.  

3) You need to take as many practice tests as possible.  Either call schools that can provide printed tests with answer keys, or search for websites:

http://id44.com/#FREEEMTSTESTS

First one I found, there could be more.

If you PM me your address I will mail you my old Workbook, as long as you promise to pay it forward to some other EMT later ^_^


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## DSemt54 (Mar 13, 2010)

SanDiegoEmt7 said:


> So here are my tips then,
> 
> 1) Do not be embarrassed.  Just because you are having a hard time on the test doesn't mean that you can't be a good EMT.  Usually you are just overthinking the questions.
> 
> ...





I appreciate your tips and your offer very much.


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## Angel (Mar 13, 2010)

i think what you should try is listing all the conditions you know...
like stroke, seizure, cardiac arrest, bleeding injuries, resp injuries ect. and list the signs and treaments.

this is pretty much the test in a nutshell. knowing whats what, and what to do first. certain books wont help because they ask dumb questions like "what is the well-being on the EMT" things like that will never show up on the NR.

A woman who just delievered her baby is having vaginal bleeding, what do you do first?
A. Pack the vagina with guaze
B. Drive faster
C. Massage the fundus of her uterus
D. Call medical control
E. Place in shock position

Think what your book said, and why thats the better answer. and why the other ones are incorrect.


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## mct601 (Mar 13, 2010)

Most of the online practice tests do ask dumb questions, but I had some of EVERYTHING on my NR- but its focus was obvious: pediatrics, AED/CPR, OB, O.D./poisoning.


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## rescue99 (Mar 13, 2010)

mct601 said:


> Most of the online practice tests do ask dumb questions, but I had some of EVERYTHING on my NR- but its focus was obvious: pediatrics, AED/CPR, OB, O.D./poisoning.



Actually, if your tests focused heavily on those subjects they are your weaker subjects.


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## mct601 (Mar 13, 2010)

rescue99 said:


> Actually, if your tests focused heavily on those subjects they are your weaker subjects.



Actually I forgot about that... lol. 

There was a good bit of peds, and ob. AED was sprinkled in between. what sucked for us is we were taught AED one way, and by the end of class they pretty much said the NR testing was different for AED.


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## DSemt54 (Mar 13, 2010)

Angel said:


> i think what you should try is listing all the conditions you know...
> like stroke, seizure, cardiac arrest, bleeding injuries, resp injuries ect. and list the signs and treaments.
> 
> this is pretty much the test in a nutshell. knowing whats what, and what to do first. certain books wont help because they ask dumb questions like "what is the well-being on the EMT" things like that will never show up on the NR.
> ...




Massage the fundus, Correct?


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## Angel (Mar 13, 2010)

yup thats right.

look for questions similar to that and things that have vital signs. 
You have a 62 year old male with two to three word dyspnea and gurgling respirations. His BP is 140/90, HR is 110 resp rate is 10 and labored
Whats your first step in his treatment?

Administer oxygen
Suction his airway
Transport in fowlers position
continue your assesment

questions like this one above are similar to what youll find on the test. 
i found more luck with reading through my book than the practice tests, though they were helpful to me with realizing how to read a question. ie if a patient is awake and complaining of something, when your beginning treatment youll skip airway because if your talking...you have a patent airway so you move on to breathing.


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## mct601 (Mar 13, 2010)

I used practice tests to let me know what areas I needed to study harder on.  Thats it. Not to simulate NR, or anything.  Of course, if you blast through a practice test that doesn't exactly mean you're proficient in that subject area.


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## AVPU (Mar 13, 2010)

I agree with all of the above. Know not just what the right answer is, but why it's the right answer. This will help you a lot, esp. if you decide to go the route of practice tests. At the top of the NREMT forum, there are two stickies related to trouble passing the NR. One lists free practice tests online. Personally I am a fan of smartmedic.com, J&B (although I don't think this one's free), and emtb.com. Through my practice tests I discovered my weakness is airway and breathing (knowing what breathing apparatus to use....BVM, non re-breather, etc) and why. 

I did not pass the first time; I'm gearing up to re-take within a couple weeks (hopefully.....the Pearson Vue website is having probs right now). I feel a lot more confident this time around. I was devastated when I found out I had failed the first time. Don't give up. It's a ton of info to know. Just keep plugging away, and you'll get it.


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## exodus (Mar 13, 2010)

JB cost money, but if you do well on the JB tests, I can almost guarantee you'll pass NR first time.


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## AVPU (Mar 13, 2010)

Oh, here's something else that may help: slow down and read each question carefully. You have plenty of time. This may sound simplistic, but on practice tests I've missed a question b/c it read "conscious child" and I read "UNconscious child." 

Also, something my instructor had warned us about, and something I noticed about the NR, is that every answer option may suck. Pick the answer that sucks LEAST. Sometimes the words "what do u do first?" tip you off. Like, in Angel's above examples, which one do u do FIRST? For a bleeding patient who has just delivered, you wouldn't transport her FIRST. You would eventually, but first u would massage (and who doesn't want a massage?...sorry, couldn't resist).

Good luck!


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## MusicMedic (Mar 13, 2010)

the JB tests worked the best for me, i pretty much took those tests every night till i got atleast a 90% on them...

its well worth the $29.00, or however much it cost...

http://www.prenhall.com/emtachieve/


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## DSemt54 (Mar 13, 2010)

Angel said:


> yup thats right.
> 
> look for questions similar to that and things that have vital signs.
> You have a 62 year old male with two to three word dyspnea and gurgling respirations. His BP is 140/90, HR is 110 resp rate is 10 and labored
> ...



Suction his airway.
It's ABC's or whats going to kill the patient first, correct?


Also, I appreciate all the help and encouragement all the fellow members on this website are giving me, this community is very helpful and I look forward to helping fellow EMT's once I pass my NR.


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## Angel (Mar 13, 2010)

right, you got it
what do you think your issue is with testing? 
i know my first time i just did not know enough....in class we skipped a few chapters and those were the questions i got the most. 

remember rule of nines for kids and adults, know about positive pressure ventilations? when and why? 
gaining access, hazmat situations, OB is a big one, lifting a moving pts (i only got 2 questions on this) 

triage, what is green red and black, EARLY signs of shock as well as late signs, contraindications for nitro, how many times to give nitro a chance to work?

 treatment for seizures, contraindications for OPA/NPA, offline med control, quality improvement, steps for stopping bleeding, (types of bleeding arterial vs. venous) 

hyperthermia/hypothermia; late signs AND early signs, who is at more of a risk? (shaking vs not shaking, AMS), treatment and transport of stroke pts.

if any of the things i said dont seem familiar then review your book. just read through the important stuff. this coupled with a case review book helped me pass...
dont go in you test being defeated...take a deep breath and go.


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## DSemt54 (Mar 13, 2010)

Angel said:


> right, you got it
> what do you think your issue is with testing?
> i know my first time i just did not know enough....in class we skipped a few chapters and those were the questions i got the most.
> 
> ...




I over think things, I've always been this way unfortunately. 

1) rule of nine's, the main difference between adults and kids is that kids have a bigger head. assisting the pt's ventilation's hypo ventilating, or non breathing/unconscious.
2) red is Immediate, Pt needs immediate care to prevent loss of life/limb.
black= dead yellow= delayed green=walking wounded (minor)
3) shock- early signs; agitation, anxiety dloc (due to cerebral hypoxia) rise in pulse (trying to compensate) late signs; drop in b.p, pale cool clammy skin, glass eyes further decrease in loc.
Contraindications Nitro Glycerine; 1-b.p lower than 100 (systolic) 2-pt. has taken sexually enhancing drugs within 24hrs, i.e Viagra (will cause irreversible hypotension) 3- pt has already taken 3 (max) doses prior to EMT arrival 4- last dose less than 5m, nitro can be given 3 times within 10m, if the pain persist, assume its a AMI.
Seizures- Do not touch the pt. during Clonic, nothing PO, remove hazards surrounding pt, Post phase, spinal precautions, LLR.
OPA- Gag reflex, Conscious pt. 
Npa- Facial Trauma
Bleeding- Direct pressure, Elevate the limb, Pressure point.
Hypothermia, core temp below 94, shivering is good, once it stops, be scared.
Hyperthermia- Sweating is good, once it stops and pt is dry, be scared. =p

This is all from memory, please correct any mistakes.


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## Angel (Mar 13, 2010)

you pretty much got everything, but for rule of 9 know whats what on the adult and child, ie both sides of the chest is 18, arms are 9 each, ect ect. and palms are 1 each
i got asked this on both tests and got it right the second time around. know the difference between superficial and partial thickness burns (blisters) and how to treat. remove jewlery or no?

know how to triage hypothermic patients, elder or infant first? (of course this depends on the condition thats presented) 
on an OB patient when do you deliever vs transport? prolapse cord, limb presentation, breech...know what to do. suction the mouth or the nose first? 
what amount of vaginal bleeding is "normal"?

you seem like you really know it, its just getting through the test.


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## DSemt54 (Mar 13, 2010)

Angel said:


> you pretty much got everything, but for rule of 9 know whats what on the adult and child, ie both sides of the chest is 18, arms are 9 each, ect ect. and palms are 1 each
> i got asked this on both tests and got it right the second time around. know the difference between superficial and partial thickness burns (blisters) and how to treat. remove jewlery or no?
> 
> know how to triage hypothermic patients, elder or infant first? (of course this depends on the condition thats presented)
> ...




Depends on their core temp, tricky, because Elders AND infants can become hypothermic quickly, 
Prolapse,Limp-Transport RLS, LLR, Hips elevated, Breech, Attempt to deliver, If the head doesn't deliver, Enter a gloved hand (V) and open an airway for the baby and transport.
Baby's and infants are obligated Nose breathers so suction the mouth first to avoid aspiration.

I went threw a very tough program, I know a lot of information and i have no problem regurgitating facts, But I really suck at test, I over think the situations. =/


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## CSLEMT (Mar 14, 2010)

*NREMT Study Material*

Check out:

http://wps.prenhall.com/chet_limmer_emergencycare_10/19/5005/1281453.cw/index.html

emtb.com

Take your time and take all the tests...  it will help.


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## DSemt54 (Mar 14, 2010)

CSLEMT said:


> Check out:
> 
> http://wps.prenhall.com/chet_limmer_emergencycare_10/19/5005/1281453.cw/index.html
> 
> ...



Thank you. B)


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## 8jimi8 (Mar 14, 2010)

DSemt54 said:


> Massage the fundus, Correct?



call medical control. is the best answer out of those choices (besides drive faster lol)

never put anything in the vagina. (while on shift)

UNLESS, you can see a portion of the umbilical cord protruding, or you see foot hanging out.  An arm would be questionable, but the correct answer is still "contact medical control"


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## 8jimi8 (Mar 14, 2010)

DSemt54 said:


> Hey Everyone,
> 
> I failed the NR twice, I came really close both attempts.
> Can someone please refer me to a NR study book I can purchase at a local Barnes n nobles that will adequately prepare me for the NR.
> ...



you should look toward attending a testing review class.  I took the "Hurst Review" (this is a nursing school review/ nursing licensure examination prep course) on day five of the hurst review, class ended and I went and took my NREMT-Basic CAT.  The reason i mention the review class is because they go IN-DEPTH about testing strategies.   You already know ABC's!  90% of the test is ABC's.  You have to begin to understand what the test wants you to think about first.  They want you to think about, what is going to kill the patient first, or Is there NOTHING that I can do now, that will definitively treat the patient's condition (in the case that you cannot, a rapid transport, or ALS intercept is the correct answer)... BUT you ALWAYS GO BACK TO ABC's!

anyway...

take a testing prep-course, don't try to study it on your own.  Get with some professionals who have studied the exams and have an intimate knowledge of proper testing strategies.


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## AVPU (Mar 15, 2010)

never put anything in the vagina. (while on shift)

Gotta love EMT humor. LOL!


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## EMSLaw (Mar 15, 2010)

8jimi8 said:


> call medical control. is the best answer out of those choices (besides drive faster lol)
> 
> never put anything in the vagina. (while on shift)
> 
> UNLESS, you can see a portion of the umbilical cord protruding, or you see foot hanging out.  An arm would be questionable, but the correct answer is still "contact medical control"



You don't need to contact medical control for vaginal bleeding post-delivery.  You put a pad against (but not in) the vagina to soak up the blood, and massage the fundus.  A certain amount of bleeding is to be expected.  

Neither EMTs nor Medics are authorized to deliver a limb presentation in the field.  A Medic can deliver a frank breech.  Limb presentation or prolapsed cord, cover with moist dressings and beat feet, since the definitive care is probably going to be an emergency c-section.  In the latter case, you can also put the mother on her knees to take pressure off the cord. 

You should follow your locol protocols, of course, but medical control isn't going to tell you anything you don't already know.  ("I see a leg sticking out where it shouldn't be."  "Come to the hospital.")


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## joeshmoe (Mar 20, 2010)

I found practice exams totally useless when it came to preparing for the NREMT. 
If your course didnt do a good job of preparing you for the exam, maybe try buying a different brand text book and reading it from cover to cover. 

I'll give the NREMT credit, the test didnt seem worried about whether you knew a lot of fancy medical terminology or whether you calculate the rule of nines exactly or the apgar scale and stuff like that. It focused on you being able to recognize and prioritize serious medical problems and provide the correct treatment in the best order.


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## Angel (Mar 21, 2010)

basically, except i did have to know the rule of nines for my test...palms (which wasnt emphasized) too


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