EMT Chapter 10 - Airway Management - Multiple Choice

Breathing is controlled by an area in the:

A. lungs.

B. brain stem.

C. spinal cord.

D. diaphragm.

Answer: B

Rationale: The pons and the medulla are the respiratory centers in the brain stem that control breathing.

The EMT should assess a patient's tidal volume by:

A. observing for adequate chest rise.

B. assessing the facial area for cyanosis.

C. counting the patient's respiratory rate.

D. measuring the patient's oxygen saturation.

Answer: A

Rationale: Tidal volume—the volume of air that is moved into or out of the lungs in a single breath—is assessed by observing for adequate chest rise. If shallow chest rise is noted, the patient's tidal volume is likely reduced.

In an otherwise healthy individual, the primary stimulus to breathe is a(n):

A. increased level of oxygen in the blood.

B. decreased level of oxygen in the blood.

C. increased level of carbon dioxide in the blood.

D. decreased level of carbon dioxide in the blood.

Answer: C

Rationale: Under control of the brain stem, rising levels of carbon dioxide in arterial blood normally stimulate breathing in an otherwise healthy patient.

Signs of adequate breathing in the adult include all of the following, EXCEPT:

A. pink, warm, dry skin.

B. shallow chest rise.

C. symmetrical chest movement.

D. a respiratory rate of 16 breaths/min.

Answer: B

Rationale: Signs of inadequate breathing in the adult include a respiratory rate less than 12 breaths/min or greater than 20 breaths/min, shallow chest rise (reduced tidal volume), cyanosis, and asymmetrical chest movement (both sides of the chest do not move equally).

During insertion of an oropharyngeal airway into an unconscious patient, she begins to vomit. The first thing you should do is:

A. turn the patient on her side.

B. remove the airway at once.

C. suction the patient's mouth.

D. use a smaller-sized oral airway.

Answer: A

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

In which of the following patients would a nasopharyngeal airway be contraindicated?

A. A semiconscious patient with a gag reflex

B. An unconscious patient with an intact gag reflex

C. A patient who fell 20 feet and landed on his or her head

D. An unconscious patient who gags when you insert an oral airway

Answer: C

Rationale: Nasopharyngeal (nasal) airways are contraindicated in patients with severe head or facial injuries and should be used with caution in patients who have delicate nasal membranes or are prone to nosebleeds. The nasal airway is better tolerated in patients who are semiconscious and/or those with a gag reflex.

You are delivering oxygen to a patient with a nasal cannula at 4 L/min when he begins to complain of a burning sensation in his nose. You should:

A. remove the nasal cannula.

B. apply a nonrebreathing mask.

C. attach an oxygen humidifier.

D. increase the flow rate to 6 L/min.

Answer: C

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

A patient is found unconscious after falling from a third floor window. His respirations are slow and irregular. You should:

A. place him in the recovery position.

B. apply oxygen via a nonrebreathing mask.

C. suction his airway for up to 15 seconds.

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

Answer: D

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

When ventilating an apneic adult with a bag-valve mask, you should squeeze the bag:

A. until it is empty.

B. over a period of 2 seconds.

C. at a rate of 20 breaths/min.

D. until visible chest rise is noted.

Answer: D

Rationale: When ventilating any apneic patient with a bag-valve mask, you should squeeze the bag over a period of 1 second and observe for visible chest rise. Ventilate the apneic adult at a rate of 10 to 12 breaths/min (one breath every 5 seconds). Ventilate infants and children at a rate of 12 to 20 breaths/min (one breath every 3 seconds).

You and your partner are ventilating an apneic adult when you notice that his stomach is becoming distended. You should:

A. suction his airway for up to 15 seconds.

B. reposition his head.

C. increase the rate and volume of your ventilations.

D. decrease your ventilation rate but use more volume.

Answer: B

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

Which of the following is the backup system to the CO2 drive?

A. carbon dioxide drive

B. hypoxic drive

C. anoxic drive

D. oxygen drive

Answer: B

Rationale: The hypoxic drive is the backup system to the CO2 drive.

You have just initiated BVM ventilations for your apneic patient. Which of the following is most important to help determine if artificial ventilations are being delivered effectively?

A. Check the pupillary response.

B. Assess distal pulses.

C. Auscultate lung sounds.

D. Palpate the chest.

Answer: C

Rationale: Two of the most important assessments to determine if artificial ventilations are being delivered effectively are auscultating lung sounds and observing for chest rise and fall.

Which of the following indicates the need for supplemental oxygen by nasal cannula or non rebreather?

A. An SaO2 reading of 93%

B. Clear bilateral lung sounds

C. Slow and shallow respirations

D. Warm, dry skin

Answer: A

Rationale: An SaO2 below 94% indicates the need for supplemental oxygen. Slow, shallow respirations indicate the need for artificial ventilations, not a nasal cannula or NRB. Clear lung sounds and warm, dry skin are normal findings.

Your patient is responsive only to painful stimuli. The airway is clear. How should you manage the patient's airway?

A. Suction the airway.

B. Insert an OPA.

C. Insert an NPA.

D. Begin artificial ventilations.

Answer: C

Rationale: The patient has a clear airway, so suction is not needed. The patient has a decreased LOC, so insertion of an NPA is indicated. The OPA is contraindicated because the patient is not unresponsive. The need for artificial ventilations is based on the patient's breathing status (not provided), not the patient's LOC.

Due to the risk of hypoxia, suction time should not exceed

A. 30 seconds for an adult.

B. 30 seconds for a child.

C. 15 seconds for an infant.

D. 15 seconds for an adult.

Answer: D

Rationale: Suctioning increases the risk of hypoxia. Suction time should not exceed 15 seconds for an adult, 10 seconds for pediatric patients, and 5 seconds for infants.

You attempt to ventilate the patient with a BVM and notice resistance. The chest does not rise during your ventilation. What should you do?

A. Reposition the airway by hyperextending the head to allow for better anatomic position, then attempt to ventilate.

B. Assume there is a foreign body airway obstruction and immediately begin chest compressions.

C. Assume there is a foreign body airway obstruction and provide forceful ventilations.

D. Reposition the airway by bringing the head back to a neutral position, then reopen the airway and attempt to ventilate.

Answer: D

Which of the following indicates that your artificial ventilations are inadequate?

A. Minimal or no chest rise and fall

B. Increased levels on pulse oximetry

C. Heart rate returning to normal range

D. Warm, pink skin

Answer: A

How can gastric distention be prevented when performing artificial ventilations?

A. Provide rapid, forceful breaths during artificial ventilation over 1 second.

B. Provide slow, gentle breaths during artificial ventilation over 1 second.

C. Provide rapid, forceful breaths during artificial ventilation over 3 seconds.

D. Provide slow, gentle breaths during artificial ventilation over 3 seconds.

Answer: B

Which of the following is contraindicated in a patient who has sustained a head injury?

A. Insertion of an oral airway

B. Jaw-thrust maneuver

C. Mouth-to-mask ventilation

D. Insertion of a nasal airway

Answer: D

While you are performing artificial ventilations on this patient, he vomits. What should you do?

A. Roll the patient onto his side to allow for drainage of emesis.

B. Continue ventilations with increased force to prevent aspiration.

C. Immediately stop ventilations and begin chest compressions.

D. Stop ventilations and wait for advanced life support to arrive.

Answer: A

Your partner applied a pulse oximeter to the patient. While ventilating, you note adequate chest rise and fall and improved skin color; however, the oxygen saturation reads 88%. Which of the following is a potential cause of an inaccurate pulse oximetry reading?

A. Hypertension

B. Peripheral vasoconstriction

C. Jaundice

D. Diabetes

Answer: B