Ready for a wild fact that makes students look at me like I have three heads?
You can miss almost HALF the questions on the NREMT and still pass.
Yes, really.
No, I’m not trying to trick you.
No, this isn’t some obscure technicality or footnote.
And no, you don’t need to reread that sentence five times (although you probably will).
Let’s walk through why that’s true, what the NREMT actually cares about, and how understanding the testing logic can completely change your mindset going into test day.
The Myth of 70%
We’ve all been conditioned in school to believe in a hard 70% cutoff.
70% = pass.
69% = fail.
Black and white. Cut and dry. Not so easy!
So when students start prepping for the NREMT, they often assume that same rule applies: “If I miss more than 30% of the questions, I’m toast.”
But here’s the thing: the NREMT is not scored like a traditional exam.
There is no universal pass/fail percentage. In fact, the number of questions you get right matters less than which questions you get right and how you perform over time.
To understand this better, we need to break the exam down by format.
CAT Logic (EMR, EMT & Paramedic)
If you’re taking the emergency medical responder (EMR), EMT, or Paramedic version of the NREMT, you’re dealing with what’s called a Computer Adaptive Test (CAT).
This is not your average multiple-choice exam. CAT exams are dynamic. Which means the difficulty of your questions changes in real time based on your performance. Every question you answer affects the next question you see.
Here’s how it works:
• The test begins with a question of medium difficulty.
• If you answer it correctly, the next question will be slightly harder.
• If you answer that correctly, the next question gets harder still.
• If you miss one, the algorithm adjusts and gives you something a bit easier.
The goal? To zero in on your true competency level. The system is constantly asking, “Is this person consistently performing at or above entry-level competency?”
And here’s where it gets interesting:
You could get 30 questions wrong out of 60 total…and still pass if the 30 you got right were more difficult, higher-value questions.
That’s because each question is scored based on difficulty level, not just a right/wrong binary. So a “hard” question counts more than an “easy” one. The system doesn’t just count how many you got correct. It’s measuring how well you performed over time and how consistent your knowledge is at different levels of difficulty.
This is why someone can finish early and pass… or answer a full 120 questions and still fail. It’s not about quantity. It’s about demonstrated competency.
Fixed Format (AEMT)
If you’re taking the AEMT exam, you’re the lone wolf still on a fixed-format test.
That means:
• Everyone gets the same number of questions.
• Everyone answers all of them.
• There’s no adaptive difficulty built in.
At first glance, this might seem more like a traditional exam, but there’s still a twist: Not every question counts.
Mixed in with the scored questions are pilot questions. These are experimental items that the NREMT is testing for future use. You won’t know which ones are pilot items and which ones are scored, and your results won’t be impacted by how you answer the pilot items.
So what does that mean for you?
• You could miss a question and think you blew it, but it may not have even been scored.
• Your focus shouldn’t be on perfection, but on steady, competent performance across every domain.
• Missing questions doesn’t mean failure. The real concern is consistently missing questions in the same domain.
So again: It’s not about how many you get right, it’s about how well-rounded and competent your answers are.
Practice Question
A 45-year-old male is unconscious with snoring respirations. You reposition the airway. Breathing improves. What’s your next step?
A) Administer oxygen
B) Insert an oropharyngeal airway ✅
C) Apply jaw-thrust again
D) Start BVM ventilations
On paper, a few of these seem reasonable. But the NREMT isn’t just checking your knowledge it’s checking your decision-making process.
• You already repositioned the airway and it worked, so repeating the jaw-thrust doesn’t make sense.
• You’ll eventually give oxygen but not before securing the airway.
• BVM? Not needed yet. Breathing improved.
The correct move here is inserting the OPA. It’s about progression. It’s about what comes next. This is a perfect example of how the NREMT isn’t just testing facts it’s testing whether you can think like a provider.
What About Long Tests? Or Really Short Ones?
One of the most stressful parts of a CAT exam is not knowing how long it’ll go. Some people finish in 70 questions. Others go all the way to 120. And everyone leaves the room thinking, I either did really well or totally failed.
Here’s the truth:
• If your test ends early: you may have passed because the system was confident in your ability.
• If your test goes long: it means the algorithm needed more data to decide. It doesn’t mean you failed.
• If you felt like the questions were hard: that’s a good sign. The test only increases in difficulty when you’re getting questions right.
This test is not about how confident you feel walking out. It’s about how consistently competent you were while answering the questions.
Bottom Line: Don’t Panic
Hard questions? That’s the point. Long test? You’re still in the game. Finished early? Doesn’t mean you failed.
Let’s recap:
• You don’t need to “score” a 70%. You need to demonstrate that you can consistently think and act like an entry-level EMS provider.
• The number of questions you miss doesn’t matter as much as the difficulty level of the ones you get right.
• Whether you’re on a CAT or fixed-format exam, your job is to stay calm, think clearly, and make good clinical decisions even if it feels hard.
• Hard questions mean you’re doing well. Long exams mean the algorithm is still gathering data. Early finishes can mean you nailed it.
So next time you catch yourself spiraling over your practice test score or worrying about how many questions you missed, remember this:
The NREMT doesn’t care about your grade – it cares about your knowledge.
Coming Next: Test-Taking Like a Pro & How to Think Like the Exam.
