1. Which of the following is your primary goal during airway management?
a. Ensure clear, unobstructed breathing.
b. Ensure that CPR is effective.
c. Provide a means of drug administration.
d. Provide optimal patient ventilation.
2. You are on scene managing a 14-year-old asthmatic male. He is breathing 28 breaths/min and has retractions. Which of the following is your primary focus?
a. Ensure adequate perfusion.
b. Ensure optimal ventilation.
c. Get ready for CPR.
d. Perform a secondary survey.
3. A 57-year-old obese male patient has been found unresponsive. Ventilating the patient’s lungs with a bag-mask device has improved the pulse oximetry up to 88%. Which of the following might continue to improve the pulse oximetry?
a. Adequate inflation of the endotracheal tube cuff
b. Assessing end-tidal CO2 when performing CPR
c. Ensuring a good mask seal when using a bag-mask device
d. Failure to ventilate between intubation attempts
4. A 27-year-old male patient has been found apneic behind a nightclub. Bystanders suggest that the patient has overdosed on heroin. You are attempting to initially ventilate the patient’s lungs using a bag-mask device, but the patient’s color fails to improve and there is difficulty squeezing the bag. A common reason for this includes:
a. Failure to properly tilt the head and lift the chin
b. Forcing the tongue into the throat with high-pressure breathing
c. Overly squeezing the bag and forcing too much air into the patient
d. Pressing too tightly with the bag-mask device on the patient’s face
5. Which of the following is a structure of the upper airway?
6. A 15-year-old is complaining of pain and pressure in his right ear and the right frontal sinus. He states he just arrived on a flight returning from vacation and, as the aircraft descended, the pain and pressure started. He also states that his hearing is diminished in his right ear. A likely cause for the teenager’s problem is:
a. Basilar skull fracture
b. Blocked eustachian tube
c. Inner ear infection
d. Right frontal sinus infection
7. Although the palatine tonsils are part of the lymphatic system, they affect the airway because:
a. They cause asthma to develop in children.
b. They cause the trachea to close when we swallow.
c. They secrete saliva coating the cilia.
d. When inflamed, they can impair breathing causing respiratory distress.
8. The narrowest part of the adult upper airway is known as the:
b. Glottic opening
9. As you and your partner are assisting ventilations with a bag-mask device, you notice significant distention of the stomach. Which of the following maneuvers will help prevent further dilation?
a. Gentle compression of the lateral neck
b. Gentle pressure below the thyroid cartilage
c. Gentle pressure over nares
d. Gentle pressure superior to the thyroid cartilage
10. Compared to the left mainstem bronchus, the right mainstem bronchus is:
a. At a more gradual angle
b. Made of thicker membrane
c. More angled from the trachea
d. More narrow
11. Which of the following is the function of the cilia?
a. Cool exhaled air
b. Filter inhaled air
c. Help O2/CO2 exchange
d. Warm inhaled air
12. Which of the following respiratory structures is the location of oxygen and carbon dioxide exchange?
13. A 15-year-old male patient is eating chips while laughing. He begins to cough forcefully. Which of the following reflexes is preventing aspiration of the chips into the lungs?
a. Gag reflex
b. Korsacoff’s reflex
c. Retch reflex
d. Vagus nerve reflex
14. You are attempting to intubate an apneic patient. As you pass the tube through the vocal cords, the patient begins to cough. Which of the following changes in the vital signs would be expected with this symptom?
a. Bradycardia, hypertension, and increased ventilation
b. Bradycardia, hypotension, and decreased ventilation
c. Tachycardia, hypotension, and decreased ventilation
d. Tachycardia, hypotension, and increased ventilation
15. A patient has overdosed on narcotic medications. Upon your arrival, the patient has no obvious gag reflex. Which of the following conditions may this patient develop because of his lack of gag reflex?
b. Aspiration pneumonia
16. A chemical substance inside the alveoli that acts to lubricate the alveoli, decrease surface tension inside the alveoli, and facilitate expansion of the alveoli is known as:
a. Atelectasis enzyme
b. Hilum expansion chemical
c. Surface enzyme
17. Pulmonary surfactant:
a. Increases airway pressures within the lungs
b. Increases the attractive forces between the water molecules in the lungs
c. Lowers the recoil in the elastic fibers in the alveolar walls
d. Lowers the surface tension, preventing alveolar collapse
18. A 4-year-old girl is in respiratory arrest. After opening the airway and ventilating the lungs using a bag-mask device, you notice that there is no chest rise and fall with the bag-mask ventilation. A head tilt/chin lift maneuver is repeated. Which of the following is the next most important step?
a. Assess for foreign body obstruction.
b. Assume pneumothorax and perform a needle decompression.
c. Assume that there is an infectious process and continue to ventilate using the bag-mask device.
d. Assume that the bag-mask device is defective and should be discarded.
19. Placing an infant or young child in a supine position may cause flexion and occlusion of the airway. Which of the following may be the cause for this occlusion?
a. The anterior location of the larynx and pharynx
b. The extreme flexibility of the infant’s airway
c. The larger size of the child’s head relative to his body
d. The larger size of the child’s tongue relative to his body
20. You are preparing to intubate a 4-year-old male patient. Upon removing the endotracheal tube from its package, you notice there is no inflatable cuff on the tube. Which of the following explains why this tube does not have a cuff?
a. The pediatric airway collapses and is too small for a cuff.
b. The pediatric airway creates a natural seal around the tube.
c. The pediatric airway is fragile and a cuff may rupture it.
d. The pediatric airway is too rigid to accommodate a cuff.
21. A 4-year-old boy requires transport to the hospital for evaluation of his autism; his parents tell you he is acting much worse today than normal. He is restless and somewhat combative. You place the child on the gurney and secure several straps across his chest and abdomen to keep him still. Shortly thereafter, the child develops respiratory distress. Which of the following could be contributing to the child’s respiratory distress?
a. A supine position may compress the airway because of the size of the head.
b. One or more straps could be interfering with the child’s diaphragm.
c. The combative child’s struggling is compromising his airway.
d. The child’s accessory muscle of breathing are impaired by the straps
22. The normal movement of the diaphragm during inspiration:
a. Causes passive inhalation
b. Causes the diaphragm to move up
c. Flattens the diaphragm
d. Increases the side-to-side dimensions of the chest
23. Which of the following is an anatomic difference in a child’s airway as compared to that of an adult?
a. A child’s tongue is small in relationship to the size of the mouth.
b. The distance from the vocal cords to the carina gets smaller with age.
c. The epiglottis is U-shaped in a child.
d. The vocal cords slope from front to back in infants.
24. Which of the following terms best describes the process of breathing?
25. A patient takes in a deep breath. The oxygen and carbon dioxide molecules transfer across the capillary in the alveoli. Which of the following terms best describes this type of respiration?
a. External respiration
b. External ventilation
c. Internal respiration
d. Pulmonary diffusion
26. A 52-year-old male patient states that he is short of breath and weak. He continues to tell you that blood has been passing in his stools. He has no history of respiratory complaints. He has a respiratory rate of 24 breaths/min and a heart rate of 118 beats/min. Which of the following may be the cause of this patient’s weakness and dyspnea?
a. Decreased carbon dioxide
b. Decreased hemoglobin
c. Decreased ventilation
d. Increased hematocrit
27. Air normally moves into the lungs from the:
a. Higher pressure within the lungs during inspiration
b. Increased intrathoracic pressure during inspiration
c. Positive pressure forcing air into the lungs
d. Pressure gradient created when the lungs expand
28. Diffusion is:
a. A gaseous substance dissolving in a liquid substance
b. The active transport of gas with energy expended
c. The movement of a gas from a higher pressure to a lower pressure across a semipermeable membrane
d. The movement of a gas from a lower pressure to a higher pressure across a semipermeable membrane
29. Which of the following is a normal PaO2?
a. 70 mm Hg
b. 90 mm Hg
c. 110 mm Hg
d. 140 mm Hg
30. The term partial pressure of gases refers to:
a. The concentration of a gas in a mixture of other gases
b. The concentration of a single gas unmixed with other gases
c. The pressure a gas exerts in a mixture of other gases
d. The pressure of a single gas unmixed with other gases
31. At sea level, the pressure of all gases is 760 mm Hg, or 760 Torr. If the concentration of oxygen in the atmosphere at sea level is 21%, the partial pressure of oxygen at sea level is approximately:
a. 150 mm Hg
b. 160 mm Hg
c. 180 mm Hg
d. 210 mm Hg
32. The normal partial pressure of oxygen in arterial blood is:
a. 80 to 100 Torr
b. 150 to 160 Torr
c. 180 to 200 Torr
d. 210 to 220 Torr
33. A 28-year-old male patient arrives in Denver (elevation 5200 feet) and immediately begins to hike up into the Rocky Mountains. He notes that he quickly became short of breath and has begun breathing rapidly. Which of the following may be a cause of his dyspnea?
a. Decreased partial pressure of carbon monoxide
b. Decreased partial pressure of oxygen
c. Increased partial pressure of nitrogen
d. Increased partial pressure of oxygen
34. One of the most prevalent atmospheric gasses is:
b. Nitric oxide
d. Water vapor
35. Measuring the oxygen levels in a patient’s blood can give the paramedic valuable information. A pulse oximeter is an external device that measures:
a. The partial pressure of carbon dioxide in the patient’s arterial blood
b. The partial pressure of oxygen in the patient’s arterial blood
c. The percentage of free oxygen in the patient’s arterial blood
d. The percentage of oxygen bound to hemoglobin in the patient’s blood
36. A patient has a pulse oximetry reading of 72%. You notice the patient has some cyanosis of his fingers and toes. He is breathing 24 breaths/min. Which of the following would be the most important action?
a. Assess for external bleeding.
b. Obtain a 12 lead ECG.
c. Place the patient on the cardiac monitor.
d. Provide supplemental oxygen.
37. A normal pulse oximetry reading is at or above:
38. You are caring for a patient in the early stages of shock for which the body is compensating adequately. Which of the following comments regarding pulse oximetry readings is appropriate?
a. The reading is completely accurate and reflects oxygen saturation.
b. The reading is inaccurate because of the poor perfusion to the periphery.
c. The reading is low and calls for aggressive airway management.
d. The reading suggests adequate breathing and oxygenation.
39. Most of the oxygen in blood is carried:
a. As carboxyhemoglobin
b. Attached to hemoglobin
c. Attached to leukocytes
d. Dissolved in plasma
40. The most important factor in determining the extent to which oxygen combines with hemoglobin is the:
a. Number of oxygen receptor sites on the hemoglobin
b. Partial pressure of oxygen in the blood plasma
c. Partial pressure of oxygen in the lungs
d. Relative number of red blood cells in the plasma
41. Which of the following is a normal PaCO2?
a. 20 mm Hg
b. 40 mm Hg
c. 50 mm Hg
d. 60 mm Hg
42. Carbon dioxide is transported to the lungs in blood in the form of:
a. Bicarbonate ions
b. Carbonic acid
c. CO2 active pump
d. CO2 gas bubble
43. A 78-year-old male with a history of severe emphysema has a pulse oximetry of 96%. However, he is breathing 26 breaths/min and is confused and combative. Which of the following would you expect to see from a blood gas reading?
a. Elevated PaCO
b. Elevated PaCO2
c. Elevated PaN
d. Elevated PaO2
44. The transfer of oxygen and carbon dioxide between the capillary red blood cells and the tissue cells is called:
a. External respiration
b. Internal respiration
c. Internal ventilation
d. Pulmonary ventilation
45. On a cross-country flight, a patient begins complaining of shortness of breath. The flight attendant provides supplemental oxygen while the pilot prepares for an emergency landing. While breathing the supplemental oxygen, the patient states that breathing difficulties have subsided. Further, as the aircraft reaches the airport, the patient states that the distress had ended. Which of the following may be causing the respiratory distress?
a. Elevated hemoglobin levels in the patient’s blood
b. Low partial pressure of oxygen in the airplane
c. Low serum potassium levels causing hypoventilation
d. Pulmonary embolism caused by deep vein thrombosis
46. The patient is a 38-year-old woman who fell and broke her left femur. The woman is complaining of severe pain. Her vital signs are blood pressure, 116/70 mm Hg; pulse, 90 beats/min; and respirations, 18 breaths/min. After caring for the woman’s injury, you and your team place the woman on the stretcher and in the ambulance. You decide to monitor the patient’s pulse oximetry. Although the woman’s vital signs remain nearly unchanged, her SpO2 drops from 98 to 92 and her skin becomes slightly pale. Which of the following is the most likely cause for the drop in SpO2?
a. Development of shock lung
b. Loss of blood because of the fracture
c. Malfunctioning pulse oximeter
d. Severe pain interrupting breathing
47. Hypercarbia is best described as:
a. Decreased carbon dioxide levels
b. Decreased oxygen levels
c. Increased carbon dioxide levels
d. Increased oxygen levels
48. A 44-year-old male with a long history of type 1 diabetes calls 9-1-1 and complains of shortness of breath. You find the patient sitting upright in a kitchen chair. An assessment reveals a normal blood pressure, elevated pulse, and respirations of 32 breaths/min. There is a sweet odor to the patient’s breath. The patient states, “I can’t slow my breathing down.” Which of the following best explains the reason for the rapid breathing?
a. Anxiety resulting in a hyperventilation syndrome
b. Elevated fever increasing CO2 production
c. Metabolic acidosis (diabetic ketoacidosis)
d. Respiratory depression associated with drug abuse
49. A patient has been found unresponsive by a friend who states that the patient has a problem with heroin abuse. Upon his arrival at the hospital, the patient’s blood gas demonstrates a PaCO2 of 90. Which of the following would be a possible cause of this hypercarbia?
d. Metabolic acidosis
50. A patient has been complaining of pain and swelling in his right lower leg. He had a sudden onset of shortness of breath. He is tachypneic and dyspneic. Based on your clinical interpretation of his condition, which of the following conditions would you expect?
d. Normal PaO2
51. Which of the following is likely to decrease carbon dioxide production?
a. Anaerobic metabolism
d. Resting quietly
52. Hyperventilation leads to:
a. Dilated cerebral vessels
c. Improved cerebral perfusion
d. Low carbon dioxide levels
53. The greatest rate of airflow that can be achieved during forced expiration beginning with the lungs fully inflated best describes:
a. Peak expiratory flow
b. Peak expiratory reserve
c. Peak inspiratory volume
d. Peak residual volume
54. For which of the following conditions is peak expiratory flow decreased?
c. Profound hypovolemia
d. Pulmonary embolism
55. A patient is being evaluated, and the pulmonologist states that the minute volume is decreased. Which of the following would also be decreased?
a. Alveolar air volume
c. Peak expiratory flow
d. Tidal volume
56. You are caring for a 58-year-old male patient who has been on a ventilator at home. One of the ventilator settings shows FiO2 = 0.40. What does this indicate?
a. The minimum peak expiratory flow rate is 4 liters per minute.
b. The percentage of carbon dioxide arterial blood is 40.
c. The inspired oxygen is set at 40%.
d. The rate of breathing is set at 40 times per minute.
57. A patient has significant respiratory distress. Upon auscultation, you note increased rales and wheezes. The patient begins to have decreased mental status and respiratory failure. After intubating the patient, what FiO2 setting should be used?
58. Which of the following best describes respiration?
a. Involuntary with some voluntary control
b. Totally involuntary
c. Totally voluntary
d. Voluntary with some automatic control
59. A patient suffered severe head trauma and is not spontaneously breathing. Which location in the brain has sustained injury and is responsible for respiration?
a. Brain stem
b. Cerebral cortex
60. While you are deep suctioning a patient’s airway, he begins to cough forcefully. You notice the patient’s heart rate has dropped. Which of the following best describes this drop in heart rate?
a. Irritation of the medulla oblongata
b. Release of histamines in the airways
c. Stimulation of the beta-receptors of the lungs
d. Stimulation of the vagus nerve
61. A patient has suffered a cervical spine fracture. He is not breathing spontaneously. Which of the following nerves is experiencing the damage from the cord injury?
a. Apneustic nerves
b. Diaphragmatic nerves
c. Phrenic nerves
d. Pneumotaxic nerves
62. Scalene and sternocleidomastoid muscles are used:
a. As accessory muscles during labored breathing
b. As voluntary muscles if a patient chooses to take a deep breath
c. During mouth breathing
d. During normal quiet breathing
63. Physiologic dead space is:
a. Composed of the nonfunctional alveoli
b. Created by the upper respiratory tract and nonrespiratory bronchioles
c. Increased in patients with respiratory diseases such as emphysema
d. Normally 10 times the volume of anatomic dead space
64. Tidal volume is the amount of air:
a. Always present in the alveoli
b. Inhaled or exhaled during a normal breath
c. Left in the lungs after a forceful exhalation
d. That oOne can inhale after a maximal inhalation
65. Minute volume is the amount of air:
a. Available for gas exchange in every minute
b. In the dead space moved in and out of the respiratory tract each minute
c. In the tidal volume multiplied by the respiratory rate
d. That can be inhaled after a maximal inhalation
66. A patient with a tidal volume of 500 mL, a dead space of 100 mL, and a respiratory rate of 10 breaths/min has a minute alveolar ventilation of:
a. 3 L/min
b. 4 L/min
c. 5 L/min
d. 6 L/min
67. The pneumotaxic center is located in the:
c. Medulla oblongata
68. The major determinant(s) in controlling respiration is (are) the:
a. Impulses generated within the lungs
b. Oxygen content in the blood
c. Partial pressure of carbon dioxide
d. pH of capillary blood
69. Chemoreceptors are located in the:
a. Arch of the aorta
b. Blood vessels in the extremities
d. Spinal cord
70. A 77-year-old male patient has developed a severe cough and fever. He is breathing rapidly. Which of the following is a factor that is responsible for his increased respiratory rate?
a. Increased carbon dioxide
b. Increased carbon monoxide
c. Increased oxygen
d. Increased partial pressure of nitrogen
71. An Olympic athlete is exercising at maximum capacity. Which of the following best explains the body’s response mechanism that causes increased breathing for this athlete?
a. Baroreceptors in the aortic arch detect decreased oxygen.
b. Chemoreceptors in the carotid arteries detect increased carbon dioxide.
c. The medulla detects decreased oxygen.
d. The pneumotaxic center decreased inhalation.
72. A patient with chronic bronchitis is likely to rely on what mechanism to stimulate respiratory drive?
a. Changes in pH
b. Elevated carbon dioxide levels
d. Increased bicarbonate ions
73. An 88-year-old female patient suffers from COPD. A blood gas reveals that her PaCO2 level is 85. She is mildly dyspneic, but not in acute distress. What would best explain these findings in this patient?
a. The PaCO2 level is normal.
b. The patient is hyponatremic.
c. The patient’s body is working on hypoxic drive.
d. The situation is acute, and the patient’s body has not responded yet.
74. Hypoxemia is defined as
a. Inadequate blood oxygen levels
b. Inadequate hemoglobin levels
c. Inadequate tissue oxygen levels
d. Inadequate tissue perfusion
75. Hypoxia is defined as:
a. Inadequate blood oxygen levels
b. Inadequate hemoglobin levels
c. Inadequate tissue oxygen levels
d. Inadequate tissue perfusion
76. A 12-year-old child fell at school. The school nurse called EMS to assess the child and, if needed, transport the child to the hospital. You find minor injuries and vitals signs of BP—112/68 breaths/min; P—90; and R—24 breaths/min. Although the blood pressure and pulse are normal, you consider the rate of breathing to be:
a. Indicative of hyperventilation
b. Suggestive of head injury
c. Too slow for the child’s age
d. Within normal limits
77. Which of the following is the most concerning?
a. A 4-month-old female patient with a respiratory rate of 18 breaths/min
b. A 6-year-old male patient with a respiratory rate of 30 breaths/min
c. A 16-year-old female patient with asthma who has a respiratory rate of 24 breaths/min after a 4-mile run
d. A 75-year-old male patient with a history of COPD and a respiratory rate of 28 breaths/min
78. A patient in respiratory distress may sit upright, leaning slightly forward. The head may be tilted back with the neck extended, chin projected forward, and mouth open. Which of the following might cause a patient to present in this position?
a. Lower airway obstruction
b. Malfunction of the medulla
c. Malfunction of the pons
d. Upper airway obstruction
79. A 77-year-old male has difficulty in breathing and cannot lie flat. He states that it is much easier for him to breath when he sits upright. During your examination, he is breathing 24 breaths/min and has rales and rhonchi heard on auscultation. Which of the following causes should you suspect?
b. Left ventricular failure
d. Pulmonary embolus
80. A patient states he is having difficulty in breathing. Which of the following terms best describes this condition?
81. A patient has an altered level of consciousness after a head injury. The patient has a breathing pattern in which he speeds up his breathing and then it slows down and almost stops. Which of the following describes this type of breathing?
b. Cheyne-Stokes respirations
d. Kussmaul respirations
82. The patient is a 60-year-old woman with a history of congestive heart failure. She called 9-1-1 because of increased trouble breathing. In describing her recent history, she states that she cannot catch her breath unless she is sitting up. Her difficulty breathing is best described as:
83. In assessing a patient complaining of trouble breathing, you notice that the patient’s anterior-posterior chest diameter seems larger than normal. This condition is more commonly known as:
a. Barrel chest
b. Chronic bronchitis
d. Pulmonary hypertrophy
84. The ease with which the lungs expand during inspiration is known as:
a. Atmospheric diffusion
c. Inspiratory pressure gradient
d. Pulmonary pressure
85. A hiccup results from stimulation of the:
b. Intercostal muscles
d. Nasal passages
86. A respiratory pattern characterized by an irregular pattern, rate, and volume, with intermittent periods of apnea is:
c. Central neurogenic hyperventilation
87. A respiratory pattern characterized by deep, rapid respirations is:
c. Central neurogenic hyperventilation
88. Your patient is 32-year-old construction worker who fell from a ladder. In assessing the patient, you notice totally irregular breathing that varies in rate and depth. Occasionally, you notice periods of apnea. Based on the patient’s recent history and the current breathing pattern, what do you suspect?
a. Acute asthma
b. Diabetic ketoacidosis
d. Severe head injury
89. Which of the following is used as a portable cylinder for the on-scene administration of oxygen?
a. E cylinder
b. K cylinder
c. L cylinder
d. M cylinder
90. You are caring for a patient in his apartment on the 10th floor. The patient is complaining of chest pain, and you have been administering oxygen via a nonrebreather mask at 15 L/min. You are preparing to move the patient to the ambulance and notice that your E cylinder gauge reads 650 psi. It will take you approximately 10 minutes to move the patient from your current position and load him into the back of the ambulance. You are concerned about the amount of oxygen remaining in the cylinder. What should you do?
a. Change the oxygen delivery device to a nasal cannula at 6 L/min.
b. Promptly transport the patient but do not worry about the remaining oxygen.
c. Reduce the liter flow to 10 L/min to conserve the remaining oxygen.
d. Take time to change the oxygen cylinder before moving the patient.
91. An advantage of liquid oxygen (LOX) over gaseous oxygen is that:
a. A larger volume of LOX can be stored in a smaller space
b. LOX is much cheaper than gaseous oxygen
c. The oxygen content in LOX is much higher
d. There are no special requirements for LOX storage and cylinder transfer
92. The purpose of a regulator attached to the oxygen cylinder is to:
a. Decrease the escape pressure from the tank.
b. Increase the escape pressure from the tank.
c. Mix room air to dilute the oxygen.
d. Provide a set flow rate of oxygen to the patient.
93. You are caring for a patient complaining of trouble breathing, and you are providing the patient high-flow oxygen with a nonrebreather mask. The patient’s spouse enters the room with a lit cigarette. Which of the following is the most appropriate action?
a. Ask the spouse to leave the room and extinguish the cigarette.
b. Discontinue the use of oxygen until the spouse leaves the room.
c. Grab the cigarette from the spouse and quickly extinguish it.
d. Use a fire extinguisher to snuff the cigarette and prevent a fire.
94. You are providing supplemental oxygen to a patient. A bystander notices the oxygen cylinder lying next to the patient’s bed and stands the tank upright, explaining that it provides better oxygen flow from the tank through the regulator. Which of the following is your next most important action?
a. Agree with and thank the bystander.
b. Return the cylinder to a flat position for safety.
c. Shake the tank to stir the oxygen to increase flow rate.
d. Use rope or chain to secure the tank to the furniture.
95. A patient with COPD is having difficulty breathing. He has an O2 saturation of 92%. You have a prolonged transport time. Which of the following would be the most appropriate for this patient?
a. Nonrebreather mask
b. Partial rebreather mask
c. Simple face mask
d. Venturi mask
96. The online medical director suggests up to 90% oxygen to a patient in moderate respiratory distress. Which of the following devices and flow rates would be used to deliver the suggested oxygen percentage?
a. Nasal cannula at 10 L/minute
b. Nonrebreather at 6 L/minute
c. Nonrebreather at 15 L/minute
d. Partial rebreather at 25 L/minute
97. The maximum acceptable flow rate for a nasal cannula is _____ L/min.
98. A nasal cannula delivers _____ % oxygen at a flow rate of 6 L/min in optimal conditions.
99. Oxygen concentrations of _____ can be delivered using a simple face mask at a flow rate of 10 L/min.
a. 20% to 40%
b. 40% to 60 %
c. 80% to 90%
100. An advantage of a Venturi mask is that:
a. It can be used to deliver a precise concentration of oxygen
b. High concentrations of oxygen can be delivered
c. It is color coded for easy recognition in dimly lit environments
d. It uses less oxygen but delivers a higher concentration
101. Which of the following best defines the purpose of humidified oxygen?
a. Bubble oxygen to add moisture to the gas
b. Dry moist oxygen to prevent airway irritation
c. Inject moisture into the oxygen cylinder
d. Moisten oxygen the inside the face mask
102. A child has a barking cough and coarse respiratory sounds. She has oxygen saturations of 99%. Which of the following treatments would be appropriate for this patient?
a. Intubate the patient.
b. Provide humidified oxygen.
c. Provide morphine sulfate.
d. Supply oxygen with a nonrereather.
103. A 48-year-old woman sustained a partial airway obstruction while eating a piece of steak. Her airway is only partially blocked by the meat. Which of the following may develop?
a. Allergic reaction to the foreign body and airway swelling
b. Drooling and saliva accumulation in the throat
c. Intact gag reflexes and monitoring for bradycardia
d. Poor oxygen-carbon dioxide exchange and hypoxia
104. A 34-year-old male patient was eating at a restaurant when, according to bystanders, he began to gasp and was unable to cough. The patient then collapsed and began turning blue. Upon arrival, which of the following is your first course of action?
a. Begin CPR.
b. Open the airway.
c. Perform a finger sweep of the oropharynx.
d. Provide supplemental oxygen.
105. A 45-year-old man chokes on a piece of steak during dinner and is coughing forcefully. What should you do?
a. Attempt a finger sweep.
b. Give abdominal thrusts.
c. Monitor the patient.
d. Perform back blows.
106. Your patient was choking on a piece of meat. He attempted to cough the meat out, then became silent and turned blue. You and your partner attempted the Heimlich maneuver without any success. The patient is now unresponsive. Which of the following would be an appropriate next action?
a. Attempt to remove the meat with Magill forceps.
b. Begin CPR.
c. Place an oropharyngeal airway.
d. Provide supplemental oxygen.
107. You are on scene with a 42-year-old male patient who had been choking and is now unresponsive. You have attempted the Heimlich maneuver without success and could not visualize the foreign object with direct laryngoscopy. Which of the following would be the next appropriate action?
a. Attempt to intubate and push food down into the right mainstem bronchus.
b. Check for a pulse.
c. Place a nasal airway.
d. Provide supplemental oxygen.
108. You arrive on scene to a patient who is unresponsive and not breathing spontaneously. In this patient, which of the following is the most common cause of airway obstruction?
a. Airway bleeding
b. Foreign bodies
c. Laryngeal edema
d. The tongue
109. A 30-year-old male was having dinner at a restaurant with friends while you and your partner were attempting to order food between calls. Suddenly, the man stands up and starts clutching his neck. His friends ask if he is okay, but all he can do is shake his head. Being a responsible paramedic, you volunteer assistance. You suspect that the primary cause of this man’s complaint is:
a. An allergic reaction to the shrimp he was eating
b. Aspiration of the alcoholic beverage he was drinking
c. Attempting to swallow a small fish bone
d. Complete airway obstruction by a foreign body
110. A 44-year-old woman has a partially obstructed airway from a piece of chicken. She is found awake, alert, and oriented, leaning over the dinner table, as the position affords her the most comfort. Although the woman has adequate air exchange, the airway could become totally obstructed. If the airway becomes obstructed, you can remove the bolus of food by:
a. Administering the Heimlich maneuver until the airway clears
b. Giving back blows until the woman coughs up the obstruction
c. Performing a cricothyroidotomy with a knife or “cric” kit
d. Visualizing the airway and removing the object with Magill forceps
111. For a complete airway obstruction in a conscious adult, which of the following is the first appropriate action?
a. Contact the medical director for permission to perform a cricothyroidotomy.
b. Immediately prepare to use a high-power suction device to clear the airway.
c. Intubate the patient in order to push the obstruction out of the way.
d. Perform abdominal thrusts to help the patient clear the obstruction.
112. A 30-year-old male patient is found unresponsive in his apartment after a night of partying. The man is exhibiting loud, sonorous respirations suggesting a partial airway obstruction. There is no suggestion of accidental trauma and nothing to indicate a possible neck injury. The best way to manually open the man’s airway is to:
a. Use the head tilt/chin life maneuver
b. Use the jaw-thrust maneuver
c. Open the mouth by tugging on the mandible
d. Open the mouth through the oropharyngeal airway
113. A 16-year-old male was standing on the top of a car when the car suddenly moved. The teen fell from the car and struck his head rendering him unresponsive. The best method for manually opening the teenager’s airway is the:
a. Head tilt/chin life maneuver
b. Head tilt/neck lift maneuver
c. Jaw-thrust maneuver
d. Oropharyngeal airway
114. A patient has suffered a direct blow to the nose and mouth by a baseball. You open the airway, and there is blood in the oropharynx. Which of the following is the most appropriate method to clear the airway?
a. Use the left lateral recumbent position.
b. Place a nasal airway.
c. Suction the upper airway.
d. Use a bag-mask device to oxygenate the patient.
115. A 24-year-old male patient has overdosed on narcotics and is unresponsive. It appears that he may have vomited and has some remaining stomach contents in his mouth. Which of the following would be an appropriate action?
a. Create an open airway without positioning the head or chin.
b. Perform a needle decompression.
c. Remove large obstructions such as a bolus of meat.
d. Suction the stomach contents from the mouth.
116. Your partner asks for a Yankauer suction tip to help clear the patient’s upper airway. Which of the following should you provide?
a. A hard but flexible catheter with a whistle tip
b. A hard plastic device angled to suction the upper airway
c. A large straw attached to the suction device
d. A soft, flexible catheter without a whistle tip
117. A patient has a tracheostomy tube in place. You are transporting this patient from an extended care facility to the emergency department. It appears that the tracheostomy may be partially obstructed. Which of the following devices or techniques would be the best to remove an obstruction from the tracheostomy tube?
a. Finger sweep
b. French catheter attached to suction
c. Remove the tracheostomy tube and flush with fluid
d Yankauer suction tip
118. A 44-year-old male patient has shot himself in the mouth. He is still conscious and awake; however, there are copious amounts of blood in his airway. Which of the following would be the next appropriate action?
a. Leave the airway intact.
b. Remove the blood and tissue with gauze.
c. Remove the blood with a suction device.
d. Provide supplemental oxygen with a bag-mask device.
119. In ideal circumstances, suctioning of an adult patient should not exceed _____ seconds.
120. Suctioning (application of negative pressure) should be activated upon:
a. Both insertion and extraction
b. Either insertion or extraction (it makes no difference)
c. Extraction of the suction catheter
d. Insertion of the suction catheter
121. A patient has copious secretions in the nares. Which is the best device to use in this situation?
a. A hard, rigid catheter
b. A soft catheter with a stylet
c. A soft, flexible catheter
d. A Yankauer suction tip
122. Which of the following best describes the purpose of the whistle tip catheter?
a. Allows gastric lavage while suctioning the airway
b. Allows positive pressure ventilation while suctioning
c. Allows suctioning of the lower airway
d. Permits endotracheal intubation during suctioning
123. You are about to suction a patient’s airway because of copious secretions. Which of the following should be completed before suctioning?
a. Provide supplemental oxygen before suctioning.
b. Provide supplemental oxygen with a bag-mask device before suctioning.
c. Remove secretions with gauze before suctioning.
d. Suction with hard catheter first.
124. A patient requires suctioning because of emesis in the oropharynx. Which of the following best describes the correct method of suctioning?
a. Apply suction when inserting and removing the catheter.
b. Keep the catheter in place until all secretions are cleared.
c. Suction the airway for no more than 30 seconds.
d. Suction the airway only while removing the catheter.
125. A catheter that is flexible and designed to suction smaller portions of the airway or through an endotracheal tube is known as a _____ catheter.
126. You have just delivered a newborn male and need to suction secretions from the airway. Which of the following best describes the amount of time that suctioning should be done on a newborn?
a. 3 to 5 seconds
b. 10 seconds or less
c. Under 15 seconds
d. 30 seconds or less
127. Which of the following is a complication of suctioning?
128. You are on scene with a patient who has a tracheostomy tube. The patient has coarse rhonchi with each ventilated breath. There are no apparent wheezes or rales. Which of the following is the next appropriate treatment?
a. Increase the tidal volume on the ventilator.
b. Inject 10 mL of fluid into the tracheostomy and then suction.
c. Use a large Yankauer catheter to suction the trach.
d. Use a sterile suction catheter to remove secretions and prevent infection of the airway.
129. During the transfer of an intubated patient, you notice that coarse breath sounds are developing. You attempt to suction the trachea for secretions. The suction catheter becomes obstructed. Which of the following best describes the next appropriate action?
a. Change the catheter tip.
b. Flush the catheter with sterile saline to clear obstruction.
c. Perform a finger sweep.
d. Stop suctioning, and continue to ventilate.
130. While suctioning copious secretions from an intubated patient, you notice that the patient’s ECG is showing multiple premature ventricular contractions. The secretions are particularly thick, requiring extensive suctioning to clear the airway and ensure adequate gas exchange. Which of the following is the next appropriate action?
a. Continue suctioning until the airway is clear, then hyperoxygenate.
b. Discontinue suctioning until you reach the emergency department.
c. Ignore the irregular heart rhythm, and continue suctioning the patient.
d. Stop suctioning, oxygenate the patient, then resume suctioning.
131. A 28-year-old female patient is unresponsive from an unknown medical cause. Verbal and physical stimulation have failed to awaken her. You notice that the patient’s airway is partially obstructed by her tongue. After properly positioning the woman’s head and chin, you decide to insert an oropharyngeal airway. To determine the proper size airway, you measure from the:
a. Center of the mouth to the larynx
b. Corner of the mouth to the ear lobe
c. Middle of the ear to the larynx
d. Tip of the nose to the ear lobe
132. The purpose of the oropharyngeal airway is to:
a. Keep the tongue from blocking the airway.
b. Lift the palate to further open the airway.
c. Open the nasopharynx to allow airflow.
d. Push the epiglottis away from the larynx.
133. A patient has sustained a closed head injury with significant nasal bleeding. A jaw thrust maneuver has been performed to open the airway. The patient has an intact gag reflex. Which of the following is the next most appropriate action?
a. Insert a nasopharyngeal airway.
b. Insert a size 0 oropharyngeal airway.
c. Suction secretions/blood from airway.
d. Supply supplemental oxygen by a bag-mask device.
134. The nasopharyngeal airway has also been called the nasal trumpet because of its flared end. When properly sized and positioned, the trumpet:
a. Is located next to the outer edge of the nostril
b. Is visible in the back of the mouth
c. Rests against the uvula in the nasopharynx
d. Vibrates gently in the upper airway
135. After inserting an oropharyngeal airway, you notice that the patient is not ventilating as easily. Which of the following may be the cause of this finding?
a. The bag-mask device is malfunctioning.
b. The oropharyngeal airway is too small and is causing the tongue to obstruct the airway.
c. The patient has an intact gag reflex.
d. The posterior airway was traumatized, and edema has formed.
136. A patient who is conscious has a severe nosebleed. You are having difficulty maintaining the airway. Which of the following might help keep the airway patent?
a. Nasal airway
b. Nose plug
c. Oral airway
137. You are inserting a nasopharyngeal airway and are meeting resistance during the insertion. Which of the following should be your next step?
a. Increase the insertion pressure until the airway is seated.
b. Remove the airway, and use an oropharyngeal airway.
c. Remove the airway, relubricate it, and insert the airway in the other nostril.
d. Tape the airway in place, and insert a second airway into the other nostril.
138. The nasopharyngeal airway should be measured:
a. From the corner of the mouth to the earlobe
b. From the tip of the nose to the chin
c. From the tip of the nose to the corner of the mouth
d. From the tip of the nose to the tragus of the ear
139. While inserting a nasal airway, the beveled tip should be directed toward the:
a. Floor of the nose
b. Lateral cartilage of the nose
c. Septum of the nose
d. Top of the nose
140. Oropharyngeal airways are designed to:
a. Allow for better visualization during endotracheal intubation
b. Prevent the tongue from obstructing the airway
c. Provide a guide for suction catheters
d. Push the tongue into the oropharynx
141. Which of the following is an advantage of the oral airway?
a. A good head position is no longer needed during ventilation.
b. Adequate mask seal is no longer necessary during ventilation.
c. The lower airway is protected from aspiration during ventilation.
d. The tongue will not obstruct the airway during ventilation.
142. After ensuring that the patient’s airway is open and inserting an oropharyngeal airway, you use a bag-mask device to ventilate the patient. You notice that with each breath, the patient’s chest rises minimally, but the abdomen is getting larger. Which action will help to prevent this problem in the future?
a. Performing cricoid pressure
b. Providing pressure to the midabdominal region
c. Providing slower ventilations with the bag-mask device
d. Providing ventilations with a larger volume
143. After ventilating a patient’s lungs by using a bag-mask device, you notice that the patient’s abdomen has enlarged because the patient’s stomach has filled with air. Which of the following complications should you anticipate?
a. Belching noxious gases
b. Decreasing blood pressure
c. Increasing heart rate
d. Vomiting and aspiration
144. When using a bag-mask device or mask to provide mouth-to-mask ventilation, the mask should be made of transparent material to permit:
a. Easy access to remove secretions or other airway obstructions
b. Escape of excess air during positive pressure breathing
c. Quick recognition of secretions or discoloration of the lips
d. Release of gastric distention in the event of hyperventilation
145. During ventilation of a patient with a bag-mask device, you notice a large air leak near the nose. Which of the following may be the cause of the problem?
a. The mask might be too small for the patient’s face.
b. The oxygen might be too high.
c. The patient might be breathing spontaneously.
d. There might be secretions present in the airway.
146. Which of the following is a complication of mouth-to-mouth ventilation?
a. Exposure to a communicable disease carried by the patient
b. Gastric collapse because of the inadequate pressure
c. Hypoventilation of the paramedic performing the procedure
d. Oversaturating the patient with excessive oxygen
147. When using a bag-mask device on room air, the paramedic will provide the patient with an oxygen concentration of approximately 21%. By adding a reservoir and supplemental oxygen to the bag-mask device at a flow rate of 15 L/min, the paramedic can deliver an oxygen concentration of:
a. 60% to 80%
b. 75% to 100%
c. 80% to 90%
d. 90% to 100%
148. While ventilating the lungs of a nonbreathing, medical patient with a bag-mask device, you notice that the patient’s chest is not rising adequately, and there is a low pulse oximetry, suggesting that the patient is not oxygenating adequately. What do you suspect?
a. Airway obstruction caused by the patient’s tongue
b. An inadequate tidal volume with each breath
c. Tension pneumothorax with increased dead space
d. The mask size is too small for the patient
149. When delivering mouth-to-mask ventilations with supplemental oxygen:
a. Deliver each breath for longer than 10 seconds.
b. It is not necessary for the patient’s chest rise to be visible.
c. Provide a minimum flow rate of 10 to 12 L/min.
d. Slow the ventilatory rate to 1 breath every 8 seconds.
150. You are using a bag-mask device to ventilate the lungs of a 4 year old. You are using an adult bag on this child. Which of the following must be done to prevent injury?
a. Squeeze the bag-mask device forcefully for each ventilation.
b. Use a lower oxygen level.
c. Use a simple mask instead of a bag-mask device.
d. Use smaller tidal volumes to prevent gastric distension.
151. You are ventilating the lungs of an adult patient. Which of the following is an appropriate indicator of adequate ventilation?
a. A gentle chest rise
b. A rapid chest rise
c. No chest rise
d. Stomach distention
152. The most reliable indication that adequate tidal volumes are being delivered during artificial ventilation is:
a. Adequate chest rise is observed
b. The oxygen saturation improves
c. The patient’s color improves
d. The stomach inflates slightly
153. Automatic transport ventilators are typically contraindicated in patients who:
a. Are breathing spontaneously
b. Are under 12 years of age
c. Are unresponsive
d. Have an airway obstruction
154. You arrive on scene and begin to ventilate an unresponsive 44-year-old female patient. Your partner is starting an IV. A medical first responder (MFR) arrives. Which of the following tasks will you assign the MFR for optimal patient care?
a. The MFR should flag additional units to this location.
b. The MFR should hang crystalloid fluids.
c. The MFR should open the drug box.
d. The MFR should use his two hands to apply gentle pressure to the bag-mask device.
155. The greatest difficulty in using a bag-mask device to deliver ventilations is:
a. Adequate mask seal
b. Adequate ventilation rate
c. Consistent bag inflation
d. Proper oxygen flow
156. A bag-mask device with a reservoir and an adequate oxygen source (at least 15 L/min) delivers an oxygen concentration of:
b. 40% to 60%
d. 90% to 100%
157. You are on scene with an adult who requires bag-mask ventilation. Which of the following should be done to prevent excessive air from entering the stomach?
a. Place the palm of the hand over the epigastrium and press firmly.
b. Push the cricoid cartilage upward and backward in the airway.
c. Use the palm of the hand over the cricoid membrane to press downward.
d. Use the thumb and index fingers to depress the cricoid cartilage downward.
158. You are ventilating the lungs of an adult patient, and your partner is applying cricoid pressure. The patient makes a retching sound as though he might vomit. Which of the following should be done to avoid injury?
a. Increase the downward pressure to prevent aspiration of gastric contents.
b. Move the cartilage laterally in the neck to reduce the tendency to vomit.
c. Release the pressure on the cricoid cartilage to prevent gastric rupture.
d. Suction the airway while maintaining pressure on the cricoid cartilage.
159. To apply cricoid pressure, place firm pressure against the:
a. Cricoid cartilage
b. Cricothyroid membrane
c. Hyoid bone
d. Thyroid cartilage
160. Which of the following would be an indication for the use of an automatic transport ventilator?
a. A nonbreathing patient being transported for an extended time
b. A nonbreathing patient being transported over a very short distance
c. A patient who is hyperventilating and in need of ventilatory control
d. An unresponsive breathing patient being transported to a close facility
161. What is a major advantage in using an automatic transport ventilator?
a. Automatic adjustments reduce the need to monitor the device.
b. CPR is more effective when using the ventilator.
c. Paramedics are able to attend to other essential tasks.
d. Only one paramedic is required to ventilate the patient’s lungs.
162. A 24-year-old male patient is in respiratory failure as a result of asthma. You have attempted multiple medical routes to manage his distress, and you determine that he requires intubation. Which of the following is the most appropriate device to ventilate this patient for the transport?
a. Automatic transport ventilator
b. Bag-mask device
c. Nasal cannula
d. Simple mask
163. A 46-year-old male patient sustained multiple chest injuries in a blast accident at a manufacturing plant. He is not breathing and needs assisted ventilation over a prolonged transport to a trauma center. Which of the following is an accurate statement?
a. Alternate between an automatic transport ventilator and bag-mask device.
b. An automatic transport ventilator should be used.
c. Intubate the patient, then ventilate the patient with a bag-mask device.
d. Use an automatic transport ventilator with low-flow oxygen.
164. Which of the following best defines tracheostomy?
a. A needle opening into the cricoid cartilage
b. A surgical opening between the tracheal rings
c. A surgical opening into the carina
d. A surgical opening through the vocal cords
165. A stoma is best described as:
a. A surgical opening into the trachea that bypasses the upper airway
b. A temporary opening in the neck to overcome a blocked airway
c. A valve on the suction catheter to permit or prevent suctioning
d. An opening into the right lung to decompress the chest
166. A patient has a tracheostomy. You attempt to ventilate the patient’s lungs through the tracheostomy tube. Air appears to leak from the nose and mouth. Which of the following is an appropriate action?
a. Change the tidal volume.
b. Close and seal the nose and mouth.
c. Inflate the balloon with more air.
d. Remove the tracheostomy.
167. A 68-year-old male with a history of throat cancer had his larynx removed. To breathe, the patient has a permanent tracheostomy tube. The procedure of removing the larynx is known as:
168. A patient has a tracheostomy tube. The patient continually coughs, and there appears to be an obstruction of the tracheostomy tube. Which of the following rationales best explains why this occurs?
a. The air bypasses the nose and mouth.
b. The air has a shorter transport to the lungs.
c. The material of the tracheostomy tube absorbs the humidity.
d. There is too much humidified air in the trachea.
169. The patient is a 62-year-old woman involved in a motor vehicle crash. You note that the woman is in obvious respiratory distress. In assessing the patient, you also note that the patient has a stoma because of a laryngectomy several years earlier. What should you do to assist the woman’s breathing?
a. Insert an endotracheal tube into the stoma and ventilate.
b. Perform nasotracheal intubation and ventilate thought the tube.
c. Use an adult bag-mask device over the patient’s mouth and nose.
d. Use an adult-sized mask and ventilate through the stoma.
170. You are called to care for a 77-year-old female patient in respiratory distress. During the patient assessment, you note that the patient has a tracheostomy tube inserted into a permanent tracheostomy. The tube has become dislodged. Which of the following should be your next action?
a. Attempt to replace the tracheostomy tube or intubate if necessary.
b. Immediately perform nasotracheal intubation to secure an open airway.
c. Insert a nasogastric tube to reduce swelling and make breathing easier.
d. Reinsert the tracheostomy tube.
171. You are called to the home of a 5-year-old boy who has a tracheotomy tube and is on a ventilator. The patient’s mother called because she could not suction the tracheotomy tube adequately and the patient’s oxygen saturation is dropping. The mother states that the patient has been ill for the past 2 days with a fever, congested lungs, and copious amounts of thick, green-tinged mucus. You attempt to suction the tracheotomy tube with no results. What is your best course of action at this point?
a. Perform a translaryngeal cannulation.
b. Rapidly transport the patient.
c. Remove the tracheotomy tube, and replace it with a new one.
d. Ventilate the patient with a bag-mask device.
172. A patient is intubated and the lungs are being manually ventilated by a bag-mask device. The tidal volume is too high. Which of the following would you expect to occur?
a. Atelectatic pneumonia and ventilatory compromise
b. Hyperventilation syndrome and hypercarbia
c. Pressure on the diaphragm and resistance to ventilation
d. Stimulation of the vagus nerve and risk of bradycardia
173. A patient has been intubated, and the lungs are being ventilated. The abdomen is very firm and distended. Which of the following would the most appropriate treatment for this patient?
a. Esophageal intubation and suctioning
b. Fine needle aspiration of the stomach
c. Nasotracheal intubation and suctioning
d. Orogastric or nasogastric suctioning
174. Which of the following best describes the advantage of a nasogastric tube over a orogastric tube?
a. Nasogastric tubes are better tolerated by the patient.
b. Nasogastric tubes are useful in patients with facial trauma.
c. Nasogastric tubes are cause less gastric irritation.
d. Nasogastric tubes are require no lubrication to insert.
175. A patient was eating dinner at a restaurant. He began having a severe asthma attack and went into respiratory distress. Following intubation, which of the following would be the most appropriate intervention for this patient?
a. Nasotracheal suctioning
b. Needle decompression of the stomach
c. Orogastric tube
d. Oropharyngeal airway
176. Nasogastric or orogastric tube placement can be confirmed by:
a. Auscultating over the epigastrium while injecting 30 to 50 mL of air
b. Lack of resistance noted upon insertion
c. Noting resistance to aspiration
d. Palpating the epigastrium during insertion
177. You have placed a nasogastric tube in a patient with obvious gastric distention. The patient has no facial injuries or other trauma. After inserting the nasogastric tube, there is no appreciable reduction in gastric distention, even though air flows freely through the tube. A likely reason for the problem is:
a. Excessive depth of tube placement
b. Kinking of the nasogastric tube
c. The tube has an open whistle tip
d. The tube has been misplaced in the trachea
178. While assessing the nonbreathing patient, you note significant gastric distention and determines that a nasogastric tube is appropriate. In preparing the equipment for the procedure, you are told that the patient has a history of alcoholism and suffers from esophageal varices. What should you do?
a. Defer nasogastric tube insertion until you arrive at the emergency department.
b. Ignore the patient’s past medical history, and insert the nasogastric tube.
c. Insert the nasogastric tube, and prepare to vigorously suction the upper airways.
d. Prepare to insert an orogastric tube rather than a nasogastric tube.
179. A patient has sustained significant facial trauma and is bleeding. While preparing to intubate this patient, which of the following should be worn for personal protection equipment?
a. Gloves and shoe coverings
b. Gloves, eye shield, and a gown if available
c. Gloves, gown, and shoe coverings
d. Gloves only
180. A patient with significant facial trauma has copious vomiting. The patient is intubated. Which of the following is the most appropriate?
a. A nasogastric tube
b. A suction catheter
c. A Yankauer suction tip
d. An orogastric tube
181. A 21-year-old male patient has been struck in the neck several times with a metal baseball bat during a gang-related fight. As you assess the patient, you hear stridor with each breath. Appropriate management for this patient includes:
a. Early Combitube or LMA placement to protect the airway
b. Early intubation to protect the airway
c. Supplement oxygen with a nasal cannula
d. Supplemental oxygen with a simple face mask
182. On scene with a pediatric patient that requires assisted ventilations, which of the following is correct?
a. An adult-sized bag-mask is preferable for a small child.
b. Because of airway diameters, proper positing of the head is critical.
c. Children have a more pronounced nasal bridge, making a mask seal easier.
d. One person can effectively create a mask seal when ventilating a child.
183. Which of the following is an effective technique for obtaining an effective mask seal?
a. Applying petroleum jelly around the mouth and nose
b. Covering the child’s eyes with the face mask
c. Inserting a nasogastric airway before ventilating
d. Using a two-person bag-mask technique
184. You are caring for a newly born infant who is not breathing adequately. Although the newborn is positioned properly, the neonatal-sized bag-mask device is not providing adequate tidal volume to provide effective ventilation. Which of the following is the next most appropriate step?
a. Change to a larger sized bag-mask device, and monitor ventilation.
b. Continue attempts to ventilate the newborn using the neonatal equipment.
c. Insert a neonatal gastric tube, and continue ventilation attempts.
d. Pad the bridge of the nose to ensure an adequate or better mask seal.
185. Following the emergency delivery of a term infant, assisted ventilations are required. Which of the following best describes how this should be accomplished?
a. Use a neonatal bag-mask device.
b. Use a nonrebreather.
c. Use a pediatric bag-mask device.
d. Use an adult bag-mask device.
186. A bag-mask device for infants and children should:
a. Be equipped with a fish-mouth-operated outlet valve
b. Be used with an oxygen flow rate of 6 to 8 L/min
c. Have a minimum volume of 450 mL
d. Have a pop-off valve to prevent overinflation of the lungs
187. Choose the correct statement pertaining to a major difference between endotracheal intubation and the use of other advanced airways such as the Combitube, LMA, or King airway.
a. Endotracheal intubation does not permit suctioning of the lower airways.
b. Endotracheal intubation does not require visualization of the vocal cords.
c. The other airways can be used on all and any patient group.
d. The other airways do not require visualization of the vocal cords for insertion.
188. A patient is in respiratory failure. Using the laryngoscope, you attempt to visualize the vocal cords with no success. Your partner attempts with no success. Which of the following would be an appropriate action at this time?
a. Insert the endotracheal tube blindly.
b. Perform a head tilt/chin lift maneuver.
c. Perform a tracheostomy.
d. Utilize a dual lumen airway.
189. The patient is a 37-year-old male who is not breathing. In maintaining the man’s airway, you note a strong gag reflex when an oropharyngeal airway is introduced. What should you do in this situation?
a. Insert a Combitube to maintain the airway and assist ventilation.
b. Insert an orogastric tube, and then use any appropriate airway device.
c. Use a head/tilt chin lift maneuver to maintain the airway and assist breathing.
d. Use an LMA to maintain the airway and assist ventilation.
190. A patient has ingested hydrochloric acid. You would like to secure the airway. Which of the following is the most appropriate method?
a. Bag-mask device with supplemental oxygen
c. Endotracheal tube
d. Laryngeal mask airway
191. You have finished inserting a Combitube into an unresponsive, nonbreathing adult female. When attempting to inflate the cuff, you notice that the cuff fails to remain inflated. What should you do next?
a. Continue to inflate the cuff.
b. Increase the tidal volume of each ventilation.
c. Remove device and inspect cuff.
d. Ventilate the patient’s lungs.
192. You are considering using the LMA to manage the patient’s airway. After inserting the airway, the patient begins to gag. What should you do next?
a. Continue ventilating the patient, as the LMA is a secure airway.
b. Provide suction through the LMA.
c. Remove the LMA, and ventilate the patient with a bag-mask device.
d. Reposition the LMA.
193. The laryngeal mask airway:
a. Is easier to insert than an endotracheal tube
b. Is ideal for conscious patients
c. Is well tolerated by a patient with an intact gag reflex
d. Provides absolute protection against aspiration
194. A disadvantage of the laryngeal mask airway is that:
a. It can be used on any sized mouth
b. Not all patients can be adequately ventilated with an LMA
c. The LMA must be removed before intubation
d. The spine must be manipulated for insertion of an LMA
195. To correctly position a patient’s head for Combitube insertion, you should:
a. Extend the head
b. Flex the neck
c. Place the head in the neutral position
d. Place the patient in the sniffing position
196. You place a Combitube on a 27-year-old male patient in cardiac arrest. After ventilating through the number 1 port, you hear breath sounds. What should you do?
a. Pull the tube back approximately 1 to 2 cm.
b. Remove the tube and ventilate the patient.
c. Secure the tube and ventilate through the number 1 port.
d. Secure the tube and ventilate through the number 2 port.
197. A 44-year-old female patient is in respiratory distress after being struck in the face with a baseball bat. The patient has an oxygen saturation of 72%. Which of the following airway maneuvers is the most appropriate?
a. Insert a dual lumen airway.
b. Insert an endotracheal tube.
c. Insert an oropharyneal airway.
d. Use a nasopharyngeal airway.
198. A 48-year-old female patient presents in respiratory failure following an exposure to toxic fumes. She is breathing four times per minute and she appears to be gasping for each breath. Which of the following devices should be used?
a. Bag-mask device ventilation
b. Endotracheal intubation
c. Inserting the LMA
d. Using the Combitube
199. Which of the following is an advantage of endotracheal intubation as compared to other airway devices?
a. Avoids delivering high-flow oxygen to the patient
b. Avoids problems with air filtration in the upper airway
c. Permits deep tracheal suctioning to remove secretions
d. Permits gastric lavage through the endotracheal tube
200. The endotracheal tube size refers to the _____ in millimeters.
a. External diameter
b. Internal diameter
d. Length of tube that will pass beyond the vocal cords
201. The distal cuff of the ET tube should hold _____ mL of air.
a. 6 to 10
b. 10 to 20
c. 15 to 25
d. 20 to 30
202. Which of the following best describes the risk of infection to the paramedic when performing endotracheal intubation?
a. In spite of personal protective equipment, exposure is highly likely.
b. The paramedic is at a lower risk of infection because of isolating the airway.
c. The risk of infection is similar to all other risks during patient contact.
d. There is a higher risk of infection because of close proximity with the airway.
203. A 78-year-old female patient with an altered mental status and copious secretions has begun coughing and experiencing respiratory distress, which quickly leads to apnea. Which of the following personal protection equipment is appropriate for this scenario?
a. Gloves and face shield only
b. Gloves, face shield, shoe covers
c. Gloves, goggles, and face shield
d. Gloves, goggles, and shoe covers
204. A 46-year-old male patient is seated at the table and leaning over his dinner plate in a family restaurant. As you approach, the man’s wife states, “He took a large bite of steak then started coughing. He’s breathing, but we think something’s stuck.” The man is sitting motionless, but he is breathing, conscious, and able to answer questions. He acknowledges that a piece of meat is stuck in his throat. Which of the following is the most appropriate intervention at this time?
a. Abdominal thrust maneuver to clear the food
b. Direct laryngoscopy to remove the food
c. Monitor patient and supply supplemental oxygen
d. Orotracheal intubation for airway control
205. A 15-year-old male patient is unresponsive after choking at the dinner table. Abdominal thrusts have not cleared the airway. What equipment is appropriate to use next?
a. Laryngoscope and large diameter endotracheal tube
b. Laryngoscope and Magill forceps
c. Laryngoscope and suction catheter
d. Scalpel and large surgical cricothyrotomy needle
206. A 79-year-old male patient is unresponsive and apneic on his dining room floor. You attempt to ventilate the patient’s lungs with a bag-mask device. There is no chest rise. Following the head/tilt chin lift for the second time, there is still no chest rise. What is your next step?
a. Perform chest compressions.
b. Perform surgical cricothyroidotomy.
c. Place a dual lumen airway.
d. Use Magill forceps to remove the foreign body.
207. Direct laryngoscopy is associated with complications including:
a. Main stem bronchus intubation
b. Oral trauma and breaking of teeth
c. Perforation of the maxillary sinus
d. Rupture of the tonsillar membrane
208. You are performing direct laryngoscopy on a still-breathing 70-year-old female patient in respiratory failure caused by COPD. As you introduce the laryngoscope into the patient’s mouth, she begins to gag and nearly vomits. Because maintaining the airway and ventilation is critical in this patient, you should:
a. Ignore the vomiting and continue
b. Perform nasotracheal intubation
c. Resort to bag-mask-device ventilation
d. Suction the oropharynx and continue
209. When using a straight blade to intubate an adult patient, the tip of the blade should be placed:
a. Above the epiglottis
b. Directly on the epiglottis
c. In the vallecula
d. Past the epiglottis at the vocal cords
210. When intubating an adult patient with a curved blade, the tip of the blade should be placed:
a. In the vallecula, at the base of the tongue
b. In the vallecula, at the opening of the vocal cords
c. To the right of the epiglottis
d. Under the epiglottis
211. The laryngoscope should be held in the _____ hand and inserted on the _____ side of the mouth.
a. Left, left
b. Left, right
c. Right, left
d. Right, right
212. The acronym BURP describes how to:
a. Confirm tube placement following intubation visualization during intubation
b. Correct a right mainstem intubation
c. Maneuver the larynx for vocal cord visualization
d. Prepare equipment for intubation
213. Which of the following is the most appropriate location for a Miller blade to be placed during intubation with direct laryngoscopy?
a. Into the carina
b. Into the vallecula
c. Through the vocal cords
d. Under the epiglottis
214. You have a patient that requires intubation. The epiglottis is soft and floppy. Which of the following would be the most appropriate airway maneuver?
a. Dual lumen airway
b. The Macintosh blade in the vallecula
c. The Macintosh blade over the epiglottis
d. The miller blade to lift the epiglottis
215. You are using an esophageal detection device to verify endotracheal tube placement. After squeezing the bulb, attaching it to the endotracheal tube, and releasing the bulb, you note that the bulb does not reinflate. Which of the following should you assume?
a. The endotracheal tube is in the esophagus.
b. The endotracheal tube is in the mainstem bronchus.
c. The endotracheal tube is in the trachea.
d. The endotracheal tube is positioned in the carina.
216. Lung sounds are heard after intubation only over the right lung of an adult patient. The 7.0id ET tube is at 27 cm at the teeth. The most likely explanation for the findings in the intubation scenario is:
a. Left-sided pneumothorax
b. Occlusion of the endotracheal tube
c. Right mainstem intubation
d. Right-sided hypertympany
217. After intubation you determine a right mainstem intubation. The next appropriate action to take is to:
a. Continue to ventilate the patient
b. Deflate the cuff and withdraw the tube 1 to 2 cm
c. Inflate the cuff with an additional 3 to 5 mL of air
d. Remove the tube
218. After placing an endotracheal tube, you cannot hear any lung sounds but you hear gurgling over the epigastrium. The endotracheal tube is most likely placed in the:
b. Left mainstem
c. Right mainstem
219. If an endotracheal tube has been correctly placed, an esophageal detector device will:
a. Change color
b. Give a normal CO2 readout
c. Reinflate easily
d. Remain collapsed
220. Once the endotracheal tube position has been confirmed, which of the following is the next most appropriate step?
a. Assess capnography and arterial blood gases every 5 minutes.
b. Insert the tube further into the airway as a precaution.
c. Manually hold the tube in place during ventilation.
d. Secure the tube with tape or a commercial tube holder.
221. A 44-year-old male patient has been intubated following experiencing respiratory failure caused by asthma. Which of the following is an appropriate step for packaging this patient?
a. Elevating the patient’s head to facilitate ventilation
b. Placing the patient in a left lateral recumbent position
c. Using a cervical collar to reduce head movement
d. Using a KED or spine board to immobilize the spine
222. A child is in severe respiratory distress. Which of the following needs to be accomplished before intubation?
a. Avoid intubation if at all possible.
b. Place the child’s head in slight flexion.
c. Place the child in Trendelenburg.
d. Provide sufficient preoxygenation.
223. A 5-year-old patient is in respiratory failure from RSV. Which of the following best describes the choice of blade for this patient?
a. A curved blade can better retract the epiglottis
b. The laryngoscope should not be used in children
c. The optimum blade size should be at least a 3
d. The optimum blade to use is the straight blade
224. Which of the following statements is correct regarding the endotracheal tube used in pediatric patients under the age of 8 years?
a. The endotracheal tube cuff should be inflated fully with 10 mL of air.
b. The cuff of the tube should be inflated with 5 mL of air.
c. The endotracheal tube should not need an inflatable cuff.
d. Use a small, cuffed tube, but do not inflate the cuff.
225. You are treating a 9-year-old child in need of intubation. Which of the following best describes the appropriate tube size?
a. 5.0 to 5.5 mm internal diameter
b. 6.0 to 6.5 mm internal diameter
c. 7.0 to 7.5 mm internal diameter
d. 8.0 to 8.5 mm internal diameter
226. A 10-year-old in respiratory failure from asthma has been intubated with the tube placed at
a depth of 30 cm. What is the next most appropriate action?
a. Begin ventilating the patient; this is the appropriate depth.
b. Pull the tube back to 17 cm and begin ventilating.
c. Push the tube in 2 cm farther.
d. Remove tube and reintubate.
227. The approximation of the correct depth of insertion in centimeters for a 10-year-old child when placing an endotracheal tube is:
a. 10 cm
b. 12 cm
c. 17 cm
d. 22 cm
228. Which of the following is an advantage of nasotracheal intubation over orotracheal intubation?
a. It is better in patients with long, thin necks and no abnormalities.
b. It is more appropriate in patients with severe nasal injuries.
c. It can be used effectively in breathing patients who require intubation.
d. It can be used in trauma patients with a Glasgow Coma Scale score of 10.
229. A patient is apneic and requires a method for securing the airway. Which of the following is the most appropriate equipment for this patient on the first attempt?
a. Bag-mask device and oropharyngeal airway
b. Dual lumen airway
c. Endotracheal tube with laryngoscope
d. Nasaltracheal tube
230. Phenylephrine spray is used during nasotracheal intubation to:
a. Anesthetize the nasal passages
b. Constrict the blood vessels
c. Lubricate the nasal passages
d. Sedate the patient before the procedure
231. You are caring for an unresponsive 45-year-old female patient who is in respiratory arrest and is trapped in a narrow, confined space. Extrication from the confined space is expected to take some time. You determine that the patient’s airway is best managed by intubation. Direct visualization of the airway is difficult if not impossible. Which of the following techniques would be an appropriate first choice?
a. Continue with a bag-mask device.
b. Create a surgical airway.
c. Perform blind digital intubation.
d. Perform nasotracheal intubation.
232. During a digital intubation attempt, which of the following needs to be done before digit insertion?
a. A bite block should be placed to avoid injury to the rescuer
b. Intravenous access should be established
c. Nasotracheal intubation
d. Placement of an endotracheal tube
233. Which position should the endotracheal tube be in for digital intubation?
a. Curved in a more exaggerated J shape
b. In a straight position to facilitate insertion
c. Larger than the tube ordinarily used
d. Well lubricated with a numbing solution
234. A 22-year-old male patient is in status epilepticus. The usual means to terminate the seizure have failed, and the patient is rapidly becoming hypoxic. Intubation is appropriate; however, the seizure activity has clenched the patient’s jaw. Which of the following is the next best method for securing the airway?
a. Digital intubation with transillumination technique
b. Nasotracheal intubation with transillumination
c. Opening the airway with a cricothyrotomy
d. Rapid sequence intubation to secure the airway
235. Which of the following is a complication of rapid sequence intubation?
a. Death from anoxia
236. A patient has suffered a significant head injury and is highly combative. While preparing to intubate this patient, which of the following medications should be administered first?
a. A paralytic
b. A sedative
237. Which of the following best describes the role of atropine in rapid sequence intubation?
a. Decreases the heart rate
b. Dilates the pupils
c. Dries airway secretions
d. Increases the blood pressure
238. A patient is being intubated using rapid sequence intubation. Which of the following medications will paralyze the patient?
239. Depolarizing agents:
a. Block the uptake of acetylcholine at the neuromuscular junction
b. Block the uptake of norepinephrine at the neuromuscular junction
c. Substitute themselves for acetylcholine at the neuromuscular junction
d. Substitute themselves for norepinephrine at the neuromuscular junction
240. To blunt any potential rise in intracranial pressure during an intubation attempt, consider administration of:
241. The patient has been sedated and paralyzed in preparation for rapid sequence intubation. After the procedure, you notice that the sedative has worn off. What should you do next?
a. Administer additional paralytic.
b. Administer additional sedative.
c. Calm and reassure the patient.
d. Continue with airway control.
242. After administering a sedative and paralytic, you attempt to pass the endotracheal tube. Unfortunately, it is not possible to insert the tube. After 45 to 60 seconds, what should you do?
a. Continue the attempts, as the patient needs the airway.
b. Invite your assistant to attempt endotracheal intubation.
c. Remove the airway, reoxygenate, and attempt intubation again.
d. Suction the airway as the attempt to intubate continues.
243. You are preparing to intubate a patient with rapid sequence intubation. Which of the following would be the first medication?
244. You are about to electively intubate a 35-year-old female patient experiencing a severe asthma attack. This may be a difficult airway. Which of the following would be the most appropriate for this patient?
245. You have just performed a needle cricothyrotomy. What is the next step?
a. Attach the needle to a special bag-mask device.
b. Connect a very small endotracheal tube.
c. Use a bag-mask device adapter.
d. Use a jet ventilator device.
246. A patient is being ventilated with a needle in the cricothyroid space. Which of the following should be monitored?
a. The cardiac monitor for hypocarbia
b. The catheter for evidence of shear
c. The chest rise for signs of hyperventilation
d. The neck for hematoma formation
247. A 22-year-old female unrestrained driver has sustained significant face and neck injuries after her car collides head on into a tree. Her neck is swollen and distended because of bleeding into the soft tissues. Endotracheal intubation is nearly impossible. Choose the correct statement about creating an airway with a surgical cricothyrotomy.
a. It is a viable option, because endotracheal intubation is not possible.
b. It is contraindicated in patients with underlying trauma to the neck.
c. It is indicated only after a needle cricothyrotomy has been done.
d. It is permissible only after nasotracheal intubation has failed.
248. After performing a surgical cricothyrotomy, you notice swelling of the soft tissues in the neck accompanied by what appears to be a large hematoma along with subcutaneous emphysemas. What should you do next?
a. Anticipate that this is a normal effect of the procedure, and continue care.
b. Check the position of the cricothyrotomy tube, and replace if needed.
c. Insert the cricothyrotomy tube deeper into the patient’s airway.
d. Perform endotracheal or nasotracheal intubation as soon as possible.
249. A 22-year-old male patient has fallen 35 feet from an open window and has a GCS score of 2, 2, 2 for a total of 6. You have determined that intubation is necessary; however, his airway is very difficult to navigate because of fractures and bleeding. To consider a surgical airway, what equipment is needed?
a. Endotracheal tube, 9 mm
b. Jet insufflation device
c. Scalpel, no. 10 or 15
d. Sterile nylon sutures
250. You have created an airway using a surgical cricothyrotomy. What should follow the insertion of the endotracheal or tracheostomy tube and verifying tube placement?
a. Secure the tube, and frequently assess ETCO2, adequate ventilation, and ECG.
b. Secure the tube, and inflate the cuff with at least 10 mL of air .
c. Secure the tube, and make sure that the EMT adequately ventilates the patient.
d. Secure the tube with sutures, and continue to monitor for ventilation.
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