1.

The upper airway of an adult consists of all the structures above the:
A) carina.
B) bronchus.
C) vocal cords.
D) cricoid ring.

2. The ______________ is the lowest portion of the pharynx and opens into the larynx anteriorly
and the esophagus posteriorly.
A) oropharynx
B) nasopharynx
C) hyperpharynx
D) laryngopharynx

3. The nasal cavity:

A) contains two bony shelves known as turbinates.
B) is extremely delicate and has a rich blood supply.
C) requires significant trauma to result in hemorrhage.
D) is separated by a septum that is midline in all people.

4. The ________ are formed by the cranial bones and prevent contaminants from entering the
respiratory tract.
A) sinuses
B) turbinates
C) bony nasal shelves
D) nasal mucous membranes

5. The oropharynx:
A) contains the adenoids on its posterior wall.
B) forms the posterior portion of the oral cavity.
C) is bordered superiorly by the hard palate only.
D) consists of the anterior portion of the oral cavity.

6. From an airway management perspective, the MOST important anatomical consideration

regarding an adult's tongue is:
A) the fact that it is easily lacerated, but bleeds minimally.
B) that it attaches directly to the mandible and hyoid bone.
C) its proportionately large size compared to a child's tongue.
D) its tendency to fall back and occlude the posterior pharynx.
7. The anterior portion of the palate is formed by the:
A) hyoid bone and mandible.
B) union of the facial bones.
C) maxilla and palatine bones.
D) soft tissues of the posterior pharynx.

8. Which of the following statements regarding the tonsils is MOST correct?

A) The tonsils are located on the posterior nasopharyngeal wall.
B) The tonsils rarely become swollen enough to obstruct the airway.
C) They are comprised of lymphatic tissue and help to trap bacteria.
D) The tonsils are located in the anterior pharynx and filter bacteria.

9. The __________ is an anatomic space located between the base of the tongue and the
epiglottis.
A) vallecula
B) uvula
C) adenoid
D) larynx

10. Anatomically, the ________ is directly anterior to the glottic opening.

A) Thyroid gland
B) Vallecular space
C) Cricoid cartilage
D) Thyroid cartilage

11. Paramedics must use extreme caution when accessing the airway via the cricothyroid
membrane because:
A) the cricothyroid membrane is highly vascular and tends to bleed profusely when it is incised.
B) the cricothyroid membrane is bordered laterally and inferiorly by the highly vascular thyroid
gland.
C) cricothyrotomy is associated with a high incidence of inadvertent laceration of a carotid
artery.
D) the thyroid cartilage is smaller than the cricoid cartilage and makes the cricothyroid
membrane difficult to locate.

12. During forceful inhalation, the vocal cords:

A) are partially open to allow for turbulent air flow.
B) open widely to provide minimum resistance to air flow.
C) abruptly spasm in order to protect the lower airway.
D) bulge anteriorly to facilitate air flow into the trachea.
13. The ____________ are pyramid-like structures that form the posterior attachment of the
vocal cords.
A) palatine tonsils
B) pyriform fossae
C) arytenoid cartilages
D) hypoepiglottic ligaments

14. Tenting of the skin under the jaw often occurs when airway devices are inadvertently
inserted into the:
A) pyriform fossae.
B) vallecular space.
C) laryngopharynx.
D) hypopharyngeal space.

15. Laryngospasm is MOST accurately defined as:

A) aspiration of foreign material.
B) spasmodic closure of the vocal cords.
C) voluntary closure of the glottic opening.
D) spontaneous collapsing of the trachea.

16. The function of the lower airway is to:

A) warm, filter, and humidify air.
B) protect the lungs from aspiration.
C) deliver oxygenated blood to the cells.
D) exchange oxygen and carbon dioxide.

17. The left and right mainstem bronchi:

A) constrict violently when their beta-2 receptors are stimulated excessively.
B) are approximately 10 to 12 cm in length and are joined together at the hilum.
C) do not contain mucous-producing cells in patients without a respiratory disease.
D) are lined with beta-2 receptors that result in bronchodilation when stimulated.

18. In contrast to the right lung, the left lung:

A) has two lobes.
B) has three lobes.
C) is encased in the parietal pleura.
D) can only hold a small volume of air.
19. Surfactant is:
A) produced by the mucous cells of the left and right mainstem bronchi.
B) quickly destroyed in patients who have a severe upper airway obstruction.
C) a proteinaceous substance that decreases surface tension on the alveolar walls.
D) a lubricating substance that increases alveolar surface tension during breathing.

20. Atelectasis occurs when:

A) the alveoli are overinflated and rupture.
B) there is a deficiency of surfactant and the alveoli collapse.
C) deoxygenated blood diffuses across the alveoli.
D) surface tension on the alveolar walls is decreased.

21. The volume of air that is inhaled or exhaled during a single respiratory cycle is called:
A) tidal volume.
B) alveolar volume.
C) minute volume.
D) inspiratory reserve volume.

22. Physiologic dead space increases with:

A) tachypnea.
B) deep breathing.
C) alveolar inflation.
D) pulmonary obstructions.

23. Approximately ____ mL of air remain in the anatomic dead space of an adult with a tidal
volume of 500 mL.
A) 100
B) 125
C) 150
D) 175

24. What is the alveolar volume of a patient with a tidal volume of 400 mL and a respiratory rate
of 14 breaths/min?
A) 240 mL
B) 265 mL
C) 280 mL
D) 300 mL
25. What is the minute volume of a patient with a respiratory rate of 12 breaths/min and a tidal
volume of 450 mL?
A) 3,650 mL
B) 3,780 mL
C) 4,260 mL
D) 5,400 mL

26. When a patient's respirations are too rapid and too shallow:
A) the majority of inhaled air lingers in areas of physiologic dead space.
B) inhaled air may only reach the anatomic dead space before being exhaled.
C) the increase in tidal volume will compensate for a rapid respiratory rate.
D) minute volume increases because a larger amount of air reaches the lungs.

27. Following an optimal inspiration, the amount of air that can be forced from the lungs in a
single exhalation is called the:
A) functional reserve capacity.
B) expiratory reserve volume.
C) residual expiratory volume.
D) fraction of inspired oxygen.

28. The fraction of inspired oxygen (FiO2) increases with:

A) increased tidal volume.
B) forceful inhalation.
C) supplemental oxygen.
D) an increase in respirations.

29. The process of moving air into and out of the lungs is called:
A) respiration.
B) inhalation.
C) ventilation.
D) exhalation.

30. Changes in the rate and depth of breathing are regulated primarily by the:
A) pH of venous blood.
B) pH of the cerebrospinal fluid.
C) saturation of oxygen and hemoglobin.
D) amount of oxygen in the blood plasma.

31. The involuntary control of breathing originates in the:

A) diencephalon.
B) hypothalamus.
C) cerebral cortex.
D) pons and medulla.

32. The Hering-Breuer reflex is a protective mechanism that:

A) terminates inhalation and prevents lung overexpansion.
B) decreases pneumotaxic function during severe hypoxia.
C) sends messages to the diaphragm via the phrenic nerves.
D) allows the apneustic center to influence the respiratory rate.

33. Which of the following statements regarding the neuronal control of breathing is MOST
correct?
A) The pneumotaxic center is responsible for increasing the number of respirations per minute.
B) In times of increased demand, the apneustic center decreases its influence, thereby increasing
the respiratory rate.
C) The apneustic center inhibits respirations and is overpowered by the pneumotaxic center
during hypoxia.
D) The apneustic center influences the respiratory rate and the pneumotaxic center inhibits
inspiration.

34. Chemoreceptors located in the carotid bodies and aortic arch sense minute changes in the
______ and send signals to the respiratory centers via the _______________ nerves.
A) PaO2; vagus and intercostal
B) PaCO2; glossopharyngeal and vagus
C) PaCO2; phrenic and glossopharyngeal
D) PaO2; hypoglossal, vagus, and intercostal

35. Under normal conditions, the central chemoreceptors in the brain increase the rate and depth
of breathing when the:
A) PaO2 level falls quickly.
B) pH of the CSF decreases.
C) PaCO2 decreases slowly.
D) pH of the CSF increases.

36. The hypoxic drive stimulates breathing in patients with:

A) chronically decreased PaO2 levels.
B) emphysema or chronic bronchitis.
C) chronically decreased PaCO2 levels.
D) mild bronchospasm caused by asthma.
37. 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.

38. During sleep, the metabolic rate is ________ and the number of respirations _________.
A) low, increases
B) high, decreases
C) low, decreases
D) high, increases

39. 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.

40. In contrast to negative-pressure ventilation, positive-pressure ventilation occurs when:

A) the diaphragm contracts.
B) air is drawn into the lungs.
C) intrathoracic pressure falls.
D) air is forced into the lungs.

41. The exchange of oxygen and carbon dioxide in the lungs is called:
A) internal respiration.
B) external respiration.
C) pulmonary ventilation.
D) intrapulmonary shunting.

42. Oxygen that is dissolved in the blood plasma:

A) can be measured with a pulse oximeter.
B) makes up the partial pressure of oxygen.
C) is quickly absorbed by bicarbonate ions.
D) cannot participate in pulmonary respiration.

43. Which of the following statements regarding anemia is MOST correct?

A) Anemia results in a decreased ability of the blood to carry oxygen.
B) Patients with anemia have a chronically low level of hemoglobin.
C) Anemia is a condition caused exclusively by a deficiency of iron.
D) Anemic patients typically present with flushed skin and bradycardia.

44. A patient with respiratory splinting:

A) is often tachypneic with deep breathing.
B) is holding his or her arm against the chest.
C) is breathing shallowly to alleviate chest pain.
D) has an increased tidal volume due to a chest injury.

45. Intrapulmonary shunting is MOST accurately defined as:

A) the return of unoxygenated blood to the left side of the heart.
B) a decrease in the surface area of the alveoli caused by damage.
C) a condition in which too much carbon dioxide is eliminated.
D) failure of blood to bypass an obstruction in a pulmonary artery.

46. 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.

47. Hypoventilation causes a/an _______ and leads to _______.:

A) increased minute volume; hypocarbia
B) decreased minute volume; hypocarbia
C) increased minute volume; hypercarbia
D) decreased minute volume; hypercarbia

48. 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.

49. An adult patient with an abnormal respiratory rate should:

A) be given oxygen at 4 L/min with a nasal cannula.
B) be assessed immediately for heart rate abnormalities.
C) be evaluated for other signs of inadequate ventilation.
D) receive ventilatory assistance with a bag-mask device.

50. A decrease in the arterial level of oxygen is called:

A) anoxia.
B) hypoxia
C) asphyxia.
D) hypoxemia.

51. Which of the following represents the MOST appropriate sequence for managing a patient's
airway?
A) Open, clear, assess, intervene
B) Clear, open, assess, intervene
C) Assess, clear, open, intervene
D) Open, assess, clear, intervene

52. 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.

53. 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.

54. When ventilating a patient with a bag-mask device, you note increased compliance. This
means that:
A) you are meeting resistance when ventilating.
B) air can be forced into the lungs with relative ease.
C) a lower airway obstruction should be suspected.
D) the patient likely has an upper airway obstruction.

55. In which of the following conditions would you be LEAST likely to encounter pulsus
paradoxus?
A) Moderate asthma attack.
B) Pericardial tamponade
C) Tension pneumothorax
D) Decompensating COPD

56. 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

57. 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

58. A patient with a suppressed cough mechanism:

A) should be intubated at once.
B) is at high risk for aspiration.
C) often requires ventilation support.
D) will have a positive eyelash reflex.

59. 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.

60. 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

61. Pulse oximetry is used to measure the:

A) percentage of hemoglobin that is saturated with oxygen.
B) exchange of oxygen and carbon dioxide at the cellular level.
C) percentage of carbon dioxide that is eliminated from the body.
D) amount of oxygen dissolved in the plasma portion of the blood.

62. The pulse oximeter would be LEAST useful when:

A) identifying deterioration of the cardiac patient.
B) assessing vascular status in orthopaedic trauma.
C) monitoring oxygenation status during intubation.
D) determining how much oxygen to give a patient.

63. Which of the following factors would MOST likely produce a falsely high pulse oximetry
reading?
A) Carboxyhemoglobin
B) Peripheral vasodilation
C) A dimly lit environment
D) Heart rate above 120 beats/min

64. An increasing peak expiratory flow reading in a patient with respiratory distress suggests
that the patient is:
A) experiencing worsened hypoxemia.
B) no longer experiencing bronchospasm.
C) responding to bronchodilator therapy.
D) in need of further bronchodilator therapy.

65. The average peak expiratory flow rate in a healthy adult is approximately:
A) 450 mL.
B) 550 mL.
C) 650 mL.
D) 750 mL.

66. When obtaining a peak expiratory flow rate on a patient with acute bronchospasm, you
should:
A) ask the patient to fully exhale before blowing into the mouthpiece.
B) perform the test three times and take the best rate of the three readings.
C) administer one bronchodilator treatment before obtaining the first reading.
D) ensure that the patient is in a supine position to obtain an accurate reading.

67. It would NOT be appropriate to place a patient in the recovery position if he or she:
A) is tachycardic.
B) is semiconscious.
C) has not been injured.
D) is breathing shallowly.

68. If you suspect that an unconscious patient has experienced a spinal injury, you should open
his or her airway by:
A) applying firm pressure to the patient's forehead and tilting the head back.
B) placing your fingers behind the angle of the jaw and lifting the jaw forward.
C) carefully grasping the tongue and jaw and slowly lifting the jaw forward.
D) lifting up on the jaw while placing the head in a slightly extended position.

69. If several attempts to open a patient's airway with the jaw-thrust maneuver are unsuccessful,
you should:
A) carefully tilt the patient's head back while lifting up on the chin.
B) maintain the patient's head in a neutral position and intubate at once.
C) insert an oropharyngeal airway and reattempt the jaw-thrust maneuver.
D) suction the mouth for 15 seconds and then reattempt to open the airway.

70. A foreign-body airway obstruction should be suspected in a child who presents with:
A) diffuse wheezing and nasal flaring.
B) a productive cough and flushed skin.
C) acute respiratory distress without fever.
D) progressive respiratory distress and hoarseness.

71. An airway obstruction secondary to a severe allergic reaction:

A) requires specific and aggressive treatment.
B) often responds well to humidified oxygen.
C) is usually the result of pulmonary aspiration.
D) is treated effectively with abdominal thrusts.

72. Laryngeal spasm and edema would MOST likely result from:
A) croup.
B) inhalation injury.
C) viral pharyngitis.
D) a mild asthma attack.

73. Complications of aspiration include all of the following, EXCEPT:

A) airway obstruction.
B) intrapulmonary infection.
C) bronchiolar tissue damage.
D) excess surfactant production.

74. Poor lung compliance during your initial attempt to ventilate an unconscious, apneic adult
should be treated by:
A) sweeping the patient's mouth with your fingers.
B) reopening the airway and reattempting to ventilate.
C) performing 30 chest compressions and reassessing.
D) administering 15 subdiaphragmatic thrusts at once.

75. If chest compressions and repositioning of the airway are unsuccessful in removing a severe
airway obstruction in an unconscious patient, you should:
A) perform a blind finger sweep of the mouth.
B) alternate chest compressions and abdominal thrusts.
C) perform laryngoscopy and use Magill forceps.
D) gain airway access via the cricothyroid membrane.

76. A whistle-tip suction catheter is MOST often used to:

A) suction large debris from the oropharynx.
B) rapidly remove large volumes of vomitus.
C) remove secretions from an endotracheal tube.
D) suction an adult's mouth for 15 to 30 seconds.

77. Placing a suction catheter past the base of the tongue:

A) may cause the patient to gag or vomit.
B) will result in aspiration of gastric contents.
C) is effective in thoroughly clearing the airway.
D) commonly causes bradycardia in adult patients.

78. An artificial airway adjunct:

A) effectively protects the airway from aspiration.
B) is a suitable substitute for manual head positioning.
C) should be inserted in any patient who is semiconscious.
D) does not obviate the need for proper head positioning.

79. If an unresponsive patient does not have a gag reflex, an oropharyngeal airway:
A) should only be inserted if the patient is not breathing.
B) should be inserted whether the patient is breathing or not.
C) will effectively prevent aspiration if the patient vomits.
D) must be inserted by depressing the tongue with a tongue blade.
80. The MOST significant complication associated with the use of an oropharyngeal airway is:
A) soft tissue trauma with oral bleeding.
B) mild bradycardia in pediatric patients.
C) significant bruising of the hard palate.
D) a tachycardic response in adult patients.

81. Inserting a nasopharyngeal airway in a patient with cerebrospinal fluid drainage from the
nose following head trauma would MOST likely:
A) result in ventricular dysrhythmias secondary to intracranial pressure.
B) cause acute herniation of the brainstem through the foramen magnum.
C) cause the device to enter the brain through a hole caused by a fracture.
D) result in acute hypertension and decreased cerebral perfusion pressure.

82. It would be appropriate to insert a nasopharyngeal airway in patients who:

A) are unresponsive with multiple facial bone fractures.
B) have an altered mental status with an intact gag reflex.
C) are semiconscious with active vomiting and cyanosis.
D) have CSF leakage from the nose and are semiconscious.

83. Administering supplemental oxygen to a patient with an acute myocardial infarction:

A) will prevent the patient from developing a lethal cardiac dysrhythmia.
B) should be given via a nonrebreathing mask set at 6 to 8 L/min.
C) oxygenates the myocardium that is distal to the occluded coronary artery.
D) enhances the body's compensatory mechanisms during the cardiac event.

84. A full (2,000 psi) D cylinder will last approximately ______ minutes if you are
administering oxygen at 12 L/min.
A) 22
B) 24
C) 26
D) 28

85. A Bourdon-gauge oxygen flowmeter:

A) reduces the high pressure in the oxygen cylinder to a safe pressure.
B) allows you to administer oxygen to a patient under high pressures.
C) is used for transferring oxygen from a larger tank to a smaller tank.
D) must be placed in an upright position because it is affected by gravity.
86. Which of the following statements regarding oxygen is MOST correct?
A) Oxygen is a highly flammable gas.
B) Grease prevents oxygen from exploding.
C) Oxygen supports the process of combustion.
D) Oxygen must be stored in a warm environment.

87. When administering oxygen via a nonrebreathing mask, you must ensure that the:
A) reservoir is half-filled first.
B) one-way valves are disabled.
C) patient has adequate tidal volume.
D) flow rate is set to at least 6 L/min.

88. The nasal cannula is of MOST benefit to patients:

A) who require high oxygen concentrations.
B) with mild hypoxemia and claustrophobia.
C) with an acute exacerbation of emphysema.
D) who are hypoxic and are mouth-breathers.

89. The venturi mask is MOST useful in the prehospital setting when:
A) a patient requires less than 15% oxygen.
B) high-flow oxygen is required for severe hypoxia.
C) patients cannot tolerate a nonrebreathing mask.
D) a COPD patient requires a long-range transport.

90. Oxygen that is totally devoid of moisture:

A) is less combustible than humidified oxygen.
B) will dry the patient's mucous membranes quickly.
C) is optimum for patients requiring long-term oxygen.
D) should be given in conjunction with bronchodilators.

91. Which of the following devices is NOT used to deliver oxygen via positive pressure?
A) Simple face mask
B) Pocket face mask
C) Bag-mask device
D) Demand valve device

92. Compared to mouth-to-mouth ventilation, mouth-to-mask ventilation is more advantageous

in that it:
A) can be used in conjunction with supplemental oxygen.
B) carries a lower risk of gastric distention and vomiting.
C) is less likely to result in hyperventilation of the rescuer.
D) allows greater tidal volume to be delivered to the patient.

93. When ventilating an apneic adult with a pulse with a bag-mask device, you should:
A) deliver 8 to 10 breaths/min and make the chest wall rise visibly.
B) make the chest rise visibly and deliver one breath every 8 seconds.
C) deliver each breath over 1 second at a rate of 10 to 12 breaths/min.
D) squeeze the bag once every 3 seconds until the chest expands widely.

94. 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.

95. 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.

96. 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.

97. A major advantage of ventilating an apneic patient with the three-person bag-mask technique
is that:
A) the risk of gastric distention is eliminated.
B) posterior cricoid pressure can be applied.
C) ventilations can be delivered at a faster rate.
D) there is no need to use an oral airway adjunct.

98. The flow-restricted, oxygen-powered ventilation device (FROPVD):

A) has a demand valve that is triggered by the negative pressure generated during inhalation.
B) is the preferred initial device for ventilating an apneic or inadequately breathing patient.
C) delivers 100% oxygen to apneic patients at a fixed flow rate of 50 to 60 L/min.
D) should be used in patients with thoracic trauma because it is less likely to cause barotrauma.

99. 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 12 to 20 breaths/min are being delivered.
D) Each ventilation is delivered over 1 second.

100. Which of the following statements regarding the automatic transport ventilator (ATV) is
MOST correct?
A) The ATV should not be used to ventilate a patient who is intubated and in cardiac arrest.
B) Inadvertent variations in the rate and duration of ventilations often occur when the ATV is
used.
C) The paramedic can control an apneic patient's minute volume with accuracy when using an
ATV.
D) Most ATVs are large and cumbersome and are therefore impractical to use in the prehospital
setting.

101. The pressure relief valve on an automatic transport ventilator (ATV) may lead to
unrecognized hypoventilation in patients with all of the following conditions, EXCEPT:
A) airway obstruction.
B) prolonged apnea.
C) poor lung compliance.
D) increased airway resistance.

102. A length-based resuscitation tape measure can be used to determine the most appropriate
size of bag-mask device for pediatric patients who weigh up to:
A) 34 kg.
B) 38 kg.
C) 42 kg.
D) 46 kg.

103. When performed properly, posterior cricoid pressure (Sellick maneuver):

A) will allow the paramedic to deliver positive-pressure ventilations using greater volume.
B) prevents gastric distention and allows the volume of each ventilation to enter the lungs.
C) eliminates the need for the paramedic to manually maintain the patient's head in position.
D) can help prevent passive regurgitation with aspiration during positive-pressure ventilation.

104. If cricoid pressure is removed during positive-pressure ventilation before a patient is

intubated:
A) the paramedic should manually decompress the stomach.
B) esophageal rupture may occur due to high gastric pressures.
C) the intubator will not be able to view the patient's vocal cords.
D) the patient may expel and aspirate a large volume of vomitus.

105. 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 endotracheal tube can be placed.
C) decompressing the stomach and decreasing pressure on the diaphragm.
D) removing blood from the esophagus in patients with esophageal varices.

106. Which of the following is NOT performed before, during, or after insertion of a nasogastric
(NG) tube in a conscious patient?
A) Administering a topical alpha agonist to constrict the nasal vasculature
B) Keeping the patient's head in a flexed position during insertion of the tube
C) Injecting 40 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

107. In contrast to the nasogastric (NG) tube, the orogastric (OG) 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.

108. 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.

109. Endotracheal intubation is MOST accurately defined as:

A) inserting an ET tube through the vocal cords via the patient's mouth.
B) passing an ET tube through an opening in the cricothyroid membrane.
C) inserting an ET tube through the glottic opening via the patient's nose.
D) passing an ET tube through the glottic opening and sealing off the trachea.

110. 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.

111. The major advantage of endotracheal intubation is that it:

A) facilitates tracheal suctioning.
B) protects the airway from aspiration.
C) is an easy to skill to learn and perform.
D) provides a route for certain medications.

112. A disadvantage of endotracheal 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.

113. Murphy's eye, an 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.

114. 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.

115. 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.
116. 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.

117. 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.

118. 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.

119. When inserting a stylet into an ET tube, you must ensure that:
A) the stylet rests at least ?” 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.

120. Which of the following statements regarding orotracheal intubation is MOST correct?
A) Orotracheal intubation is a blind technique used only in emergency situations.
B) It is the most common method of performing endotracheal intubation.
C) You cannot perform orotracheal intubation on patients who are breathing.
D) Orotracheal intubation is most commonly performed without a laryngoscope.

121. Before performing orotracheal intubation, it is MOST important for the paramedic to:
A) hyperventilate the patient.
B) preoxygenate with a bag-mask device.
C) wear gloves and facial protection.
D) apply a pulse oximeter to the patient.

122. 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.

123. 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.

124. 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.

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

126. After correctly positioning the laryngoscope blade in the patient's mouth, you should next:
A) ask your partner to apply firm posterior pressure to the cricoid cartilage.
B) gently pry back on the laryngoscope to obtain a view of the vocal cords.
C) exert gentle traction at a 45° angle to the floor as you lift the patient's jaw.
D) pull slightly back on the laryngoscope blade in order to view the epiglottis.

127. 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.

128. The BURP maneuver usually involves applying backward, upward, and rightward pressure
to the:
A) upper third of the cricoid cartilage.
B) lower third of the cricoid cartilage.
C) upper third of the thyroid cartilage.
D) lower third of the thyroid cartilage.

129. When applied correctly during an intubation attempt, the Sellick maneuver:
A) effectively moves the larynx into a more anterior position.
B) reduces the acuity of the angle between the pharynx and larynx.
C) shifts the thyroid cartilage backward, upward, and to the right.
D) puts pressure on the arytenoid cartilage and lifts the entire larynx.

130. The ONLY 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.

131. 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.

132. When using a straight blade, a major mistake of new paramedics is to:
A) try to pass the ET tube down the barrel of the blade.
B) insert the blade directly between the vocal cords.
C) use traction while lifting up on the patient's mandible.
D) insert the blade into the left side of the patient's mouth.

133. 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 end-tidal CO2 detector to the tube.
D) inflate the distal cuff with 5 to 10 mL of air.

134. 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.
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.

135. Decreased ventilation compliance following intubation is LEAST suggestive of:

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

136. End-tidal carbon dioxide (ETCO2) detection 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) ETCO2 detectors measure the amount of exhaled oxygen.
D) it measures the amount of carbon dioxide in inhaled air.

137. If the ET tube is placed in the trachea properly, the colorimetric paper inside the ETCO2
detector should:
A) not change colors.
B) turn yellow during inhalation.
C) turn yellow during exhalation.
D) remain purple during ventilations.

138. Capnography may be inaccurate in patients with cardiac arrest 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.

139. If using a bulb-style esophageal detector device (EDD) to assist you in confirming proper
ET tube placement, you should expect the bulb to:
A) inflate slowly when you let go of it.
B) refill briskly if the tube is in the trachea.
C) stay collapsed if the tube is in the trachea.
D) expand quickly if the tube is in the esophagus.
140. The average depth of ET tube insertion for adult patients is:
A) 21 to 25 cm.
B) 22 to 26 cm.
C) 23 to 27 cm.
D) 24 to 28 cm.

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

142. 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.

143. 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

144. The paramedic should be especially diligent when confirming tube placement following
blind nasotracheal intubation because:
A) the ET tube cannot be secured effectively when it is in the nose.
B) most patients who are intubated nasally are extremely combative.
C) he or she did not visualize the tube passing between the vocal cords.
D) most nasotracheal intubation attempts result in esophageal placement.

145. The MOST common complication associated with nasotracheal intubation is:
A) bleeding.
B) aspiration.
C) hypoxemia.
D) regurgitation.

146. 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.

147. 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.

148. 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.

149. If you must 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.

150. If you see a soft tissue bulge on either side of the airway when performing nasotracheal
intubation:
A) inadvertent esophageal intubation has likely occurred.
B) you should completely remove the tube and reoxygenate.
C) you have probably inserted the tube into the pyriform fossa.
D) the tube is positioned correctly just above the glottic opening.

151. Which of the following is NOT a step that is performed during nasotracheal intubation?
A) Advancing the ET tube as the patient inhales
B) Preoxygenation with a bag-mask as necessary
C) Ensuring that the patient's head is hyperflexed
D) Placing the patient's head in a neutral position

152. 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.

153. Digital intubation can be performed on critically injured patients because:

A) the head does not have to be placed in a sniffing position.
B) most trauma patients have distortion of the airway anatomy.
C) orotracheal intubation is unsafe to perform on trauma patients.
D) the technique is easier to perform than other forms of intubation.

154. Digital intubation should be performed only on a patient who has a bite block inserted in
his or her mouth and who is_______ and _____.
A) unconscious; apneic
B) stuporous; bradypneic
C) comatose; breathing inadequately
D) semiconscious; tachypneic

155. The MOST significant complication associated with digital intubation is:
A) hypoxia.
B) dental trauma.
C) airway swelling.
D) vocal cord damage.

156. 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.

157. When determining whether transillumination-guided intubation should be attempted, you

should:
A) consider the amount of soft tissue that is overlying the trachea.
B) avoid the procedure if the patient is thin or is greater than 6 ft tall.
C) ensure the airway is clear of secretions by suctioning for 30 seconds.
D) recall that patients with short necks are often easy to transilluminate.

158. Transillumination-guided intubation can be difficult or impossible to perform:

A) in any patient with dentures.
B) if the patient has oral secretions.
C) in a brightly lit environment.
D) in patients over 70 years of age.

159. Which of the following represents the MOST correct technique for performing
transillumination-guided intubation?
A) Place the patient's head in a hyperflexed position and insert the tube-stylet combination into
the left side of the mouth.
B) Grasp the lower jaw with your thumb and forefinger, displace it forward, and insert the
tube-stylet combination in the midline of the patient's mouth.
C) Hyperextend the patient's head, pull the jaw down, and insert the tube-stylet combination into
the right side of the patient's mouth.
D) Place the patient's head in a neutral position, displace the tongue with a tongue blade, and
insert the tube-stylet combination in the midline of the mouth.

160. 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

161. Once you have confirmed that the lighted stylet-ET tube combination has entered the
trachea, you should:
A) secure the tube manually, remove the stylet, and attach a bag-mask device.
B) slightly withdraw the stylet and tube to ensure placement above the carina.
C) remove the lighted stylet and inflate the distal cuff with 5 to 10 mL of air.
D) hold the stylet in place and advance the tube about 2 to 4 cm into the trachea.

162. 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.

163. 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 further than 6 to 8 inches.
D) applying suction while gently inserting the catheter.
164. 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.

165. Which of the following statements regarding field extubation is MOST 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.

166. The MOST obvious risk associated with extubation is:

A) moderate airway swelling as the endotracheal 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 endotracheal tube.
D) stimulation of the parasympathetic nervous system with resulting bradycardia.

167. 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.

168. Which of the following statements regarding pediatric endotracheal intubation in the
prehospital setting is MOST correct?
A) An average-sized toddler would require a 4.5 mm cuffed endotracheal tube to secure the
airway adequately.
B) When intubating an infant or small child, it is important to remember that the epiglottis is less
floppy.
C) Bag-mask ventilation can be as effective as intubation for EMS systems that have short
transport times.
D) Because the pediatric airway is smaller than an adult's, paramedics should routinely intubate
children in the field.

169. In which of the following situations would endotracheal intubation of a pediatric patient be
LEAST necessary?
A) Traumatic brain injury with unconsciousness
B) To administer certain resuscitative medications
C) Cardiopulmonary arrest due to respiratory failure
D) Difficulty effectively ventilating with a bag-mask

170. When intubating a 3-year-old child, you would MOST likely use a:
A) size 2 straight blade.
B) 6.5 mm uncuffed ET tube.
C) 5.0 mm cuffed ET tube.
D) size 1 curved blade.

171. What size ET tube would be MOST appropriate to use for a 4-year-old child?
A) 3.5 mm
B) 4.0 mm
C) 4.5 mm
D) 5.0 mm

172. Uncuffed ET tubes are used in children less than 8 years of age because:
A) the cuff would apply pressure and obstruct the airway.
B) the high-pressure cuff would likely rupture the trachea.
C) most children are only intubated for short periods of time.
D) a cuff at the cricoid ring is not necessary to obtain a seal.

173. Approximately how far should you insert a 5.0-mm ET tube in a 4-year-old child?
A) 12 cm
B) 15 cm
C) 17 cm
D) 19 cm

174. When preoxygenating an uninjured child prior to endotracheal intubation, you should:
A) place the child's head in the sniffing position, insert an oral airway if needed, and ventilate
with a bag-mask for at least 30 seconds.
B) hyperextend the child's head, insert an oral airway if needed, and hyperventilate the child at
40 breaths/min for at least 2 to 3 minutes.
C) maintain the child's head in a neutral position, insert an oral airway if needed, and deliver 1
breath every 10 seconds for at least 3 minutes.
D) place the child's head in the sniffing position, insert an oral airway if needed, and moderately
hyperventilate the child at 24 breaths/min for 30 seconds.

175. Because intubation can stimulate the parasympathetic nervous system and result in
 bradycardia in some children, you should routinely:
A) give 0.02 mg/kg of atropine to all children prior to intubation.
B) apply a cardiac monitor and closely observe the child's heart rate.
C) limit your intubation attempts to less than 30 seconds in children.
D) ensure that the child's heart rate is at least 120 beats/min before intubating.

176. When intubating a 3-year-old child, you should insert the ET tube until:
A) the distal cuff is 1 to 2 cm beyond the vocal cords.
B) you meet resistance, and then withdraw the tube 2 cm.
C) the vocal cord guide is 2 to 3 cm beyond the vocal cords.
D) the cm marking on the tube reads 15 cm at the child's lips.

177. Which of the following is NOT an appropriate method for confirming proper ET tube
placement in a 15-kg child?
A) End-tidal CO2 detector
B) Esophageal bulb or syringe
C) Bilateral auscultation of breath sounds
D) Assessing skin color and oxygen saturation

178. If intubation of a child is unsuccessful after several attempts, your MOST appropriate
action should be to:
A) have your partner attempt to intubate as you apply gentle posterior pressure to the cricoid
cartilage.
B) insert a multilumen airway device and confirm placement by means of auscultation of breath
sounds and capnography.
C) turn the child on his or her side, apply manual pressure to the epigastrium to relieve
distension, and reattempt intubation.
D) discontinue attempts to intubate, ventilate the child with a bag-mask device, and transport
immediately.

179. Which of the following clinical findings is LEAST suggestive of a pneumothorax in an

intubated child?
A) Decreased ventilation compliance
B) Stronger breath sounds on the right side
C) Persistent cyanosis despite ventilations
D) Stronger breath sounds on the left side

180. Using the DOPE mnemonic, which of the following interventions would you MOST likely
have to perform if you suspect O as the cause of acute deterioration in the intubated child?
A) Tracheobronchial suctioning
B) Immediate extubation of the child
C) Needle decompression of the chest
D) Checking the bag-mask device for defects

181. The MOST effective way to minimize the risk of hypoxia while intubating a child is to:
A) limit your intubation attempt to 20 seconds.
B) monitor the child's cardiac rhythm at all times.
C) premedicate the child with 0.02 mg/kg of atropine.
D) not allow the oxygen saturation to fall below 100%.

182. Which of the following statements regarding multilumen airways is MOST correct?
A) Multilumen airways can be used safely in pediatric patients if endotracheal intubation is
unsuccessful.
B) To ensure proper placement, multilumen airways should be inserted under direct
laryngoscopy.
C) Multilumen airways are equipped with an oropharyngeal cuff, which eliminates the need for
a face mask.
D) Compared with esophageal airways, multilumen airway devices have not been shown to
provide better ventilation.

183. 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.

184. 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.

185. In contrast to the pharyngeotracheal lumen airway (PtL), the Combitube:

A) has one tube that is open at its distal end.
B) consists of a single tube with two lumens.
C) typically enters the trachea during insertion.
D) has two cuffs that are inflated simultaneously.

186. Multilumen airways are contraindicated in patients with:

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

187. Whether you are using the PtL or the Combitube:

A) you should attempt ventilation before inflating the cuffs.
B) the patient's head should be placed in a sniffing position.
C) the balloons on both devices should be inflated sequentially.
D) both devices are inserted blindly into the posterior pharynx.

188. After inserting the PtL and inflating the balloons, you should:
A) properly secure the device in place.
B) apply pressure to the cricoid cartilage.
C) ventilate through the short tube first.
D) ventilate through the long tube first.

189. After insertion of the Combitube, you should next:

A) inflate the distal cuff with 5 mL of air.
B) ventilate through the pharyngeal tube first.
C) inflate the pharyngeal cuff with 100 mL of air.
D) apply a cervical collar to minimize head movement.

190. The laryngeal mask airway (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.

191. 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.

192. 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.

193. 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.

194. A size 3 or 4 LMA:

A) is most suitable for use in morbidly obese patients.
B) is less likely to become dislodged than smaller sizes.
C) will accommodate the passage of a 6.0-mm ET tube.
D) is appropriate to use in children younger than 6 years of age.

195. Appropriate 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, using your finger to push the airway against
the hard palate.

196. If used properly, and under the correct circumstances, sedation during airway management:
A) chemically paralyzes the patient, thus facilitating placement of an advanced airway device.
B) effectively increases patient compliance, thus making definitive airway management safer to
perform.
C) significantly reduces the pain and discomfort associated with laryngoscopy and endotracheal
intubation.
D) minimizes the risks of bradycardia and hypotension that occasionally occur during advanced
airway management.

197. Undersedation of a patient during airway management would likely result in all of the
following, EXCEPT:
A) respiratory depression.
B) trauma to the airway.
C) poor patient compliance.
D) tachycardia and hypertension.

198. Fentanyl (Sublimaze) is a/an:

A) narcotic analgesic.
B) benzodiazepine sedative.
C) sedative-hypnotic drug.
D) butrophenone sedative.

199. Which of the following medications does NOT possess hypnotic properties?
A) Versed
B) Brevital
C) Afentanil
D) Etomidate

200. Diazepam and midazolam provide all of the following therapeutic effects, EXCEPT:
A) sedation.
B) analgesia.
C) anxiolysis.
D) retrograde amnesia.

201. Which of the following medications is safest to use in patients with borderline hypotension
or hypovolemia?
A) Brevital
B) Pentothal
C) Sublimaze
D) Etomidate

202. Neuromuscular blocking agents:

A) are most commonly used as the sole agent to facilitate placement of an endotracheal tube.
B) convert a breathing patient with a marginal airway into an apneic patient with no airway.
C) induce total body paralysis within 10 to 15 minutes following administration via IV push.
D) have a negative effect on both cardiac and smooth muscle and commonly cause
dysrhythmias.

203. When a patient is given a paralytic without sedation:

A) he or she is fully aware and can hear and feel.
B) you should only give one-tenth the standard dose.
C) placement of an endotracheal tube is less traumatic.
D) paralysis is not achieved and intubation is not possible.

204. Paralytic medications exert their effect by:

A) blocking the release of epinephrine and norepinephrine from the sympathetic nervous system.
B) competitively binding to the motor neurons in the brain, thus blocking their ability to send
messages.
C) functioning at the neuromuscular junction and relaxing the muscle by impeding the action of
acetylcholine.
D) blocking the function of the autonomic nervous system and impeding the action of
acetylcholinesterase.

205. Nondepolarizing neuromuscular blocking agents include all of the following, EXCEPT:
A) vecuronium bromide.
B) rocuronium bromide.
C) pancuronium bromide.
D) succinylcholine chloride.

206. Which of the following is NOT characteristic of a depolarizing neuromuscular blocking

agent?
A) Bradycardia
B) Tachycardia
C) Muscle fasciculations
D) Short duration of action

207. To prevent muscular fasciculations associated with the use of succinylcholine, you should
administer:
A) 0.5 mg of atropine sulfate via rapid IV push.
B) 10% of the usual dose of a nondepolarizing paralytic.
C) an infusion of potassium chloride set at 5 mEq per hour.
D) 1 to 1.5 mg/kg of lidocaine over 10 to 15 minutes.

208. Drugs such as vecuronium bromide (Norcuron) and pancuronium bromide (Pavulon) are
MOST appropriate to administer when:
A) extended periods of paralysis are needed.
B) longer-acting paralytics are contraindicated.
C) you have a transport time of less than 15 minutes.
D) intubation of the patient is anticipated to be difficult.

209. Before intubating a patient who has been chemically sedated and paralyzed, it is MOST
important for the paramedic to:
A) administer 0.5 mg of atropine sulfate.
B) hyperventilate the patient at 24 breaths/min.
C) adequately preoxygenate with 100% oxygen.
D) suction the oropharynx to clear any secretions.
210. Which of the following medications may prevent an acute increase in intracranial pressure
caused by stimulation of the glottis?
A) Atropine
B) Lidocaine
C) Amiodarone
D) Furosemide

211. Immediately after the patient has been chemically sedated and paralyzed, you should:
A) intubate the trachea in less than 30 seconds.
B) hyperventilate the patient for about 30 seconds.
C) insert a nasogastric tube to relieve gastric distention.
D) have an assistant apply posterior cricoid pressure.

212. If the patient's oxygen saturation drops at any point during rapid-sequence intubation (RSI),
you should:
A) stop and hyperventilate the patient at a rate of 24 breaths/min.
B) abort the intubation attempt and ventilate with a bag-mask device.
C) release cricoid pressure and immediately resume bag-mask ventilations.
D) continue the intubation attempt and monitor the cardiac rhythm closely.

213. The external jugular veins run ____________ and are located ____________ to the
cricothyroid membrane.
A) vertically; lateral
B) vertically; medial
C) horizontally; lateral
D) horizontally; medial

214. 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.

215. 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.

216. Open cricothyrotomy is indicated when:

A) endotracheal intubation is unsuccessful after 3 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.

217. Open cricothyrotomy is generally contraindicated in all of the following situations,

EXCEPT:
A) tracheal tumors or subglottic stenosis.
B) any patient who is younger than 16 years of age.
C) crushing laryngeal injuries or tracheal transection.
D) inability to identify the correct anatomic landmarks.

218. 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.

219. Incising the cricothyroid membrane vertically will:

A) minimize the risk of damaging the thyroid gland.
B) facilitate insertion of an 8.0 to 9.0 mm ET tube.
C) completely eliminate the risk of any external bleeding.
D) increase the risk of damaging the external jugular veins.

220. 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.
221. 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.

222. Which of the following statements regarding translaryngeal catheter ventilation is MOST
correct?
A) It is more difficult to perform than an open cricothyrotomy.
B) It provides a more definitive airway than an open cricothyrotomy.
C) Ventilation is achieved by the use of a high-pressure jet ventilator.
D) The technique uses the tracheal wall as an entry point to the airway.

223. 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.

224. Because the high-pressure ventilator used with needle cricothyrotomy would cause an
increase in intrathoracic pressure, ___________ and ___________ may result.
A) hypercarbia; hypoxia
B) barotrauma; pneumothorax
C) hypoventilation; hypocarbia
D) esophageal rupture; hemorrhage

225. 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.

226. The MOST significant disadvantage associated with needle cricothyrotomy is:
A) air leakage around the insertion site.
B) the inability to exhale via the glottis.
C) local infection due to poor technique.
D) the potential for pulmonary aspiration.

227. 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.

228. You should turn the jet ventilator release valve off when:
A) the audible alarm sounds.
B) wide chest expansion is noted.
C) the patient's chest visibly rises.
D) you can auscultate breath sounds.

229. Proper insertion of the needle into the cricothyroid membrane involves a ___ angle toward
the ________.
A) 45°; feet
B) 90°; posterior trachea
C) 45°; posterior trachea
D) 90°; feet

230. A surgical opening into the trachea is called a:

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

231. Patients with a partial laryngectomy:

A) have had their entire larynx removed and breathe through an opening in the neck called a
stoma.
B) are called partial neck breathers because they breathe through both a stoma and the nose and
mouth.
C) are easy to differentiate from patients who have had a total laryngectomy, especially when
they are apneic.
D) cannot be ventilated with the mouth-to-mask technique because there is no connection
between the pharynx and lower airway.

232. Patients with laryngectomies MOST commonly develop mucous plugs in their stoma
because:
A) they are at higher risk for pneumonia.
B) they do not possess an efficient cough.
C) the diameter of the stoma is small.
D) their swallowing mechanism is suppressed.
233. When suctioning a patient's stoma, you should:
A) insert the catheter until resistance is felt.
B) ask the patient to inhale as you are suctioning.
C) insert the catheter no more than 15 cm.
D) provide suction for no longer than 20 seconds.

234. If a patient has a stoma and no tracheostomy tube in place:

A) you should not seal the nose and mouth when ventilating.
B) suctioning of the stoma must be performed before ventilating.
C) ventilations can be performed by placing a mask over the stoma.
D) you must perform a head tilt-chin lift maneuver before ventilating.

235. Whether you are providing ventilations to a patient with a stoma using a resuscitation mask
or bag-mask device, you must FIRST:
A) perform a head tilt-chin lift maneuver.
B) place the patient's head in a neutral position.
C) adequately cleanse the stoma site with iodine.
D) suction the stoma for no longer than 10 seconds.

236. In order for a tracheostomy tube to be compatible with a mechanical ventilator or bag-mask
device:
A) it should have a stylet that can be removed easily.
B) it should have an internal diameter of at least 6.0 mm.
C) the patient's head must be in a hyperextended position.
D) it must be equipped with a 15/22-mm proximal adaptor.

237. When replacing a dislodged tracheostomy tube, it is MOST important that you:
A) insert the tube 2 cm beyond the cuff.
B) take appropriate BSI precautions.
C) lubricate the tube before insertion.
D) use a tracheostomy tube of the same size.

238. Removal of a dental appliance after intubating a patient is:

A) dangerous and may cause dislodgement of the tube.
B) generally preferred but should be performed carefully.
C) mandatory in the event the patient will require surgery.
D) acceptable only if the device is an upper or lower bridge.
239. Which of the following interventions is NOT appropriate when treating an unconscious
patient whose airway is obstructed by a dental appliance?
A) Abdominal thrusts
B) Chest compressions
C) Direct laryngoscopy
D) Use of Magill forceps

240. When ventilating a patient with facial injuries, it is MOST important to:
A) ventilate with a higher-than-normal volume.
B) suction the oropharynx every 2 to 3 minutes.
C) be alert for changes in ventilation compliance.
D) ensure that a cervical collar has been applied.

241. Which of the following patients has the lowest minute volume?
A) Tidal volume of 400 mL; respiratory rate of 14 breaths/min
B) Tidal volume of 350 mL; respiratory rate of 12 breaths/min
C) Tidal volume of 400 mL; respiratory rate of 24 breaths/min
D) Tidal volume of 300 mL; respiratory rate of 16 breaths/min

242. After opening an unconscious 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.

243. 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 2-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

244. Which of the following findings is MOST clinically significant in a 30-year-old woman
with difficulty breathing and a history of asthma?
A) Oral temperature of 97.9°F
B) Expiratory wheezing on exam
C) Prior ICU admission for her asthma
D) 3 mm Hg drop in systolic BP during inhalation

245. After obtaining a peak expiratory flow reading of 200 mL, you administered one
bronchodilator treatment to a 21-year-old woman with an acute episode of expiratory
wheezing. The next peak flow reading is 400 mL. You should:
A) recognize that the patient's condition has improved.
B) give another bronchodilator treatment and reassess.
C) try another treatment modality to treat her wheezing.
D) assist ventilations and be prepared to intubate her.

246. You respond to a residence for a possible overdose. The patient, a young man, is
unconscious with slow, snoring respirations. There are obvious needle track marks on his
arms. Your FIRST action should be to:
A) insert an oral airway.
B) suction his oropharynx.
C) manually open his airway.
D) begin ventilation assistance.

247. A 40-year-old man fell 20 feet from a tree while trimming branches. Your assessment
reveals that he is unconscious. You cannot open his airway effectively with the jaw-thrust
maneuver. You should:
A) insert a nasopharyngeal airway and assess his respirations.
B) carefully open his airway with the head tilt-chin lift maneuver.
C) assist his ventilations and prepare to intubate him immediately.
D) suction his oropharynx and reattempt the jaw-thrust maneuver.

248. A 50-year-old woman presents with acute respiratory distress while eating. Upon your
arrival, you note that she is conscious, coughing, and wheezing between coughs. Further
assessment reveals that her skin is pink and moist. In addition to transporting her to the
hospital, you should:
A) perform abdominal thrusts until she becomes unconscious.
B) encourage her to cough and closely monitor her condition.
C) deliver positive-pressure ventilations via bag-mask device.
D) look in her mouth and attempt to visualize a foreign body.

249. Two attempts to ventilate an unconscious 10-year-old boy have been unsuccessful. You
should next:
A) intubate his trachea.
B) deliver abdominal thrusts.
C) look inside the patient's mouth.
D) perform chest compressions.

250. Several cycles of basic life support maneuvers have failed to relieve a severe airway
obstruction in an unconscious 44-year-old woman. You should:
A) intubate the patient and attempt to push the foreign body into one of the mainstem bronchi.
B) continue basic life support maneuvers and transport the patient to the hospital immediately.
C) perform direct laryngoscopy and attempt to remove the obstruction with Magill forceps.
D) place the patient's head in a neutral position and perform an emergency cricothyrotomy.

251. After inserting an oropharyngeal airway in an unconscious woman, the patient begins to
gag. You should:
A) remove the airway and have suction ready.
B) suction her oropharynx for up to 15 seconds.
C) spray an anesthetic medication into her mouth.
D) turn the patient on her side in case she vomits.

252. A construction worker fell approximately 15 feet and landed on his head. He is conscious
but confused. His respiratory rate is 14 breaths/min with adequate depth. Further
assessment reveals blood draining from his nose. You should:
A) administer oxygen via nonrebreathing mask and continue your assessment.
B) insert a nasopharyngeal airway and assist ventilations with a bag-mask device.
C) suction his nasopharynx for up to 30 seconds and apply oxygen via nasal cannula.
D) insert a nasopharyngeal airway and administer oxygen via nonrebreathing mask.

253. 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 a 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.

254. A 66-year-old woman is found to be unconscious 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 8 to 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.
255. You have been providing bag-mask ventilations to an unconscious, 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.

256. Approximately 10 seconds into an intubation attempt, you catch a glimpse of the patient's
vocal cords, but quickly lose sight of them. You should:
A) sweep the patient's tongue to the right side of the mouth and revisualize.
B) abort the intubation attempt and ventilate the patient with a bag-mask device.
C) ask your partner to apply backward, upward, rightward pressure to the thyroid.
D) gently pry back on the laryngoscope to improve your view of the upper airway.

257. 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 end-tidal CO2 detector to the tube.
C) secure the ET tube with a commercial device.
D) begin ventilations and auscultate breath sounds.

258. 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.

259. You are transporting an intubated patient and note that the digital capnometry reading has
quickly 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.

260. You are caring for a 69-year-old man with congestive heart failure. His breathing is
profoundly labored, his oxygen saturation reads 79% on oxygen via nonrebreathing mask,
and he is showing signs of physical exhaustion. Considering that your protocols do not
 allow you to perform rapid-sequence intubation, you should:
A) insert an oral airway, assist ventilations with a bag-mask device, and transport at once.
B) preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation.
C) give him Valium for sedation, perform orotracheal intubation, and transport to the hospital at
once.
D) insert a nasopharyngeal airway and ensure that the nonrebreathing mask is tightly secured to
his face.

261. Several attempts to orotracheally intubate an unconscious, apneic young man have failed.
You resume bag-mask ventilations and begin transport to a hospital located 25 miles away.
En route, you begin having difficulty maintaining an adequate mask-to-face seal with the
bag-mask device. Assuming that you have the proper equipment, which of the following
techniques to secure a patent airway would be MOST appropriate?
A) Transillumination intubation
B) Blind nasotracheal intubation
C) An open or needle cricothyrotomy
D) Further attempts at orotracheal intubation

262. You have intubated a 70-year-old man with chronic bronchitis and are en route to the
hospital. During transport, you note that ventilations are becoming increasingly difficult
and the digital capnometry reading is falling. Your partner tells you that she can still hear
bilaterally equal breath sounds, but they are faint. She further tells you that there are no
sounds over the epigastrium. What intervention is MOST likely indicated for this patient?
A) Immediate extubation
B) Withdrawing the tube 2 cm
C) Tracheobronchial suctioning
D) Hyperventilation at 24 breaths/min

263. An intubated 33-year-old man is becoming agitated and begins moving his head around.
Your estimated time of arrival at the hospital is 15 minutes. You should:
A) administer a sedative medication.
B) suction his airway and carefully extubate.
C) chemically paralyze him with vecuronium.
D) physically restrain his head to the stretcher.

264. You are attempting to intubate a 5-year-old girl when you note that her heart rate has fallen
from 120 beats/min to 80 beats/min. A patent IV line has been established. The MOST
appropriate action is to:
A) administer 0.02 mg/kg of atropine to increase her heart rate.
B) abort the intubation attempt and begin chest compressions at 100/min.
C) give a 20 mL/kg normal saline bolus and continue your intubation attempt.
D) abort the attempt and ventilate with a bag-mask device and 100% oxygen.

265. While transporting an intubated 8-year-old boy, he suddenly jerks his head and becomes
cyanotic shortly thereafter. His oxygen saturation and capnometry readings are both
falling, and he is becoming bradycardic. You attempt to auscultate breath sounds, but are
unable to hear because of the drone of the engine. What has MOST likely happened?
A) Tension pneumothorax
B) Inadvertent extubation
C) Obstruction of the tube
D) Right mainstem intubation

266. You have just inserted a Combitube in a 59-year-old cardiac arrest patient. You attach the
bag-mask device to the pharyngeal (blue) tube, begin ventilations, and note the presence of
bilaterally equal breath sounds, absent epigastric sounds, and visible chest rise. You
should:
A) perform laryngoscopy to visualize placement of the Combitube.
B) continue to ventilate and use additional confirmation techniques.
C) continue ventilating the patient at a rate of 10 to 12 breaths/min.
D) ventilate through the clear tube and auscultate all four lung fields.

267. You are assessing a young woman whose boyfriend purposely struck her in the head with a
baseball bat. The patient is semiconscious and has slow, irregular respirations. Further
assessment reveals CSF drainage from her nose and periorbital ecchymosis. She has blood
in her mouth, but clenches her teeth and becomes combative when you attempt to suction
her oropharynx. The MOST appropriate airway management for this patient involves:
A) sedating her with a benzodiazepine, chemically paralyzing her with a neuromuscular blocker,
and intubating her trachea.
B) suctioning along the inside of her cheek with a whistle-tip catheter and then performing blind
nasotracheal intubation.
C) opening her mouth with a dental prod, suctioning her oropharynx for 15 seconds, and
intubating her trachea via direct laryngoscopy.
D) inserting a nasopharyngeal airway, administering supplemental oxygen via nonrebreathing
mask, and continuing suction attempts.

268. A 36-year-old man experienced significant burns to his face, head, and chest following an
incident with a barbeque pit. Your assessment of his airway reveals severe swelling. After
administering medications to sedate and paralyze the patient, you are unable to intubate
him. Furthermore, bag-mask ventilations are producing minimal chest rise. The quickest
way to secure a patent airway in this patient is to:
A) ventilate with a demand valve.
B) insert a laryngeal mask airway.
C) perform a needle cricothyrotomy.
D) perform an open cricothyrotomy.

269. You are dispatched to the residence of a 19-year-old man who has a tracheostomy tube and
is on a mechanical ventilator. According to the patient's mother, he began experiencing
difficulty breathing about 30 minutes ago. Auscultation of his lungs reveals bilaterally
diminished breath sounds, and his oxygen saturation is 90%. You disconnect the patient
from the mechanical ventilator and begin bag-mask ventilations; however, you meet
significant resistance. You should:
A) suspect that he has bilateral pneumothoraces.
B) ventilate with a demand valve and transport at once.
C) remove the bag-mask and suction his tracheostomy tube.
D) remove his tracheostomy tube and replace it with a new one.

270. A young woman experienced massive facial trauma after being ejected from her car when it
struck a tree. She is semiconscious, has blood draining from her mouth, and has poor
respiratory effort. The MOST appropriate initial airway management for this patient
involves:
A) vigorously suctioning her oropharynx for no longer than 15 seconds and then inserting a
multilumen airway device.
B) alternating suctioning her oropharynx for 15 seconds and assisting her ventilations for 2
minutes until you can definitively secure her airway.
C) suctioning her oropharynx and performing direct laryngoscopy to assess the amount of upper
airway damage or swelling that is present.
D) providing positive-pressure ventilatory support with a bag-mask device and making
preparations to perform an open cricothyrotomy.

Answer Key - Chapter11

1. C
2. D
3. B
4. A
5. B
6. D
7. C
8. C
9. A
10. D
11. B
12. B
13. C
14. A
15. B
16. D
17. D
18. A
19. C
20. B
21. A
22. D
23. C
24. C
25. D
26. B
27. A
28. C
29. C
30. B
31. D
32. A
33. D
34. B
35. B
36. A
37. A
38. C
39. B
40. D
41. B
42. B
43. A
44. C
45. A
46. D
47. D
48. B
49. C
50. D
51. A
52. C
53. B
54. B
55. A
56. D
57. C
58. B
59. B
60. C
61. A
62. D
63. A
64. C
65. B
66. B
67. D
68. B
69. A
70. C
71. A
72. B
73. D
74. B
75. C
76. C
77. A
78. D
79. B
80. A
81. C
82. B
83. D
84. B
85. A
86. C
87. C
88. B
89. D
90. B
91. A
92. A
93. C
94. B
95. D
96. D
97. B
98. A
99. C
100. C
101. B
102. A
103. D
104. D
105. C
106. B
107. A
108. A
109. D
110. C
111. B
112. B
113. B
114. D
115. C
116. A
117. D
118. B
119. A
120. B
121. C
122. B
123. D
124. B
125. A
126. C
127. A
128. D
129. B
130. B
131. C
132. A
133. D
134. D
135. B
136. A
137. C
138. C
139. B
140. A
141. D
142. A
143. B
144. C
145. A
146. A
147. D
148. B
149. D
150. C
151. C
152. B
153. A
154. A
155. A
156. D
157. A
158. C
159. B
160. B
161. D
162. C
163. A
164. D
165. A
166. B
167. B
168. C
169. B
170. A
171. D
172. D
173. B
174. A
175. C
176. C
177. B
178. D
179. B
180. A
181. A
182. C
183. D
184. B
185. B
186. A
187. D
188. C
189. C
190. B
191. A
192. A
193. D
194. C
195. D
196. B
197. A
198. A
199. C
200. B
201. D
202. B
203. A
204. C
205. D
206. B
207. B
208. A
209. C
210. B
211. D
212. B
213. A
214. D
215. A
216. C
217. B
218. B
219. A
220. D
221. C
222. C
223. B
224. B
225. A
226. D
227. C
228. C
229. A
230. D
231. B
232. B
233. A
234. C
235. B
236. D
237. B
238. A
239. A
240. C
241. B
242. D
243. D
244. C
245. A
246. C
247. B
248. B
249. D
250. C
251. A
252. A
253. B
254. D
255. C
256. C
257. A
258. B
259. D
260. B
261. A
262. C
263. A
264. D
265. B
266. B
267. A
268. C
269. C
270. B