2. The (a)   is the lowest portion of the pharynx and opens into the larynx anteriorly and the esophagus posteriorly.

A) oropharynx

B) nasopharynx

C) hyperpharynx

D) laryngopharynx

3. The nasal cavity:

A) contains two bony shelves known as turbinates.

B) is extremely delicate and has a rich blood supply.

C) requires significant trauma to result in hemorrhage.

D) is separated by a septum that is midline in all people.

(a)  

4. The (a)   are formed by the cranial bones and prevent contaminants from entering the respiratory tract.

A) sinuses

B) turbinates

C) bony nasal shelves

D) nasal mucous membranes

5. The oropharynx:

A) contains the adenoids on its posterior wall.

B) forms the posterior portion of the oral cavity.

C) is bordered superiorly by the hard palate only.

D) consists of the anterior portion of the oral cavity.

(a)  

6. From an airway management perspective, the MOST important anatomic consideration regarding an adult's tongue is:

A) that it is easily lacerated, but bleeds minimally.

B) that it attaches directly to the mandible and hyoid bone.

C) its proportionately large size compared to a child's tongue.

D) its tendency to fall back and occlude the posterior pharynx.

(a)  

7. The anterior portion of the palate is formed by the:

A) hyoid bone and mandible.

B) union of the facial bones.

C) maxilla and palatine bones.

D) soft tissues of the posterior pharynx.

(a)  

8. Which of the following statements regarding the tonsils is correct?

A) The tonsils are located on the posterior nasopharyngeal wall.

B) The tonsils rarely become swollen enough to obstruct the airway.

C) The tonsils are comprised of lymphatic tissue and help to trap bacteria.

D) The tonsils are located in the anterior pharynx and filter bacteria.

(a)  

9. The (a)   is an anatomic space located between the base of the tongue and the epiglottis.

A) vallecula

B) uvula

C) adenoid

D) larynx

10. Anatomically, the (a)   is directly anterior to the glottic opening.

A) thyroid gland

B) vallecular space

C) cricoid cartilage

D) thyroid cartilage

11. Paramedics must use extreme caution when accessing the airway via the cricothyroid membrane because:

A) the cricothyroid membrane is highly vascular and tends to bleed profusely when it is incised.

B) the cricothyroid membrane is bordered laterally and inferiorly by the highly vascular thyroid gland.

C) cricothyrotomy is associated with a high incidence of inadvertent laceration of a carotid artery.

D) the thyroid cartilage is smaller than the cricoid cartilage and makes the cricothyroid membrane difficult to locate.

(a)  

12. During forceful inhalation, the vocal cords:

A) are partially open to allow for turbulent air flow.

B) open widely to provide minimum resistance to air flow.

C) abruptly spasm in order to protect the lower airway.

D) bulge anteriorly to facilitate air flow into the trachea.

(a)  

13. The (a)   are pyramid-like structures that form the posterior attachment of the vocal cords.

A) palatine tonsils

B) pyriform fossae

C) arytenoid cartilages

D) hypoepiglottic ligaments

14. Tenting of the skin under the jaw often occurs when airway devices are inadvertently inserted into the:

A) pyriform fossae.

B) vallecular space.

C) laryngopharynx.

D) hypopharyngeal space.

(a)  

15. Laryngospasm is defined as:

A) aspiration of foreign material.

B) spasmodic closure of the vocal cords.

C) voluntary closure of the glottic opening.

D) spontaneous collapsing of the trachea.

(a)  

16. The function of the lower airway is to:

A) warm, filter, and humidify air.

B) protect the lungs from aspiration.

C) deliver oxygenated blood to the cells.

D) exchange oxygen and carbon dioxide

(a)  

17. The trachea and mainstem bronchi:

A) constrict violently when their beta-2 receptors are stimulated excessively.

B) are approximately 10 to 12 cm in length and are joined together at the hilum.

C) do not contain mucous-producing cells in patients without a respiratory disease.

D) are lined with beta-2 receptors that result in bronchodilation when stimulated.

(a)  

18. In contrast to the right lung, the left lung:

A) has two lobes.

B) has three lobes.

C) is encased in the parietal pleura.

D) can only hold a small volume of air.

(a)  

19. Surfactant is:

A) produced by the mucous cells of the left and right mainstem bronchi.

B) quickly destroyed in patients who have a severe upper airway obstruction.

C) a phospholipid compound that decreases surface tension on the alveolar walls.

D) a lubricating substance that increases alveolar surface tension during breathing.

(a)  

20. Atelectasis occurs when:

A) the alveoli are overinflated and rupture.

B) a deficiency of surfactant causes alveolar collapse.

C) deoxygenated blood diffuses across the alveoli.

D) surface tension on the alveolar walls is decreased.

(a)  

21. The volume of air that is moved into or out of the respiratory tract in one breath is called:

A) tidal volume.

B) alveolar volume.

C) minute volume.

D) inspiratory reserve volume.

(a)  

22. Physiologic dead space increases with:

A) tachypnea.

B) deep breathing.

C) alveolar inflation.

D) pulmonary obstructions.

(a)  

23. Approximately (a)   mL of air remains in the anatomic dead space of an adult with a tidal volume of 500 mL.

A) 100

B) 125

C) 150

D) 175

24. The normal alveolar volume in a healthy adult is:

A) 250 mL.

B) 300 mL.

C) 350 mL.

D) 400 mL.

(a)  

25. What is the alveolar minute volume of a patient with a respiratory rate of 12 breaths/min, a tidal volume of 450 mL, and a dead space volume of 135 mL?

A) 3,650 mL

B) 3,780 mL

C) 4,260 mL

D) 5,400 mL

(a)  

26. When a patient's respirations are too rapid and too shallow:

A) the majority of inhaled air lingers in areas of physiologic dead space.

B) inhaled air may only reach the anatomic dead space before being exhaled.

C) the increase in tidal volume will compensate for a rapid respiratory rate.

D) minute volume increases because a larger amount of air reaches the lungs.

(a)  

27. Following an optimal inspiration, the amount of air that can be forced from the lungs in a single exhalation is called the:

A) functional reserve capacity.

B) expiratory reserve volume.

C) residual expiratory volume.

D) fraction of inspired oxygen.

(a)  

28. The fraction of inspired oxygen (FIO₂) increases with:

A) increased tidal volume.

B) forceful inhalation.

C) supplemental oxygen.

D) an increase in respirations.

(a)  

29. The process of moving air into and out of the lungs is called:

A) respiration.

B) inhalation.

C) ventilation.

D) exhalation.

(a)  

30. Changes in the rate and depth of breathing are regulated primarily by the:

A) pH of venous blood.

B) pH of the CSF.

C) saturation of oxygen and hemoglobin.

D) amount of oxygen in the blood plasma

(a)  

31. The involuntary control of breathing originates in the:

A) diencephalon.

B) hypothalamus.

C) cerebral cortex.

D) pons and medulla.

(a)  

32. The Hering-Breuer reflex is a protective mechanism that:

A) terminates inhalation and prevents lung overexpansion.

B) decreases pneumotaxic function during severe hypoxia.

C) sends messages to the diaphragm via the phrenic nerves.

D) allows the apneustic center to influence the respiratory rate.

(a)  

33. The dorsal respiratory group is primarily responsible for:

A) motor control of the inspiratory and expiratory muscles.

B) decreasing the respiratory rate when the blood pH is above 7.45.

C) terminating inspiration in order to prevent pulmonary overexpansion.

D) initiating respiration based on information received from the chemoreceptors.

(a)  

34. Chemoreceptors located in the carotid bodies and aortic arch sense minute changes in the ______ and send signals to the respiratory centers via the _______________ nerves.

A) PaO₂, vagus and intercostal

B) PaCO₂, glossopharyngeal and vagus

C) PaCO₂, phrenic and glossopharyngeal

D) PaO₂, hypoglossal, vagus, and intercostal

(a)  

35. Under normal conditions, the central chemoreceptors in the brain increase the rate and depth of breathing when the:

A) PaO₂ level falls quickly.

B) pH of the CSF decreases.

C) PaCO₂ decreases slowly.

D) pH of the CSF increases.

(a)  

36. The hypoxic drive stimulates breathing in patients with:

A) chronically decreased PaO₂ levels.

B) emphysema or chronic bronchitis.

C) chronically decreased PaCO₂ levels.

D) mild bronchospasm caused by asthma.

(a)  

37. All of the following factors would increase a person's respiratory rate, EXCEPT:

A) narcotic analgesic use.

B) increased metabolism.

C) the use of amphetamines.

D) a rise in body temperature.

(a)  

38. During sleep, the metabolic rate is ________ and the number of respirations _________.

A) low, increases

B) high, decreases

C) low, decreases

D) high, increases

(a)  

39. Negative-pressure ventilation occurs when:

A) the diaphragm ascends and the intercostal muscles retract.

B) air is drawn into the lungs when intrathoracic pressure decreases.

C) pressure within the chest decreases and air is forced from the lungs.

D) the phrenic nerves stop sending messages to the diaphragm.

(a)  

40. In contrast to negative-pressure ventilation, positive-pressure ventilation occurs when:

A) the diaphragm contracts.

B) air is drawn into the lungs.

C) intrathoracic pressure falls.

D) air is forced into the lungs.

(a)  

41. The exchange of oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries is called:

A) internal respiration.

B) external respiration.

C) pulmonary ventilation.

D) intrapulmonary shunting.

(a)  

42. Oxygen that is dissolved in the blood plasma:

A) can be measured with a pulse oximeter.

B) makes up the partial pressure of oxygen.

C) is quickly absorbed by bicarbonate ions.

D) cannot participate in pulmonary respiration.

(a)  

43. Which of the following statements regarding anemia is correct?

A) Anemia results in a decreased ability of the blood to carry oxygen.

B) Patients with anemia have a chronically low level of hemoglobin.

C) Anemia is a condition caused exclusively by a deficiency of iron.

D) Anemic patients typically present with flushed skin and bradycardia.

(a)  

44. A patient with respiratory splinting:

A) is often tachypneic with deep breathing.

B) is holding his or her arm against the chest.

C) is breathing shallowly to alleviate chest pain.

D) has an increased tidal volume due to a chest injury.

(a)  

45. Intrapulmonary shunting is defined as:

A) the return of unoxygenated blood to the left side of the heart.

B) a decrease in the surface area of the alveoli caused by damage.

C) a condition in which too much carbon dioxide is eliminated.

D) failure of blood to bypass an obstruction in a pulmonary artery.

(a)  

46. All of the following conditions will cause an increase in the circulating levels of carbon dioxide in the blood, EXCEPT:

A) lactic acidosis.

B) increased metabolism.

C) anaerobic metabolism.

D) acute hyperventilation.

(a)  

47. Hypoventilation causes a(n) __________ and leads to __________.

A) increased minute volume, hypocarbia

B) decreased minute volume, hypocarbia

C) increased minute volume, hypercarbia

D) decreased minute volume, hypercarbia

(a)  

48. Normally, an adult at rest should have respirations that:

A) are 20 to 24 breaths/min with adequate chest rise.

B) follow a regular pattern of inhalation and exhalation.

C) have a slightly reduced tidal volume and normal rate.

D) are adequate to sustain a heart rate of 80 beats/min.

(a)  

49. An adult patient with an abnormal respiratory rate should:

A) be given oxygen at 4 L/min with a nasal cannula.

B) be assessed immediately for heart rate abnormalities.

C) be evaluated for other signs of inadequate ventilation.

D) receive ventilatory assistance with a bag-mask device.

(a)  

50. The condition in which the body's tissues and cells do not receive enough oxygen is called:

A) anoxia.

B) hypoxia

C) asphyxia.

D) hypoxemia

(a)  

51. Which of the following represents the correct sequence for managing a patient's airway?

A) Open, clear, assess, intervene

B) Clear, open, assess, intervene

C) Assess, clear, open, intervene

D) Open, assess, clear, intervene

(a)  

52. A patient with orthopnea:

A) has blood-tinged sputum.

B) awakens at night with dyspnea.

C) has dyspnea while lying flat.

D) is breathing through pursed lips.

(a)  

53. Asymmetric chest wall movement is characterized by:

A) chest rise that is minimally visible.

B) one side of the chest moving less than the other.

C) alternating movement of the chest and abdomen.

D) a part of the chest wall that bulges during exhalation.

(a)  

54. When ventilating a patient with a bag-mask device, you note increased compliance. This means that:

A) you are meeting resistance when ventilating.

B) air can be forced into the lungs with relative ease.

C) a lower airway obstruction should be suspected.

D) the patient likely has an upper airway obstruction.

(a)  

55. In which of the following conditions would you be LEAST likely to encounter pulsus paradoxus?

A) Moderate asthma attack

B) Pericardial tamponade

C) Tension pneumothorax

D) Decompensating COPD

(a)  

56. Which of the following clinical findings would be of LEAST significance in a patient experiencing respiratory distress?

A) Fever of 102.5°F

B) Productive cough

C) Chest pain or pressure

D) BP of 148/94 mm Hg

(a)  

57. Which of the following findings is MOST significant in a patient with acute respiratory distress?

A) A regular heart rate of 110 beats/min

B) A family history of pulmonary embolism

C) Prior ICU admission for the same problem

D) Low-grade fever and flu-like symptoms

(a)  

58. A patient with a suppressed cough mechanism:

A) should be intubated at once.

B) is at serious risk for aspiration.

C) often requires ventilation support.

D) will have a positive eyelash reflex.

(a)  

59. Biot respirations are characterized by:

A) slow, shallow irregular respirations or occasional gasping breaths.

B) an irregular pattern of breathing with intermittent periods of apnea.

C) deep, gasping respirations that are often rapid but may be slow.

D) increased respirations followed by apneic periods

(a)  

60. Which of the following abnormal respiratory patterns generally do NOT suggest brain injury or cerebral anoxia?

A) Biot respirations

B) Agonal respirations

C) Kussmaul respirations

D) Cheyne-Stokes respirations

(a)  

61. Pulse oximetry is used to measure the:

A) percentage of hemoglobin that is saturated with oxygen.

B) exchange of oxygen and carbon dioxide at the cellular level.

C) percentage of carbon dioxide that is eliminated from the body.

D) amount of oxygen dissolved in the plasma portion of the blood.

(a)  

62. The pulse oximeter would be LEAST useful when:

A) identifying deterioration of the cardiac patient.

B) assessing vascular status in orthopaedic trauma.

C) monitoring oxygenation status during intubation.

D) determining if a patient should receive oxygen.

(a)  

63. Which of the following factors would MOST likely produce a falsely normal pulse oximetry reading?

A) Carboxyhemoglobin

B) Peripheral vasodilation

C) A dimly lit environment

D) Heart rate above 120 beats/min

(a)  

64. An increasing peak expiratory flow reading in a patient with respiratory distress suggests that the patient is:

A) experiencing worsened hypoxemia.

B) no longer experiencing bronchospasm.

C) responding to bronchodilator therapy.

D) in need of further bronchodilator therapy.

(a)  

65. The average peak expiratory flow rate in a healthy adult is approximately:

A) 450 mL.

B) 550 mL.

C) 650 mL.

D) 750 mL.

(a)  

66. When obtaining a peak expiratory flow rate for a patient with acute bronchospasm, you should:

A) ask the patient to fully exhale before blowing into the mouthpiece.

B) perform the test three times and take the best rate of the three readings.

C) administer one bronchodilator treatment before obtaining the first reading.

D) ensure that the patient is in a supine position to obtain an accurate reading.

(a)  

67. It would NOT be appropriate to place a patient in the recovery position if he or she:

A) is tachycardic.

B) is semiconscious.

C) has not been injured.

D) is breathing shallowly.

(a)  

68. If you suspect that an unconscious patient has experienced a spinal injury, you should open his or her airway by:

A) applying firm pressure to the patient's forehead and tilting the head back.

B) placing your fingers behind the angle of the jaw and lifting the jaw forward.

C) carefully grasping the tongue and jaw and slowly lifting the jaw forward.

D) lifting up on the jaw while placing the head in a slightly extended position.

(a)  

69. If several attempts to open a patient's airway with the jaw-thrust maneuver are unsuccessful, you should:

A) carefully tilt the patient's head back while lifting up on the chin.

B) maintain the patient's head in a neutral position and intubate at once.

C) insert an oropharyngeal airway and reattempt the jaw-thrust maneuver.

D) suction the mouth for 15 seconds and then reattempt to open the airway.

(a)  

70. A foreign-body airway obstruction should be suspected in a child who presents with:

A) diffuse wheezing and nasal flaring.

B) a productive cough and flushed skin.

C) acute respiratory distress without fever.

D) progressive respiratory distress and hoarseness.

(a)  

71. An airway obstruction secondary to a severe allergic reaction:

A) requires specific and aggressive treatment.

B) often responds well to humidified oxygen.

C) is usually the result of pulmonary aspiration.

D) is treated effectively with abdominal thrusts.

(a)  

72. Which of the following conditions would MOST likely cause laryngeal spasm and edema?

A) Croup

B) Inhalation injury

C) Viral pharyngitis

D) Mild asthma attack

(a)  

73. Complications of aspiration include all of the following, EXCEPT:

A) airway obstruction.

B) intrapulmonary infection.

C) bronchiolar tissue damage.

D) excess surfactant production.

(a)  

74. Poor lung compliance during your initial attempt to ventilate an unconscious, apneic adult should be treated by:

A) sweeping the patient's mouth with your fingers.

B) reopening the airway and reattempting to ventilate.

C) performing 30 chest compressions and reassessing.

D) administering 15 subdiaphragmatic thrusts at once.

(a)  

75. If chest compressions and repositioning of the airway are unsuccessful in removing a severe airway obstruction in an unconscious patient, you should:

A) perform a blind finger sweep of the mouth.

B) alternate chest compressions and abdominal thrusts.

C) perform laryngoscopy and use Magill forceps.

D) gain airway access via the cricothyroid membrane.

(a)  

76. A whistle-tip suction catheter is MOST often used to:

A) suction large debris from the oropharynx.

B) rapidly remove large volumes of vomitus.

C) remove secretions from an ET tube.

D) suction an adult's mouth for 15 to 30 seconds.

(a)  

77. Placing a suction catheter past the base of the tongue:

A) may cause the patient to gag or vomit.

B) will result in aspiration of gastric contents.

C) is effective in thoroughly clearing the airway.

D) commonly causes bradycardia in adult patients.

(a)  

78. An artificial airway adjunct:

A) effectively protects the airway from aspiration.

B) is a suitable substitute for manual head positioning.

C) should be inserted in any patient who is semiconscious.

D) does not obviate the need for proper head positioning.

(a)  

79. If an unresponsive patient does not have a gag reflex, an oropharyngeal airway:

A) should only be inserted if the patient is not breathing.

B) should be inserted whether the patient is breathing or not.

C) will effectively prevent aspiration if the patient vomits.

D) must be inserted by depressing the tongue with a tongue blade.

(a)  

80. The MOST significant complication associated with the use of an oropharyngeal airway is:

A) soft-tissue trauma with oral bleeding.

B) mild bradycardia in pediatric patients.

C) significant bruising of the hard palate.

D) a tachycardic response in adult patients.

(a)  

81. Inserting a nasopharyngeal airway in a patient with CSF drainage from the nose following head trauma may:

A) result in ventricular dysrhythmias secondary to intracranial pressure.

B) cause acute herniation of the brainstem through the foramen magnum.

C) cause the device to enter the brain through a hole caused by a fracture.

D) result in acute hypertension and decreased cerebral perfusion pressure.

(a)  

82. It would be appropriate to insert a nasopharyngeal airway in patients who:

A) are unresponsive with multiple facial bone fractures.

B) have an altered mental status with an intact gag reflex.

C) are semiconscious with active vomiting and cyanosis.

D) have CSF leakage from the nose and are semiconscious.

(a)  

83. Supplemental oxygen given to a patient with an acute myocardial infarction:

A) will prevent the patient from developing a lethal cardiac dysrhythmia.

B) should not exceed 3 L/min in order to prevent oxidative injury.

C) oxygenates the myocardium that is distal to the occluded coronary artery.

D) enhances the body's compensatory mechanisms during the cardiac event.

(a)  

84. A full (2,000 psi) D cylinder will last approximately (a)   minutes if you are administering oxygen at 12 L/min.

A) 22

B) 24

C) 26

D) 28

85. A Bourdon-gauge oxygen flowmeter:

A) reduces the high pressure in the oxygen cylinder to a safe pressure.

B) allows you to administer oxygen to a patient under high pressures.

C) is used for transferring oxygen from a larger tank to a smaller tank.

D) must be placed in an upright position because it is affected by gravity.

(a)  

86. Which of the following statements regarding oxygen is correct?

A) Oxygen is a highly flammable gas.

B) Grease prevents oxygen from exploding.

C) Oxygen supports the process of combustion.

D) Oxygen must be stored in a warm environment.

(a)  

87. When administering oxygen via a nonrebreathing mask, you must ensure that the:

A) reservoir is half-filled first.

B) one-way valves are disabled.

C) patient has adequate tidal volume.

D) flow rate is set to at least 6 L/min.

(a)  

88. The nasal cannula is of MOST benefit to patients:

A) who require high oxygen concentrations.

B) with mild hypoxemia and claustrophobia.

C) with an acute exacerbation of emphysema.

D) who are hypoxic and are mouth-breathers.

(a)  

89. The Venturi mask is MOST useful in the prehospital setting when:

A) a patient requires less than 15% oxygen.

B) high-flow oxygen is required for severe hypoxia.

C) patients cannot tolerate a nonrebreathing mask.

D) a COPD patient requires a long-range transport.

(a)  

90. Oxygen that is entirely devoid of moisture:

A) is less combustible than humidified oxygen.

B) will dry the patient's mucous membranes quickly.

C) is optimum for patients requiring long-term oxygen.

D) should be given in conjunction with bronchodilators.

(a)  

91. In contrast to negative-pressure ventilation, positive-pressure ventilation:

A) may impair blood return to the heart.

B) moves air into the esophagus and trachea.

C) causes decreased intrathoracic pressure.

D) is the act of normal, unassisted breathing.

(a)  

92. Compared to mouth-to-mouth ventilation, mouth-to-mask ventilation is more advantageous in that it:

A) can be used in conjunction with supplemental oxygen.

B) carries a lower risk of gastric distention and vomiting.

C) is less likely to result in hyperventilation of the rescuer.

D) allows greater tidal volume to be delivered to the patient.

(a)  

93. When ventilating an apneic adult with a pulse with a bag-mask device, you should:

A) deliver 8 to 10 breaths/min and make the chest wall rise visibly.

B) make the chest rise visibly and deliver one breath every 8 seconds.

C) deliver each breath over 1 second at a rate of 10 to 12 breaths/min.

D) squeeze the bag once every 3 seconds until the chest expands widely.

(a)  

94. Hyperventilating an apneic patient:

A) is appropriate if the patient is an adult.

B) may decrease venous return to the heart.

C) is beneficial if the pulse rate is too slow.

D) reduces the incidence of gastric distention.

(a)  

95. Complications associated with the one-person bag-mask ventilation technique are MOST often related to:

A) hyperinflation of the lungs.

B) unrecognized rescuer fatigue.

C) improper manual head positioning.

D) inadequate tidal volume delivery.

(a)  

96. When two paramedics are ventilating an apneic patient with a bag-mask device, the paramedic not squeezing the bag should:

A) apply posterior cricoid pressure.

B) manually position the patient's head.

C) continually auscultate breath sounds.

D) maintain an adequate mask-to-face seal.

(a)  

97. An 8-year-old child in cardiac arrest has been intubated. When ventilating the child, the paramedic should:

A) observe for full chest expansion.

B) deliver 8 to 10 breaths per minute.

C) allow partial exhalation between breaths.

D) deliver one breath every 15 seconds.

(a)  

98. The flow-restricted, oxygen-powered ventilation device:

A) has a demand valve that is triggered by the negative pressure generated during inhalation.

B) is the preferred initial device for ventilating an apneic or inadequately breathing patient.

C) delivers 100% oxygen to apneic patients at a fixed flow rate of 50 to 60 L/min.

D) should be used in patients with thoracic trauma because it is less likely to cause barotrauma.

(a)  

99. Which of the following is an indicator of inadequate artificial ventilation when ventilating an apneic, tachycardic adult with a bag-mask device?

A) The patient's heart rate slows down.

B) One breath is given every 10 to 12 seconds.

C) About 12 to 20 breaths/min are being delivered.

D) Each ventilation is delivered over 1 second.

(a)  

100. Which of the following statements regarding the automatic transport ventilator (ATV) is correct?

A) The ATV should not be used to ventilate a patient who is intubated and in cardiac arrest.

B) Inadvertent variations in the rate and duration of ventilations often occur when the ATV is used.

C) The paramedic can control an apneic patient's minute volume with accuracy when using an ATV.

D) Most ATVs are large and cumbersome and are therefore impractical to use in the prehospital setting

(a)  

101. The pressure relief valve on an automatic transport ventilator may lead to unrecognized hypoventilation in patients with all of the following conditions, EXCEPT:

A) airway obstruction.

B) prolonged apnea.

C) poor lung compliance.

D) increased airway resistance.

(a)  

102. A length-based resuscitation tape measure can be used to determine the most appropriate size of bag-mask device for pediatric patients who weigh up to:

A) 34 kg.

B) 38 kg.

C) 42 kg.

D) 46 kg.

(a)  

103. Physiologic effects of CPAP include:

A) increased intrathoracic pressure.

B) forcing of fluid into the alveoli.

C) increased alveolar surface tension.

D) opening of collapsed alveoli.

(a)  

104. Indications for CPAP include:

A) cardiopulmonary arrest.

B) acute pulmonary edema.

C) severe opiate toxicity.

D) acute bacterial pneumonia.

(a)  

105. CPAP is NOT appropriate for patients with:

A) acute or chronic bronchospasm.

B) slow, shallow respiratory effort.

C) an oxygen saturation less than 90%.

D) evidence of congestive heart failure.

(a)  

106. Which of the following patients may benefit from CPAP?

A) Alert patient with respiratory distress following submersion in water

B) Comatose patient with shallow breathing after overdosing on heroin

C) Trauma patient with labored breathing and extensive chest wall bruising

D) Patient with pulmonary edema who is unable to follow verbal commands

(a)  

107. When administering CPAP therapy to a patient, it is important to remember that:

A) acute symptomatic bradycardia has been directly linked to CPAP therapy.

B) SpO2 of 100% must be achieved as quickly as possible.

C) the increased intrathoracic pressure caused by CPAP can result in hypotension.

D) the head straps must be secured immediately in order to achieve an adequate seal

(a)  

108. Signs of clinical improvement during CPAP therapy include:

A) a decrease in systolic BP.

B) an increase in the heart rate.

C) increased ETCO₂.

D) increased ease of speaking.

(a)  

109. A gastric tube is MOST useful for:

A) performing prehospital gastric lavage in patients with a toxic ingestion.

B) blocking off the esophagus so that an ET tube can be placed.

C) decompressing the stomach and decreasing pressure on the diaphragm.

D) removing blood from the esophagus in patients with esophageal varices.

(a)  

110. Which of the following is NOT proper procedure when inserting a nasogastric tube in a responsive patient?

A) Administering a topical alpha agonist to constrict the nasal vasculature

B) Keeping the patient's head in an extended position while inserting the tube

C) Injecting 40 mL of air into the tube while auscultating over the epigastrium

D) Encouraging the patient to swallow or drink to facilitate passage of the tube

(a)  

111. In contrast to the nasogastric tube, the orogastric tube:

A) is safer to use in patients with severe facial trauma.

B) should only be used in patients who are conscious.

C) can be used in patients who require gastric lavage.

D) is not necessary in patients who have been intubated.

(a)  

112. When determining the correct-sized nasogastric tube for a patient, you should measure the tube:

A) from the nose to the ear and to the xiphoid process.

B) from the nose to the chin and to the epigastric region.

C) from the mouth to the chin and to the xiphoid process.

D) from the nose, around the ear, and to the xiphoid process.

(a)  

113. Endotracheal intubation is MOST accurately defined as:

A) inserting an ET tube through the vocal cords via the patient's mouth.

B) passing an ET tube through an opening in the cricothyroid membrane.

C) inserting an ET tube through the glottic opening via the patient's nose.

D) passing an ET tube through the glottic opening and sealing off the trachea.

(a)  

114. All of the following are complications associated with orotracheal intubation, EXCEPT:

A) laryngeal swelling.

B) damage to the vocal cords.

C) necrosis of the nasal mucosa.

D) barotrauma from forceful ventilation.

(a)  

115. The major advantage of ET intubation is that it:

A) facilitates tracheal suctioning.

B) protects the airway from aspiration.

C) is an easy skill to learn and perform.

D) provides a route for certain medications.

(a)  

116. A disadvantage of ET intubation is that it:

A) is associated with a high incidence of vocal cord damage and bleeding into the oropharynx.

B) bypasses the upper airway's physiologic functions of warming, filtering, and humidifying.

C) does not eliminate the incidence of gastric distention and can result in pulmonary aspiration.

D) is only a temporary method of securing the patient's airway until a more definitive device can be inserted.

(a)  

117. Murphy's eye, an opening on the distal side of an ET tube, allows ventilation to occur:

A) whether the tube is in the trachea or in the esophagus.

B) even if the tip of the tube is occluded by blood or mucus.

C) if the tube is inserted into the right mainstem bronchus.

D) even if the ET tube does not enter the patient's trachea fully.

(a)  

118. An ET tube that is too large for a patient:

A) is much more likely to enter the esophagus.

B) will lead to an increased resistance to airflow.

C) will make ventilating the patient more difficult.

D) can be difficult to insert and may cause trauma.

(a)  

119. Normally, an adult male will require an ET tube that ranges from:

A) 6.5 to 7.0 mm.

B) 7.0 to 7.5 mm.

C) 7.5 to 8.5 mm.

D) 8.5 to 9.0 mm.

(a)  

120. Regardless of the internal diameter, all ET tubes have:

A) a 15/22-mm proximal adaptor.

B) an inflatable cuff at the distal tip.

C) a pilot balloon on the proximal end.

D) black millimeter markings on the side.

(a)  

121. The procedure in which the vocal cords are visualized for placement of an ET tube is called direct:

A) bronchoscopy.

B) tracheostomy.

C) pharyngoscopy.

D) laryngoscopy.

(a)  

122. In contrast to a curved laryngoscope blade, a straight laryngoscope blade is designed to:

A) move the patient's tongue to the left.

B) extend beneath the epiglottis and lift it up.

C) fit into the vallecular space at the base of the tongue.

D) indirectly lift the epiglottis to expose the vocal cords.

(a)  

123. When inserting a stylet into an ET tube, you must ensure that:

A) the stylet rests at least ½ in back from the end of the tube.

B) you use a petroleum-based gel to facilitate easy removal.

C) the stylet is rigid and does not allow the ET tube to bend.

D) the tube is bent in the form of a U to facilitate placement.

(a)  

124. Which of the following statements regarding orotracheal intubation is correct?

A) Orotracheal intubation should be performed on any patient who is apneic.

B) Orotracheal intubation is the most common method of performing ET intubation.

C) You cannot perform orotracheal intubation on patients who are breathing.

D) Orotracheal intubation is most commonly performed without a laryngoscope.

(a)  

125. Before performing orotracheal intubation, it is MOST important for the paramedic to:

A) monitor the patient's cardiac rhythm.

B) preoxygenate with a bag-mask device.

C) wear gloves and facial protection.

D) apply a pulse oximeter to the patient.

(a)  

126. Most of the complications caused by intubation-induced hypoxia:

A) are easily reversible.

B) are subtle and occur gradually.

C) can be predicted with pulse oximetry.

D) are dramatic and occur immediately.

(a)  

127. Orotracheal intubation should be performed with the patient's head:

A) slightly flexed.

B) hyperextended.

C) in a neutral position.

D) in the sniffing position.

(a)  

128. Intubation of the trauma patient is MOST effectively performed:

A) with a curved blade.

B) by two paramedics.

C) with a cervical collar in place.

D) with the patient's head elevated.

(a)  

129. After properly positioning the patient's head for intubation, you should open his or her mouth and insert the blade:

A) into the right side of the mouth and sweep the tongue to the left.

B) in the midline of the mouth and gently lift upward on the tongue.

C) into the left side of the mouth and move the blade to the midline.

D) in the midline of the mouth and gently sweep the tongue to the left.

(a)  

130. After correctly positioning the laryngoscope blade in the patient's mouth, you should:

A) ask your partner to apply firm posterior pressure to the cricoid cartilage.

B) gently pry back on the laryngoscope to obtain a view of the vocal cords.

C) exert gentle traction at a 45° angle to the floor as you lift the patient's jaw.

D) pull slightly back on the laryngoscope blade in order to view the epiglottis.

(a)  

131. You will know that you have achieved the proper laryngoscopic view of the vocal cords when you see:

A) two white fibrous bands that lie vertically within the glottic opening.

B) the tip of the straight blade touching the posterior wall of the pharynx.

C) the thyroid cartilage bulge anteriorly as you lift up on the laryngoscope.

D) the epiglottis lift when the tip of the curved blade is resting underneath it.

(a)  

132. The BURP maneuver usually involves applying backward, upward, and rightward pressure to the:

A) upper third of the cricoid cartilage.

B) lower third of the cricoid cartilage.

C) upper third of the thyroid cartilage.

D) lower third of the thyroid cartilage.

(a)  

133. The BEST way to be certain that the ET tube has passed through the vocal cords is to:

A) feel the ridges of the tracheal wall with the ET tube.

B) visualize the tube passing between the vocal cords.

C) note the appropriate color change of the capnographer.

D) ensure the presence of bilaterally equal breath sounds.

(a)  

134. You should insert the ET tube between the vocal cords until the:

A) centimeter marking reads 15 cm at the patient's teeth.

B) distal end of the cuff is 1 to 2 cm past the vocal cords.

C) proximal end of the cuff is 1 to 2 cm past the vocal cords.

D) tube meets resistance as it makes contact with the carina.

(a)  

135. When using a straight blade, a major mistake of new paramedics is to:

A) try to pass the ET tube down the barrel of the blade.

B) insert the blade directly between the vocal cords.

C) use traction while lifting up on the patient's mandible.

D) insert the blade into the left side of the patient's mouth.

(a)  

136. After inserting the ET tube between the vocal cords, you should remove the stylet from the tube and then:

A) attach the bag-mask device and ventilate.

B) secure the tube with a commercial device.

C) attach an ETCO₂ detector to the tube.

D) inflate the distal cuff with 5 to 10 mL of air.

(a)  

137. If the ET tube has been positioned properly in the trachea:

A) breath sounds should be somewhat louder on the right side and the epigastrium should be silent.

B) you should not see vapor mist in the ET tube during exhalation when ventilating with a bag-mask.

C) breath sounds should be loud at the apices of the lungs but somewhat diminished at the bases.

D) the bag-mask device should be easy to compress and you should see corresponding chest expansion.

(a)  

138. Decreased ventilation compliance following intubation is LEAST suggestive of:

A) gastric distention.

B) left bronchus intubation.

C) esophageal intubation.

D) tension pneumothorax.

(a)  

139. Capnography is a reliable method for confirming proper ET tube placement because:

A) carbon dioxide is not present in the esophagus.

B) it is a reliable indicator of the patient's PaO₂ level.

C) capnographers measure the amount of exhaled oxygen.

D) capnographers measure the amount of carbon dioxide in inhaled air.

(a)  

140. If the ET tube is placed in the trachea properly, the colorimetric paper inside the ETCO₂ detector should:

A) not change colors.

B) turn yellow during inhalation.

C) turn yellow during exhalation.

D) remain purple during ventilations.

(a)  

141. The use of capnography in patients with prolonged cardiac arrest may be limited because:

A) of an excess buildup of nitrogen in the blood.

B) the paramedic often ventilates the patient too slowly.

C) of acidosis and minimal carbon dioxide elimination.

D) metabolic alkalosis damages the colorimetric paper.

(a)  

142. Typically, ETCO₂ is approximately:

A) 2 to 5 mm Hg higher than the arterial PaCO₂.

B) 2 to 5 mm Hg lower than the arterial PaCO₂.

C) 5 to 10 mm Hg higher than the arterial PaCO₂.

D) 5 to 10 mm Hg lower than the arterial PaCO₂.

(a)  

143. What point(s) on the capnographic waveform represent(s) a mixture of alveolar gas and dead space gas?

A) A-B

B) B

C) B-C

D) D

(a)  

144. What phase of the capnographic waveform is called the expiratory upslope?

A) A-B

B) B-C

C) C-D

D) D-E

(a)  

145. On a capnographic waveform, point (a)   is the maximal ETCO₂ and is the best reflection of the alveolar CO₂ level.

A) B

B) C

C) D

D) E

146. According to the most current guidelines for emergency cardiac care, the MOST reliable method for monitoring correct ET tube placement is:

A) pulse oximetry.

B) the esophageal detector device.

C) waveform capnography.

D) colorimetric capnography.

(a)  

147. Following ET intubation, the ideal time to attach the capnography T-piece is:

A) when the bag is attached to the ET tube.

B) after 6 to 8 positive pressure breaths.

C) immediately after removing the stylet.

D) after auscultating the lungs and epigastrium.

(a)  

148. Capnography can serve as an indicator of:

A) proper ventilatory depth.

B) cerebral perfusion pressure.

C) coronary perfusion pressure.

D) chest compression effectiveness.

(a)  

149. If using a bulb-style esophageal detector device to assist you in confirming proper ET tube placement, you should expect the bulb to:

A) inflate slowly when you let go of it.

B) refill briskly if the tube is in the trachea.

C) stay collapsed if the tube is in the trachea.

D) expand quickly if the tube is in the esophagus.

(a)  

150. The average depth of ET tube insertion for adult patients is:

A) 21 to 25 cm.

B) 22 to 26 cm.

C) 23 to 27 cm.

D) 24 to 28 cm.

(a)