Airway Management

Question 1

Intrapulmonary shunting occurs when:

Answer 1

Select one:

a.
nonfunctional alveoli inhibit the diffusion of oxygen and carbon dioxide.

b.
blood entering the lungs from the right side of the heart is hyperoxygenated.

c.
blood returning to the left side of the heart is low in carbon dioxide.

d.
a blockage in the pulmonary artery prevents blood from reaching the lungs.
Feedback
The correct answer is: nonfunctional alveoli inhibit the diffusion of oxygen and carbon dioxide.

Question 2

The partial pressure of carbon dioxide (PaCO2) increases when:

Answer 2

Select one:

a.
carbon dioxide moves across the pulmonary capillaries.

b.
a person’s respiratory rate is significantly increased.

c.
a patient is hyperventilated with a bag-mask device.

d.
excessive carbon dioxide is dissolved in the plasma.
Feedback
The correct answer is: excessive carbon dioxide is dissolved in the plasma.

Question 3

What protective function does the Hering-Breuer reflex serve?

Answer 3

Select one:

a.
It prevents overexpansion of the lungs.

b.
It protects the abdominal organs when the diaphragm descends.

c.
It prevents collapse of the alveoli.

d.
It prevents atrophy of the respiratory muscles.
Feedback
The correct answer is: It prevents overexpansion of the lungs.

Question 4

If the brain is deprived of oxygen for 4 to 6 minutes:

Answer 4

Select one:

a.
mild tissue hypoxia occurs.

b.
anoxic brain injury may occur.

c.
the patient will die.

d.
respiratory arrest is irreversible.
Feedback
The correct answer is: anoxic brain injury may occur.

Question 5

Which of the following statements regarding the nonrebreathing mask is incorrect?

Answer 5

Select one:

a.
It delivers passive oxygen to the patient.

b.
It is of no benefit to an apneic patient.

c.
It can deliver an FiO2 of up to 90%.

d.
It increases a patient’s tidal volume.
Feedback
The correct answer is: It increases a patient’s tidal volume.

Question 6

A stoma, located superior to the suprasternal notch, is the resultant orifice following a:

Answer 6

Select one:

a.
tracheostomy.

b.
cricothyrotomy.

c.
laryngectomy.

d.
thyroidectomy.
Feedback
The correct answer is: tracheostomy.

Question 7

You are treating a 56-year-old man with CPAP. He has a history of congestive heart failure and is experiencing marked respiratory distress. When you reassess him, you note that he is no longer able to follow verbal commands. You should:

Answer 7

Select one:

a.
discontinue CPAP and assist his ventilations with a bag-mask device.

b.
request a paramedic unit because the patient needs to be intubated.

c.
recheck the mask seal and adjust the amount of PEEP accordingly.

d.
remove the CPAP device and prepare to insert a supraglottic airway.
Feedback
The correct answer is: discontinue CPAP and assist his ventilations with a bag-mask device.

Question 8

In order for continuous positive airway pressure (CPAP) to be beneficial, the patient must:

Answer 8

Select one:

a.
weigh more than 110 pounds.

b.
have a slow respiratory rate.

c.
be able to follow commands.

d.
not have a history of asthma.
Feedback
The correct answer is: be able to follow commands.

Question 9

A supraglottic airway device:

Answer 9

Select one:

a.
protects the airway better than an ET tube.

b.
features two separate lumens.

c.
does not enter the trachea or esophagus.

d.
eliminates the risk of aspiration.
Feedback
The correct answer is: does not enter the trachea or esophagus.

Question 10

In contrast to the dorsal respiratory group, the ventral respiratory group is:

Answer 10

Select one:

a.
controlled by the phrenic nerve, which innervates the diaphragm muscle and allows it to contract.

b.
anatomically located within the pons and functions by terminating the inspiratory phase.

c.
responsible for initiating inspiration based on the information received from the chemoreceptors.

d.
primarily responsible for motor control of the inspiratory and expiratory muscles.
Feedback
The correct answer is: primarily responsible for motor control of the inspiratory and expiratory muscles.

Question 11

After inserting a King LT airway, you attach the bag-mask device and begin to ventilate the patient. However, you meet resistance with your initial ventilation attempts. You should:

Answer 11

Select one:

a.
deflate the cuffs and advance the device 2 cm further.

b.
remove the device and resume bag-mask ventilations.

c.
ventilate with greater force until resistance is not felt.

d.
withdraw the device slightly until ventilations are easy.
Feedback
The correct answer is: withdraw the device slightly until ventilations are easy.

Question 12

When using CPAP on a patient with respiratory distress, it is important to remember that:

Answer 12

Select one:

a.
most patients being treated with CPAP experience hypotension at some point.

b.
the patient’s condition is such that he or she will likely need to be intubated.

c.
it often takes at least 10 to 15 minutes before clinical improvement is noted.

d.
you are not treating the underlying cause of the patient’s respiratory distress.
Feedback
The correct answer is: you are not treating the underlying cause of the patient’s respiratory distress.

Question 13

Unresponsive patients most often experience airway obstructions from:

Answer 13

Select one:

a.
foreign bodies, such as food, that block the glottic opening.

b.
coagulated blood or thick mucus in the mouth.

c.
occlusion of the posterior pharynx by the tongue.

d.
loose dentures that fall back into the posterior pharynx.
Feedback
The correct answer is: occlusion of the posterior pharynx by the tongue.

Question 14

You respond to a call for an unconscious person. Upon arriving at the scene, you find an unconscious young male lying in a prone position in his front yard. After taking standard precautions, you should:

Answer 14

Select one:

a.
apply 100% supplemental oxygen and perform a quick primary assessment.

b.
maintain control of his c-spine and open his airway while he is in the prone position.

c.
roll the patient into a supine position, without twisting his body, and open his airway.

d.
assess the quality of the patient’s breathing by looking for rise and fall of his back.
Feedback
The correct answer is: roll the patient into a supine position, without twisting his body, and open his airway.

Question 15

The preferred initial method for ventilating an apneic patient is the:

Answer 15

Select one:

a.
bag-mask device with one rescuer.

b.
bag-mask device with two rescuers.

c.
mouth-to-mask with one-way valve.

d.
manually triggered ventilation device.
Feedback
The correct answer is: bag-mask device with two rescuers.

Question 16

Partial pressure is the term used to describe the amount of gas that is:

Answer 16

Select one:

a.
exchanged in the lungs.

b.
dissolved in fluid.

c.
in venous blood.

d.
in arterial blood.
Feedback
The correct answer is: dissolved in fluid.

Question 17

CPAP produces all of the following physiologic effects, except:

Answer 17

Select one:

a.
opening collapsed alveoli and improving respiration.

b.
forcing interstitial fluid into the pulmonary circulation.

c.
pushing more oxygen across the alveolar membrane.

d.
dispersing thick secretions within the lung tissue.
Feedback
The correct answer is: dispersing thick secretions within the lung tissue.

Question 18

When the diaphragm and intercostal muscles contract:

Answer 18

Select one:

a.
atmospheric pressure exceeds intrapulmonary pressure.

b.
intrapulmonary pressure falls below atmospheric pressure.

c.
intrapulmonary and atmospheric pressures are equal.

d.
atmospheric pressure draws air out of the lungs.
Feedback
The correct answer is: intrapulmonary pressure falls below atmospheric pressure.

Question 19

The condition in which the alveoli collapse is called:

Answer 19

Select one:

a.
atelectasis.

b.
pleuritis.

c.
pneumothorax.

d.
bronchitis.
Feedback
The correct answer is: atelectasis.

Question 20

The exchange of oxygen and carbon dioxide occurs by a process of diffusion, in which:

Answer 20

Select one:

a.
gas moves from an area of higher concentration to an area of lower concentration.

b.
carbon dioxide is not allowed to move across the pulmonary capillary membrane.

c.
gas moves from an area of lower concentration to an area of higher concentration.

d.
gases in the cells remain in equal concentration until arterial oxygen levels fall.
Feedback
The correct answer is: gas moves from an area of higher concentration to an area of lower concentration.

Question 21

A 40-year-old male is unconscious, has inadequate breathing, and is producing copious, continuous secretions from his mouth. This situation is most effectively managed by:

Answer 21

Select one:

a.
continuous ventilation until the patient can be intubated.

b.
continuously suctioning until the secretions are cleared.

c.
suctioning for 15 seconds and ventilating for 2 minutes.

d.
ventilating for 30 seconds and suctioning for 2 minutes.
Feedback
The correct answer is: suctioning for 15 seconds and ventilating for 2 minutes.

Question 22

Chemoreceptors send messages to the brain to increase respirations when the:

Answer 22

Select one:

a.
arterial carbon dioxide levels increase.

b.
pH of the cerebrospinal fluid increases.

c.
arterial blood pressure falls.

d.
arterial oxygen levels increase.
Feedback
The correct answer is: arterial carbon dioxide levels increase.

Question 23

What do snoring respirations in an unconscious patient indicate?

Answer 23

What do snoring respirations in an unconscious patient indicate?
Select one:

a.
Blood or other secretions in the upper airway

b.
Spasm of the larynx and closure of the vocal cords

c.
Partial occlusion of the posterior pharynx by the tongue

d.
Severe upper airway obstruction from a foreign body
Feedback
The correct answer is: Partial occlusion of the posterior pharynx by the tongue

Question 24

Which of the following is a sign that CPAP is improving your patient’s clinical status?

Answer 24

Select one:

a.
Decrease in respiratory rate

b.
Increase in respiratory rate

c.
Increase in heart rate

d.
The patient becoming combative
Feedback
The correct answer is: Decrease in respiratory rate

Question 25

Following severe head trauma, a patient presents with an irregular rate, pattern, and depth of breathing with brief periods of apnea. This breathing pattern is characteristic of:

Answer 25

Following severe head trauma, a patient presents with an irregular rate, pattern, and depth of breathing with brief periods of apnea. This breathing pattern is characteristic of:
Select one:

a.
central neurogenic hyperventilation.

b.
Biot’s respirations.

c.
agonal respirations.

d.
Cheyne-Stokes respirations.
Feedback
The correct answer is: Biot’s respirations.

Question 26

After applying the AED to your cardiac arrest patient, you receive a “shock advised” message. You should:
Select one:

Answer 26

a.
reanalyze again before you deliver the shock.

b.
perform CPR for 2 minutes and then reanalyze.

c.
resume CPR as the defibrillator is charging.

d.
check to ensure the pads are correctly placed.
Feedback
The correct answer is: resume CPR as the defibrillator is charging.

Question 27

What is the approximate cardiac output of a person with a heart rate of 70 beats/min and a stroke volume of 75

Answer 27

a. 6 L/min
b. 7 L/min
c. 5 L/min

d. 4 L/min
Feedback
The correct answer is: 5 L/min

Question 28

According to the Starling law of the heart:

Answer 28

According to the Starling law of the heart:
Select one:

a.
decreased venous return reduces the amount of blood delivered to the lungs.

b.
damage to the right ventricle causes blood to back up in the systemic circulation.

c.
increased venous return stretches the ventricles, resulting in increased contractility.

d.
the cardiac muscle can generate its own electrical impulses without outside influence.
Feedback
The correct answer is: increased venous return stretches the ventricles, resulting in increased contractility.

Question 29

Unstable angina pectoris is characterized by:

Select one:

Answer 29

a.
chest pain or pressure that occurs during periods of strenuous activity and promptly subsides with rest.

b.
chest pain or pressure that lasts longer than 15 minutes and is associated with myocardial necrosis.

c.
a fixed frequency of chest pain or pressure that is often relieved by rest and several doses of nitroglycerin.

d.
chest pain or discomfort that may not be relieved by rest or nitroglycerin, and that occurs without a fixed frequency.
Feedback
The correct answer is: chest pain or discomfort that may not be relieved by rest or nitroglycerin, and that occurs without a fixed frequency.

Question 30

An acute myocardial infarction is more apt to occur in the left ventricle because:
Select one:

Answer 30

a.
its coronary arteries are more susceptible to atherosclerotic disease.

b.
it is a fairly small chamber that is quickly depleted of oxygenated blood.

c.
its inherently low oxygen demand predisposes it to injury or infarct.

d.
it is large and thick and demands more oxygen than the right ventricle.
Feedback
The correct answer is: it is large and thick and demands more oxygen than the right ventricle.

Question 31

Which of the following cardiac dysrhythmias requires immediate defibrillation?
Select one:

Answer 31

a.
Sinus bradycardia without a pulse

b.
Sinus tachycardia with a low BP

c.
Perfusing ventricular tachycardia

d.
Nonperfusing ventricular fibrillation
Feedback
The correct answer is: Nonperfusing ventricular fibrillation

Question 32

When treating a patient with a blood pressure of 80/40 mm Hg due to “pump failure,” you should:
Select one:

Answer 32

a.
place the patient in a supine position with his or her legs elevated.

b.
apply a nonrebreathing mask if the patient is breathing shallowly.

c.
give 250-mL fluid boluses as needed to improve perfusion.

d.
assist the patient with his or her prescribed nitroglycerin.
Feedback
The correct answer is: give 250-mL fluid boluses as needed to improve perfusion.

Question 33

What are the physiologic effects of nitroglycerin when
given to a patient with suspected cardiac-related chest pain?
Select one:

Answer 33

a.
Vascular smooth muscle contraction and increased venous return

b.
Vascular smooth muscle relaxation and coronary artery dilation

c.
Coronary artery dilation and increased systemic vascular resistance

d.
Decreased venous pooling of blood and coronary vasoconstriction
Feedback
The correct answer is: Vascular smooth muscle relaxation and coronary artery dilation

Question 34

While treating a patient who is in cardiogenic shock, your paramedic partner makes the comment that the patient needs an inotropic medication. You should recall that this type of medication is intended to:
Select one:

Answer 34

a.
constrict the blood vessels.

b.
affect electrical conduction through the heart.

c.
increase the patient’s heart rate.

d.
affect the strength of cardiac contraction.
Feedback
The correct answer is: affect the strength of cardiac contraction.

Question 35

You respond to call at a residence for a “man down.” Your primary survey reveals that the patient is unresponsive, pulseless, and apneic. His wife tells you that he has recently had the flu, and that he collapsed about 10 minutes ago. You should:
Select one:

Answer 35

a.
begin CPR, insert a King airway, and request a paramedic unit.

b.
begin CPR, start an IV, and give a 20-mL/kg fluid bolus.

c.
elevate the patient’s legs, begin CPR, and attach an AED.

d.
begin CPR and apply the AED as soon as it is available.
Feedback
The correct answer is: begin CPR and apply the AED as soon as it is available.

Question 36

If a patient has a ventricular assist device (VAD) that provides continuous blood flow:
Select one:

Answer 36

a.
it is not possible for the ventricles to fibrillate.

b.
the VAD is supporting the right ventricle.

c.
he or she will not have any palpable pulses.

d.
strong central pulses will be easily palpable.
Feedback
The correct answer is: he or she will not have any palpable pulses.

Question 37

A 60-year-old female is in possible cardiogenic shock. She is semiconscious with shallow respirations, an irregular pulse, and hypotension. Appropriate treatment for this patient should include:
Select one:

Answer 37

a.
high-flow oxygen via nonrebreathing mask, a saline lock, thermal management, and transport.

b.
continuous positive airway pressure, a 500-mL saline bolus, thermal management, and transport.

c.
assisted ventilation with a bag-mask device, thermal management, 250-mL fluid boluses, and transport.

d.
insertion of a supraglottic airway device, mild hyperventilation, a saline lock, and prompt transport.
Feedback
The correct answer is: assisted ventilation with a bag-mask device, thermal management, 250-mL fluid boluses, and transport.

Question 38

When treating a 56-year-old female with chest pain, you have placed on her oxygen, established IV access, and administered two doses of sublingual nitroglycerin. However, the patient’s pain has not improved. You reassess her blood pressure and note that it is 106/66 mm Hg. You should:
Select one:

Answer 38

a.
give a 500-mL saline bolus to raise her BP.

b.
administer one more dose of nitroglycerin.

c.
transport at once and closely monitor her.

d.
request permission to give her morphine.
Feedback
The correct answer is: administer one more dose of nitroglycerin.

Question 39

Percutaneous coronary intervention (PCI) is a procedure in which:
Select one:

Answer 39

a.
the coronary thrombus is destroyed with a fibrinolytic agent.

b.
the affected coronary artery is bypassed by way of a graft.

c.
the coronary artery is mechanically cleared via angioplasty.

d.
medications are given in order to increase cardiac contractility.
Feedback
The correct answer is: the coronary artery is mechanically cleared via angioplasty.

Question 40

Shortly after administering a second nitroglycerin dose to a 44-year-old male with chest pain, he becomes lightheaded. You take his blood pressure, and it reads 80/50 mm Hg. You have already established IV access and are administering oxygen. You should:
Select one:

Answer 40

a.
give him a 500-mL normal saline bolus.

b.
contact medical control for further guidance.

c.
cover him with a blanket to keep him warm.

d.
place him supine and reassess his BP.
Feedback
The correct answer is: place him supine and reassess his BP.

Question 41

When assessing a middle-aged male patient with chest pain, you note a large vertical scar in the center of his chest. This indicates that he has most likely had:
Select one:

Answer 41

a.
a percutaneous coronary angioplasty.

b.
a surgically implanted cardiac pacemaker.

c.
a coronary artery bypass graft.

d.
coronary artery stent placement.
Feedback
The correct answer is: a coronary artery bypass graft.

Question 42

When applying the AED pads to a patient with a surgically implanted pacemaker, you should:
Select one:

Answer 42

a.
apply the pads at least 1 inch away from the pacemaker.

b.
apply the pad directly over the implanted pacemaker.

c.
avoid applying the AED and perform CPR only.

d.
apply both pads on the posterior aspect of the chest.
Feedback
The correct answer is: apply the pads at least 1 inch away from the pacemaker.

Question 43

When the parasympathetic nervous system is stimulated, it:

Select one:

Answer 43

a.
produces epinephrine and increases cardiac contractility.

b.
enhances conduction through the atrioventricular node.

c.
slows the heart rate by decreasing SA node discharge.

d.
increases the heart rate by increasing SA node discharge.
Feedback
The correct answer is: slows the heart rate by decreasing SA node discharge.

Question 44

You are assessing a 62-year-old female who has an automatic implantable cardiac defibrillator (AICD). As you are applying oxygen to her, she becomes unconscious, pulseless, and apneic. You should:
Select one:

Answer 44

a.
deactivate the AICD with a magnet and begin CPR.

b.
begin CPR and insert a multilumen airway device.

c.
begin CPR and apply the AED as soon as possible.

d.
allow the AICD to defibrillate her and start CPR.
Feedback
The correct answer is: begin CPR and apply the AED as soon as possible.

Question 45

Ventricular tachycardia often causes hypotension because:

Select one:

Answer 45

a.
afterload increases, which causes the ventricles to work against higher pressure.

b.
there is not enough time between beats for the left ventricle to fill with blood.

c.
blood from the atria fills the ventricles too quickly due to the rapid heart rate.

d.
tachycardia causes widespread vasodilation, which lowers the blood pressure.
Feedback
The correct answer is: there is not enough time between beats for the left ventricle to fill with blood.