Chapter 11 - Airway Management

Question 1

A 19-year-old female is found unconscious by her roommate. Your primary assessment reveals that her breathing is inadequate. As you insert an oropharyngeal airway, she begins to gag violently. You should:

Select one:

A. select a smaller oropharyngeal airway and attempt to insert it.

B. remove the airway and be prepared to suction her oropharynx.

C. insert the airway no further but leave it in place as a bite block.

D. continue to insert the airway as you suction her oropharynx.

Answer 1

B. remove the airway and be prepared to suction her oropharynx.

Question 2

A man was found unresponsive in his bed at home. There is no evidence of injury and the patient’s medical history is not known. The patient’s face is cyanotic, yet the pulse oximeter reads 98%. Which of the following would MOST likely explain this?

Select one:

A. Carbon monoxide poisoning
B. Severe pulmonary edema
C. Increased body temperature
D. His extremities are cold

Answer 2

A. Carbon monoxide poisoning

Question 3

A patient who is suspected of being hypoxic and is breathing adequately should be given supplemental oxygen with a:

Select one:

A. nonrebreathing mask.
B. nasal cannula.
C. bag-valve mask.
D. mouth-to-mask device.

Answer 3

A. nonrebreathing mask.

Question 4

During your assessment of a patient with respiratory distress, you hear wheezing when listening to breath sounds. This indicates:

Select one:

A. a lower airway obstruction.
B. secretions in the airway.
C. swelling of the upper airway.
D. fluid in the alveoli.

Answer 4

A. a lower airway obstruction.

Question 5

How does CPAP improve oxygenation and ventilation in patients with certain respiratory problems?

Select one:

A. It decreases intrathoracic pressure, which allows more room for lung expansion.

B. It forces the alveoli open and pushes oxygen across the alveolar membrane.

C. It pushes thick, infected pulmonary secretions into isolated areas of the lung.

D. It prevents alveolar collapse by pushing air into the lungs during inhalation.

Answer 5

B. It forces the alveoli open and pushes oxygen across the alveolar membrane.

Question 6

In which of the following patients would the head tilt–chin lift maneuver be the MOST appropriate method of opening the airway?

Select one:

A. A 50-year-old male who is unconscious following head trauma

B. A 24-year-old male who is found unconscious at the base of a tree

C. A 45-year-old male who is semiconscious after falling 20 feet

D. A 37-year-old female who is found unconscious in her bed

Answer 6

D. A 37-year-old female who is found unconscious in her bed

Question 7

Irregular respirations characterized by an increasing rate and depth of breathing followed by periods of apnea are called:

Select one:

A. Cheyne-Stokes respirations.
B. ataxic respirations.
C. eupneic respirations.
D. agonal respirations.

Answer 7

A. Cheyne-Stokes respirations.

Question 8

The nasopharyngeal airway is MOST beneficial because it:

Select one:

A. can maintain a patent airway in a semiconscious patient with a gag reflex.

B. is generally well-tolerated in conscious patients with an intact gag reflex.

C. effectively maintains the airway of a patient in cardiopulmonary arrest.

D. can effectively stabilize fractured nasal bones if it is inserted properly.

Answer 8

A. can maintain a patent airway in a semiconscious patient with a gag reflex.

Question 9

The physical act of moving air into and out of the lungs is called:

Select one:

A. diffusion.
B. respiration.
C. oxygenation.
D. ventilation.

Answer 9

D. ventilation.

Question 10

What occurs when a patient is breathing very rapidly and shallowly?

Select one:

A. Air is forcefully drawn into the lungs due to the negative pressure created by the rapid respirations.

B. Air moves primarily in the anatomic dead space and does not participate in pulmonary gas exchange.

C. Minute volume increases because of a marked increase in both tidal volume and respiratory rate.

D. The majority of tidal volume reaches the lungs and diffuses across the alveolar-capillary membrane.

Answer 10

B. Air moves primarily in the anatomic dead space and does not participate in pulmonary gas exchange.

Question 11

When testing a mechanical suctioning unit, you should turn on the device, clamp the tubing, and ensure that it generates a vacuum pressure of more than:

Select one:

A. 300 mm Hg.
B. 200 mm Hg.
C. 400 mm Hg.
D. 100 mm Hg.

Answer 11

A. 300 mm Hg.

Question 12

Which of the following is the MOST reliable indicator of adequately performed bag-valve-mask ventilation in an apneic adult with a pulse?

Select one:

A. Twenty breaths/min being delivered to the adult
B. Consistently increasing heart rate
C. Decreased compliance when squeezing the bag
D. Adequate rise of the chest when squeezing the bag

Answer 12

D. Adequate rise of the chest when squeezing the bag

Question 13

Which of the following patients is breathing adequately?

Select one:

A. A conscious male with respirations of 18 breaths/min and reduced tidal volume

B. A conscious male with respirations of 19 breaths/min and pink skin

C. An unconscious 52-year-old female with snoring respirations and cool, pale skin

D. A conscious female with facial cyanosis and rapid, shallow respirations

Answer 13

B. A conscious male with respirations of 19 breaths/min and pink skin

Question 14

Which of the following patients should you place in the recovery position?

Select one:

A. A 19-year-old conscious male with a closed head injury and normal respirations

B. A 31-year-old semiconscious male with low blood sugar and adequate breathing

C. A 40-year-old conscious female with a possible neck injury and regular respirations

D. A 24-year-old unconscious female who overdosed and has a reduced tidal volume

Answer 14

B. A 31-year-old semiconscious male with low blood sugar and adequate breathing

Question 15

Which of the following statements regarding breathing adequacy is correct?

Select one:

A. Patients breathing shallowly may require assisted ventilation despite a normal respiratory rate.

B. A patient with slow respirations and adequate depth will experience an increase in minute volume.

C. The single most reliable sign of breathing adequacy in the adult is his or her respiratory rate.

D. Patients with a grossly irregular breathing pattern usually do not require assisted ventilation.

Answer 15

A. Patients breathing shallowly may require assisted ventilation despite a normal respiratory rate.

Question 16

Which of the following statements regarding normal gas exchange in the lungs is correct?

Select one:

A. The oxygen content in the alveoli is highest during the exhalation phase.

B. Blood that returns to the lungs from the body has low levels of carbon dioxide.

C. The actual exchange of oxygen and carbon dioxide occurs in the capillaries.

D. Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries.

Answer 16

D. Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries.

Question 17

Which of the following statements regarding oxygen is correct?

Select one:

A. Oxygen supports the combustion process and may cause a fire.

B. Oxygen is most safely administered in an enclosed environment.

C. Oxygen cylinders must always remain in an upright position.

D. Oxygen is flammable and may explode if under high pressure.

Answer 17

A. Oxygen supports the combustion process and may cause a fire.

Question 18

Which of the following structures is NOT found in the upper airway?

Select one:

A. Bronchus
B. Pharynx
C. Larynx
D. Oropharynx

Answer 18

A. Bronchus

Question 19

You are performing mouth-to-mask ventilations with oxygen connected and set at a flow rate of 15 L/min. What percentage of oxygen is your patient receiving?

Select one:

A. 45%
B. 75%
C. 55%
D. 65%

Answer 19

C. 55%

Question 20

You are ventilating a patient with a stoma; however, the air is escaping from the mouth and nose. To prevent this, you should:

Select one:

A. thoroughly suction the stoma.
B. ventilate with less pressure.
C. seal the mouth and nose.
D. thrust the jaw forward.

Answer 20

C. seal the mouth and nose.

Question 21

Breathing is controlled by an area in the:
A. lungs.
B. brainstem.
C. spinal cord.
D. diaphragm.

Answer 21

B. brainstem.
The pons and the medulla are the respiratory centers in the brainstem that control breathing.

Question 22

The EMT should assess a patient’s tidal volume by:
A. observing for adequate chest rise.
B. assessing the facial area for cyanosis.
C. counting the patient’s respiratory rate.
D. measuring the patient’s oxygen saturation.

Answer 22

A. observing for adequate chest rise.

Question 23

In an otherwise healthy individual, the primary stimulus to breathe is a(n):
A. increased level of oxygen in the blood.
B. decreased level of oxygen in the blood.
C. increased level of carbon dioxide in the blood.
D. decreased level of carbon dioxide in the blood

Answer 23

C. increased level of carbon dioxide in the blood.

Question 24

Signs of adequate breathing in the adult include all of the following, EXCEPT:
A. pink, warm, dry skin.
B. shallow chest rise.
C. symmetrical chest movement.
D. a respiratory rate of 16 breaths/min.

Answer 24

B. shallow chest rise.

Question 25

During insertion of an oropharyngeal airway into an unconscious patient, she begins to vomit. The first thing you should do is:
A. turn the patient on her side.
B. remove the airway at once.
C. suction the patient’s mouth.
D. use a smaller-sized oral airway.

Answer 25

A. turn the patient on her side.

Whenever an unconscious patient begins to vomit—whether you are inserting an oropharyngeal airway or not—you should immediately turn the patient onto his or her side; this will allow drainage of vomit from the mouth and prevent aspiration. After the patient is on his or her side, remove the oral airway and suction the mouth.

Question 26

In which of the following patients would a nasopharyngeal airway be contraindicated?
A. A semiconscious patient with a gag reflex
B. An unconscious patient with an intact gag reflex
C. A patient who fell 20 feet and landed on his or her head
D. An unconscious patient who gags when you insert an oral airway

Answer 26

C. A patient who fell 20 feet and landed on his or her head
Nasopharyngeal (nasal) airways are contraindicated in patients with severe head or facial injuries and should be used with caution in patients who have delicate nasal membranes or are prone to nosebleeds. The nasal airway is better tolerated in patients who are semiconscious and/or those with a gag reflex.

Question 27

You are delivering oxygen to a patient with a nasal cannula at 4 L/min when he begins to complain of a burning sensation in his nose. You should:
A. remove the nasal cannula.
B. apply a nonrebreathing mask.
C. attach an oxygen humidifier.
D. increase the flow rate to 6 L/min.

Answer 27

C. attach an oxygen humidifier.

Administering “dry” oxygen through a nasal cannula—especially over a prolonged period of time—can result in drying of the nasal membranes, in which case the patient might complain of a burning sensation in the nose. Humidified oxygen will serve to keep the nasal membranes moist.

Question 28

A patient is found unconscious after falling from a third-floor window. His respirations are slow and irregular. You should:
A. place him in the recovery position.
B. apply oxygen via a nonrebreathing mask.
C. suction his airway for up to 15 seconds.
D. assist his breathing with a bag-mask device.

Answer 28

D. assist his breathing with a bag-mask device.

The patient is not breathing adequately. Slow, irregular respirations will not result in adequate oxygenation. You should assist the patient’s breathing with a bag-mask device attached to 100% oxygen. Suctioning is indicated if the patient has blood or other liquids in the airway; there is no evidence of this in the scenario.

Question 29

When ventilating an apneic adult with a bag-mask device, you should squeeze the bag:
A. until it is empty.
B. over a period of 2 seconds.
C. at a rate of 20 breaths/min.
D. until visible chest rise is noted.

Answer 29

D. until visible chest rise is noted.

Question 30

You and your partner are ventilating an apneic adult when you notice that his stomach is becoming distended. You should:
A. suction his airway for up to 15 seconds.
B. reposition his head.
C. increase the rate and volume of your ventilations.
D. decrease your ventilation rate but use more volume.

Answer 30

B. reposition his head.

Gastric distention occurs when air enters the stomach. Severe gastric distention can result in vomiting and aspiration if not recognized and treated. To minimize the amount of air that enters the stomach during ventilations, you should reposition the patient’s head.

Question 31

You and your partner are caring for a critically injured patient who is unresponsive and apneic. Your partner is controlling severe bleeding from the patient’s lower extremities as you attempt ventilations with a bag-mask device. After repositioning the mask several times, you are unable to effectively ventilate the patient. You should:
Select one:
A. insert an oropharyngeal airway and reattempt ventilations.
B. hyperextend the patient’s head and reattempt ventilations.
C. continue attempted ventilations and transport immediately.
D. suction the patient’s airway for 30 seconds and reattempt ventilations.

Answer 31

A. insert an oropharyngeal airway and reattempt ventilations.

Question 32

Which of the following oxygen flowmeters is NOT affected by gravity and can be used in any position when attached to an oxygen cylinder?
Select one:
A. Ball-and-float flowmeter
B. Vertical-position flowmeter
C. Pressure-compensated flowmeter
D. Bourdon-gauge flowmeter

Answer 32

D. Bourdon-gauge flowmeter

Question 33

The purpose of the pin-indexing system for compressed gas cylinders is to:
Select one:
A. help you determine what type of oxygen regulator to use.
B. prevent destroying or stripping the threads on the cylinder.
C. reduce the cylinder pressure to a safe and more useful range.
D. ensure that the correct regulator is used for the cylinder

Answer 33

D. ensure that the correct regulator is used for the cylinder

Question 34

Without adequate oxygen, the body’s cells:
Select one:
A. cease metabolism altogether, resulting in carbon dioxide accumulation in the blood.
B. incompletely convert glucose into energy, and lactic acid accumulates in the blood.
C. rely solely on glucose, which is completely converted into adenosine triphosphate.
D. begin to metabolize fat, resulting in the production and accumulation of ketoacids.

Answer 34

B. incompletely convert glucose into energy, and lactic acid accumulates in the blood.

Question 35

Which of the following statements regarding positive-pressure ventilation is correct?
Select one:
A. Positive-pressure ventilation allows blood to naturally be pulled back to the heart from the body.
B. Unlike negative-pressure ventilation, positive-pressure ventilation does not affect the esophageal opening pressure.
C. To prevent hypotension, the EMT should increase the rate and force of positive-pressure ventilation.
D. With positive-pressure ventilation, more volume is required to have the same effects as normal breathing

Answer 35

D. With positive-pressure ventilation, more volume is required to have the same effects as normal breathing

Question 36

As the single EMT managing an apneic patient’s airway, the preferred initial method of providing ventilations is the:
Select one:
A. mouth-to-mask technique with a one-way valve.
B. manually triggered ventilation device.
C. one-person bag-valve mask.
D. mouth-to-mouth technique.

Answer 36

A. mouth-to-mask technique with a one-way valve

Question 37

Which of the following statements regarding the one-person bag-mask technique is correct?
Select one:
A. The bag-mask device delivers more tidal volume and a higher oxygen concentration than the mouth-to-mask technique.
B. Adequate tidal volume is often difficult to achieve when one EMT is operating the bag-mask device.
C. Bag-mask ventilations should be delivered every 2 seconds when the device is being operated by one person.
D. The C-clamp method of holding the mask to the face is not effective when ventilating a patient with a bag-mask device.

Answer 37

B. Adequate tidal volume is often difficult to achieve when one EMT is operating the bag-mask device.

Question 38

A 23-year-old male experienced severe head trauma after his motorcycle collided with an oncoming truck. He is unconscious, has agonal gasps, and has copious bloody secretions in his mouth. How should you manage his airway?
Select one:
A. Provide continuous ventilations with a bag-mask device to minimize hypoxia.
B. Suction his oropharynx with a rigid catheter until all secretions are removed.
C. Alternate oropharyngeal suctioning and ventilation with a bag-mask device.
D. Insert a nasopharyngeal airway and provide suction and assisted ventilations

Answer 38

C. Alternate oropharyngeal suctioning and ventilation with a bag-mask device.

Question 39

Gas exchange in the lungs is facilitated by:
Select one:
A. adequate amounts of surfactant.
B. surfactant-destroying organisms.
C. pulmonary capillary constriction.
D. water or blood within the alveoli

Answer 39

A. adequate amounts of surfactant.

Question 40

You are performing bag-mask ventilations with oxygen connected and set at a flow rate of 15 L/min. What percentage of oxygen are you delivering?
Select one:
A. 55%
B. Nearly 100%
C. 65%
D. 45%

Answer 40

B. Nearly 100%

Question 41

You are ventilating a 40-year-old uninjured man who is apneic but has a pulse. When your partner reassesses his blood pressure, she notes that he has decreased significantly from previous readings. You should:
Select one:
A. increase the volume of your ventilations and reassess his blood pressure.
B. reduce the rate or volume of the ventilations you are delivering.
C. perform a head-to-toe assessment to look for signs of bleeding.
D. increase the rate at which you are ventilating and reassess his blood pressure

Answer 41

B. reduce the rate or volume of the ventilations you are delivering.

Question 42

Hypoxia is MOST accurately defined as:
Select one:
A. high oxygen levels in the tissues and cells.
B. inadequate oxygen to the tissues and cells.
C. a decrease in arterial oxygen levels.
D. an increase in carbon dioxide in the blood.

Answer 42

B. inadequate oxygen to the tissues and cells.

Question 43

CPAP is indicated for patients who:
Select one:
A. are unresponsive and have signs of inadequate ventilation.
B. have pulmonary edema and can follow verbal commands.
C. have signs of pneumonia but are breathing adequately.
D. are hypotensive and have a marked reduction in tidal volume.

Answer 43

B. have pulmonary edema and can follow verbal commands.

Question 44

A patient who is suspected of being hypoxic and is breathing adequately should be given supplemental oxygen with a:
Select one:
A. bag-mask device.
B. nonrebreathing mask.
C. nasal cannula.
D. mouth-to-mask device

Answer 44

B. nonrebreathing mask.

Question 45

Which of the following statements regarding oxygenation and ventilation is correct?
Select one:
A. Oxygenation without adequate ventilation can occur in climbers who quickly ascend to an altitude of lower atmospheric pressure.
B. In carbon monoxide (CO) poisoning, ventilation is impaired because CO binds to oxygen very quickly.
C. Oxygenation is the movement of air into and out of the lungs, whereas ventilation is the exchange of gases.
D. In mines or confined places, where oxygen levels are low, ventilation may continue despite inadequate oxygenation.

Answer 45

D. In mines or confined places, where oxygen levels are low, ventilation may continue despite inadequate oxygenation.

Question 46

A ventilation/perfusion (V/Q ratio) mismatch occurs when:
Select one:
A. a traumatic injury or medical condition impairs the body’s ability to effectively bring oxygen into the lungs and remove carbon dioxide from the body.
B. ventilation is compromised, resulting in the accumulation of carbon dioxide in the bloodstream, alveoli, and the tissues and cells of the body.
C. a disruption in blood flow inhibits the exchange of oxygen and carbon dioxide in the lungs, even though the alveoli are filled with fresh oxygen.
D. ventilation is inadequate due to a traumatic injury or medical condition, which results in an impairment in pulmonary gas exchange.

Answer 46

C. a disruption in blood flow inhibits the exchange of oxygen and carbon dioxide in the lungs, even though the alveoli are filled with fresh oxygen.