Chapter 10: Airway

QUESTION: You must transport a patient with carbon monoxide poisoning to a specialized facility for treatment. Transport time is estimated at 1.5 hours. The patient is on a nonrebreather face mask with a continuous oxygen flow of 15 lpm. In the ambulance, you have a G tank with 1100 psi inside. Knowing that the cylinder constant is 2.41, which action should the EMT take in relation to the amount of available oxygen and transport time? A) Complete the transport, and replace the G cylinder when back at the station B) Apply a nasal cannula at 8 lpm for the transport C) Decrease the oxygen flow to 10 lpm for the transport D) Return to the EMS station so you can replace the G cylinder with a full one

A

QUESTION: A 2-year-old boy who just seized must have his airway opened. When performing the head-tilt, chin-lift airway maneuver, the EMT must remember: A) If necessary, the head should be only slightly extended B) The head must be flexed forward C) The head must be hyperextended D) A towel roll should be placed under the head

A

QUESTION: A 21-year-old female patient has overdosed on an unknown drug. She has snoring respirations and an intact gag reflex. She has weak respiratory effort and is slightly cyanotic. Given these assessment findings, your care should include: A) insertion of a nasal airway B) transport of the patient in the lateral recumbent (recovery) position C) oxygen via nonrebreather face mask D) placement of an oropharyngeal airway

A

QUESTION: A 52-year-old male patient with a brain tumor has gone into respiratory arrest, but still has a pulse and obtainable blood pressure. You assign the task of artificially ventilating the patient with the bag-valve mask to a new Emergency Medical Responder. How will you instruct him to ventilate the patient? A) Deliver 10 breaths per minute B) Administer 8 breaths per minute C) Give the patient 24 breaths per minute D) Give the patient 20 breaths per minute

A

QUESTION: A patient complaining of shortness of breath and a history of asthma has the following vital signs: pulse, 96; respirations, 20 breaths/min; blood pressure, 132/86 mmHg; and SpO2, 92% on room air. Mild wheezing is noted bilaterally, and the patient states that she has run out of her rescue inhaler (albuterol). Regarding the patient's respiratory status, how should you initially administer oxygen? A) 2 lpm O2 through a nasal cannula B) 12 lpm O2 through a nonrebreather mask C) 4 lpm O2 through a nasal cannula D) 15 lpm O2 through a nonrebreather mask

A

QUESTION: A patient who inhaled superheated steam in an industrial fire is most likely to exhibit which abnormal upper airway noise? A) Stridor B) Snoring C) Gurgling D) Wheezing

A

QUESTION: A young child with multiple physical and developmental abnormalities has a severe nosebleed. You must suction his nasopharynx to decrease the amount of blood he is swallowing. Which action should be part of this care? A) Insert a soft catheter into the nose the same length as the distance from the patient's nose to the tip of his ear B) Irrigate the nostrils with water to thin and loosen the blood prior to suctioning with a rigid catheter C) Insert the soft catheter through the nose past the base of the tongue D) Place the patient on his side and gently insert a rigid-tip catheter 1 inch into each nostril, starting with the right nostril

A

QUESTION: A young male patient has been stabbed in the right lateral chest. Regarding the respiratory system, which finding presents the greatest danger to his well-being? A) Collection of air between the pleural and visceral membranes B) Loss of serous fluid from membranes in the chest C) Fracture of the rib and predisposition to a pulmonary infection D) Loss of oxygen from the lungs through the stab wound

A

QUESTION: Despite coaching and explaining the benefits of a nonrebreather face mask, a hypoxic patient with moderate shortness of breath in conjunction with lung cancer states that she cannot tolerate the mask over her face. The more she panics, the worse the shortness of breath becomes. What is your best course of action? A) Disconnect the nonrebreather mask and replace it with a nasal cannula B) Remove the nonrebreather mask and apply a simple face mask C) Decrease the oxygen flow rate entering the nonrebreather face mask D) Discontinue oxygen therapy and continually monitor the patient's breath sounds during transport

A

QUESTION: For which of these patients is placement of an oropharyngeal airway indicated? A) An unresponsive patient who has no gag or cough reflex B) A patient with snoring respirations who coughs as the oral airway is placed into his mouth C) A patient who responds to painful stimuli by moaning and has vomited D) A responsive but confused patient with stridorous respirations

A

QUESTION: The EMT exhibits an accurate understanding of breathing when he states: A) "Inhalation requires energy, while exhalation for most patients is a passive process." B) "When a person inhales, carbon dioxide is drawn into the lungs, and when he exhales, oxygen leaves the body." C) "Respiration is best described as the process of moving air into and out of the body." D) "In between breaths, the epiglottis protectively closes over the trachea."

A

QUESTION: The EMT has just placed an oropharyngeal airway in a patient. By doing so, what has the EMT accomplished? A) Displaced the tongue away from the back of the airway B) Protected the airway from vomit or other secretions C) Minimized the risk of vomiting by closing off the esophagus D) Obtained a patent airway by preventing closure of the mouth

A

QUESTION: The EMT is properly applying continuous positive airway pressure (CPAP) when he: A) Places the mask over the patient's mouth and nose and tightens it to the face B) Checks and documents the pulse oximetry reading every 15 minutes C) Places a confused patient receiving CPAP in a lateral recovery position D) Adjusts the ventilation rate to between 16 and 18 breaths/min

A

QUESTION: The EMT recognizes a late sign of hypoxia in a patient in a coma when he observes: A) Cyanosis in the fingers B) Restlessness and agitation C) Complaint of a headache D) Elevation in blood pressure

A

QUESTION: The EMT should use the jaw-thrust maneuver to open the airway for the patient with which type of presentation? A) Unresponsive after falling from a porch B) Overdose with snoring respirations C) Cardiac arrest in bed D) Stroke with gurgling respirations

A

QUESTION: The EMT shows that he is correctly using the flow-restricted, oxygen-powered ventilation device when he: A) Stops ventilating as soon as the patient's chest begins to rise B) Administers each ventilation over a 2- to 3-second period C) Increases pressure if the air enters the stomach instead of the lungs D) Ventilates the patient at a rate of 20 breaths per minute

A

QUESTION: The EMT shows that she understands how to use an oropharyngeal airway when she states: A) "I must remain alert for vomiting or spasm of the vocal cords even with proper insertion." B) "If this airway is too small, it could push the epiglottis over the opening of the trachea." C) "Once this airway has been placed, the head-tilt, chin-lift maneuver is no longer needed." D) "This airway protects the patient from aspirating vomit or other secretions."

A

QUESTION: When administering continuous positive airway pressure (CPAP) to a patient, you would recognize that the patient is benefiting from the treatment when the: A) Patient states he is breathing easier B) Patient can resume control of his airway C) Systolic blood pressure drops below 100 mmHg D) Heart rate increases from baseline by 10 percent

A

QUESTION: Which description demonstrates the EMT knows how to correctly position the BVM on the patient's face? A) "I place the narrow part of the mask over the bridge of the nose, and the bottom part in the cleft above the chin." B) "The mask is properly positioned when the top portion lies over the bridge of the nose and the lower portion below the chin." C) "The wide portion of the mask is placed at the top of the nose and the narrow part below the lower lip." D) "If two rescuers are using the BVM, the mask needs to be placed only over the mouth and the nose pinched closed."

A

QUESTION: Which of these sequences best describes the path that oxygen must travel to get into the cells of the body? A) Oropharynx, larynx, trachea, carina, bronchioles B) Pharynx, larynx, trachea, alveoli, bronchioles C) Nose, pharynx, esophagus, bronchi, alveoli D) Nasopharynx, oropharynx, carina, trachea, alveoli 79)

A

QUESTION: Which of these statements is most correct regarding the difference between respiration and ventilation? A) Respiration describes the exchange of O 2 and CO2, while ventilation describes the movement of air that carries them into and out of the body B) Ventilation describes the absorption of O2 into the cells, while ventilation is the excretion of CO2 from the cells C) Ventilation describes the exchange of gases at the cellular level, while respiration describes the same process between the lungs and the external environment D) Respiration and ventilation are similar terms that both describe normal and healthy breathing in the living organism

A

QUESTION: Which of these statements made by another crew member would cause you to disregard the use of continuous positive airway pressure (CPAP) for a patient? A) "His respirations are agonal and slow." B) "His blood pressure is 186/108 mmHg." C) "His SpO2 has fallen from 92% to 88%." D) "He had bleeding stomach ulcers two years ago."

A

QUESTION: Which of these statements, when made by the EMT, reflects correct knowledge regarding the use of oxygen in a patient with a suspected acute coronary syndrome who denies dyspnea, has a pulse oximeter reading of 96%, and has acceptable vital signs? A) "Oxygen administration is no longer considered standard therapy for this patient." B) "Over-oxygenating a patient is not an issue for EMS, given the short amount of time we have patient contact." C) "Oxygen administration should be used in such a way that a patient's SpO2 reaches 97% to 100% if he or she is having chest pain." D) "Aside from patients with chest pain, stroke, and trauma, oxygen is no longer used in emergency care."

A

QUESTION: Which statement about the flow-restricted, oxygen-powered ventilation device is true? A) "It can be used to ventilate spontaneously breathing patients whose breathing is too shallow." B) "It is very easy to use and has almost no complications associated with its use." C) "It is an effective tool by which children can be ventilated when they are apneic." D) "It has a safety valve that prevents lung damage from overinflation."

A

QUESTION: Which statement made by an EMT shows that she understands how to suction patients in a field setting? A) "I activate the suction device only when I am withdrawing the suction catheter." B) "When caring for a young child, I suction for a minimum of 5 seconds." C) "It is helpful to pour sterile water into the patient's mouth to further liquefy vomit and make it easier to suction." D) "To thoroughly suction a patient, I insert the rigid-tip catheter past the base of the tongue and into the pharynx."

A

QUESTION: While a 61-year-old female patient in cardiac arrest receives emergency care, you note that her abdomen grows larger with each ventilation provided from a bag-valve mask. Which instructions should you provide to your partner? A) "Let's slow the ventilation rate to 10 per minute, providing each breath over 1 second." B) "The ventilation rate and force of ventilation need to be increased so air goes into the lungs." C) "Try delivering each ventilation over 3 seconds, and let's slow down the rate." D) "I need another rescuer to apply firm pressure over the stomach, while we ventilate this patient."

A

QUESTION: While the EMT is inserting an oropharyngeal airway, the patient gags. The EMT should: A) Remove the airway and maintain the head-tilt, chin-lift maneuver B) Use a tongue depressor to better place the oral airway C) Lubricate the oropharyngeal airway and reattempt insertion D) Reattempt insertion using a smaller oropharyngeal airway

A

QUESTION: While you are transporting a patient with altered mental status, he suddenly vomits partially digested food along with large blood clots. The vomitus is too big for the rigid suction catheter. The EMT should immediately place the patient on his side and: A) Perform a finger sweep B) Administer abdominal thrusts C) Use a soft suction catheter D) Encourage the patient to cough

A

QUESTION: You are caring for a 46-year-old male patient who is unresponsive. Which statement made by your partner indicates the need to immediately stop suctioning the patient's airway and resume positive pressure ventilation? A) "His heart rate is 48 beats per minute." B) "You have been suctioning now for 10 seconds." C) "He is starting to have gurgling respirations." D) "His pulse oximeter has dropped 2 percentage points."

A

QUESTION: You are checking the D oxygen tank in the ambulance and note that the reading on the pressure regulator is 1000 psi. You should recognize that the tank is: A) Half full B) Leaking C) Almost empty D) Overfilled

A

QUESTION: You are starting to ventilate a patient with a laryngectomy and stoma. As you provide the first few ventilations, you note that the air passes easily into the patient, but does not cause the chest to rise. Your next action should be to: A) Seal the patient's mouth and nose B) Perform a head-tilt, chin-lift maneuver C) Suction the tracheostomy tube D) Ventilate through the mouth and nose

A

QUESTION: You are transferring an unresponsive patient from her house to the ambulance on the stretcher. An oral airway has been placed and ventilations with the bag-valve mask are being administered. Suddenly, the patient regains consciousness and starts to gag. Your immediate action should be to: A) Remove the oral airway B) Suction the airway C) Reassure and calm the patient D) Leave the airway in but stop ventilations

A

QUESTION: You are using an automatic transport ventilator (ATV) for a patient who has an insufficient respiratory effort. What is the best indicator of adequate artificial ventilation by the ATV? A) The patient's chest rises and falls with each mechanical ventilation B) The inspiratory to expiratory ratio is 2 seconds to 1 second C) The preset tidal and minute volumes on the ATV are being used D) There is no air leak between the mask and the patient's face

A

QUESTION: You must immobilize a 6-year-old male patient who was involved in a motor vehicle accident. Regarding the airway, why should you consider placing padding under his shoulders and back? A) The child's occipital skull is larger in proportion to his body B) The child's cricoid cartilage is prone to collapse C) The child's diaphragm is lower and more difficult to move D) The child's tongue is larger and weaker than an adult's

A

QUESTION: You must suction the oropharynx of a male patient who has a decreased ability to swallow secondary to a previous stroke. He also has a history of smoking and lung cancer. What would be the most appropriate suction catheter for use with this patient? A) Yankauer B) French C) Texas D) Soft

A

QUESTION: Your paramedic partner has applied continuous positive airway pressure (CPAP) to a patient in respiratory distress from congestive heart failure (CHF). As an EMT, you realize that this treatment should benefit the patient by: A) Displacing fluid in the alveoli back into the bloodstream B) Causing the diaphragm to relax during inspiration C) Collapsing portions of the diaphragm D) Removing air from the lungs during exhalation

A

Question: When inserting a nasopharyngeal airway, the EMT should remember that: A) The nasal mucosa may bleed even with proper insertion B) An oil-based lubricant is needed for smooth insertion C) The patient cannot be responsive or have a gag reflex D) The head-tilt, chin-lift maneuver or jaw-thrust maneuver is not needed after insertion

A

Question: You arrive at work and note that the portable oxygen tank in the ambulance is now yellow instead of green, as during the previous shift. As a knowledgeable EMT, you should: A) Remove the tank and retrieve a green cylinder B) Determine that your service has switched to the new lightweight oxygen tank C) Realize that a yellow color indicates a new-style tank that holds more oxygen D) Recognize the addition of more effective synthetic oxygen

A

QUESTION: A patient was eating dinner when a piece of food became caught in his throat. Although coughing has failed to remove the food, he remains able to move an adequate amount of air into and out of his lungs. A nasal cannula has been applied and vital signs are stable. During transport, the patient suddenly begins to exhibit stridorous respirations. Your immediate action should be to: A) Place the patient supine and suction his airway B) Perform abdominal thrusts C) Start positive pressure ventilation D) Continue care and transport

B

QUESTION: A patient with chest discomfort has the following vital signs: pulse, 88; respirations, 14 breaths/min; blood pressure, 154/84 mmHg; and SpO 2, 97% on room air. In this situation, the EMT would address oxygen therapy by: A) Administering blow-by oxygen at 5 lpm B) Withholding the use of oxygen C) Providing oxygen via a nonrebreather at 15 lpm D) Using a nasal cannula with flow of 4 lpm

B

QUESTION: After 2 minutes of continuous positive airway pressure (CPAP) at 4 cmH2O, you see no improvement in the patient's respirations or SpO2 level. What is your next step? A) Continue the CPAP as is and monitor the patient for another 5 minutes B) Increase the continuous positive airway pressure by 2 cmH2O and reassess the patient C) Stop the CPAP and begin to provide positive pressure ventilation D) Place an oral airway and continue the continuous positive airway pressure

B

QUESTION: The EMT is appropriately sizing the nasal airway when she measures the: A) Diameter of the larger nostril B) Distance from the tip of the nose to earlobe C) Distance from the mouth to the angle of the jaw D) Diameter of the patient's little finger 59)

B

QUESTION: The EMT is correctly performing the jaw-thrust airway maneuver when she: A) Opens the patient's airway by slightly extending the head and thrusting the jaw upward B) Places her hands on the side of the patient's head and lifts the jaw upward C) Places one hand on the patient's forehead and lifts the jaw upward with her other hand D) Maintains the patient's head in a neutral position and slightly tilts the head backward

B

QUESTION: The EMT should recognize that the oropharyngeal airway has been appropriately inserted when: A) Vomiting is no longer occurring B) Its flange rests on the teeth C) It cannot be dislodged by the EMT D) The respiratory rate returns to normal

B

QUESTION: The EMT would recognize that administering continuous positive airway pressure (CPAP) at a pressure that is too high can cause: A) Oral cavity pressure trauma B) Lung collapse C) Hypertension D) Pulmonary edema

B

QUESTION: The structure that lies between the trachea and bronchi is the: A) Larynx B) Carina C) Cricoid cartilage D) Bronchioles

B

QUESTION: Typically, the highest continuous positive airway pressure (CPAP) pressure used by the EMT without special permission from medical direction is: A) 2 cmH2O B) 10 cmH2O C) 20 cmH2O D) 5 cmH2O 92)

B

QUESTION: What is the preferred method of providing high-concentration oxygen to a breathing patient in the prehospital setting? A) Nasal cannula B) Nonrebreather face mask C) Venturi mask D) Simple face mask

B

QUESTION: When does hypoxia occur? A) When carbon dioxide accumulates within the body B) If inadequate amounts of O 2 are available to the cells C) If the respiratory rate decreases to less than 12 breaths per minute D) When carbon dioxide is excreted too rapidly from the lungs

B

QUESTION: When properly using a nonrebreather face mask, which of these statements is true? A) Oxygen is delivered into the lungs even when the patient is not inhaling B) The concentration of inhaled oxygen will be approximately 90% C) The mask is comfortable and well tolerated by all patients when properly applied D) The air exhaled by the patient will be recycled with oxygen

B

QUESTION: When providing an in-service program on ventilating the geriatric patient, you should emphasize which point in regard to a patient who has dentures? A) It is best to leave the top appliance in place, but remove the bottom one B) Loose appliances should be removed if they interfere with the airway or the seal between the mask and face C) Removal of dentures enables the EMT to maintain a better face to mask seal D) It is always best to remove dentures, regardless of whether they are loose

B

QUESTION: When using a therapy regulator, what can be readily observed by the EMT? A) Temperature of oxygen in the cylinder B) Liter flow (flow rate) of oxygen leaving the cylinder C) Concentration of oxygen received by the patient D) Liters of oxygen remaining in the oxygen cylinder

B

QUESTION: Which configuration on the bag-valve mask (BVM) will enable the EMT to deliver the highest concentration of oxygen to the patient? A) BVM attached to oxygen at 15 lpm B) BVM with oxygen reservoir attached, receiving oxygen at 15 lpm C) BVM with oxygen reservoir attached D) BVM with room-air oxygen being used by two EMTs

B

QUESTION: Which of these conditions would the EMT associate with a hypoxic respiratory drive? A) Diabetes B) Chronic obstructive pulmonary disease C) Pneumonia D) Congestive heart failure

B

QUESTION: Which of these patients is most likely to lose neurologic control and regulation of the respiratory system? A) A 56-year-old patient with heart problems and chest pain B) A 31-year-old patient with a severe head injury C) A 44-year-old patient who smokes and is nauseated D) A 61-year-old patient diagnosed with diabetes

B

QUESTION: Which of these statements regarding the use of a nasal cannula is true? A) "I can adjust the oxygen flow rate anywhere from 1 to 8 lpm, depending on how much oxygen the patient needs." B) "When the nasal cannula is set to the highest appropriate oxygen flow rate, a large portion of the air inspired by the patient is still ambient air." C) "It is best to see how the patient tolerates the nasal cannula before attempting to place a nonrebreather mask on the patient." D) "The nasal cannula is preferred over the nonrebreather mask because it gives the oxygen through the nose instead of the mouth."

B

QUESTION: Which statement indicates that the EMT has an accurate understanding of the bronchioles? A) "They are large structures that pass oxygen from the lungs directly into the bloodstream." B) "They are small passages located in the lower airway that have smooth muscle surrounding them." C) "They are small air sacs located just before the alveoli." D) "They are large airways located after the carina and are supported by cartilage."

B

QUESTION: Which statement regarding airway management in the trauma patient is correct? A) Research has shown that the jaw-thrust maneuver is easier to perform and, therefore, is indicated for the more critical trauma patient B) Performing the head-tilt, chin-lift maneuver on a patient with a possible spinal injury could further injure or paralyze the patient C) Trauma patients should always have their airway opened with the jaw-thrust maneuver, whereas medical patients should receive the head-tilt, chin-lift only D) The jaw-thrust maneuver is useful in the trauma patient, but only if he or she is complaining of head or neck pain 14)

B

QUESTION: Which type of portable suction unit has the lowest potential for problems during its use? A) Air powered B) Hand powered C) Battery powered D) Oxygen powered

B

QUESTION: Why is the jaw-thrust maneuver indicated for a patient with a possible spinal injury? A) It is the EMT's preference as to whether to use the head-tilt, chin-lift maneuver or the jaw-thrust maneuver B) It manipulates the head and cervical spine less than the head-tilt, chin-lift maneuver C) It is a permanent airway intervention that does not require a mechanical airway if performed correctly D) It is less painful for the patient since he is already in pain from the injury

B

QUESTION: You are administering oxygen at 2 lpm through a nasal cannula to a confused patient. During transport, you note the SpO2 to be 91%, up from 90% on scene. The patient remains confused. What would your next action be? A) Start positive pressure ventilation with supplemental oxygen B) Increase the oxygen flow to 4 lpm C) Keep the oxygen flow at 2 lpm and continue to monitor D) Administer oxygen at 15 lpm through a nonrebreather mask

B

QUESTION: You are assessing an unresponsive patient who overdosed on a narcotic pain medication. Given the situation, what is the greatest concern regarding potential airway occlusion? A) Swelling of the carina B) Relaxation of the tongue C) Collapse of the bronchi D) Spasm of the epiglottis

B

QUESTION: You are teaching a group of firefighters who are taking classes to become Emergency Medical Responders. The topic is artificial ventilation with the bag-valve mask (BVM). Which point related to use of the BVM is it important to emphasize? A) The BVM is useless unless it is hooked to supplemental oxygen B) Maintaining a good mask-to-face seal is difficult C) The bag must be fully squeezed to give the proper amount of volume with each breath D) It is better to ventilate too quickly than too slowly

B

QUESTION: You arrive at a residence to assist another crew with a patient in cardiac arrest. As you enter the room, a brand-new EMT informs you that he is having difficulty maintaining the mask seal to the patient's face while ventilating with the BVM. Which response shows that you understand and can help with the problem? A) "Why don't you try using a larger adult mask and flex the head forward?" B) "Let me maintain the face-to-mask seal while you squeeze the bag." C) "I will check breath sounds to see if air is reaching the lungs." D) "I will administer some cricoid pressure. That should help."

B

Question: The EMT believes that a patient is mildly hypoxic based on findings from the primary assessment. Which other sign could the EMT use to confirm his suspicion of mild hypoxia? A) Responsive to verbal stimuli B) Restlessness C) Sleepy appearance D) Cyanosis

B

QUESTION: 20) A patient with a stoma and tracheostomy tube is responsive to painful stimuli. He has shallow respirations and is breathing at a rate of 6 times per minute. He has cyanosis of the fingertips and a weak, rapid radial pulse. Which strategy should be used in providing respiratory care to this patient? A) Use a continuous positive airway pressure device over the stoma B) Place a tracheostomy mask over the tube and administer high-concentration oxygen C) Attach the bag-valve device directly to the tracheostomy tube D) Remove the tracheostomy tube, place a child-size mask on the bag-valve device, and ventilate the patient through the stoma

C

QUESTION: A listless and lethargic 84-year-old male patient responds to physical stimuli with garbled speech. His respirations show poor effort and are rapid and labored, with a room-air SpO 2 of 84%. Additionally, you cannot appreciate breath sounds in his right lung. The best form of oxygen therapy for this patient would be: A) Continuous positive airway pressure (CPAP) B) Oxygen at 2 lpm via nasal cannula initially and increase the liter flow as needed C) Positive pressure ventilation D) High-concentration oxygen via a nonrebreather mask

C

QUESTION: A patient with a heavy smoking history and chronic obstructive pulmonary disease (emphysema) presents in marked respiratory distress with cyanosis noted to her fingertips. When administering oxygen to this patient, the EMT would remember that: A) Oxygen must be administered only through a nasal cannula B) Oxygen should be provided at the same level as the patient receives at home C) High-concentration oxygen must be provided if the patient's condition warrants such therapy D) High-concentration oxygen will be toxic to the patient and must be avoided

C

QUESTION: For which of these disease processes would continuous positive airway pressure (CPAP) be most beneficial? A) Stroke with agonal respirations B) Altered mental status with history of COPD C) CHF with moderate to severe dyspnea D) Asthma with mild shortness of breath

C

QUESTION: If an injured patient has lost all use of his diaphragm, the EMT should recognize that the patient: A) Requires immediate cardiopulmonary resuscitation and frequent suctioning B) Is breathing adequately but most likely will complain of chest pain C) Has lost a major portion of his ability to breathe D) Requires supplemental oxygen with a nonrebreather face mask

C

QUESTION: In a healthy patient, for air to be exhaled from the lungs, what must occur? A) The pressure is the lungs must be low B) The CO2 levels must be low C) The diaphragm must relax D) The intercostals muscles must contract 95)

C

QUESTION: In a healthy person, the primary stimulus to breathe is: A) Oxygen levels in the arteries B) Diaphragm position C) Carbon dioxide levels in the bloodstream D) Lung pressures

C

QUESTION: On arrival at a lethargic patient's side, you note her to have gurgling respirations. What is the best treatment for this condition? A) Oropharyngeal airway B) Head-tilt, chin-lift maneuver C) Suction D) Jaw-thrust maneuver

C

QUESTION: What is obstructing the airway when snoring is heard? A) Bronchospasm B) Swelling of the larynx C) The tongue D) Fluid in the upper airway

C

QUESTION: When a person's diaphragm contracts and the intercostal muscles pull the ribs upward, what will occur relative to the exchange of air and/or gases? A) Pressure inside the chest will increase B) Carbon dioxide will be exhaled C) Air will flow into the lungs D) Oxygen will leave the body

C

QUESTION: When completing a primary assessment, what would be a good indication that the patient has an open airway? A) The breath sounds are clear B) The respiratory rate is normal C) The patient speaks with ease D) The patient is conscious

C

QUESTION: When monitoring a patient receiving oxygen through a nasal cannula, which of these observations warrants immediate intervention? A) Tubing positioned over the ears and under the chin B) Breathing normally with the nasal cannula in place C) Oxygen flow rate of 15 liters per minute D) Prongs in the nostrils curving posteriorly into the nose

C

QUESTION: When providing oxygen via nonrebreather face mask, which piece of equipment is essential for the EMT to have? A) Oxygen humidifier B) D or E oxygen cylinder C) Therapy regulator D) High-pressure regulator

C

QUESTION: When using a pocket mask to ventilate an unresponsive adult patient, the EMT must always: A) Ventilate at twice the patient's normal rate of breathing B) Deliver 1 breath every 3 seconds C) Maintain the head-tilt, chin-lift maneuver or jaw-thrust maneuver D) Provide each breath over 3 seconds

C

QUESTION: Which action should you perform when attaching a therapy regulator to a new oxygen tank? A) Tighten the regulator to the oxygen cylinder with an oxygen wrench B) Lubricate the stem of the cylinder with oil prior to attaching the regulator C) Open the cylinder valve for 1 second prior to attaching the regulator D) Stand the tank upright on the floor for 2 minutes prior to attaching the regulator

C

QUESTION: Which body system or structure is responsible for the control and regulation of a person's breathing? A) Alveoli B) Lungs C) Brain D) Spinal cord

C

QUESTION: Which of these actions indicates that the EMT is correctly using a nonrebreather face mask on an adult patient? A) He sets the oxygen flow rate to between 6 and 16 liters per minute B) He ensures that the reservoir fully collapses with each breath C) He fully inflates the reservoir prior to placing the mask on the patient D) He instructs the patient to take deeper breaths when the mask is on 85)

C

QUESTION: Which of these conditions would result in the greatest decrease in oxygen delivery to the cells? A) Temperature greater than 103°F B) Heart rate greater than 120 beats/ min C) Decreased amount of circulating hemoglobin D) Diastolic blood pressure greater than 100 mmHg

C

QUESTION: Which of these is a correct statement about the ventilation of a nonbreathing patient through a stoma? A) Mouth-to-stoma ventilation is an easy and safe procedure to perform on a nonbreathing patient B) A head-tilt, chin-lift maneuver or jaw-thrust airway maneuver is still needed to open the airway C) The EMT should ventilate through the stoma with a child-sized face mask attached to a bag-valve mask D) A nasal airway should be inserted into the stoma prior to any attempt at ventilating the patient

C

QUESTION: Which of these patients should the EMT suspect as being mildly hypoxic? A) A 44-year-old male breathing 28 times per minute who is confused and has an SpO2 of 97% B) A 24-year-old female breathing 8 times per minute with cyanosis of the lips C) An 18-year-old male who is restless, has shallow respirations and is breathing at a rate of 16 times per minute, with no cyanosis D) A 36-year-old female with asthma, breathing 22 times per minute, with cyanosis of the fingertips

C

QUESTION: Which tip should you give a new EMT about artificially ventilating a patient with the bag-valve mask? A) "To direct air into the lungs and away from the stomach, flex the patient's head forward when ventilating with the BVM." B) "Always remove the oropharyngeal airway. If it is in place when you are ventilating with a BVM, it may be pushed deep into the airway." C) "It is important to maintain the head-tilt, chin-lift maneuver or the jaw-thrust maneuver while ventilating the patient." D) "If the patient has dentures, they should be removed so a better mask-to-face seal can be achieved." 98)

C

QUESTION: You are assessing a patient with altered mental status. Which of these assessment findings contraindicates the use of the nonrebreather face mask? A) Clear and equal breath sounds B) Confusion C) Respiratory rate of 18 breaths/min, with poor tidal volume D) Respiratory rate of 24 breaths/min

C

QUESTION: You are assessing a young male patient who was ejected from an automobile at a high rate of speed. He responds to painful stimuli by posturing and displays agonal breathing. His pulse is weak and thready, and his skin is cool and diaphoretic. When addressing this patient's airway and breathing, the EMT must immediately: A) Immobilize the patient on a long spine board, and then start positive pressure ventilation B) Open the patient's airway using the head-tilt, chin-lift maneuver and begin ventilations with the bag-valve mask attached to supplemental oxygen C) Perform the jaw-thrust maneuver and begin artificial ventilations with the bag-valve mask D) Administer oxygen at 15 lpm with a nonrebreather face mask

C

QUESTION: You arrive at a residence for a male patient who is unresponsive. As you enter the room, you observe an obese man lying on a recliner. His eyes are closed, and he has gurgling respirations. While your partner is quickly performing a primary assessment, you should immediately prepare to: A) Insert an oropharyngeal airway B) Administer high-concentration oxygen C) Suction the airway D) Auscultate breath sounds

C

QUESTION: You have arrived next to a patient who reportedly had a seizure. Assessment reveals him to be apneic with vomitus in the airway. He has a radial pulse, and his skin is cool and diaphoretic. What should you do immediately? A) Start artificial ventilation B) Check breath sounds C) Suction the airway D) Apply a nonrebreather mask

C

QUESTION: You have arrived on the scene of an assault in which several people were injured. You are directed to assist another crew with a patient who has been shot once. As you approach, you are told that the patient has slow and irregular breathing that is inadequate. You observe the patient being ventilated with a bag-valve mask while another EMT maintains her airway with the jaw-thrust maneuver. Based on your observation, where might you expect that this patient was shot? A) Pelvis B) Chest C) Head D) Lower abdomen

C

QUESTION: You have been called for a patient who has overdosed on drugs and alcohol. The patient is responsive to painful stimuli, has shallow respirations and is breathing at a rate of 8 times per minute, but exhibits no cyanosis. What is the priority treatment? A) Inadequate breathing; administer oxygen at 15 lpm through a nonrebreather face mask B) Adequate breathing; administer oxygen at 15 lpm through a nonrebreather face mask C) Inadequate respirations; start positive pressure ventilation with supplemental oxygen D) Adequate breathing; initiate positive pressure ventilation with supplemental oxygen

C

QUESTION: You have been called to a long-term nursing care facility for a 77-year-old female patient with Parkinson's disease. According to the nursing staff, she is more confused than normal and is to be transported to the emergency department for evaluation. Since the patient neither understands nor can answer any of your questions, which sign provides the best evidence that her breathing is adequate? A) Strong radial pulse B) Respiratory rate of 18 breaths/min C) Pulse oximeter reading at 98% D) Clear bronchiole breath sounds

C

QUESTION: You have opened an apneic patient's airway using the head-tilt, chin-lift maneuver and are ready to ventilate with a pocket mask. The first ventilation you attempt is unsuccessful. You should immediately: A) Use a jaw-thrust maneuver B) Ventilate over 3 seconds C) Reposition the patient's head D) Provide five abdominal thrusts

C

QUESION: Assessment findings on an elderly patient with congestive heart failure indicate that her failing heart is causing fluid to collect and fill her alveoli. Based on this pathophysiology, for which pulmonary complication should the EMT treat the patient? A) Collapse of the bronchi B) Decreased blood pressure C) Swelling of the tongue D) Decreased gas exchange

D

QUESTION: Which of these patients should the EMT recognize as having a potential occlusion of the upper airway? A) A 61-year-old male with a piece of fruit stuck in his trachea B) A 45-year-old female with spasm of the bronchioles C) A 78-year-old female with a large mucus plug in her bronchi D) A 3-year-old male with a fever and swelling of the larynx

D

QUESTION: A paramedic has asked you to place the patient on a nonrebreather mask at 15 liters per minute. To administer oxygen at this flow rate, you should: A) Attach a high-pressure regulator to the oxygen cylinder B) Slowly decrease the tank pressure valve until 15 psi is achieved C) Adjust the tank pressure to 15 psi D) Select "15" on the oxygen therapy regulator

D

QUESTION: An elderly male patient who is short of breath is on home oxygen. He is wearing a nasal cannula connected to an oxygen tank with the flow regulator set to 3 liters per minute. As a knowledgeable EMT, you should recognize that the patient is getting approximately what percentage of oxygen with each breath? A) 20% B) 40% C) 24% D) 32%

D

QUESTION: Assessment findings for an alert and oriented patient complaining of shortness of breath reveal an open airway and strong radial pulse, accompanied by skin that is cool and diaphoretic. The depth of respirations is adequate, and breath sounds include wheezing throughout the lungs. Vital signs are a pulse of 124, respiratory rate of 24 breaths/min, blood pressure of 146/82 mmHg, and SpO2 of 93%. The patient has a history of asthma, for which he takes medications. How should you initiate oxygen therapy on this patient? A) Nonrebreather mask B) Bag-valve mask C) Venturi mask D) Nasal cannula

D

QUESTION: To receive treatment with continuous positive airway pressure (CPAP), the patient must exhibit: A) Minor to moderate respiratory distress B) Inability to maintain his airway C) SpO2 between 90% and 100% D) Ability to breathe on his own adequately

D

QUESTION: What is a benefit of using a humidification system when administering oxygen? A) Humidification reduces the chances of respiratory infection B) Increased diffusion of oxygen occurs across the respiratory membrane C) A higher flow rate can be used with a nasal cannula when humidification is added D) Oxygen therapy is less drying to the upper respiratory tract

D

QUESTION: When administering continuous positive airway pressure (CPAP) to a patient in respiratory distress, which of these statements made by the patient would be most concerning? A) "My nose hurts from the mask." B) "The mask is too tight." C) "My mouth is getting dry." D) "I feel nauseated."

D

QUESTION: When administering oxygen to a hypoxic patient with Alzheimer's disease, which of these findings would seemingly indicate that the patient's hypoxic status is improving? A) The patient becomes more restful and wants to sleep B) The blood pressure increases from 136/78 to 150/86 mmHg C) The respirations slow from 24 to 22 breaths/min D) The patient has an SpO2 reading of 94%

D

QUESTION: Which of these patients would benefit from the head-tilt, chin-lift manual airway maneuver as opposed to any other initial airway management technique? A) An 85-year-old female who hit her head on a tree limb and is now responsive to painful stimuli B) A 67-year-old female who fell down a flight of stairs and is unresponsive C) A 45-year-old female who is alert and vomiting blood D) A 39-year-old male who just had a seizure and has snoring respirations

D

QUESTION: Which of these statements about an automatic transport ventilator (ATV) is true? A) When it is in use, there is no need for a face -to-mask seal B) The EMT can more readily identify an increase or decrease in the patient's lung compliance C) It eliminates the need for a head-tilt, chin-lift maneuver or jaw-thrust maneuver D) It can help minimize gastric distention associated with positive pressure ventilation

D

QUESTION: Which of these statements about different sizes of oxygen cylinders is true? A) D cylinders hold the most oxygen B) M tanks are the easiest to carry on the stretcher C) H tanks are the smallest oxygen cylinders D) G and E tanks have the same psi when full

D

QUESTION: Which of these statements best describes the EMT's understanding of oxygen? A) It is a highly flammable substance B) It is an odorless cloudy gas when pressurized C) It is a moist gas that supports cellular activity D) It is a gas classified as a drug

D

QUESTION: Which of these statements best describes the purpose of a Venturi mask? A) It provides a seal over the larynx, preventing aspiration during positive pressure ventilation B) The device is used to deliver positive pressure ventilation C) It allows a 100% concentration of oxygen to be delivered without a leak between the patient's face and mask D) Precise concentrations of oxygen can be delivered with this device

D

QUESTION: Which of these statements indicates that the EMT has a correct understanding of the use of oxygen in the prehospital setting? A) "If the patient has a poor tidal volume, oxygen should be administered at 15 lpm through a nonrebreather mask." B) "If providing positive pressure ventilation, lower concentrations of oxygen may be used." C) "Oxygen should be withheld from a patient with chronic obstructive pulmonary disease." D) "Oxygen should never, ever be withheld from a patient whom you think may need it."

D

QUESTION: Which of these statements is true regarding the form or function of the alveoli? A) The alveoli are thin walled and covered by smooth muscle B) The alveoli are air passages that permit ventilation of the lung C) The alveoli are covered with small arteries that allow gas exchange D) The alveoli permit gas exchange between the lungs and bloodstream

D

QUESTION: Which oxygen administration systems will provide the patient with the greatest amount of oxygen? A) Nasal cannula at 15 liters per minute of oxygen B) Simple face mask at 12 liters per minute of oxygen C) Venturi face mask set to deliver 40% oxygen D) Nonrebreather face mask at 15 liters per minute of oxygen 118)

D

QUESTION: Which statement about the bag-valve mask (BVM) is true? A) Oxygen must be attached so that the squeezable bag will reinflate B) The oxygen reservoir should deflate by one -third every time a breath is given C) The nonrebreather valve prevents the EMT from being exposed to possible pathogens in the patient's exhaled air D) A 15/22 mm adapter allows the BVM to be attached to an advanced airway such as the endotracheal tube 104)

D

QUESTION: Which statement made by an EMT with whom you are working for the first time shows he understands the use of the pocket mask? A) "When using the pocket mask to ventilate a patient, the EMT must make sure that the reservoir bag is in place." B) "The EMT must remove the oral airway and replace it with a nasal airway when ventilating with a pocket mask." C) "Although the pocket mask is very effective at ventilating a patient, the EMT is directly exposed to secretions from the patient." D) "In comparison to the bag-valve mask, the pocket mask can deliver just as good, if not better, tidal volume."

D

QUESTION: While assisting with the review of airway skills with new EMT hires, which of these statements from a new EMT demonstrates he knows how to properly size an oral airway prior to placement? A) "An appropriately sized oral airway can be selected by looking in the patient's mouth and estimating the length of the tongue." B) "It is better to have an oral airway that is too large, rather than one that is too small." C) "To select an appropriately sized oral airway, you must estimate the patient's height and weight." D) "The airway should approximate the distance from the front teeth to the angle of the jaw."

D

QUESTION: You are artificially ventilating an adult male patient who is in respiratory arrest with a bag-valve mask. Which finding would demonstrate that you are ventilating this patient properly? A) Ability to fully deflate the self-inflating bag B) Ventilation rate of 20 breaths per minute C) Clear and equal breath sounds D) Adequate chest rise and fall

D

QUESTION: You are by the side of a patient who fell 5 feet from a ladder, landing on a concrete porch and hitting his lower back and buttocks. Assessment reveals an intact airway, adequate respirations, rapid radial pulse, and skin that is pale, cool, and diaphoretic. The patient complains of lower back and left leg pain. No deformity to the extremity is noted; however, the lower back is tender on palpation. The following vital signs are obtained: pulse, 132; respirations, 20 breaths/min; blood pressure, 102/88 mmHg; and SpO 2, 97% on room air. Regarding oxygen therapy, you would: A) Provide 2 lpm O2 through a nasal cannula B) Start positive pressure ventilation to support breathing C) Recognize a normal SpO2 and forego oxygen therapy D) Administer oxygen at 15 lpm through a nonrebreather mask

D

QUESTION: You are having a difficult time getting air from the bag-valve mask to pass into the lungs of a patient with suspected stroke. What should your first action be? A) Administer abdominal thrusts B) Turn the patient on his side and try ventilations again C) Perform a finger sweep of the airway D) Perform the head-tilt, chin-lift maneuver again

D

QUESTION: You are observing an EMT insert an oropharyngeal airway into the airway of a 36-year-old male patient who has overdosed on a street drug. Which observation indicates a correct technique? A) The airway is inserted in its normal anatomic position until the flange of the airway is 1 cm above the lips B) The EMT uses a tongue depressor to press the back of the tongue downward, and then inserts the oral airway upside -down C) The oral airway is introduced sideways into the mouth, and then rotated 180 degrees once it has reached the base of the tongue D) The airway is inserted into the mouth upside-down, and then turned 180 degrees once it contacts the soft palate

D

QUESTION: You are watching an EMT prepare the ambulance for the upcoming shift. In regard to oxygen cylinders and equipment, which action requires immediate intervention? A) The EMT ensures that the temperature in the oxygen storage room is less than 100°F B) The EMT lays tanks on the floor when they are removed from the ambulance C) The EMT makes certain that all valves on the empty oxygen tanks are closed D) The EMT cleans a dirty oxygen tank by spraying it with a petroleum-based agent cleanser

D

QUESTION: You must suction frothy secretions from the mouth and pharynx of a 31-year-old male patient whose respiration rate is 4 breaths/min. Which process to do so is most appropriate given the patient's condition? A) Use a soft-tip catheter and suction for no more than 30 seconds before providing additional oxygen with a nonrebreather face mask B) Place the patient into a side-lying position and alternate 30 seconds of suctioning and ventilation C) Forego suctioning and continue to provide positive pressure ventilation, as frothy secretions rarely complicate the airway D) Suction for no more than 15 seconds at a time, followed by 2 minutes of positive pressure ventilation

D

QUESTION: Your medical director is holding an in-service program focusing on the prehospital management of adult patients with respiratory complaints. He asks the group to explain how they can determine if the patient is breathing adequately. Which response is most appropriate? A) "A patient is breathing adequately if the depth of breathing is shallow, but the rate is increased above normal." B) "The EMT can assume breathing is adequate if the patient has an open airway and a normal respiratory rate." C) "If the pulse oximeter reads 94% or greater, then the patient is breathing adequately." D) "For an adult patient to be breathing adequately, the rate should be within 8 to 24 breaths/min with a full chest rise with each breath."

D

Question: A 6-year-old boy has gotten into his mother's prescribed medications and ingested a large number of her opioid tablets. The patient is now found unresponsive and apneic, but he still has a weak palpable carotid pulse. You would instruct your partner to ventilate this patient in which manner? A) One ventilation every 6 seconds B) One ventilation every 2 seconds C) 6 times a minute D) 10 times a minute

D

Question: Proper positioning of the airway with the head-tilt, chin-lift maneuver during ventilation can help reduce gastric inflation by: A) Obstructing the esophagus B) Allowing slower ventilation C) Reducing airway resistance D) Reducing the volume of exhaled air

c