EMT Ch 10 Test

8) Which of the following describes why fast respiration may decrease minute volume? A) The lungs may not have the time to fill and exchange gas. B) The rate causes turbulence in the trachea that increases the friction and decreases the amount of air movement. C) It is due to the delay in the movement of the intercostal muscles and the pleural space. D) The rate does not decrease minute volume; it actually increases.

Explanation: A) CORRECT. Exceptionally fast breathing can decrease the amount of time that the lungs have to refill and negatively impact alveolar function, decreasing both tidal volume and minute volume. B) INCORRECT. Tracheal turbulence would not cause an increase in friction that could impact air movement. C) INCORRECT. Rapid breathing would not cause movement delays in the intercostal muscles. D) INCORRECT. Extremely rapid breathing can reduce minute volume. Page Ref: 217 Objective: 10.5

7) The normal stimulus to breathe is stimulated by the chemoreceptors that measure the change of what two gases? A) Low hydrogen and high carbon monoxide B) High carbon monoxide and low oxygen C) High hydrogen and low carbon dioxide D) High carbon dioxide and low oxygen

Explanation: A) INCORRECT. Chemoreceptors do not measure hydrogen or carbon monoxide. B) INCORRECT. Carbon monoxide levels do not register on the body's chemoreceptors. C) INCORRECT. The chemoreceptors in the cardiovascular system do not monitor hydrogen. D) CORRECT. Special sensors in the cardiovascular system, called chemoreceptors, detect increasing levels of carbon dioxide as well as low levels of oxygen. Page Ref: 219 Objective: 10.4

4) In assessing a patient's breathing, what is your first question? A) Is he breathing? B) Is he alive or dead? C) Is his breathing adequate or inadequate? D) Is he big sick or little sick?

Explanation: A) CORRECT. The first thing that an EMT must determine when assessing a patient's breathing is whether or not the patient is breathing. B) INCORRECT. Determining life status is not the first step in assessing a patient's breathing. C) INCORRECT. The adequacy of the breathing is not the first thing that an EMT must determine when assessing a patient's breathing. D) INCORRECT. Although a patient's breathing can provide clues about his overall condition, this is not the first breathing assessment question that an EMT must ask. Page Ref: 223 Objective: 10.2

5) Why is inhalation described as an active process? A) It requires the diaphragm to relax and use energy to move, creating a positive pressure. B) It requires chest muscles to relax and use energy to move, creating a positive pressure. C) It requires chest muscles to contract and use energy to move, creating a negative pressure. D) It uses oxygen to assist chest muscles to contract, creating a negative pressure.

Explanation: A) INCORRECT. The term active indicates effort or the expense of energy, the diaphragm relaxing does not use energy. B) INCORRECT. The chest muscles do not relax during inhalation. C) CORRECT. Inhalation is an active process. The muscles of the chest expand at the same time the diaphragm contracts in a downward motion. These movements increase the size of the chest cavity and create a negative pressure. D) INCORRECT. The use of oxygen is not directly related to the term active process, and during inhalation the chest muscles do not contract. Page Ref: 216 Objective: 10.3

22) What device is used to perform mouth-to-mask ventilation? A) Pocket face mask B) Bag-valve mask C) Stoma D) Automatic transport ventilator

Explanation: A) CORRECT. A pocket face mask is used to perform mouth-to-mask ventilation. B) INCORRECT. A bag-valve mask is used during bag-valve mask ventilation, not mouth-to-mask ventilation. C) INCORRECT. A stoma is a surgical opening in the neck through which the patient breathes and is not involved in mouth-to-mask ventilation. D) INCORRECT. An automatic transport ventilator is used to provide positive pressure ventilations and is not used in mouth-to-mask ventilations. Page Ref: 228 Objective: 10.13

34) Which of these patients would require a tracheostomy mask for supplemental oxygen administration? A) A patient with a stoma B) A patient with quadriplegia C) A patient with chronic bronchitis D) A patient with upper airway inflammation

Explanation: A) CORRECT. A tracheostomy mask is designed to be placed over a stoma or tracheostomy tube to provide supplemental oxygen. B) INCORRECT. Quadriplegia (paralysis of all four limbs) is not necessarily an indicator that a tracheostomy mask will be required. C) INCORRECT. A tracheostomy mask would not be indicated just because a patient has chronic bronchitis. D) INCORRECT. A tracheostomy mask would not be used for a patient because of upper airway inflammation. Page Ref: 249 Objective: 10.18

19) Your patient is a motorcyclist who was ejected after striking a guard rail. The patient is unresponsive to painful stimuli and is breathing shallowly six to eight times per minute. Which of the following should you do first? A) Use a bag-valve mask with supplemental oxygen. B) Perform a rapid trauma assessment. C) Apply a cervical collar. D) Apply a nonrebreather mask with an oxygen flow rate of 15 lpm.

Explanation: A) CORRECT. An unresponsive patient who is not breathing adequately requires immediate positive pressure ventilations and supplemental oxygen in addition to immediate manual spinal stabilization. B) INCORRECT. This patient is in need of life-saving intervention, the rapid trauma assessment can wait. C) INCORRECT. For a critical patient who is unresponsive and not breathing adequately, it would not be appropriate to apply a cervical collar as the first intervention. D) INCORRECT. A nonrebreather mask is only indicated for patients who are already breathing adequately. Page Ref: 221 Objective: 10.10

32) You are transporting a 44-year-old female with chest pain and sudden respiratory distress. She is agitated, anxious, and refuses to have a nonrebreather mask applied. Which of the following is the best option? A) Use a nasal cannula instead. B) Have her breathe into a paper bag to control her hyperventilation. C) Do not make further attempts to administer oxygen as it will only agitate the patient further. D) Consult with medical control about restraining the patient.

Explanation: A) CORRECT. It is not uncommon for patients in respiratory distress to dislike the thought of a mask being placed over their mouth and nose; if the patient absolutely refuses, some oxygen from a nasal cannula is better than none. B) INCORRECT. This patient needs oxygen; it would be poor patient care to have her breathe into a paper bag. C) INCORRECT. A patient with chest pain and in respiratory distress would benefit from supplemental oxygen; the responders should continue trying to administer it. D) INCORRECT. It would be inappropriate to restrain this patient. Page Ref: 248 Objective: 10.17

43) The safe residual for an oxygen cylinder is ________ psi. A) 200 B) 300 C) 500 D) 1,000

Explanation: A) CORRECT. Oxygen cylinders should never be allowed to empty below the safe residual or the tank may be permanently damaged. The safe residual for an oxygen cylinder is when the pressure gauge reads 200 psi or above. B) INCORRECT. 300 psi is generally higher than required for an oxygen cylinder safe residual. C) INCORRECT. The safe residual for an oxygen cylinder is lower than 500 psi. D) INCORRECT. 1,000 psi is far too high for a standard safe residual. Page Ref: 238 Objective: 10.20

23) What is NOT one of the basic parts of a bag-valve-mask system? A) Self-refilling shell B) Non-jam valve C) Be nonrebreathing D) 15/25 respiratory fitting

Explanation: A) INCORRECT. A self-refilling shell is one of the basic parts of a bag-valve-mask system. B) INCORRECT. A non-jam valve is one of the basic parts of a bag-valve-mask system. C) INCORRECT. A bag-valve-mask system should be nonrebreathing. D) CORRECT. A bag-valve-mask system should have a respiratory fitting, but it should be 15/22 and not 15/25. Page Ref: 230 Objective: 10.13

21) You are ventilating an adult patient with a bag-valve mask when you notice that his abdomen is getting bigger. You should: A) apply cricoid pressure. B) decrease the flow of oxygen. C) apply pressure to the abdomen. D) suction the airway.

Explanation: A) CORRECT. Positive pressure ventilation may cause air to enter the esophagus, causing gastric distention. Cricoid pressure moves the tracheal opening to a better position for artificial ventilation. B) INCORRECT. Gastric distention would not be caused or resolved by adjusting the oxygen flow. C) INCORRECT. Applying pressure to the patient's abdomen is not the proper way to manage gastric distention. D) INCORRECT. There is no reason to suction this patient's airway unless the gastric distention causes vomiting. Page Ref: 226 Objective: 10.12

9) To calculate the minute volume, you need to multiply what two measurements? A) Tidal volume and respiratory rate B) Alveolar ventilation and respiratory rate C) Respiratory rate and bronchial dilation D) Tidal volume and dead space air

Explanation: A) CORRECT. The amount of air moved into and out of the lungs per minute is called minute volume. Minute volume is calculated by multiplying the tidal volume and the respiratory rate. B) INCORRECT. Alveolar ventilation cannot be measured in the prehospital setting; it is not calculated into minute volume. C) INCORRECT. Bronchial dilation cannot be measured by EMTs and is not used to calculate minute volume. D) INCORRECT. There is no way to calculate or multiply dead space air when figuring minute volume. Page Ref: 217 Objective: 10.5

31) A nonrebreather mask at 12 to 15 liters per minute will generally provide the patient what percentage of oxygen? A) 80-100 B) 16-21 C) 24-44 D) 90-100

Explanation: A) CORRECT. The nonrebreather mask will provide concentrations of oxygen ranging from 80 to 100% at the optimum flow rate of 12 to 15 liters per minute. B) INCORRECT. Nonrebreather masks provide more than 16-21% of oxygen. C) INCORRECT. At optimum flow rates, nonrebreather masks will provide more than 24% to 44% of oxygen. D) INCORRECT. Nonrebreather masks do not provide 90-100% oxygen. Page Ref: 247 Objective: 10.17

27) What is the percentage of oxygen provided by connecting a high flow of oxygen to the oxygen inlet found on a pocket mask? A) 50% B) 21% C) 100% D) 16%

Explanation: A) CORRECT. When high-concentration oxygen is attached to the inlet on a pocket mask, it delivers an oxygen concentration of approximately 50%. B) INCORRECT. When used correctly, a pocket mask with supplemental oxygen will provide much more than 21%. C) INCORRECT. A pocket mask with high-flow oxygen attached will not provide 100% oxygen to the patient. D) INCORRECT. A pocket mask without supplemental oxygen will provide about 16% oxygen to the patient. Page Ref: 228 Objective: 10.16

37) The oxygen flow rate for a nasal cannula should not exceed ________ liters per minute. A) 8 B) 4 C) 6 D) 2

Explanation: A) INCORRECT. 8 liters per minute is too high for a nasal cannula; it would be very uncomfortable for the patient. B) INCORRECT. Nasal cannulas can be used with a higher liter flow than 4. C) CORRECT. When a cannula is used, the liters per minute delivered should be no more than 6. At higher flow rates the cannula begins to feel more uncomfortable and dries out the nasal mucous membranes. D) INCORRECT. Sometimes patients will require more than 2 liters of oxygen with a nasal cannula. Page Ref: 248 Objective: 10.19

41) Of the three types of oxygen flowmeters, which one can only be used upright? A) Bourdon gauge flowmeter B) Hudson gauge flowmeter C) Constant flow selector valve D) Pressure-compensated flowmeter

Explanation: A) INCORRECT. A Bourdon gauge flowmeter, the most common type of meter for pressurized canisters, does not need to be kept upright. B) INCORRECT. There is no requirement that a Hudson regulator must stay in an upright position. C) INCORRECT. A constant flow selector valve can operate when held at any angle. D) CORRECT. A pressure-compensated flowmeter is gravity dependent and must be in an upright position to deliver an accurate reading. Page Ref: 241 Objective: 10.20

26) A 21-year-old patient presents with labored breathing and audible wheezes, heart rate of 124, respiration 36; he has significantly altered mentation. What is the treatment for this patient? A) Supplement the breaths with high-concentration oxygen through a nonrebreather mask. B) Use a pocket mask, which will provide adequate oxygen to improve the patient's condition. C) Ventilate with a bag-valve mask with high oxygen or FROPVD. D) Give mouth-to-mouth breathing with a nasal cannula, providing the patient with an increase of oxygen.

Explanation: A) INCORRECT. A nonrebreather mask should only be used for patients who are breathing adequately on their own; this patient requires assistance to breathe. B) INCORRECT. A pocket mask would not be the EMT's first choice for this patient; it is only a last option when other treatments are not available or effective. C) CORRECT. Since this patient is not breathing adequately positive pressure ventilation is indicated; a BVM or FROPVD should be used to force air or oxygen into his lungs. D) INCORRECT. It would not be appropriate to provide mouth-to-mouth ventilations or use a nasal cannula on this patient. Page Ref: 221 Objective: 10.16

2) What are the signs of hypoxia? A) Warm dry skin, with difficulty in breathing, and hypertension B) Commonly seen as blue or gray skin, deterioration of patient's mental status like confusion or restlessness C) Disease process that robs the patient of adequate breathing and perfusion D) Shock caused from the lack of blood flowing to the vital organs like the brain and heart that is irreversible

Explanation: A) INCORRECT. A patient with hypoxia will not present with warm, dry skin, and hypertension is unrelated. B) CORRECT. Hypoxia will cause the patient's skin to have an ashen, bluish appearance and patient's mental status will be severely impaired. C) INCORRECT. Hypoxia is the result of inadequate breathing and perfusion, not the cause of it; also, the term sign means a condition that can be determined by the EMT through visualization or palpation. D) INCORRECT. Irreversible shock caused by lack of blood is not the definition of hypoxia, nor is it a sign of it. Page Ref: 219 Objective: 10.1

40) Which of the following is acceptable for maintaining a seal between an oxygen cylinder and regulator? A) Pop-off valve B) Gasket C) Grease plug D) Medical grade adhesive tape

Explanation: A) INCORRECT. A pop-off valve is an emergency pressure release, unrelated to the seal between a cylinder and a regulator. B) CORRECT. A gasket that is clean and in good condition can prevent dangerous leaks when it is properly seated between the cylinder and the regulator. C) INCORRECT. Never use grease, oil, or fat-based soaps on oxygen cylinders or their components. D) INCORRECT. Never use adhesive tape to protect an oxygen tank outlet or to mark or label any oxygen cylinders or oxygen delivery apparatus. The oxygen can react with the adhesive and debris and cause a fire. Page Ref: 240 Objective: 10.20

29) Which of the following is the best device to deliver high-concentration oxygen to a breathing patient? A) Simple face mask B) Nonrebreather mask C) Nasal cannula D) Oropharyngeal airway

Explanation: A) INCORRECT. A simple face mask is not an oxygen delivery device. B) CORRECT. The nonrebreather (NRB) mask is the EMT's best way to deliver high concentrations of oxygen to a breathing patient. C) INCORRECT. High-concentration oxygen cannot be delivered effectively using a nasal cannula. D) INCORRECT. An oropharyngeal airway does not supply supplemental oxygen. Page Ref: 247 Objective: 10.16

17) Which of the following BEST describes inadequate breathing? A) The respiratory rate is slower than normal. B) The minute volume is less than normal. C) The minute volume is greater than normal. D) The respiratory rate is faster than normal.

Explanation: A) INCORRECT. A slower than normal respiratory rate can still provide adequate respiration. B) CORRECT. In order for the minute volume to be decreased, the respiratory rate and tidal volume must both also be decreased, which indicates inadequate breathing. C) INCORRECT. An increase in tidal volume and respiratory rate does not describe breathing that is inadequate. D) INCORRECT. A rapid respiratory rate alone does not indicate inadequate breathing. Page Ref: 216-217 Objective: 10.8

14) What is the relatively rare condition that can cause respiratory depression? A) Lungs can react unfavorably to oxygen when the concentration is too high for a long period of time and this can depress breathing. B) Chronic obstructive pulmonary disease (COPD) has changed the stimulus to breathe to the hypoxic drive and high concentration can depress breathing. C) High concentration of oxygen can depress breathing when the patient has an allergic reaction from the oxygen. D) The eyes can develop scar tissue on the retina from a high concentration of oxygen.

Explanation: A) INCORRECT. Absent certain chronic respiratory diseases, high-concentrations of oxygen will not cause depressed breathing. B) CORRECT. COPD patients with a hypoxic drive can experience depressed breathing when exposed to high levels of supplemental oxygen over an extended period; it does not generally apply in the prehospital setting. C) INCORRECT. Human beings do not develop allergies to oxygen. D) INCORRECT. Regardless of whether excessive oxygen can cause eye problems in certain situations, it would not be related to respiratory depression. Page Ref: 219, 243 Objective: 10.7

25) You and your EMT partner are preparing to ventilate an elderly non-trauma patient who has a stoma. Your partner performs the head-tilt, chin-lift maneuver and you ask him to return the patient's head to a neutral position. "Why? This is not a pediatric patient!" your partner protests. What would you say? A) Elderly patients should never have their heads tilted back because spinal curvatures are common and can prevent airway positioning. B) It is not necessary to position the airway of a stoma breather when providing ventilations. C) Stoma breathers should only have their airways positioned after placement of the ventilation device. D) Using the head-tilt, chin-lift prior to clearing any mucus plugs from the stoma can cause airway occlusion.

Explanation: A) INCORRECT. Although some elderly patients can have spinal deformities that can make proper airway positioning difficult, that would not be the reason for leaving this patient's head in a neutral position. B) CORRECT. When providing ventilations to a stoma breather, leave the head and neck in a neutral position, as it is unnecessary to position the airway. C) INCORRECT. It is never correct to attach ventilation devices prior to proper positioning of the patient's airway. D) INCORRECT. Mucus plugs should be cleared prior to ventilating stoma breathers, but it is unrelated to airway positioning. Page Ref: 233 Objective: 10.15

12) Why does a patient involved in an auto crash who has major internal abdominal bleeding require oxygen to maintain internal respiration? A) The red blood cells have a reduction of hemoglobin that reduces the amount of oxygen that can be transported. B) A lack of oxygen in the air decreases the oxygen diffused into the bloodstream, which creates an increase of carbon dioxide. C) The swelling of the abdominal space causes the diaphragm to be restricted, which will reduce the thorax space. D) A lack of circulating volume decreases the oxygen and carbon dioxide transport capability.

Explanation: A) INCORRECT. Bleeding does not cause the red blood cells to lose hemoglobin. B) INCORRECT. There would not be a lack of oxygen in the air, just a lack of this patient's ability to utilize it effectively. C) INCORRECT. Although severe abdominal injuries can affect diaphragm function, this patient's bleeding is a larger concern related to internal respiration. D) CORRECT. As blood volume is lost, the ability of the body to properly manage oxygen and carbon dioxide is reduced; supplemental oxygen will help bolster the oxygen levels in the decreased blood volume. Page Ref: 219 Objective: 10.6

16) When does respiratory distress change to respiratory failure? A) When the respiratory challenge continues, the systems fail with the demand for oxygen, pupils dilate, and the skin becomes hot and dry. B) When the respiratory challenge continues, the systems cannot keep up with the demand, and skin color and mental status change. C) When the patient who is short of breath, with noisy respiration, presents in the tripod position but then suddenly has the condition clear up and return to normal. D) When the compensatory mechanism is no longer needed and the patient goes into arrest.

Explanation: A) INCORRECT. Dilated pupils and hot, dry skin are not signs of respiratory failure. B) CORRECT. When the patient's body can no longer compensate for the breathing challenge, the struggle to breathe will weaken, mental status will become altered, and skin color will become bluish-gray. C) INCORRECT. Recovery from respiratory distress is not respiratory failure. D) INCORRECT. Respiratory arrest directly follows respiratory failure, not distress. Page Ref: 220 Objective: 10.8

13) The movement of oxygen and carbon dioxide across the cell membranes from the capillaries is called: A) external respiration. B) dehydration. C) internal respiration. D) oxygenation.

Explanation: A) INCORRECT. External (or pulmonary) respiration refers to the gas exchange that occurs between the alveoli and the blood. B) INCORRECT. Dehydration refers to inadequate fluid levels within the body; it does not relate directly to cellular gas exchange. C) CORRECT. Internal respiration occurs between the blood in the capillaries and the cells. D) INCORRECT. The term oxygenation refers to the movement of oxygen only. Page Ref: 219 Objective: 10.6

42) Which of the following colors identifies an oxygen cylinder? A) Orange and red B) Black and tan C) Blue and yellow D) Green and white

Explanation: A) INCORRECT. Oxygen cylinders should not be colored orange and red. B) INCORRECT. Black and tan tanks would most likely not contain oxygen. C) INCORRECT. Blue and yellow are not the designated colors for oxygen cylinders. D) CORRECT. The United States Pharmacopoeia has assigned a color code to distinguish compressed gases. Green and white cylinders have been assigned to all grades of oxygen. Page Ref: 238 Objective: 10.20

44) Which of the following is necessary to deliver oxygen to patients at a safe pressure? A) Filter B) Float ball C) Regulator D) Flowmeter

Explanation: A) INCORRECT. Filters do not adjust the pressure being released from oxygen cylinders. B) INCORRECT. A float ball is used on some oxygen delivery systems as a pressure indicator only; it does not change the pressure. C) CORRECT. The pressure in an oxygen cylinder is too high to be delivered to a patient so a pressure regulator must be connected to the cylinder to provide a safe working pressure of 30 to 70 psi. D) INCORRECT. A flowmeter allows control of the oxygen flow rate; it does not control the pressure. Page Ref: 240 Objective: 10.21

10) Which of the following statements BEST describes the exchange of gas in the alveoli? A) Blood moves by way of the pulmonary capillaries, air arrives at the alveoli, and osmosis occurs. B) Blood moves from the left heart to the lungs, air arrives in the alveoli sacks, and diffusion occurs. C) Air moves into the airway, blood arrives via the pulmonary veins, and osmosis occurs. D) Air moves into the alveoli, blood is transported by the pulmonary capillaries, and diffusion occurs.

Explanation: A) INCORRECT. Gas is not exchanged in the alveoli through the process of osmosis. B) INCORRECT. Blood does not move from the left heart to the lungs; the left heart feeds the body with oxygenated blood. C) INCORRECT. Blood does not arrive at the lungs via the pulmonary veins, and osmosis is not involved in gas exchange. D) CORRECT. When air is inhaled, it moves to the lungs where oxygen and carbon dioxide are exchanged between the alveoli and pulmonary capillaries through the process of diffusion. Page Ref: 217 Objective: 10.5

45) Concerning the use of humidified oxygen, which of the following is true? A) It should only be used when assisting ventilations with a bag-valve-mask device. B) The water in the reservoir should be treated with chlorine tablets to prevent the growth of bacteria. C) It is not of great benefit during short transports but can make the patient more comfortable. D) The water reservoir should be changed on a weekly basis.

Explanation: A) INCORRECT. Humidified oxygen is generally not indicated for BVM use and definitely shouldn't be restricted to it. B) INCORRECT. Proper cleaning of the humidifier equipment is the best way to keep it free from bacteria; chlorine tablets should never be used. C) CORRECT. In most short-term use, the dryness of the oxygen is not a problem; however, for long transports the patient is usually more comfortable when given humidified oxygen. D) INCORRECT. Although single-patient-use humidifiers are preferred, if reusable equipment is used, the water reservoir should be cleaned and changed before each shift. Page Ref: 241 Objective: 10.21

11) The movement of oxygen and carbon dioxide between the alveoli and circulating blood is called: A) internal respiration. B) osmosis. C) cellular respiration. D) pulmonary (external) respiration.

Explanation: A) INCORRECT. Internal respiration describes the movement of gases between the blood and the cells of the body. B) INCORRECT. Osmosis refers to the movement of fluids through cellular membranes, not gases. C) INCORRECT. When oxygen and carbon dioxide are exchanged between the blood and the cells, it is called cellular respiration. D) CORRECT. The diffusion of oxygen and carbon dioxide between the alveoli and the blood is called pulmonary respiration. Page Ref: 217 Objective: 10.6

35) A ________ is NOT typically used in the prehospital setting for oxygen administration. A) nasal cannula B) partial rebreather mask C) regulator D) tracheostomy mask

Explanation: A) INCORRECT. Nasal cannulas are very common on ambulances and regularly used for oxygen administration. B) CORRECT. Partial rebreather masks are used for some patients to preserve the carbon dioxide levels in the blood in order to stimulate breathing. These masks are not typically used in EMS but may be occasionally found in the home setting. C) INCORRECT. All oxygen administration requires a regulator of some type on the cylinder. D) INCORRECT. Tracheostomy masks are used to provide supplemental oxygen to patients with stomas or tracheostomy tubes; although not as common as other oxygen delivery devices, they are used in EMS. Page Ref: 247 Objective: 10.18

39) You are attempting to replace the oxygen cylinder in your truck. After removing the regulator from the old cylinder, removing the old cylinder, and placing the new cylinder in the oxygen compartment, you attempt to connect the regulator. The new cylinder has a yellow stripe around it instead of a green one but was stored with the green cylinders. You are unable to get the regulator to seat properly and it will not turn. You should: A) attempt to force the regulator onto the cylinder. B) remove the cylinder and get a green cylinder. C) replace the oxygen regulator with a new one. D) put the old cylinder back on the truck.

Explanation: A) INCORRECT. Never force a regulator onto a cylinder. B) CORRECT. Medical gas cylinders are designed to be used only with gas-specific regulators. Air cylinders will not work with oxygen regulators. C) INCORRECT. A yellow-striped cylinder would not be oxygen, so the regulator is not the problem. D) INCORRECT. A cylinder that does not contain oxygen or that does not work with an oxygen regulator should not be placed onto the ambulance. Page Ref: 238 Objective: 10.20

33) Before applying a nonrebreather mask, the EMT should take what action? A) Insert a properly sized oropharyngeal airway. B) Connect the mask to a humidified oxygen source and wait for the patient's heart rate to slow. C) Make sure the oxygen supply has greater than 2,000 psi in the tank. D) Inflate the reservoir bag and make sure the bag does not deflate during inspiration

Explanation: A) INCORRECT. Nonrebreather masks are for breathing patients with patent airways; if an oropharyngeal airway is indicated then the patient most likely requires positive pressure ventilations. B) INCORRECT. Waiting for a patient's heart rate to slow is not required before administering oxygen with a nonrebreather mask. C) INCORRECT. 2,000 psi is essentially a full oxygen tank; as long as it is not below 200 psi the tank can be used. D) CORRECT. The reservoir bag must be inflated before the nonrebreather mask is placed on the patient's face. Page Ref: 247 Objective: 10.18

3) What signs and symptoms would indicate inadequate breathing in a patient? A) Increased effort to breathe, increased depth of respiration, pink dry skin, normal mental status B) Rapid breathing, pale skin, and a normal mental status C) Decreased depth of respiration, decreased rate of breathing, hot clammy skin, normal mental status D) Increased effort to breathe, cyanosis, cool clammy skin, altered mental status

Explanation: A) INCORRECT. Other than an increased effort to breathe, the other signs and symptoms indicate normal breathing. B) INCORRECT. A normal mental status is not indicative of inadequate breathing. C) INCORRECT. Inadequate breathing will not cause hot, clammy skin and a normal mental status. D) CORRECT. Inadequate breathing can cause a patient to present with an altered mental status, cyanosis, cool, clammy skin, and an increased effort to breathe. Page Ref: 224 Objective: 10.2

15) A 16-year-old patient presents with labored breathing and increased respiratory rate, increased heart rate, and leaning forward with his hands on his knees. His skin is pink and his accurate pulse oximetry is 96. This patient is suffering from respiratory: A) failure. B) hypoxia. C) distress. D) arrest.

Explanation: A) INCORRECT. Respiratory failure occurs when the patient can no longer compensate for the breathing challenge; pink skin and a pulse oximetry reading of 96 do not indicate failure. B) INCORRECT. An accurate pulse oximetry of 96 would indicate that this patient is not hypoxic. C) CORRECT. This patient is still compensating effectively for the respiratory difficulty, but is considered to be in distress. D) INCORRECT. Respiratory arrest is when breathing stops. Page Ref: 220 Objective: 10.8

6) The process of air moving in and out of the chest is called: A) tidal volume. B) inhalation. C) respiration. D) ventilation

Explanation: A) INCORRECT. The amount of air moved in one in-and-out respiratory cycle is known as the tidal volume. B) INCORRECT. Inhalation refers just to the process of air moving into the body. C) INCORRECT. Respiration refers to the exchange of gases between the alveoli and the blood and between the blood and the cells. D) CORRECT. Air is moved into and out of the chest in a process called ventilation. Page Ref: 219 Objective: 10.3

24) You are aggressively ventilating an adult patient with a bag-valve mask when you notice that his previously strong pulse is getting weaker. You should: A) increase the concentration of oxygen. B) reduce the concentration of oxygen. C) reduce the volume of the ventilations. D) begin chest compressions.

Explanation: A) INCORRECT. The concentration of oxygen would not be causing this result; increasing the oxygen would not resolve the issue. B) INCORRECT. Reducing the concentration of oxygen but continuing aggressive ventilations would not resolve this patient's issue. C) CORRECT. Positive pressure ventilation can increase the pressure inside the chest, inhibiting blood return to the heart. You should ventilate just enough to see the chest rise. D) INCORRECT. Chest compressions are not indicated for a patient with a pulse. Page Ref: 226 Objective: 10.14

18) You have arrived at the scene of a call for a "man down." As you enter the residence you note that your patient is a male in his mid-60s who is awake but does not seem to acknowledge your presence. He is perspiring profusely, has cyanosis of his ears and lips, and has rapid, shallow respirations. Which of the following should you do first? A) Check for a radial pulse. B) Obtain the patient's medical history. C) Listen to his lung sounds. D) Assist ventilations with a bag-valve mask and supplemental oxygen.

Explanation: A) INCORRECT. The patient clearly has a pulse so checking for one wouldn't be the first thing an EMT should do in this situation. B) INCORRECT. Taking the time to ask questions about this patient's medical history before doing anything else would not be appropriate. C) INCORRECT. Listening to this patient's lung sounds should not be the first thing that an arriving EMT does. D) CORRECT. This patient is in obvious respiratory failure; providing immediate positive pressure ventilations with supplemental oxygen will help. Page Ref: 221 Objective: 10.9

1) For life to be maintained, a balance of oxygen and carbon dioxide is needed. The condition when oxygen levels are low is called: A) hypotension. B) hypercarbia. C) hyperventilation. D) hypoxia.

Explanation: A) INCORRECT. The term hypotension refers to low blood pressure; it is not directly related to oxygen levels. B) INCORRECT. The condition of having higher than normal levels of carbon dioxide in the blood is called hypercarbia. C) INCORRECT. A breathing rate that is too rapid to maintain proper carbon dioxide levels is called hyperventilation. D) CORRECT. The brain and body cells need a steady supply of oxygen to accomplish the tasks of everyday living. Low levels of oxygen, or hypoxia, will disrupt normal function. Page Ref: 219 Objective: 10.1

30) Your patient is a 65-year-old male with a history of COPD. He is sitting up and complaining of a severe shortness of breath. You should: A) suction the airway with a rigid suction catheter. B) administer 4 lpm of oxygen via nasal cannula. C) insert a nasal airway and ventilate. D) apply a nonrebreather mask giving 15 lpm of oxygen

Explanation: A) INCORRECT. There is no reason to suction this patient's airway. B) INCORRECT. 4 lpm of oxygen via nasal cannula would not be appropriate for this patient. C) INCORRECT. A nasopharyngeal airway and positive pressure ventilations would not be indicated for this patient's current presentation. D) CORRECT. COPD patients that are experiencing severe respiratory distress should receive high-concentration oxygen. Never withhold oxygen from a patient in respiratory distress. Page Ref: 247 Objective: 10.17

28) Your patient is a 55-year-old man with a history of chronic bronchitis. You have been called to his home today because of an increase in his level of respiratory distress. The patient is on 2 liters per minute of oxygen by nasal cannula at home. Your assessment reveals difficulty speaking due to shortness of breath, leaning forward to breathe, a productive cough, and a respiratory rate of 32 per minute. Which of the following is true concerning the best course of action for this patient? A) Because increased blood levels of carbon dioxide are the primary stimulus to breathe, you should encourage the patient to rebreathe his exhaled air from a paper bag. B) You should increase the patient's oxygen flow rate to deliver adequate amounts of oxygen to his tissues. If his respiratory rate decreases, you can assist him with a bag-valve-mask device. C) You should increase the patient's oxygen flow rate until his respiratory rate decreases and then resume oxygen administration at 2 liters per minute. D) You should not increase the patient's oxygen flow rate because of his likely dependence on a hypoxic drive to stimulate breathing.

Explanation: A) INCORRECT. This patient is in respiratory distress and requires oxygen, having him breather into a paper bag is not appropriate care. B) CORRECT. For chronic respiratory patients, as with all patients, make decisions on oxygenation based on patient presented level of distress and pulse oximetry. Do not withhold oxygen from any patient in distress. C) INCORRECT. An EMT in the prehospital setting should not be attempting to regulate a COPD patient in this manner. D) INCORRECT. Regardless of the patient's chronic history, all respiratory distress situations in the prehospital setting should be treated with consistent oxygen therapy. Page Ref: 243 Objective: 10.16

20) Which of the following patients does NOT require the administration of supplemental oxygen? A) A 60-year-old woman with a history of chronic obstructive pulmonary disease (COPD) who can speak two or three words at a time without a breath B) A 6-year-old male with a history of asthma whose breath sounds are silent and who is drowsy C) A 31-year-old male who is unresponsive due to an overdose of narcotics D) A 24-year-old woman who is breathing 28 times per minute after being in an argument with her husband

Explanation: A) INCORRECT. This patient is obviously not breathing adequately and would benefit from supplemental oxygen in the prehospital setting. B) INCORRECT. A drowsy asthmatic with no breath sounds would require supplemental oxygen. C) INCORRECT. This unresponsive patient who has overdosed on narcotics would definitely benefit from supplemental oxygen. D) CORRECT. This patient is upset and hyperventilating; the administration of supplemental oxygen would potentially worsen her condition. Page Ref: 237 Objective: 10.11

36) Venturi masks are designed to mix oxygen with: A) nitrogen. B) inhaled air. C) humidified air. D) carbon monoxide.

Explanation: A) INCORRECT. Venturi masks are not specifically used to combine nitrogen with oxygen. B) CORRECT. Most commonly used for COPD patients, Venturi masks deliver specific concentrations of oxygen by mixing oxygen with inhaled air. C) INCORRECT. Venturi masks are not specifically made to mix oxygen with humidified air. D) INCORRECT. Carbon monoxide is a potentially poisonous gas and is not related to Venturi mask use. Page Ref: 249 Objective: 10.18

38) Which of the following oxygen cylinders would normally run out after 50 minutes when flowing at 10 liters per minute? A) M tank B) D tank C) G tank D) E tank

Explanation: A) INCORRECT. With a capacity of 3,000 liters of oxygen, an M tank would last almost five hours at 10 lpm. B) INCORRECT. A D cylinder holds approximately 350 liters, which would run out in about 35 minutes. C) INCORRECT. G tanks are normally part of an on-board oxygen system and hold up to 5,300 liters — or nearly nine hours of oxygen flowing at 10 liters per minute. D) CORRECT. An E tank holds approximately 625 liters of oxygen; running at 10 lpm, it would last almost an hour. Page Ref: 238 Objective: 10.19