Question 1

Which of the following patients would MOST likely benefit from the use of a nasopharyngeal airway (NPA)?

Accepted Answer

An NPA is indicated for patients who require an airway adjunct but have an intact gag reflex, which contraindicates an Oropharyngeal Airway (OPA). It is contraindicated in cases of severe head injury or suspected basilar skull fracture (indicated by blood from the nose) because it could push into the cranium.

Question 2

You are suctioning the oropharynx of an adult patient who vomited. You should suction for no longer than:

Accepted Answer

Suctioning should be limited to 15 seconds for adults (10 for children, 5 for infants) to prevent hypoxia. Prolonged suctioning removes residual oxygen from the airway and can stimulate the vagus nerve, causing bradycardia.

Question 3

A 67-year-old male complains of shortness of breath. He has a history of COPD. He is breathing 24 times per minute with shallow depth. His skin is cyanotic. What is the MOST appropriate initial treatment?

Accepted Answer

While the patient has COPD, the immediate life threat is respiratory failure indicated by shallow depth (inadequate tidal volume) and cyanosis. Oxygen alone is insufficient if the patient cannot move enough air. Assisted ventilation with a BVM is required to ensure adequate gas exchange.

Question 4

Which technique is the preferred method for opening the airway of a patient with a suspected cervical spine injury?

Accepted Answer

The jaw-thrust maneuver is the standard of care for opening the airway in trauma patients with suspected spinal injury because it moves the mandible forward without manipulating the cervical spine.

Question 5

You are assessing a 4-year-old female with a high fever and difficulty breathing. She is sitting forward, drooling, and anxious. You suspect epiglottitis. You should:

Accepted Answer

Epiglottitis is a bacterial infection causing swelling of the epiglottis. Agitating the child or inserting objects into the mouth (tongue depressor, suction, OPA) can trigger a laryngospasm and complete airway obstruction. Keep the child calm and provide blow-by or humidified oxygen.

Question 6

Which of the following sounds indicates swelling of the upper airway?

Accepted Answer

Stridor is a high-pitched sound heard on inspiration, indicating obstruction or swelling in the upper airway (larynx/trachea). Wheezing is lower airway constriction. Rales/Rhonchi are fluids in the lower airway.

Question 7

An adult patient is breathing at a rate of 6 times per minute. This rate is considered:

Accepted Answer

Normal adult respiratory rate is 12-20 bpm. A rate below 12 is bradypnea. A rate of 6 is inadequate and requires assisted ventilation.

Question 8

When ventilating an apneic adult patient with a bag-valve mask, you should squeeze the bag:

Accepted Answer

The standard ventilation rate for an adult with a pulse but who is not breathing is 1 breath every 5-6 seconds (10-12 breaths/min).

Question 9

You are treating a patient with severe asthma. You assist them with their prescribed albuterol inhaler. The primary action of this medication is to:

Accepted Answer

Albuterol is a beta-2 agonist (bronchodilator) that relaxes the smooth muscle of the bronchioles, reversing bronchoconstriction associated with asthma attacks.

Question 10

A full D-cylinder of oxygen contains approximately how much pressure?

Accepted Answer

A full oxygen cylinder (regardless of size D, E, M) is pressurized to approximately 2,000 psi. The safe residual pressure to change the tank is typically 200-500 psi.

Question 11

You arrive at a restaurant for a choking victim. You find a conscious male clutching his throat. He cannot speak, cough, or breathe. What is your FIRST action?

Accepted Answer

The patient has a complete airway obstruction (indicated by the inability to speak or move air). For a conscious adult with complete obstruction, immediate abdominal thrusts (Heimlich maneuver) are indicated until the object is expelled or the patient becomes unconscious.

Question 12

You are transporting a 55-year-old male with emphysema. He is on oxygen at 2 LPM via nasal cannula. He suddenly becomes lethargic and his respiratory rate drops to 8 breaths/min. You should FIRST:

Accepted Answer

The patient is in respiratory failure (rate <10, lethargic). Regardless of the cause (hypoxic drive suppression or fatigue), the priority is ensuring adequate ventilation. You must assist his breathing with a BVM.

Question 13

Which of the following structures is the boundary between the upper and lower airway?

Accepted Answer

The larynx (specifically the vocal cords) marks the transition. Structures above (pharynx, nose, mouth) are upper airway; structures below (trachea, bronchi, alveoli) are lower airway.

Question 14

A 22-year-old female is hyperventilating after an argument. Her respiratory rate is 30, and she complains of numbness in her hands and around her mouth. Her SpO2 is 99%. You should:

Accepted Answer

The numbness is caused by respiratory alkalosis (blowing off too much CO2). Paper bags are dangerous (can cause hypoxia). Oxygen is not needed (SpO2 99%). The best treatment is coaching her to control her breathing.

Question 15

When inserting an Oropharyngeal Airway (OPA), you measure from the:

Accepted Answer

Correct sizing for an OPA is from the corner of the mouth to the earlobe (or angle of the jaw). Nose to earlobe is for NPA sizing.

Question 16

A 'See-Saw' breathing pattern in a pediatric patient indicates:

Accepted Answer

See-saw breathing (chest retracts and abdomen expands during inspiration) suggests extreme respiratory effort and impending failure in infants/children due to their compliant chest walls and reliance on the diaphragm.

Question 17

Which of the following is a sign of INADEQUATE breathing?

Accepted Answer

Nasal flaring is a sign of increased work of breathing (respiratory distress), indicating the current breathing is inadequate or difficult. The other options are signs of normal/adequate breathing.

Question 18

You have inserted an OPA in an unconscious patient. As you begin bagging, the patient begins to gag. You should:

Accepted Answer

If a patient gags, the airway is stimulating the gag reflex, which can cause vomiting and aspiration. You must remove the OPA immediately. Be prepared to suction. Consider an NPA if the airway needs support.

Question 19

Gas exchange in the lungs occurs in the:

Accepted Answer

The alveoli are the microscopic air sacs at the end of the airway where oxygen and carbon dioxide are exchanged with the capillaries.

Question 20

A 19-year-old female has swallowed a handful of pills. She is semi-conscious with snoring respirations. Her respiratory rate is 10 and shallow. Pulse is 110. The snoring sound indicates:

Accepted Answer

Snoring is the hallmark sound of the tongue falling back against the pharynx in a patient with a decreased level of consciousness. Manual airway maneuvers (head-tilt chin-lift) or adjuncts correct this.

Question 21

When using a non-rebreather mask, you must ensure that:

Accepted Answer

The reservoir bag must be pre-filled and remain mostly inflated during inspiration to ensure the patient receives high-concentration oxygen rather than room air. If it collapses, increase the flow rate (typically 10-15 LPM).

Question 22

A patient with spontaneous pneumothorax would MOST likely present with:

Accepted Answer

Spontaneous pneumothorax (lung collapse) usually presents with sudden, sharp (pleuritic) chest pain and shortness of breath. Breath sounds may be diminished on one side. Fever suggests pneumonia; wheezing suggests asthma/COPD.

Question 23

The primary drive to breathe in a healthy human is based on levels of:

Accepted Answer

The hypercapnic drive (CO2 levels) is the primary stimulus. When CO2 rises, the brainstem signals an increase in respiration to blow it off. (The hypoxic drive—low O2—is secondary).

Question 24

Which condition causes pulmonary edema (fluid in the lungs) due to the heart's inability to pump effectively?

Accepted Answer

Left-sided heart failure (CHF) causes blood to back up into the pulmonary veins, forcing fluid into the alveoli (pulmonary edema), often presenting with rales (crackles) and pink, frothy sputum.

Question 25

You are assisting ventilations for an adult patient who is in respiratory arrest. You notice the patient's abdomen distending. You should:

Accepted Answer

Gastric distension is caused by ventilating too forcefully or too fast, pushing air into the stomach. This increases aspiration risk. You must reposition the airway to ensure it is open and deliver breaths more gently (just enough to see chest rise).

Question 26

What is the correct procedure for suctioning a patient's airway?

Accepted Answer

Never suction on insertion (it removes O2). Insert to the appropriate depth, then apply suction only on withdrawal, rotating the catheter to clear the oral cavity.

Question 27

A 70-year-old male with a history of emphysema is complaining of difficulty breathing. His SpO2 is 88% on room air. He is alert but anxious. Which oxygen device is MOST appropriate initially?

Accepted Answer

While 'hypoxic drive' is a concern in COPD, a patient in respiratory distress with hypoxia (88%) needs oxygen. Prehospital protocols prioritize treating hypoxia over the theoretical risk of apnea. Start with an NRB to bring saturation up; monitor closely for respiratory depression.

Question 28

Pulse oximetry readings may be inaccurate in patients with:

Accepted Answer

Standard pulse oximeters measure hemoglobin saturation but cannot distinguish between oxygen and carbon monoxide. A patient with CO poisoning will have a falsely high SpO2 (e.g., 100%) despite being hypoxic.

Question 29

A 'stoma' patient requires ventilation. The best way to ventilate is:

Accepted Answer

Ventilate directly through the stoma using a pediatric-sized mask (to fit the neck contour) or connect the BVM directly to the tracheostomy tube if present.

Question 30

In a healthy adult, the normal respiratory rate is:

Accepted Answer

12-20 breaths per minute is the standard range for a resting adult. <12 is bradypnea; >20 is tachypnea.

Question 31

The normal range for end-tidal carbon dioxide (ETCO2) is:

Accepted Answer

Normal ETCO2 is 35-45 mmHg. Levels below 35 indicate hyperventilation (blowing off too much CO2) or poor perfusion. Levels above 45 indicate hypoventilation (retaining CO2).

Question 32

A 56-year-old female is in severe respiratory distress. She has rales (crackles) in both lung bases, JVD, and pedal edema. She is conscious but struggling to breathe. BP is 160/90. Which intervention is MOST appropriate?

Accepted Answer

The patient has signs of Congestive Heart Failure (CHF) with pulmonary edema (fluid in the lungs). CPAP is the gold standard for conscious CHF patients as it pushes fluid out of the alveoli back into the capillaries, improving gas exchange.

Question 33

Which of the following is a contraindication for the use of CPAP?

Accepted Answer

CPAP requires the patient to be alert and able to follow commands to maintain the mask seal and coordinate breathing. An unconscious patient cannot protect their airway and is at risk for aspiration.

Question 34

You are treating an unresponsive 8-month-old infant with a complete airway obstruction. You should perform:

Accepted Answer

For infants (<1 year) with FBAO (Foreign Body Airway Obstruction), abdominal thrusts are dangerous due to liver size. The correct technique is 5 back slaps followed by 5 chest thrusts.

Question 35

Deep, rapid, gasping respirations commonly seen in patients with Diabetic Ketoacidosis (DKA) are called:

Accepted Answer

Kussmaul respirations are the body's attempt to blow off excess acid (CO2) in metabolic acidosis (DKA). They are deep and rapid.

Question 36

Which suction catheter is best suited for suctioning the oropharynx of an adult patient with thick secretions?

Accepted Answer

The Yankauer (tonsil-tip) is rigid and has a large diameter, making it effective for clearing thick secretions, blood, or vomit from the mouth/oropharynx.

Question 37

You are ventilating a patient with a BVM. You notice that the chest does not rise with each ventilation. Your FIRST action should be to:

Accepted Answer

The most common cause of failed ventilation is improper head position. Repositioning the head (head-tilt chin-lift or jaw thrust) often opens the airway effectively. Squeezing harder causes gastric distention.

Question 38

A 'Barking Seal' cough in a pediatric patient is a hallmark sign of:

Accepted Answer

Croup is a viral infection causing swelling below the vocal cords, producing the classic seal-bark cough and sometimes stridor.

Question 39

The primary physiological problem in asthma is:

Accepted Answer

Asthma causes the smooth muscles of the bronchioles to spasm (constrict) and swell (inflammation), trapping air and causing wheezing.

Question 40

A 30-year-old female presents with sudden onset of sharp chest pain and shortness of breath. Her lungs sounds are clear. She has a history of recent surgery and long-distance travel. You suspect:

Accepted Answer

Sudden onset dyspnea + clear lung sounds + risk factors (surgery, travel/immobility) strongly suggests a Pulmonary Embolism (clot in the lung). Pneumothorax would have diminished sounds. Pneumonia has fever/sputum.

Question 41

Agonal gasps are:

Accepted Answer

Agonal gasps are a brainstem reflex often seen in the first minutes of cardiac arrest. They are not effective breathing and require immediate artificial ventilation/CPR.

Question 42

You are assessing a patient who has overdosed on heroin. You expect their pupils to be:

Accepted Answer

Opioids (heroin, fentanyl) cause parasympathetic stimulation leading to pinpoint pupils and respiratory depression.

Question 43

Which of the following is the MOST reliable indicator that you are providing adequate artificial ventilations?

Accepted Answer

Visible chest rise is the primary immediate indicator of effective ventilation volume. Skin color and heart rate are lagging indicators.

Question 44

A 2-year-old child is in respiratory distress. You note that his nostrils widen every time he inhales. This is called:

Accepted Answer

Nasal flaring is a compensatory mechanism to increase airway diameter and reduce resistance, indicating significant respiratory distress.

Question 45

When ventilating a patient with a stoma, air begins to escape from the mouth and nose. You should:

Accepted Answer

If the stoma does not have a sealed tube, air can travel up the airway and out the nose/mouth. Sealing the nose and mouth ensures air goes down into the lungs.

Question 46

Which of the following describes the correct technique for the 'jaw-thrust' maneuver?

Accepted Answer

The jaw-thrust moves the mandible forward to lift the tongue off the pharynx without moving the cervical spine.

Question 47

The maximum flow rate for a nasal cannula is typically:

Accepted Answer

Nasal cannulas are effective at 1-6 LPM. Flow rates higher than 6 LPM dry out the mucosa and are uncomfortable without significantly increasing FiO2.

Question 48

Hypoxic drive is a phenomenon where the body stimulates breathing based on low oxygen levels instead of high CO2 levels. This is most common in patients with:

Accepted Answer

Chronic CO2 retention in COPD desensitizes the brainstem to CO2, causing the body to rely on backup oxygen sensors (chemoreceptors) to drive breathing.

Question 49

Which lung sound is caused by fluid in the small airways (alveoli)?

Accepted Answer

Crackles (rales) are bubbling/popping sounds caused by fluid in the alveoli (e.g., CHF, pneumonia). Rhonchi are lower-pitched sounds from mucus in larger airways.

Question 50

A patient is coughing up thick, green sputum and has a fever of 102°F. You suspect:

Accepted Answer

The combination of fever and purulent (green/yellow) sputum is classic for a bacterial lung infection like pneumonia.

Question 51

You are treating a 24-year-old male who was pulled from a house fire. He has soot around his nose and mouth and his voice is hoarse. You should be MOST concerned about:

Accepted Answer

Soot, hoarseness, and singed nasal hairs indicate inhalation of superheated gases. This causes rapid, life-threatening laryngeal swelling. Immediate airway management/ALS intercept is critical.

Question 52

Which of the following is a late sign of hypoxia?

Accepted Answer

Restlessness, anxiety, and tachycardia are early signs. Cyanosis (blue skin) is a late sign, indicating significant oxygen deprivation.

Question 53

Cheyne-Stokes respirations are characterized by:

Accepted Answer

Cheyne-Stokes is a rhythmic waxing and waning of depth/rate with apnea, commonly seen in stroke or head injury patients.

Question 54

When ventilating a patient with a BVM, you should deliver each breath over:

Accepted Answer

Breaths should be delivered over 1 second to produce visible chest rise while minimizing the risk of gastric distention.

Question 55

Which of the following patients is in Respiratory FAILURE?

Accepted Answer

Respiratory distress involves increased effort (anxiety, wheezing). Failure involves the system collapsing (lethargy/altered mental status, inadequate rate/volume). Failure requires assisted ventilation (BVM).

Question 56

The primary purpose of surfactant in the lungs is to:

Accepted Answer

Surfactant reduces surface tension within the alveoli, preventing them from collapsing (atelectasis) during exhalation.

Question 57

A 'French' catheter (soft-tip) is most useful for suctioning:

Accepted Answer

Flexible French catheters are designed for the nasopharynx, stomas, or situations where rigid catheters cannot be used.

Question 58

Which of the following is a genetic disorder affecting the lungs and digestive system, characterized by thick mucus production?

Accepted Answer

Cystic fibrosis is a genetic disease where the body produces abnormally thick, sticky mucus that clogs the lungs and pancreas.

Question 59

You are ventilating a patient in cardiac arrest. An advanced airway (King/iGel/Combitube) has been inserted. You should ventilate at a rate of:

Accepted Answer

Once an advanced airway is in place, compressions become continuous, and ventilations are asynchronous at a rate of 1 breath every 6 seconds (10/min).

Question 60

When using a bag-valve mask with a reservoir and supplemental oxygen at 15 LPM, you can deliver an oxygen concentration of approximately:

Accepted Answer

A BVM with a reservoir and high-flow O2 delivers nearly 100% oxygen.

Question 61

Which position is best for a patient with difficulty breathing who is alert?

Accepted Answer

Fowler's (or semi-Fowler's) position allows the diaphragm to drop and the chest to expand most easily, aiding respiration.

Question 62

A patient is found unconscious and vomiting. You cannot keep the airway clear with suction alone. You should:

Accepted Answer

If suction cannot manage the volume of emesis, gravity is your best tool. Rolling the patient allows fluid to drain out, preventing aspiration. Ventilation would force vomit into the lungs.

Question 63

The diaphragm is innervated by the:

Accepted Answer

The phrenic nerve (C3-C4-C5) controls the diaphragm. Spinal injury above C3 can cause respiratory arrest.

Question 64

Which of the following creates a risk of hypoxic drive suppression?

Accepted Answer

In end-stage COPD, high oxygen levels can theoretically satisfy the hypoxic drive, causing the patient to stop breathing. (Note: Never withhold oxygen from a hypoxic patient, but monitor respirations).

Airway Practice Questions

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