9 free AEMT practice questions: Respiratory Emergencies and Nebulized Medications

A leak in the capnography sampling line: A sampling cannula sits loosely in the nose, so checking the equipment is a fair first step when a tracing looks odd. A leak makes the waveform small or ragged and lowers the reading. A leak does not slant the upstroke. A steady slow climb is an airflow problem, not a sampling problem.

A fall in the patient's cardiac output: Capnography shows circulation as well as breathing. When cardiac output falls, less blood carries carbon dioxide to the lungs, and the waveform gets shorter. Falling cardiac output changes the height of the waveform, not the slope of the upstroke.

Ventilations being delivered too quickly: Ventilations delivered too fast blow off carbon dioxide and lower the reading. This patient is breathing without help, and the reading is 48 mmHg. A rate problem moves the number and leaves the slope of the upstroke alone.

One breath every 6 seconds: the adult rate for a patient with a pulse. A child needs more oxygen than an adult, so this child gets too few breaths at the adult rate.

One breath every 10 seconds: only 6 breaths a minute. That rate is too slow for a patient of any age. A child ventilated that slowly keeps getting worse.

Two breaths after every 30 compressions: the ratio for CPR. This child has a pulse of 150, so this child needs ventilations, not compressions.

Remove the oxygen and watch the breathing: Removing the oxygen follows the hypoxic drive myth, the idea that oxygen shut off this patient's drive to breathe. Hypoxic drive is not real physiology. This patient was hypoxic 10 minutes ago. Taking the oxygen off makes this patient hypoxic again and does nothing for the failing ventilation.

Sit the patient up and reassess in 5 minutes: Sitting up helps a patient who is still moving air and doing the work of breathing. This patient is at R 8 and hard to rouse, with no effort left for that position to help. Waiting 5 minutes is far too long.

Repeat the nebulized bronchodilator treatment: A nebulized treatment only works if the patient can pull the mist deep into the lungs. This patient is barely moving air. The medication cannot reach airways that air is not reaching.

1 mg mixed with saline and driven by oxygen: 1 mg is less than the standard dose. Nebulized albuterol is not titrated down for an adult with active bronchospasm. A smaller dose just treats this patient less.

0.3 mg mixed with saline and driven by oxygen: 0.3 mg is the adult epinephrine auto-injector dose, not an albuterol dose. Tie 0.3 mg to anaphylaxis and 2.5 mg to the nebulizer.

10 mg mixed with saline and driven by oxygen: 10 mg is double even the highest documented dose. Protocols that allow more than the standard dose reach about 5 mg for severe bronchospasm, not 10 mg.

Acute pulmonary edema, because fluid has filled the alveoli: Pulmonary edema fills the alveoli with fluid, and that gives you crackles. The crackles start at the bases and move upward on both sides. This patient has coarse sounds over one lobe that change with a cough.

An acute asthma attack, because the lower airways have narrowed: An asthma attack narrows the small airways. You hear wheezing across both lung fields with a long exhale. This patient has coarse sounds in one spot that change with a cough, with clear sounds everywhere else.

A spontaneous pneumothorax, because air has entered the pleural space: A pneumothorax is air in the pleural space. A pneumothorax gives you decreased or absent breath sounds on the affected side, and it comes on suddenly. This patient has three days of fever and coarse sounds that change with a cough.

Fluid filling the alveoli behind a failing left ventricle: Fluid in the alveoli behind a failing left ventricle is pulmonary edema. Pulmonary edema makes crackles, which sound like fine popping. Crackles come from a different level of the lung than these coarse sounds.

Air trapped behind small airways that cannot empty fully: Air trapping is real in COPD, and air trapping is why the exhale takes so long. Trapped air does not make a coarse, low-pitched sound. Air trapping shows up as the diminished sounds and the wheezing.

Narrowing of the upper airway above the level of the vocal cords: Narrowing above the vocal cords makes stridor. Stridor is heard on inhalation, and stridor comes from the upper airway instead of the chest.

Wheezing heard through both lung fields: Wheezing through both lung fields happens in asthma and in COPD. Both conditions narrow the same small airways with bronchospasm. Wheezing does not tell you which patient you have.

Breathing that returns to normal between flares: describes the asthma patient. The bronchospasm and inflammation of asthma reverse completely. The COPD damage does not go away, and the COPD patient only gets back to their own baseline shortness of breath.

A prolonged expiratory phase during the attack: A prolonged expiratory phase happens with any narrowing of the lower airways. Air trapping slows the exhale in asthma and in COPD. A long exhale does not separate COPD from asthma.

0.5 mg, which is one fifth of the usual adult dose: One fifth of the adult dose undertreats a child in active bronchospasm. A nebulized dose is not scaled by body size the way an injected or IV drug is.

1.25 mg, calculated at half of the adult dose: Half the adult dose looks like careful pediatric dosing. The standard nebulized albuterol dose for a child is the same as the adult dose. A dose of 1.25 mg gives this child only half of that.

0.1 mg per kilogram, which comes to 2 mg here: A per-kilogram dose is right for many pediatric drugs. Nebulized albuterol is not one of them. Having a weight in the question does not make the dose weight-based.

It provides a much higher oxygen concentration than an NRB delivers: You can turn up the oxygen on a CPAP circuit. A nonrebreather at 15 liters per minute already gives about 90% oxygen. CPAP does not get these fast results by giving more oxygen than a nonrebreather. The improvement comes from the pressure on the alveoli.

It relaxes bronchial smooth muscle to reverse the airway constriction causing this: Relaxing bronchial smooth muscle is how a bronchodilator like albuterol works in asthma or COPD. In those patients, tight airways cause wheezing. Cardiogenic pulmonary edema fills the alveoli with fluid. Pulmonary edema does not tighten the airways, so CPAP has no constriction to reverse here.

It actively suctions the accumulated fluid out of the alveoli through the mask: CPAP has no suction in the mask or the circuit and works only by keeping positive pressure in the airway. The fluid moves because the pressure pushes it back into the pulmonary circulation. Nothing pulls fluid out through the mask.