Unit3

28) Which of the following is an advantage of using a nasopharyngeal airway (NPA)? A) It may be tolerated by many patients with a gag reflex. B) It is ideal for patients with a suspected skull fracture. C) It eliminates the need for manual positioning of the patient's head to keep the airway open. D) All of the above

A) Explanation: CORRECT. A patient with a gag reflex who cannot tolerate an oropharyngeal airway may be able to tolerate a nasopharyngeal airway. Page Ref: 220

26) Which of the following is true concerning the procedure for inserting a nasopharyngeal airway (NPA)? A) The bevel should be turned toward the nasal septum or the base of the nostril. B) The length of the device is not as important as it is with oropharyngeal airways. C) It can only be placed in the right nostril. D) If a water-soluble lubricant is not available, a silicon spray can be substituted.

A) Explanation: CORRECT. Most nasopharyngeal airways are designed to be placed in the right nostril with the bevel pointed toward the septum or the base of the nostril. Page Ref: 222

22) Which of the following is a sign of an inadequate airway? A) Nasal flaring B) Regular chest movements C) Equal expansion of both sides of the chest on inhalation D) Movement of air around the mouth and nose

A) Explanation: CORRECT. Signs that indicate no airway or a potentially inadequate airway include nasal flaring, especially in infants and children. Page Ref: 209

13) When assessing a patient's breathing, what is your first question? A) Is he breathing? B) Is he alive or dead? C) Is he seriously ill or mildly ill? D) Is his breathing adequate or inadequate?

A) Explanation: CORRECT. The first thing that an EMT must determine when assessing a patient's breathing is whether or not the patient is breathing. Page Ref: 248

21) The jaw-thrust maneuver is the only ________ airway procedure for an unconscious patient with possible head, neck, or spine injury or an unknown mechanism of injury. A) recommended B) required C) discouraged D) prohibited

A) Explanation: CORRECT. The jaw-thrust maneuver is the only recommended airway procedure for an unconscious patient with a possible head, neck, or spine injury or unknown mechanism of injury. Page Ref: 213

9) 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) It is not necessary to position the airway of a stoma breather when providing ventilations. B) Stoma breathers should only have their airways positioned after placement of the ventilation device. C) Using the head-tilt, chin-lift prior to clearing any mucus plugs from the stoma can cause airway occlusion. D) Elderly patients should never have their heads tilted back because spinal curvatures are common and can prevent airway positioning.

A) Explanation: 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.Page Ref: 262

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

A) Explanation: 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. Page Ref: 276

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

A) Explanation: 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. Page Ref: 267

1) You have performed a head tilt-chin lift maneuver on a 17-month-old boy and are attempting to ventilate him with a bag-valve mask. You are experiencing a lot of resistance with each breath and the chest is barely rising. Prior to attempting ventilations again, you should: A) ease the head forward a little. B) tilt the head back further. C) finger sweep the airway. D) perform chest thrusts.

A) Explanation: CORRECT. The trachea of a small child is more pliable than that of an adult. Exaggerated flexion of the airway causes the trachea to bend unnaturally and block off the flow of air Page Ref: 212

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

A) Explanation: 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: 241

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

B) Explanation: CORRECT. A pocket face mask is used to perform mouth-to-mask ventilation. Page Ref: 257

30) Which of the following patients should not have their airway opened using a head-tilt, chin-lift maneuver? A) A 25-year-old man who is still unresponsive after a grand mal seizure. B) A homeless person of undetermined age found lying unresponsive in an alley with no bystanders. C) A 50-year-old woman who choked on a piece of food while dining in a restaurant and was lowered to the floor by a waiter. D) A 35-year-old diabetic woman in the driver's seat of the car in her driveway who becomes unresponsive while speaking to her husband.

B) Explanation: CORRECT. If the mechanism of injury is unknown, do not use the head-tilt, chin-lift maneuver. You should assume head or spinal injuries have occurred because it is impossible to determine otherwise due to the patient's lack of response and the lack of witnesses. Page Ref: 213

29) Your patient is breathing 4 shallow breaths per minute due to overdosing on his pain medication but he has a palpable radial pulse. He vomited prior to your arrival and is choking. You should: A) perform chest thrusts to clear the lungs. B) roll him onto his side to clear the airway. C) insert an oropharyngeal airway and ventilate. D) move the patient to the ambulance and suction.

B) Explanation: CORRECT. Rolling the victim on his side requires no equipment and is a fast alternative for clearing the airway. This maneuver will clear most of the vomit in the patient's airway using gravity. Page Ref: 227

15) When does respiratory distress change to respiratory failure? A) When a patient who is short of breath presents in the tripod position with noisy respirations that suddenly clear up and return to normal. B) When continuation of a respiratory challenge results in the systems being unable to keep up with the demand, and the skin color and mental status change. C) When continuation of a respiratory challenge causes the systems to fail, the pupils to dilate, and the skin to become hot and dry due to the demand for oxygen. D) When a compensatory mechanism is no longer needed and the patient goes into respiratory arrest.

B) Explanation: CORRECT. When the patient's body can no longer compensate for a breathing challenge, the struggle to breathe will weaken, mental status will become altered, and skin color will become bluish-gray. Page Ref: 244-248

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

C) Explanation: CORRECT. A tracheostomy mask is designed to be placed over a stoma or tracheostomy tube to provide supplemental oxygen. Page Ref: 278

24) You are ventilating an 85-year-old male without difficulty. A nurse tells you that the patient has dentures. To ensure a good mask seal, you should: A) use an infant mask over the nose. B) tape the dentures in place. C) leave the dentures in place. D) remove the dentures.

C) Explanation: CORRECT. Dentures should be left in place as long as they do not move in the mouth. Dentures give the mouth structure, making it easier to maintain a mask seal. Page Ref: 234

20) Which of the following is the correct method of suctioning? A) Begin suctioning as you insert the suction tip or catheter into the mouth. B) Suction intermittently, both while inserting and withdrawing the suction tip or catheter. C) Insert the catheter or tip to the desired depth prior to applying suction. D) Suction continuously, both while inserting and withdrawing the suction tip or catheter.

C) Explanation: CORRECT. For suctioning, place the tip or catheter where you want to begin the suctioning and suction on the way out. Page Ref: 232

14) What are the signs of hypoxia? A) Warm dry skin, difficulty breathing, and hypertension B) Disease process that robs the patient of adequate breathing and perfusion C) Cyanosis (blue or gray skin) and deterioration of the patient's mental status D) Irreversible shock caused by the lack of blood flowing to the vital organs like the brain and heart

C) Explanation: CORRECT. Hypoxia will cause the patient's skin to have an ashen, bluish appearance and the patient's mental status will be severely impaired. Page Ref: 250

23) Which of the following should be kept in mind when assessing and managing the airway of a pediatric patient? A) The tongue is not as likely to obstruct the airway as in an adult. B) Gastric distention is unlikely. C) The trachea is easily obstructed by swelling. D) Due to their short necks, pediatric patients require a greater degree of hyperextension to open the airway than do adults.

C) Explanation: CORRECT. The trachea is narrower in pediatric patients and more easily obstructed by swelling. Page Ref: 205

10) The paramedic is intubating a patient and asks you to assist by gently pressing your thumb and index finger to either side of the throat just over the patient's Adam's apple. As you press, you gently direct the throat upward and to the patient's right. What is the purpose of this maneuver? A) It keeps the tube from becoming displaced and entering the esophagus. B) It lessens the patient's gag reflex and eases tube insertion. C) It pushes the patient's vocal cords into the paramedic's view. D) It prevents the tube from entering the right mainstem bronchus.

C) Explanation: CORRECT. This maneuver-known as Bringing Up and to the Right Position (BURP)-pushes the vocal cords into the paramedic's view and allows the tube to be moved past the vocal cords correctly. Page Ref: 281

25) To be effective, a suction unit must be able to generate air flow of at least ________ liters per minute and create a vacuum of no less than ________ mmHg. A) 300; 330 B) 30; 30 C) 30; 300 D) 300; 30

C) Explanation: CORRECT. To be effective, suction devices must furnish an air intake of at least 30 liters per minute at the open end of a collection tube. This will occur if the system can generate a vacuum of no less than 300 mmHg when the collecting tube is clamped. Page Ref: 228

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

C) Explanation: CORRECT. When high-concentration oxygen is attached to the inlet on a pocket mask, it delivers an oxygen concentration of approximately 50%. Page Ref: 257

27) Perhaps the simplest way to determine if a patient has a patent airway is to: A) determine the respiratory rate. B) auscultate for breath sounds. C) say "hello." D) check for appropriate chest rise.

C) Explanation: CORRECT. You can determine the presence of an airway in most patients by simply saying hello. The patient's ability to speak is an immediate indicator that he is capable of moving air. Page Ref: 207

3) 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 is yellow rather than green, but it was stored with the green cylinders. You are unable to get the regulator to seat properly and it will not turn. You should: A) put the old cylinder back on the truck. B) attempt to force the regulator onto the cylinder. C) remove the yellow cylinder and get a green cylinder. D) replace the oxygen regulator with a new one.

C) Explanation: CORRECT. Compressed gases are color coded per the United States Pharmacopoeia, and oxygen cylinders are always only green or green and white. In addition, gas cylinders are designed to be used only with gas-specific regulators. In this case, you are attempting to put an oxygen regulator on a non-oxygen tank. The cylinder should be removed from the truck and replaced with a green oxygen tank. Page Ref: 266-268

11) The normal urge to breathe is stimulated by chemoreceptors that measure changing levels of what two gases? A) Hydrogen and carbon dioxide B) Carbon monoxide and oxygen C) Carbon dioxide and oxygen D) Hydrogen and carbon monoxide

C) Explanation: CORRECT. Special sensors in the cardiovascular system, called chemoreceptors, detect increasing levels of carbon dioxide as well as low levels of oxygen. Page Ref: 243

19) You are ventilating a cardiac arrest patient when he begins to vomit copious amounts of large pieces of undigested food. Which of the following would be most effective in clearing the airway? A) Using a 14 French suction catheter B) Using a rigid pharyngeal suction tip C) Irrigating the mouth with sterile water to dilute the material before suctioning D) Using large bore suction tubing without a tip or catheter attached

D) Explanation: CORRECT. In the event of copious, thick secretions or vomiting, consider removing the rigid tip or catheter and using the large bore, rigid suction tubing. Page Ref: 230

17) When suctioning the airway, you should try to limit suctioning to no longer than ________ seconds at a time. A) 60 B) 45 C) 30 D) 10

D) Explanation: CORRECT. Limit suctioning to no longer than 10 seconds at a time. This is because prolonged suctioning will cause hypoxia and, potentially, death. Page Ref: 232

2) 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) begin chest compressions. B) reduce the concentration of oxygen. C) increase the concentration of oxygen. D) reduce the volume of the ventilations.

D) Explanation: 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. Page Ref: 251

18) Which of the following structures is found in the lower airway? A) Pharynx B) Uvula C) Tonsils D) Bronchi

D) Explanation: CORRECT. The bronchi are the air passages that split off from the trachea in the lower airway and enter each lung. Page Ref: 205

4) 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) Have her breathe into a paper bag to control her hyperventilation. B) Do not make further attempts to administer oxygen as it will only agitate the patient further. C) Consult with medical control about restraining the patient. D) Use a nasal cannula instead.

D) Explanation: 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. Page Ref: 276