AIRWAY MID

Question 1

A 19-year-old woman ingested a large quantity of Darvon. She is responsive to pain only and has slow, shallow respirations. The MOST appropriate airway management for this patient involves:

A: inserting an oral airway and assisting ventilations with a bag-mask device.
B: inserting a nasal airway and assisting ventilations with a bag-mask device.
C: inserting an oral airway and administering oxygen via nonrebreathing mask.
D: suctioning her airway, inserting an oral airway, and administering 100% oxygen.

Answer 1

B: inserting a nasal airway and assisting ventilations with a bag-mask device.

Question 2

A 66-year-old woman is found to be unresponsive and apneic. Her carotid pulse is weak and rapid. When ventilating this patient, you should deliver:

A: each breath over 2 seconds at a rate of 10 breaths/min.
B: one breath over 1 second every 3 to 5 seconds
C: one breath over 2 seconds every 5 to 6 seconds.
D: each breath over 1 second at a rate of 10 to 12 breaths/min.

Answer 2

D: each breath over 1 second at a rate of 10 to 12 breaths/min.

Question 3

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 3

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

Question 4

After opening an unresponsive patient’s airway, you determine that his respirations are rapid, irregular, and shallow. You should:

A: intubate him at once.
B: apply a nonrebreathing mask.
C: suction his mouth for 15 seconds.
D: begin positive pressure ventilations.

Answer 4

D: begin positive pressure ventilations

Question 5

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 5

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

Question 6

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 6

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

Question 7

After you have intubated an apneic patient with chest trauma, your partner is auscultating breath sounds and tells you that breath sounds are faint on the right side of the chest. You should:

A: slightly withdraw the tube as your partner auscultates breath sounds.
B: suspect that the patient has a pneumothorax on the right side of the chest.
C: immediately remove the ET tube and oxygenate the patient for 30 seconds.
D: increase the force of your ventilations as your partner reauscultates the lungs.

Answer 7

B: suspect that the patient has a pneumothorax on the right side of the chest.

Question 8

A hyperventilating patient:

A: may be acidotic and trying to decrease (should be increase) her or his pH level.
B: is most effectively treated by administering a sedative drug.
C: should rebreathe her or his carbon dioxide to effect resolution.
D: presents with tachypnea and marked use of accessory muscles.

Answer 8

A: may be acidotic and trying to decrease (should be increase) her or his pH level.

Question 9

A known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. You should:

A: suction his oropharynx, perform intubation, and then administer naloxone via slow IV push.
B: preoxygenate him with a bag-mask device for 2 to 3 minutes and then intubate his trachea.
C: apply oxygen via nonrebreathing mask, administer naloxone, and be prepared to assist ventilations.
D: assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.

Answer 9

D: assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.

Question 10

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.

Answer 10

C: necrosis of the nasal mucosa.

Question 11

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.

Answer 11

D: acute hyperventilation.

Question 12

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.

Answer 12

A: narcotic analgesic use.

Question 13

A morbidly obese man called 9-1-1 because of difficulty breathing. When you arrive, you find the 39-year-old patient lying supine in his bed. He is in marked respiratory distress and is only able to speak in two-word sentences. He has a history of hypertension, but denies any respiratory conditions. What should you do FIRST?

A: Begin assisting his ventilations.
B: Assess his oxygen saturation level.
C: Administer a beta-2 agonist drug.
D: Sit him up or place him on his side.

Answer 13

D: Sit him up or place him on his side.

Question 14

A mouth-opening width of less than ___ inches indicates a potentially difficult airway.

A: 2
B: 3
C: 4
D: 5

Answer 14

A: 2

Question 15

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 10 breaths per minute.
C: allow partial exhalation between breaths.
D: deliver one breath every 15 seconds.

Answer 15

B: deliver 10 breaths per minute.

Question 16

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 16

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

Question 17

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.

Answer 17

C: has dyspnea while lying flat.

Question 18

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 18

A: gently inserting the catheter until resistance is felt

Question 19

Assessment of a patient in respiratory distress reveals capnographic waveforms that resemble a shark fin. What should you suspect?

A: Pneumonia
B: Heart failure
C: Bronchospasm
D: Hyperventilation

Answer 19

C: Bronchospasm

Question 20

20. Assessment of a spontaneously perfusing patient’s ETCO2 reveals small capnographic waveforms and a reading of 22 mm Hg. Which of the following does this indicate?

A: Bradypnea
B: Hyperventilation
C: Respiratory acidosis
D: Metabolic alkalosis

Answer 20

B: Hyperventilation

Question 21

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.

Answer 21

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

Question 22

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 22

C: wear gloves and facial protection.

Question 23

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.

Answer 23

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

Question 24

Capnography can serve as an indicator of:

A: proper ventilatory depth.
B: cerebral perfusion pressure.
C: coronary perfusion pressure.
D: chest compression effectiveness.

Answer 24

D: chest compression effectiveness.

Question 25

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.

Answer 25

A: carbon dioxide is not present in the esophagus.

Question 26

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.

Answer 26

C: improper manual head positioning.

Question 27

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.

Answer 27

B: slow, shallow respiratory effort.

Question 28

CPAP is used to treat patients with sleep apnea by:

A: improving patency of the lower airway through the use of positive-end expiratory pressure.
B: maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction.
C: increasing the rate and depth of ventilation, thus improving minute volume and mitigating hypoxia.
D: delivering one pressure during the inspiratory phase and a different pressure during the expiratory phase.

Answer 28

B: maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction.

Question 29

Decreased ventilation compliance following intubation is LEAST suggestive of:

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

Answer 29

B: left bronchus intubation.

Question 30

Digital intubation is absolutely contraindicated if the patient:

A: has copious airway secretions.
B: is unconscious but breathing.
C: is trapped in a confined space.
D: is extremely obese or has a short neck.

Answer 30

B: is unconscious but breathing.

Question 31

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: nject 10 mL of saline down the ET tube to loosen secretions.

Answer 31

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

Question 32

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.

Answer 32

B: may decrease venous return to the heart.

Question 33

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

A: increased minute volume, hypocapnia
B: decreased minute volume, hypocapnia
C: increased minute volume, hypercapnia
D: decreased minute volume, hypercapnia

Answer 33

D: decreased minute volume, hypercapnia

Question 34

If return of spontaneous circulation (ROSC) occurs, which of the following ETCO2 findings would you expect to encounter?

A: An abrupt and sustained increase in ETCO2
B: Complete loss of a capnographic waveform
C: A progressive decrease in the ETCO2 reading
D: Capnographic waveforms that get smaller

Answer 34

A: An abrupt and sustained increase in ETCO2

Question 35

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 35

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

Question 36

If the ET tube is placed in the trachea properly, the colorimetric paper inside the CO2 detector should:

A: not change colors.
B: turn yellow during inhalation.
C: turn yellow during exhalation.
D: remain purple during ventilations.

Answer 36

C: turn yellow during exhalation.

Question 37

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: into the vallecular space at the base of the tongue.
D: indirectly lift the epiglottis to expose the vocal cords.

Answer 37

B: extend beneath the epiglottis and lift it up.

Question 38

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.

Answer 38

A: may impair blood return to the heart.

Question 39

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 39

B: by two paramedics.

Question 40

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.

Answer 40

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

Question 41

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.

Answer 41

B: follow a regular pattern of inhalation and exhalation.

Question 42

Rigorous tube confirmation protocol must be followed after performing digital intubation because:

A: inadvertent extubation of the patient is very common.
B: capnography is unreliable in digitally intubated patients.
C: ET tubes that are placed digitally do not have a pilot balloon.
D: the procedure of digital intubation is truly a blind technique.

Answer 42

D: the procedure of digital intubation is truly a blind technique.

Question 43

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.

Answer 43

D: increased ease of speaking.

Question 44

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 44

B: visualize the tube passing between the vocal cords.

Question 45

The MOST common complication associated with nasotracheal intubation is:

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

Answer 45

A: bleeding.

Question 46

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 46

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

Question 47

The primary treatment of bronchospasm is:

A: assisted ventilation.
B: humidified oxygen.
C: bronchodilator therapy.
D: corticosteroid therapy.

Answer 47

C: bronchodilator therapy.

Question 48

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 48

D: laryngoscopy.

Question 49

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.

Answer 49

C: of acidosis and minimal carbon dioxide elimination

Question 50

The use of phenylephrine hydrochloride (Neo-Synephrine) during nasotracheal intubation will:

A: reduce the likelihood and severity of nasal bleeding.
B: sedate the patient and facilitate his or her compliance.
C: dilate the nasal vasculature and facilitate tube insertion.
D: anesthetize the nasopharynx and reduce patient discomfort.

Answer 50

A: reduce the likelihood and severity of nasal bleeding

Question 51

Use of an automated transport ventilator is NOT appropriate for patients who are:

A: in cardiac arrest.
B: apneic with a pulse.
C: chemically paralyzed.
D: breathing spontaneously.

Answer 51

D: breathing spontaneously.

Question 52

Wheezing is resolved with medications that:

A: dry up secretions in the lower airway.
B: reduce soft tissue swelling in the larynx.
C: relax the smooth muscle of the bronchioles.
D: cause bronchoconstriction and improved airflow.

Answer 52

C: relax the smooth muscle of the bronchioles.

Question 53

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 within the first 5 minutes of CPAP application.
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.

Answer 53

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

Question 54

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 54

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

Question 55

When looking inside a patient’s mouth, you cannot see the posterior pharynx and only the base of the uvula is exposed. This is indicative of a Mallampati Class:

A: I.
B: II.
C: III.
D: IV.

Answer 55

C: III.

Question 56

When nasally intubating a patient, the ET tube is advanced:

A: as the patient exhales.
B: when the patient inhales.
C: when the patient swallows.
D: in between the patient’s breaths.

Answer 56

B: when the patient inhales.

Question 57

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.

Answer 57

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

Question 58

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

Answer 58

C: Kussmaul respirations

Question 59

Which of the following capnography findings indicates that a patient is rebreathing previously exhaled carbon dioxide?

A: Increasing ETCO2 value and waveforms that never return to the baseline
B: Decreasing ETCO2 value and waveforms that fall well below the baseline
C: Intermittent loss of a capnographic waveform, especially during inhalation
D: Small capnographic waveforms with a complete loss of alveolar plateau

Answer 59

A: Increasing ETCO2 value and waveforms that never return to the baseline

Question 60

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

Answer 60

D: BP of 148/94 mm Hg

Question 61

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

Answer 61

C: Prior ICU admission for the same problem

Question 62

Which of the following indicates that the lighted stylet has entered the trachea?

A: Dim, diffuse light at the anterior part of the neck
B: Bulging of the soft tissue above the thyroid cartilage
C: Tightly circumscribed light below the thyroid cartilage
D: Absent illumination at the midline of the patient’s neck

Answer 62

C: Tightly circumscribed light below the thyroid cartilage

Question 63

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 20 breaths per minute are being delivered.
D: Each ventilation is delivered over 1 second.

Answer 63

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

Question 64

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 64

B: Spinal injury

Question 65

Which of the following patients is LEAST likely in need of positive pressure ventilation?

A: Confused 46-year-old woman with labored respirations, adventitious breath sounds, and pallor
B: Conscious 41-year-old woman with two-word dyspnea, perioral cyanosis, and tachycardia
C: Semiconscious 39-year-old man with shallow chest wall movement, cyanosis, and bradypnea
D: Conscious 36-year-old man with difficulty breathing, symmetrical chest rise and fall, and flushed skin

Answer 65

D: Conscious 36-year-old man with difficulty breathing, symmetrical chest rise and fall, and flushed skin

Question 66

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 66

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

Question 67

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

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

Answer 67

C: Epiglottis

Question 68

While ventilating an intubated patient, you note a complete loss of capnographic waveform and numeric value, yet the patient’s chest rises with ventilations and you are able to hear bilateral breath sounds. What should you do?

A: Decrease the rate of ventilation.
B: Replace the ETCO2 inline adaptor.
C: Increase the rate of ventilation.
D: Extubate and ventilate with a bag-mask.

Answer 68

B: Replace the ETCO2 inline adaptor

Question 69

With regard to intubation difficulty, neck mobility problems are MOST commonly associated with:

A: female patients.
B: tall, thin patients.
C: small children.
D: elderly patients.

Answer 69

D: elderly patients.

Question 70

You are intubating a 60-year-old man in cardiac arrest and have visualized the ET tube passing between the vocal cords. After removing the laryngoscope blade from the patient’s mouth, manually stabilizing the tube, and removing the stylet, you should:

A: inflate the distal cuff with 5 to 10 mL of air.
B: attach an ETCO2 detector to the tube.
C: secure the ET tube with a commercial device.
D: begin ventilations and auscultate breath sounds.

Answer 70

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

Question 71

You are transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should:

A: continue the CPAP treatment and administer a diuretic to remove fluids from his lungs quickly.
B: remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.
C: suspect that he has developed a pneumothorax and prepare to perform a needle chest decompression.
D: decrease the amount of positive-end expiratory pressure that you are delivering and reassess.

Answer 71

B: remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.

Question 72

You are transporting an intubated patient and note that his ETCO2 reading has fallen below 30 mm Hg. You should:

A: hyperventilate the patient to see if the ETCO2 reading increases.
B: slow your ventilation rate to see if the ETCO2 reading decreases.
C: promptly extubate the patient and ventilate with a bag-mask device.
D: take immediate measures to confirm proper placement of the ET tube.

Answer 72

D: take immediate measures to confirm proper placement of the ET tube.

Question 73

You have been providing bag-mask ventilations to an unresponsive, apneic patient with facial trauma for approximately 10 minutes. After intubating the patient, you should:

A: hyperventilate the patient with 100% oxygen.
B: insert a nasogastric tube to decompress the stomach.
C: insert an orogastric tube to relieve gastric distention.
D: ventilate the patient at a rate of 12 to 20 breaths/min.

Answer 73

C: insert an orogastric tube to relieve gastric distention.

Question 74

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 74

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

Question 75

You would MOST likely observe a grossly low respiratory rate and volume in a patient who overdosed on:

A: LSD.
B: ibuprofen.
C: Prozac.
D: heroin.

Answer 75

D: heroin.

Question 76

After inserting the needle into through the cricothyroid membrane, you should next:

A: change your angle to 90° and advance the catheter over the needle.
B: aspirate with the syringe and then insert the needle about 2 cm farther.
C: insert the needle about 1 cm farther and then aspirate with the syringe.
D: advance the catheter over the needle until the hub is flush with the skin.

Answer 76

C: insert the needle about 1 cm farther and then aspirate with the syringe.

Question 77

Compared with an open cricothyrotomy, needle cricothyrotomy:

A: allows for subsequent attempts to intubate the patient.
B: requires the paramedic to manipulate the patient’s cervical spine.
C: is technically more difficult and takes longer to perform.
D: is associated with a higher risk of damage to adjacent structures.

Answer 77

A: allows for subsequent attempts to intubate the patient.

Question 78

During ventilation with the LMA, the paramedic should:

A: observe the patient for signs of inadequate ventilation.
B: maintain the patient’s head in a slightly flexed position.
C: suction the patient’s oropharynx at least every 2 minutes.
D: hyperventilate the patient to maximize tidal volume delivery.

Answer 78

A: observe the patient for signs of inadequate ventilation.

Question 79

How does the i-gel differ from the LMA?

A: The i-gel has a noninflatable mask.
B: The i-gel comes in only two sizes.
C: The i-gel mask holds more air than the LMA.
D: The lumen of the i-gel is smaller than the LMA.

Answer 79

A: The i-gel has a noninflatable mask.

Question 80

If ventilation is difficult after inserting a King LT airway, you should:

A: deflate both of the cuffs, withdraw the device 2 cm, and reattempt ventilation.
B: remove the King LT and immediately resume ventilation with a bag-mask device.
C: attach a manually triggered ventilator and observe for adequate chest rise.
D: gently withdraw the device, without deflating the cuffs, until ventilation is easier.

Answer 80

D: gently withdraw the device, without deflating the cuffs, until ventilation is easier.

Question 81

In contrast to a needle cricothyrotomy, an open cricothyrotomy:

A: involves the use of a high-pressure jet ventilator.
B: enables the paramedic to provide greater tidal volume.
C: is the preferred technique in patients with short, fat necks.
D: is easier to perform in children younger than 8 years of age.

Answer 81

B: enables the paramedic to provide greater tidal volume.

Question 82

In general, a multilumen airway should not be used in patients who are:

A: greater than 6 feet tall.
B: younger than 16 years of age.
C: older than 65 years of age.
D: less than 4 feet 5 inches tall.

Answer 82

B: younger than 16 years of age.

Question 83

Multilumen airways are contraindicated in patients with:

A: esophageal cancer.
B: cervical spine trauma.
C: traumatic cardiac arrest.
D: a history of gastric ulcers.

Answer 83

A: esophageal cancer.

Question 84

Needle cricothyrotomy is contraindicated in patients with:

A: uncontrolled oropharyngeal bleeding.
B: obstruction above the catheter insertion site.
C: massive maxillofacial trauma and trismus.
D: a suspected injury to the cervical spine.

Answer 84

B: obstruction above the catheter insertion site.

Question 85

Open cricothyrotomy is indicated when:

A: ET intubation is unsuccessful after three attempts.
B: all other methods of advanced airway management have failed.
C: you are unable to secure a patent airway with less invasive means.
D: the patient has a head injury that precludes nasotracheal intubation.

Answer 85

B: all other methods of advanced airway management have failed.

Question 86

Proper insertion of the LMA involves:

A: inserting the LMA into the patient’s mouth by following the curvature of the patient’s tongue.
B: lifting the patient’s jaw upward and blindly inserting the LMA until you meet resistance.
C: flexing the patient’s neck, depressing the tongue with a tongue blade, and blindly inserting the LMA.
D: inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate.

Answer 86

D: inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate

Question 87

Proper placement of the King LT airway is performed by all of the following techniques, EXCEPT:

A: auscultation of bilateral breath sounds.
B: the esophageal detector device.
C: quantitative waveform capnography.
D: observation for symmetrical chest rise.

Answer 87

B: the esophageal detector device.

Question 88

The cricothyroid membrane is the ideal site for making a surgical opening into the trachea because:

A: no important structures lie between the skin covering the cricothyroid membrane and the airway.
B: the tough cartilage that comprises the cricothyroid membrane can easily be incised with a scalpel.
C: there are no major blood vessels or other structures that lie adjacent to the cricothyroid membrane.
D: the cricoid cartilage helps prevent accidental perforation through the back of the airway and into the esophagus.

Answer 88

A: no important structures lie between the skin covering the cricothyroid membrane and the airway.

Question 89

The external jugular veins run ____________ and are located ____________ to the cricothyroid membrane.

A: vertically, lateral
B: vertically, medial
C: horizontally, lateral
D: horizontally, medial

Answer 89

A: vertically, lateral

Question 90

The King airway should NOT be used in patients:

A: with known esophageal disease.
B: with prolonged cardiac arrest.
C: with a traumatic brain injury.
D: who weigh less than 25 kg.

Answer 90

A: with known esophageal disease.

Question 91

The King LT airway can be used to:

A:administer certain cardiac medications directly into the trachea.
B: maintain a patent airway in spontaneously breathing patients.
C: establish a patent airway in patients of any age and body size.
D: suction pulmonary secretions from the tracheobronchial tree.

Answer 91

B: maintain a patent airway in spontaneously breathing patients.

Question 92

The King LT-D airway features a:

A: straight tube with two inflatable cuffs that hold an equal amount of air.
B: port through which gastric contents can be suctioned from the stomach.
C: curved tube with ventilation ports located between two inflatable cuffs.
D: universal size with two inflation ports and is used for patients of any age

Answer 92

C: curved tube with ventilation ports located between two inflatable cuffs.

Question 93

The LMA is:

A: a suitable airway device for use in morbidly obese patients.
B: an alternative to bag-mask ventilation when intubation is not possible.
C: associated with a higher risk of damage to the vocal cords than intubation.
D: especially effective for CHF patients who require high pulmonary pressures.

Answer 93

B: an alternative to bag-mask ventilation when intubation is not possible.

Question 94

The main disadvantage of the LMA is that it:

A: does not provide protection against aspiration.
B: spontaneously dislodges in the majority of patients.
C: is associated with significant upper airway swelling.
D: is technically more difficult to perform than intubation.

Answer 94

A: does not provide protection against aspiration.

Question 95

The major advantage of the multilumen airway is that:

A: it can be used in children and adults as an alternative airway device.
B: no mask seal is required to ventilate with either of the multilumen airways.
C: intubating the trachea with the multilumen airway in place is extremely easy.
D: effective ventilation is possible if the tube enters the esophagus or the trachea.

Answer 95

D: effective ventilation is possible if the tube enters the esophagus or the trachea.

Question 96

The MOST significant complication associated with the use of multilumen airways is:

A: laryngospasm or vomiting during insertion of the tube.
B: unrecognized displacement of the tube into the esophagus.
C: vocal cord damage if the tube inadvertently enters the trachea.
D: pharyngeal or esophageal trauma secondary to poor technique.

Answer 96

B: unrecognized displacement of the tube into the esophagus.

Question 97

When checking the cuff of the LMA prior to insertion, you should:

A: stretch the cuff to check for tears or other damage.
B: inflate the cuff with 100 mL of air and then deflate.
C: gently pull on the cuff at the tube to ensure integrity.
D: inflate the cuff with 50% more air than is required.

Answer 97

D: inflate the cuff with 50% more air than is required.

Question 98

When performing an open cricothyrotomy, you should FIRST:

A: maintain aseptic technique as you cleanse the area with iodine.
B: slide your index finger between the thyroid and cricoid cartilages.
C: palpate for the V notch of the thyroid cartilage and stabilize the larynx.
D: hyperextend the patient’s neck and then palpate the cricoid cartilage.

Answer 98

C: palpate for the V notch of the thyroid cartilage and stabilize the larynx.

Question 99

When performing an open cricothyrotomy, you will MOST likely avoid damage to the jugular veins if:

A: the patient’s head is hyperextended.
B: you incise the cricothyroid membrane at a transverse angle.
C: the patient’s head is in a neutral position.
D: the cricothyroid membrane is incised vertically.

Answer 99

D: the cricothyroid membrane is incised vertically.

Question 100

You should be MOST suspicious of tube misplacement following an open cricothyrotomy if:

A: bleeding from the subcutaneous tissues is observed.
B: there is minimal rise of the chest during ventilations.
C: progressive redness is noted around the insertion site.
D: a crackling sensation is noted when palpating the neck.

Answer 100

D: a crackling sensation is noted when palpating the neck