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Purpose: To adjust item numbers in a national test, this study used item response theory to examine changes in average scores, reliability, difficulty, and discrimination according to the adjustment of item numbers. Methods: We analyzed the dichotomous coding of correct and incorrect answers of 473 examinees in a mock test conducted in 2023. Additionally, as an explanatory pilot study, we used an online questionnaire to survey experts on their perceptions of the appropriate item numbers for each test subject from January 18, 2024, to February 15, 2024. Results: Regarding the item numbers on the national exam, experts preferred to reduce the number of management of emergency patients (33.14±6.09, p<.05) and advanced emergency medical care: subtopics (104.49±11.55, p<.05), and the total number of questions (217.82±20.95, p<.05). In a simulation set in which items with low item fit were removed after fitting a two-parameter item response theory model, reliability was maintained at .910 until the 5th test consisting of 185 questions with little loss of difficulty, discrimination, and average score, and there was no correlation between item numbers and average score. Conclusion: Experts responded that reducing the number of items on the national exam was appropriate. As a result of the item reduction simulation, there was no significant loss in the average score, difficulty, discrimination, or reliability. More reliable results could be obtained if the results were based on a validity analysis and analyzed using actual national exams.