AIRWAY 3

Question 1

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.

Answer 1

B: bypasses the upper airway’s physiologic functions of warming, filtering, and humidifying.

Question 2

After confirming that an intubated patient remains responsive enough to maintain his or her own airway, you should first:

A: fully deflate the distal cuff on the ET tube.
B: have the patient sit up or lean slightly forward.
C: suction the oropharynx to remove any secretions.
D: insert an orogastric tube to ensure the stomach is empty.

Answer 2

B: have the patient sit up or lean slightly forward.

Question 3

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.

Answer 3

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

Question 4

After properly positioning the patient’s head for intubation, you should open his or her mouth and insert the laryngoscope 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.

Answer 4

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

Question 5

After tracheobronchial suctioning is complete, you should:

A: visualize the vocal cords to ensure the tube is still in the correct position.
B: hyperventilate the patient at 24 breaths/min for approximately 3 minutes.
C: instill 3 to 5 mL of saline down the tube to loosen any residual secretions.
D: reattach the bag-mask device, continue ventilations, and reassess the patient.

Answer 5

D: reattach the bag-mask device, continue ventilations, and reassess the patient.

Question 6

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 more easily placed.
C: decompressing the stomach and decreasing pressure on the diaphragm.
D: removing blood from the esophagus in patients with esophageal varices.

Answer 6

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

Question 7

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

A: damage to the vocal cords.
B: necrosis of the nasal mucosa.
C: no complications
D: barotrauma from forceful ventilation.

Answer 7

B: necrosis of the nasal mucosa.

Question 8

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.

Answer 8

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

Question 9

Appropriate insertion of a soft-tip (whistle-tip) suction catheter down the ET tube involves:

A: gently inserting the catheter until resistance is felt.
B: inserting the catheter until secretions are observed.
C: inserting the catheter no farther than 6 to 8 in.
D: applying suction while gently inserting the catheter.

Answer 9

A: gently inserting the catheter until resistance is felt.

Question 10

A surgical opening into the trachea is called a:

A: stoma.
B: laryngectomy.
C: laryngectomee.
D: tracheostomy.

Answer 10

D: tracheostomy.

Question 11

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.

Answer 11

C: wear gloves and facial protection.

Question 12

Before securing the ET tube in place with a commercial device, you should:

A: remove the bag-mask device from the ET tube.
B: hyperventilate the patient for 30 seconds to 1 minute.
C: move the ET tube to the center of the patient’s mouth.
D: note the centimeter marking on the ET tube at the patient’s teeth.

Answer 12

D: note the centimeter marking on the ET tube at the patient’s teeth.

Question 13

Compared to orotracheal intubation, nasotracheal intubation is less likely to result in hypoxia because:

A: it must be performed on spontaneously breathing patients.
B: the procedure should be performed in less than 10 seconds.
C: it does not involve direct visualization of the vocal cords.
D: patients requiring nasotracheal intubation are usually stable.

Answer 13

A: it must be performed on spontaneously breathing patients.

Question 14

Decreased ventilation compliance following intubation is LEAST suggestive of:

A: gastric distention.
B: left bronchus intubation.
C: esophageal intubation.
D: tension pneumothorax.

Answer 14

B: left bronchus intubation.

Question 15

During tracheobronchial suctioning, it is MOST important to:

A: apply suction for no longer than 5 seconds in the adult.
B: avoid rotating the catheter as you are suctioning the trachea.
C: monitor the patient’s cardiac rhythm and oxygen saturation.
D: inject 10 mL of saline down the ET tube to loosen secretions.

Answer 15

C: monitor the patient’s cardiac rhythm and oxygen saturation.

Question 16

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 device.
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.

Answer 16

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

Question 17

If you insert the ET tube into the patient’s left nostril, you should:

A: insert the tube straight back without rotating it.
B: insert the tube with the beveled tip facing upward.
C: ensure that the bevel is facing away from the septum.
D: rotate the tube 180° as its tip enters the nasopharynx.

Answer 17

D: rotate the tube 180° as its tip enters the nasopharynx.

Question 18

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.

Answer 18

B: extend beneath the epiglottis and lift it up

Question 19

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.

Answer 19

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

Question 20

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.

Answer 20

B: by two paramedics.

Question 21

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

Answer 21

B: are subtle and occur gradually.

Question 22

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

Answer 22

C: 7.5 to 8.5 mm.

Question 23

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.

Answer 23

D: in the sniffing position.

Question 24

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.

Answer 24

A: a 15/22-mm proximal adaptor.

Question 25

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.

Answer 25

B: visualize the tube passing between the vocal cords.

Question 26

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.

Answer 26

B: protects the airway from aspiration.

Question 27

The MOST common complication associated with nasotracheal intubation is:

A: bleeding.
B: aspiration.
C: hypoxemia.
D: regurgitation.

Answer 27

A: bleeding

Question 28

he MOST obvious risk associated with extubation is:

A: moderate airway swelling as the ET tube is removed.
B: overestimating the patient’s ability to protect his or her own airway.
C: patient retching and gagging as you remove the ET tube.
D: bradycardia from stimulation of the parasympathetic nervous system.

Answer 28

B: overestimating the patient’s ability to protect his or her own airway.

Question 29

The 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.

Answer 29

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

Question 30

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.

Answer 30

D: laryngoscopy.

Question 31

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.

Answer 31

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

Question 32

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

A: the stylet rests at least ½ inch 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.

Answer 32

A: the stylet rests at least ½ inch back from the end of the tube.

Question 33

When performing nasotracheal intubation, you should use an ET tube that is:

A: equipped with a stylet in order to make the tube formfitting.
B: uncuffed so as to avoid unnecessary damage to the nasal mucosa.
C: slightly larger than the nostril into which the tube will be inserted.
D: 1 to 1.5 mm smaller than you would use for orotracheal intubation.

Answer 33

D: 1 to 1.5 mm smaller than you would use for orotracheal intubation.

Question 34

Which of the following is NOT a contraindication for nasotracheal intubation?

A: Apnea
B: Spinal injury
C: Frequent use of cocaine
D: Patients taking an anticoagulant

Answer 34

B: Spinal injury

Question 35

Which of the following is NOT a step that is performed during nasotracheal intubation?

A: Advancing the ET tube as the patient inhales
B: Preoxygenating with a bag-mask device as necessary
C: Ensuring that the patient’s head is hyperflexed
D: Placing the patient’s head in a neutral position

Answer 35

C: Ensuring that the patient’s head is hyperflexed

Question 36

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 25 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

Answer 36

B: Keeping the patient’s head in an extended position while inserting the tube

Question 37

Which of the following statements regarding field extubation is correct?

A: It is generally better to sedate the patient rather than extubate.
B: The patient should be extubated if spontaneous breathing occurs.
C: The risk of laryngospasm following extubation is relatively low.
D: Extubation should be performed with the patient in a supine position.

Answer 37

A: It is generally better to sedate the patient rather than extubate.

Question 38

Which of the following structures is the MOST critical to visualize during orotracheal intubation?

A: Uvula
B: Tongue
C: Epiglottis
D: Tonsils

Answer 38

C: Epiglottis

Question 39

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.

Answer 39

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

Question 40

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.

Answer 40

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