EMT Ch 9 Test

When suctioning the airway, suction should never be applied for longer than ________ seconds. A) 10 B) 30 C) 45 D) 60

Explanation: A) CORRECT. Limit suctioning to no longer than 10 seconds at a time. This is because prolonged suctioning will cause hypoxia and, potentially, death. B) INCORRECT. Continuous suctioning should never be applied for 30 seconds. C) INCORRECT. 45 seconds is too long to safely suction a patient's airway. D) INCORRECT. Suction should never be applied for a full minute. Page Ref: 208

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. B) If a water-soluble lubricant is not available, a silicon spray can be substituted. C) It can only be placed in the right nostril. D) The length of the device is not as important as it is with oropharyngeal airways.

Explanation: A) CORRECT. Most nasopharyngeal airways are designed to be placed in the right nostril with the bevel pointed toward the septum. B) INCORRECT. Non-water-soluble lubricants can damage the tissue lining of the nasal cavity and the pharynx and increase the risk of infection. C) INCORRECT. Although most NPAs are designed for the right nostril, they are flexible and can be inserted in the left if necessary. D) INCORRECT. Whether using an oro- or nasopharyngeal airway, proper sizing is critical to their effectiveness. Page Ref: 206

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

Explanation: A) CORRECT. The bronchi are the airway passages that split off from the trachea in the lower airway and enter each lung. B) INCORRECT. The uvula is in the soft tissue that hangs in the back of the mouth, which is considered to be in the upper airway. C) INCORRECT. The throat, or pharynx, is part of the upper airway. D) INCORRECT. The tonsils are found in the back of the mouth and pharynx, not the lower airway. Page Ref: 193

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

Explanation: A) 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. B) INCORRECT. The jaw-thrust maneuver is recommended for this type of patient but it is not required. C) INCORRECT. The jaw-thrust maneuver is recommended, not prohibited, for this type of patient. D) INCORRECT. The jaw-thrust maneuver is recommended, not forbidden, for this type of patient. Page Ref: 201

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

Explanation: A) CORRECT. The trachea is narrower in pediatric patients and more easily obstructed by swelling. B) INCORRECT. Pediatric patients have proportionally larger tongues that are actually more likely to cause an airway obstruction. C) INCORRECT. Pediatric patients actually require only very slight extension of the neck to open their airways. D) INCORRECT. Gastric distention is just as likely in pediatric patients. Page Ref: 211

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

Explanation: A) 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. B) INCORRECT. Although checking for adequate chest rise can show airway patency, there is an easier way. C) INCORRECT. Assessing the patient's breathing rate takes some time and effort; there are simpler ways to determine airway patency. D) INCORRECT. Using a stethoscope to listen for a patient's breath sounds is a challenging way to determine if the patient's airway is patent. Page Ref: 195

When inserting an oropharyngeal airway, how many degrees do you need to rotate the airway so the tip is pointing down into the patient's pharynx? A) 45 B) 90 C) 180 D) 270

Explanation: A) INCORRECT. A 45-degree turn will not rotate the airway sufficiently. B) INCORRECT. A 90-degree turn will not rotate the airway sufficiently. C) CORRECT. If you rotate the airway 180 degrees, the tip will then be pointing down into the patient's pharynx. D) INCORRECT. A 270-degree turn will rotate the airway too much. Page Ref: 203

Which of the following is a disadvantage of oropharyngeal airways (OPAs)? A) They cannot be used in patients with a suspected skull fracture. B) They do not come in pediatric sizes. C) They require the use of a water-soluble lubricant. D) They cannot be used in a patient with a gag reflex.

Explanation: A) INCORRECT. A nasopharyngeal airway should not be used on patients with suspected skull fractures. B) INCORRECT. OPAs are made in a wide range in sizes, from pediatric to large adult. C) INCORRECT. Lubricant is not required when utilizing an oropharyngeal airway. D) CORRECT. OPAs should not be used for patients with gag reflexes. Page Ref: 202

What is the danger that an altered mental status can pose to a patient's breathing? A) Depressed alveolar function B) Loss of muscle tone and airway collapse C) Bronchospasms D) Hyperoxia

Explanation: A) INCORRECT. A patient's alveolar function is generally not related to mental status. B) CORRECT. Conditions like altered mental status and neurologic disorders can result in a loss of this muscle tone and lead to collapse of the airway. C) INCORRECT. Bronchospasms are not caused by an altered mental status. D) INCORRECT. An altered mental status will not result in hyperoxia. Page Ref: 195

To be effective, a suction unit must be able to generate air flow of ________ liters per minute and create a vacuum of ________ mmHg. A) 300; 30 B) 30; 30 C) 300; 330 D) 30; 300

Explanation: A) INCORRECT. A standard medical suction device does not require an air flow of 300 liters per minute. B) INCORRECT. A vacuum pressure of 30 mmHg is not nearly enough for proper suctioning. C) INCORRECT. An air flow of 300 liters per minute and 330 mmHg of vacuum is too high for medical suction devices. D) 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: 206

On which of the following types of calls should you bring your portable suction unit to the patient's side upon arrival on the scene? A) Motor vehicle collision B) Cardiac arrest C) Seizure D) All of the above

Explanation: A) INCORRECT. Although having a suction unit available for trauma patients is preferred, there are also other types of patients listed that may require suctioning. B) INCORRECT. The need for suction when treating a cardiac arrest patient is common, but there are other situations presented when suction may be required. C) INCORRECT. Having a suction unit available when responding to a seizure is a good idea, but there are other situations presented which may also require suctioning. D) CORRECT. The patient's airway must be kept clear of foreign materials, blood, vomitus, and other secretions. Suctioning is the method of using a vacuum device to remove such materials and should be readily available when caring for all patients. Page Ref: 206

The high-pitched sound caused by an upper airway obstruction is known as: A) gurgling. B) stridor. C) rhonchi. D) rales.

Explanation: A) INCORRECT. Although it could be the result of an upper airway obstruction, a gurgling sound would not be described as high-pitched. B) CORRECT. Stridor is a high-pitched sound generated from partially obstructed air flow in the upper airway. C) INCORRECT. Rhonchi is a low-pitched sound caused by respiratory diseases like asthma. D) INCORRECT. A crackling sound in the lungs, usually caused by such ailments as pneumonia or congestive heart failure, is referred to as rales. Page Ref: 195

All of the following can result in airway obstructions, except: A) burns. B) infections. C) the tongue. D) facial trauma.

Explanation: A) INCORRECT. Burns to the face or pharynx can cause airway obstructions due to swelling, tissue damage, or excess fluid. B) INCORRECT. Respiratory infections can cause both tissue swelling and excessive fluid production, which can lead to airway compromise. C) CORRECT. Often people think that the tongue causes an obstructed airway but, in reality, the epiglottis is connected to the tongue and is what actually causes the obstruction. D) INCORRECT. Swelling, bleeding, and tissue from facial trauma are common causes of airway obstructions. Page Ref: 195

Which of the following is a sign of an inadequate airway? A) Regular chest movements B) Nasal flaring C) Equal expansion of both sides of the chest when patient inhales D) Typical skin coloration

Explanation: A) INCORRECT. Chest movements that are regular are not an indication of an inadequate airway. B) CORRECT. Signs that would indicate no airway or a potentially inadequate airway include nasal flaring, especially in infants and children. C) INCORRECT. Equal expansion of the chest during inhalation is a sign of an adequate airway and good respiration. D) INCORRECT. An inadequate airway will generally lead to discoloration of the skin. Page Ref: 197

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) finger sweep the airway. B) tilt the head back further. C) perform chest thrusts. D) ease the head forward a little.

Explanation: A) INCORRECT. Finger sweeping this child's airway would not be the best option in this situation. B) INCORRECT. Tilting this child's head back can collapse his undeveloped trachea and further occlude the airway. C) INCORRECT. Chest thrusts would not be indicated in this situation. D) CORRECT. The airway of a small child is more pliable than that of an adult. It is possible to tilt the head too far back when dealing with an emergent child. Page Ref: 211

Which of the following patients should NOT have their airway opened using a head-tilt, chin-lift maneuver? A) A 35-year-old diabetic woman who is in the driver's seat of the car in her driveway, who becomes unresponsive while speaking to her husband. 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 25-year-old man who is still unresponsive after a grand mal seizure.

Explanation: A) INCORRECT. It would be appropriate to use the head-tilt, chin-lift maneuver on this patient. B) CORRECT. If any indication of head, neck, or spine injury is present, do not use the head-tilt, chin-lift maneuver. A person found unresponsive with no witnesses to the cause should be assumed to have head or spinal injuries. C) INCORRECT. The head-tilt, chin-lift maneuver would be the preferred way to initially open this patient's airway. D) INCORRECT. As long as the seizure did not potentially cause head or spine injury, the head-tilt, chin-lift maneuver would be preferred in this situation. Page Ref: 201

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) insert an oropharyngeal airway and ventilate. B) roll him over onto his side to clear the airway. C) perform chest thrusts to clear the lungs. D) move the patient to the ambulance and suction.

Explanation: A) INCORRECT. It would not be appropriate to immediately ventilate this patient because vomit would be forced into the lungs. B) CORRECT. Rolling the victim on his side requires no equipment and minimal skill. This maneuver will clear most of the vomit in the patient's airway using gravity. C) INCORRECT. Chest thrusts are not used to clear the lungs; rather, they are used to clear the airway. D) INCORRECT. It would take too much time to move the patient to the ambulance; his airway needs to be cleared immediately. Page Ref: 211

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

Explanation: A) INCORRECT. Positioning the patient's head appropriately is still required with the use of an NPA. B) INCORRECT. Nasopharyngeal airways are contraindicated in patients with suspected skull fractures, as the tube may be forced through the fracture. C) CORRECT. A patient with a gag reflex who cannot tolerate an oropharyngeal airway may be able to tolerate a nasopharyngeal airway. D) INCORRECT. All of the above answers are not correct. Page Ref: 205

What is the sound of the soft tissue of the upper airway creating impedance or partial obstruction to the flow of air? A) Stridor B) Hoarseness C) Snoring D) Gurgling

Explanation: A) INCORRECT. Stridor is when air is forced by pressure through a partial obstruction, and a high-pitched, sometimes almost whistling sound can be heard. B) INCORRECT. Hoarseness is when the voice has a raspy sound to it. C) CORRECT. Snoring is the sound of the soft tissue of the upper airway creating impedance or partial obstruction to the flow of air. Sometimes a person may snore while asleep, but if a patient is snoring in the case of injury or illness might indicate a decrease in mental status or that the airway needs assistance to stay open. D) INCORRECT. Gurgling is the sound of fluid obstructing the airway. Page Ref: 198

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

Explanation: A) INCORRECT. Suctioning intermittently while inserting and withdrawing the catheter is not the proper technique. B) CORRECT. For suctioning, place the tip or catheter where you want to begin the suctioning and suction on the way out. C) INCORRECT. It is not correct to suction as you insert the catheter. D) INCORRECT. Applying suction while inserting and withdrawing the tip is not the correct procedure. Page Ref: 210

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) tape the dentures in place. B) remove the dentures. C) leave the dentures in place. D) use an infant mask over the nose.

Explanation: A) INCORRECT. Taping the dentures in place would never be appropriate. B) INCORRECT. Removing the dentures could make getting a good mask seal more difficult. C) 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. D) INCORRECT. Using an infant mask over this patient's nose would not be necessary. Page Ref: 211

The trachea branches off at the ________ and forms two mainstem bronchi. A) bronchioles B) pleura C) alveoli D) carina

Explanation: A) INCORRECT. The bronchioles are not part of the structure where the trachea branches. B) INCORRECT. The pleura are the membranes of the lungs and are not part of the trachea. C) INCORRECT. The tiny air sacs in the lungs that assist in gas exchange are called alveoli; they are not connected to the trachea. D) CORRECT. The trachea branches off at the carina and forms two mainstem bronchi. Page Ref: 193

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 rigid pharyngeal suction tip B) Irrigating the mouth with sterile water to dilute the material before suctioning C) Using a 14 French suction catheter D) Using large bore suction tubing without a tip or catheter attached

Explanation: A) INCORRECT. When suctioning copious amounts of vomit, a rigid suction tip would not be effective enough. B) INCORRECT. To prevent aspiration, additional fluids should not be introduced to the patient's airway and suctioning should be immediate. C) INCORRECT. A 14 French catheter is not large enough to be effective on copious amounts of vomit. D) 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: 208