Chapter 10: Respiration and Artificial Ventilation

1) For life to be maintained, a balance of oxygen and carbon dioxide is needed. The condition when oxygen levels are low is called:

A) hypoperfusion.

B) hypercapnia.

C) hyperventilation.

D) hypoxia.

D) hypoxia. Hypoxia means low oxygen levels in the body, which disrupts normal cell and organ function.

2) What are the signs of hypoxia?

A) Warm dry skin, difficulty breathing, and hypertension

B) Cyanosis (blue or gray skin) and deterioration of the patient's mental status

C) Disease process that robs the patient of adequate breathing and perfusion

D) Irreversible shock caused by the lack of blood flowing to the vital organs like the brain and heart

B) Cyanosis (blue or gray skin) and deterioration of the patient's mental status. Hypoxia reduces oxygen delivery to tissues, often causing cyanosis and altered mental status.

3) What signs and symptoms would indicate inadequate breathing in a patient?

A) Increased effort to breathe, increased depth of respiration, normal skin, normal mental status

B) Rapid breathing, pale skin, and normal mental status

C) Decreased depth of respiration, decreased rate of breathing, clammy skin, normal mental status

D) Increased effort to breathe, cyanosis, clammy skin, altered mental status

D) Increased effort to breathe, cyanosis, clammy skin, altered mental status. Inadequate breathing results in poor oxygenation and ventilation, leading to cyanosis and altered mental status.

4) When assessing a patient's breathing, what is your first question?

A) Is he breathing?

B) Is he alive or dead?

C) Is his breathing adequate or inadequate?

D) Is he seriously ill or mildly ill?

A) Is he breathing? The first step is to determine whether breathing is present at all before judging adequacy.

5) Why is inhalation described as an active process?

A) It requires the diaphragm to relax and use energy to move, creating a negative pressure.

B) It requires chest muscles to relax and use energy to move, creating a positive pressure.

C) It requires chest muscles to contract and use energy to move, creating a negative pressure.

D) It requires the diaphragm to contract and use energy to move, creating a positive pressure.

C) It requires chest muscles to contract and use energy to move, creating a negative pressure. Inhalation uses muscle contraction to expand the chest cavity and create negative pressure to pull air in.

6) The process of air moving in and out of the chest is called:

A) tidal volume.

B) inhalation.

C) respiration.

D) ventilation.

D) ventilation. Ventilation refers specifically to the movement of air in and out of the lungs.

7) The normal urge to breathe is stimulated by chemoreceptors that measure changing levels of what two gases?

A) Hydrogen and carbon monoxide

B) Carbon monoxide and oxygen

C) Hydrogen and carbon dioxide

D) Carbon dioxide and oxygen

D) Carbon dioxide and oxygen. Chemoreceptors detect rising CO₂ and low oxygen levels, triggering the respiratory drive.

8) Which of the following describes why fast respiration may decrease minute volume?

A) The lungs may not have adequate time to fill and exchange gas.

B) The rate causes turbulence in the trachea that increases the friction and decreases the amount of air movement.

C) It is due to the delay in the movement of the intercostal muscles and the pleural space.

D) The rate does not decrease minute volume, it actually increases it.

A) The lungs may not have adequate time to fill and exchange gas. Breathing too rapidly can reduce tidal volume, lowering overall minute volume.

9) What two measurements are multiplied to calculate the minute volume?

A) Tidal volume and respiratory rate

B) Alveolar ventilation and respiratory rate

C) Respiratory rate and bronchial dilation

D) Tidal volume and dead space air

A) Tidal volume and respiratory rate. Minute volume is the total air moved per minute, found by multiplying tidal volume by the respiratory rate.

10) Which of the following statements best describes the exchange of gas in the alveoli?

A) Blood moves by way of the pulmonary capillaries, air arrives at the alveoli, and osmosis occurs.

B) Blood moves from the left heart to the lungs, air arrives in the alveoli sacs, and diffusion occurs.

C) Air moves into the airway, blood arrives via the pulmonary veins, and osmosis occurs.

D) Air moves into the alveoli, blood is transported by the pulmonary capillaries, and diffusion occurs.

D) Air moves into the alveoli, blood is transported by the pulmonary capillaries, and diffusion occurs. Gas exchange occurs by diffusion between alveoli and capillaries.

11) The movement of oxygen and carbon dioxide between the alveoli and circulating blood is called:

A) internal respiration.

B) diffusion.

C) cellular respiration.

D) pulmonary respiration.

D) pulmonary respiration. Pulmonary respiration is the gas exchange between alveoli and the bloodstream.

12) Why does a patient involved in an auto crash who has major internal abdominal bleeding require oxygen to maintain internal respiration?

A) The remaining red blood cells have a reduction of hemoglobin that reduces the amount of oxygen that can be transported.

B) A lack of oxygen in the air decreases the oxygen diffused into the bloodstream, which creates an increase of carbon dioxide.

C) The swelling of the abdominal space causes the diaphragm to be restricted, which will reduce the thorax space.

D) A lack of circulating volume decreases the oxygen and carbon dioxide transport capability of the blood.

D) A lack of circulating volume decreases the oxygen and carbon dioxide transport capability of the blood. Blood loss reduces oxygen-carrying capacity, so oxygen helps maximize remaining transport.

13) The movement of oxygen and carbon dioxide across the cell membranes from the capillaries is called:

A) external respiration.

B) hyperventilation.

C) internal respiration.

D) oxygenation.

C) internal respiration. Internal respiration is gas exchange between capillary blood and body cells.

14) Which of the following can cause respiratory depression?

A) The lungs react unfavorably to high concentrations of oxygen administered for long periods of time and breathing becomes depressed.

B) End-stage COPD changes the stimulus to breathe from high carbon dioxide levels to low oxygen levels, causing breathing to become depressed when oxygen is administered.

C) High concentrations of oxygen depress breathing when the patient has an allergic reaction to administered oxygen.

D) The eyes develop scar tissue on the retina from high concentrations of oxygen, leading to breathing becoming depressed.

B) End-stage COPD changes the stimulus to breathe from high carbon dioxide levels to low oxygen levels, causing breathing to become depressed when oxygen is administered. Severe COPD patients may rely on hypoxic drive, so excessive oxygen over time can reduce respiratory drive.

15) A 16-year-old patient presents with labored breathing and increased respiratory rate, increased heart rate, and leaning forward with his hands on his knees. His skin is a normal color and his pulse oximetry is 96. This patient is suffering from respiratory:

A) failure.

B) hypoxia.

C) distress.

D) arrest.

C) distress. He is compensating with increased work of breathing but still has adequate oxygenation.

16) When does respiratory distress change to respiratory failure?

A) When continuation of a respiratory challenge causes the systems to fail, the pupils to dilate, and the skin to become hot and dry due to the demand for oxygen.

B) When continuation of a respiratory challenge results in the systems being unable to keep up with the demand, and the skin color and mental status change.

C) When a patient who is short of breath presents in the tripod position with noisy respirations that suddenly clear up and return to normal.

D) When a compensatory mechanism is no longer needed and the patient goes into respiratory arrest.

B) When continuation of a respiratory challenge results in the systems being unable to keep up with the demand, and the skin color and mental status change. Failure occurs when compensation stops and signs like cyanosis and AMS develop.

17) Which of the following best describes inadequate breathing?

A) The respiratory rate is slower than normal.

B) The minute volume is less than normal.

C) The minute volume is greater than normal.

D) The respiratory rate is faster than normal.

B) The minute volume is less than normal. Inadequate breathing means insufficient air movement overall, resulting in decreased minute volume.

18) You have arrived at the scene of a call for a "man down." As you enter the residence you note that your patient is a male in his mid-60s who is awake but does not seem to acknowledge your presence. He is perspiring profusely, has cyanosis of his ears and lips, and has rapid, shallow respirations. Which of the following should you do first?

A) Check for a radial pulse.

B) Obtain the patient's medical history.

C) Listen to his lung sounds.

D) Assist ventilations with a bag-valve mask and supplemental oxygen.

D) Assist ventilations with a bag-valve mask and supplemental oxygen. These are signs of respiratory failure requiring immediate ventilation support.

19) Your patient is a motorcyclist who was ejected after striking a guard rail. The patient is unresponsive to painful stimuli and is breathing shallowly six to eight times per minute. Which of the following should you do first?

A) Use a bag-valve mask with supplemental oxygen.

B) Perform a rapid trauma assessment.

C) Apply a cervical collar.

D) Apply a nonrebreather mask with an oxygen flow rate of 15 lpm.

A) Use a bag-valve mask with supplemental oxygen. Unresponsive patients with inadequate respirations require immediate assisted ventilation.

20) Which of the following patients does not require the administration of supplemental oxygen?

A) A 60-year-old woman with a history of chronic obstructive pulmonary disease (COPD) who can speak two or three words at a time without a breath

B) A 6-year-old male with a history of asthma whose breath sounds are silent and who is drowsy

C) A 31-year-old male who is unresponsive due to an overdose of narcotics

D) A 24-year-old woman who is breathing 28 times per minute after being in an argument with her husband

D) A 24-year-old woman who is breathing 28 times per minute after being in an argument with her husband. This is likely anxiety-induced hyperventilation and oxygen may worsen it.

21) What device is used to perform mouth-to-mask ventilation?

A) Pocket face mask

B) Bag-valve mask

C) Stoma

D) Automatic transport ventilator

A) Pocket face mask. A pocket mask is designed specifically for mouth-to-mask rescue breathing.

22) What is not one of the basic parts of a bag-valve-mask system?

A) Self-refilling shell

B) Non-jam valve

C) Nonrebreathing

D) 15/25 respiratory fitting

D) 15/25 respiratory fitting. The correct fitting is 15/22, not 15/25.

23) You are aggressively ventilating an adult patient with a bag-valve mask when you notice that his previously strong pulse is getting weaker. You should:

A) increase the concentration of oxygen.

B) reduce the concentration of oxygen.

C) reduce the volume of the ventilations.

D) begin chest compressions.

C) reduce the volume of the ventilations. Over-ventilation increases intrathoracic pressure and reduces venous return, weakening the pulse.

24) You and your EMT partner are preparing to ventilate an elderly non-trauma patient who has a stoma. Your partner performs the head-tilt, chin-lift maneuver and you ask him to return the patient's head to a neutral position. "Why? This is not a pediatric patient!" your partner protests. What would you say?

A) Elderly patients should never have their heads tilted back because spinal curvatures are common and can prevent airway positioning.

B) It is not necessary to position the airway of a stoma breather when providing ventilations.

C) Stoma breathers should only have their airways positioned after placement of the ventilation device.

D) Using the head-tilt, chin-lift prior to clearing any mucus plugs from the stoma can cause airway occlusion.

B) It is not necessary to position the airway of a stoma breather when providing ventilations. Ventilating through a stoma does not require head-tilt positioning.

25) A 21-year-old patient presents with labored breathing and audible wheezes, heart rate of 124, respiration 36 - he has significantly altered mentation. What is the treatment for this patient?

A) Supplement the breaths with high-concentration oxygen through a nonrebreather mask.

B) Use a pocket mask, which will provide adequate oxygen to improve the patient's condition.

C) Ventilate with a bag-valve mask with high oxygen or FROPVD.

D) Give mouth-to-mouth breathing with a nasal cannula, providing the patient with an increase of oxygen.

C) Ventilate with a bag-valve mask with high oxygen or FROPVD. Altered mentation and severe respiratory distress indicate inadequate breathing requiring positive pressure ventilation.

26) What is the percentage of oxygen provided by connecting a high flow of oxygen to the oxygen inlet found on a pocket mask?

A) 50%

B) 21%

C) 100%

D) 16%

A) 50%. A pocket mask with high-flow oxygen delivers about 50% oxygen concentration.

27) Your patient is a 55-year-old man with a history of chronic bronchitis. You have been called to his home today because of an increase in his level of respiratory distress. The patient is on 2 liters per minute of oxygen by nasal cannula at home. Your assessment reveals difficulty speaking due to shortness of breath, leaning forward to breathe, a productive cough, and a respiratory rate of 32 per minute. Which of the following is true concerning the best course of action for this patient?

A) Because increased blood levels of carbon dioxide are the primary stimulus to breathe, you should encourage the patient to rebreathe his exhaled air from a paper bag.

B) You should increase the patient's oxygen flow rate to deliver adequate amounts of oxygen to his tissues. If his respiratory rate decreases, you can assist him with a bag-valve-mask device.

C) You should increase the patient's oxygen flow rate until his respir

B) You should increase the patient's oxygen flow rate to deliver adequate amounts of oxygen to his tissues. If his respiratory rate decreases, you can assist him with a bag-valve-mask device. Oxygen should not be withheld from a patient in respiratory distress.

28) Which of the following is the best device to deliver high-concentration oxygen to a breathing patient?

A) Simple face mask

B) Nonrebreather mask

C) Nasal cannula

D) Oropharyngeal airway

B) Nonrebreather mask. A nonrebreather mask provides the highest oxygen concentration for a spontaneously breathing patient.

29) Your patient is a 65-year-old male with a history of COPD. He is sitting up and complaining of a severe shortness of breath. You should:

A) suction the airway with a rigid suction catheter.

B) administer 4 lpm of oxygen via nasal cannula.

C) insert a nasal airway and ventilate.

D) apply a nonrebreather mask giving 15 lpm of oxygen.

D) apply a nonrebreather mask giving 15 lpm of oxygen. COPD patients in severe distress should receive high-concentration oxygen.

30) A nonrebreather mask at 12 to 15 liters per minute will generally provide the patient what percentage of oxygen?

A) 80-90

B) 16-21

C) 24-44

D) 90-100

A) 80-90. At proper flow rates, a nonrebreather provides approximately 80-90% oxygen.

31) You are transporting a 44-year-old female with chest pain and sudden respiratory distress. She is agitated, anxious, and refuses to have a nonrebreather mask applied. Which of the following is the best option?

A) Use a nasal cannula instead.

B) Have her breathe into a paper bag to control her hyperventilation.

C) Do not make further attempts to administer oxygen as it will only agitate the patient further.

D) Consult with medical control about restraining the patient.

A) Use a nasal cannula instead. If the patient refuses a mask, a nasal cannula is better than no oxygen.

32) Before applying a nonrebreather mask, the EMT should take what action?

A) Insert a properly sized oropharyngeal airway.

B) Connect the mask to a humidified oxygen source and wait for the patient's heart rate to slow.

C) Make sure the oxygen supply has greater than 2,000 psi in the tank.

D) Inflate the reservoir bag and make sure the bag does not deflate during inspiration.

D) Inflate the reservoir bag and make sure the bag does not deflate during inspiration. The reservoir bag must be inflated before applying the mask to ensure proper oxygen delivery.

33) Which of these patients would require a tracheostomy mask for supplemental oxygen administration?

A) A patient with a stoma

B) A patient with quadriplegia

C) A patient with chronic bronchitis

D) A patient with upper airway inflammation

A) A patient with a stoma. A tracheostomy mask is designed to deliver oxygen directly over a stoma or tracheostomy tube.

34) A ________ is not typically used in the prehospital setting for oxygen administration.

A) nasal cannula

B) partial rebreather mask

C) regulator

D) tracheostomy mask

B) partial rebreather mask. Partial rebreather masks are uncommon in EMS and more likely to be found in home settings.

35) Venturi masks are designed to mix oxygen with:

A) nitrogen.

B) inhaled air.

C) humidified air.

D) carbon monoxide.

B) inhaled air. Venturi masks blend oxygen with room air to deliver specific oxygen concentrations.

36) The oxygen flow rate for a nasal cannula should not exceed ________ liters per minute.

A) 8

B) 4

C) 6

D) 2

C) 6. Flow rates above 6 LPM are uncomfortable and dry the nasal mucosa.

37) Which of the following oxygen cylinders would normally run out after 50 minutes when flowing at 10 liters per minute? Assume a pressure of 2,000 psi displayed on the pressure gauge.

A) M cylinder

B) D cylinder

C) G cylinder

D) E cylinder

D) E cylinder. An E cylinder holds about 625 liters, which lasts roughly 50 minutes at 10 LPM.

38) You are attempting to replace the oxygen cylinder in your truck. After removing the regulator from the old cylinder, removing the old cylinder, and placing the new cylinder in the oxygen compartment, you attempt to connect the regulator. The new cylinder is yellow rather than green, but it was stored with the green cylinders. You are unable to get the regulator to seat properly and it will not turn. You should:

A) attempt to force the regulator onto the cylinder.

B) remove the yellow cylinder and get a green cylinder.

C) replace the oxygen regulator with a new one.

D) put the old cylinder back on the truck.

B) remove the yellow cylinder and get a green cylinder. Oxygen tanks are green (or green and white), and regulators are gas-specific and should never be forced.

39) Which of the following is acceptable for maintaining a seal between an oxygen cylinder and regulator?

A) Pop-off valve

B) Gasket

C) Grease plug

D) Medical grade adhesive tape

B) Gasket. A properly seated gasket prevents leaks between the cylinder and regulator.

40) Of the three types of oxygen flowmeters, which one can only be used upright?

A) All flowmeters must be used upright

B) High-pressure flowmeter

C) Constant flow selector valve

D) Pressure-compensated flowmeter

D) Pressure-compensated flowmeter. Pressure-compensated flowmeters rely on gravity and must remain upright to read correctly.

41) Which of the following colors identifies an oxygen cylinder?

A) Orange

B) Black

C) Blue

D) Green

D) Green. Oxygen cylinders are color coded green (or green and white) in the United States.

42) The safe residual for an oxygen cylinder is ________ psi.

A) 200

B) 300

C) 500

D) 1,000

A) 200. Oxygen cylinders should not drop below 200 psi to avoid damage and ensure usable supply.

43) Which of the following is necessary to deliver oxygen to patients at a safe pressure?

A) Filter

B) Float ball

C) Regulator

D) Flowmeter

C) Regulator. A regulator reduces the high cylinder pressure to a safe working pressure for patient delivery.

44) Concerning the use of humidified oxygen, which of the following is true?

A) It should only be used when assisting ventilations with a bag-valve-mask device.

B) The water in the reservoir should be treated with chlorine tablets to prevent the growth of bacteria.

C) It is not of great benefit during short transports but can make the patient more comfortable.

D) The water reservoir should be changed on a weekly basis.

C) It is not of great benefit during short transports but can make the patient more comfortable. Humidification is mainly helpful for longer oxygen use to reduce dryness and irritation.

45) While ventilating an intubated patient with a bag-valve-mask-unit, you notice increased resistance to the ventilations. This may indicate that:

A) the patient is becoming more alert and is breathing independently.

B) air is escaping through a hole in the lung and filling the pleural space.

C) the gag reflex is returning.

D) cardiac arrest is imminent.

B) air is escaping through a hole in the lung and filling the pleural space. Increased resistance can indicate a pneumothorax developing and is a serious complication.

46) The paramedic is intubating a patient and asks you to assist by gently pressing your thumb and index finger to either side of the throat just over the patient's Adam's apple. As you press, you gently direct the throat upward and to the patient's right. What is the purpose of this maneuver?

A) It prevents the tube from entering the right mainstem bronchus.

B) It lessens the patient's gag reflex and eases tube insertion.

C) It pushes the patient's vocal cords into the paramedic's view.

D) It keeps the tube from becoming displaced and entering the esophagus.

C) It pushes the patient's vocal cords into the paramedic's view. The BURP maneuver improves visualization of the vocal cords to assist intubation.