10 free EMT practice questions: Breathing Assessment

Apply an NRB at 15 L/min: An NRB at 15 L/min raises the oxygen concentration of each breath, which is the correct treatment when a patient is moving adequate air but is hypoxic, an oxygenation problem. This patient's problem is ventilation, the volume of air being moved, and enriching a breath that is too small to matter does not make the breath any bigger. The key adds volume to each breath and can deliver high-concentration oxygen at the same time, so it does everything the mask does plus the thing the mask cannot.

Reassess the patient's breathing again in 5 minutes: Reassessing in 5 minutes is what you do for a stable patient with a reassuring assessment where you are watching for change. Here the assessment has already identified inadequate ventilation, and inadequate ventilation is a treat-now finding rather than a watch-and-see one. The key acts on what the exam has already established instead of confirming it again in five minutes, during which a patient with a low tidal volume can decompensate.

Apply a pulse oximeter to determine whether ventilatory support is needed: A pulse oximeter measures oxygen saturation, not ventilation, so it can read normal in a patient who is retaining carbon dioxide and moving far too little air, especially early and especially in a young patient. The decision to assist ventilations is made on rate and tidal volume at the bedside, both of which you have already assessed. Waiting for a number to authorize a decision the physical exam has already made only delays care, and the key acts on the exam.

Assist ventilations with a BVM to slow the breathing rate: BVM ventilation is for inadequate breathing: shallow or absent chest rise, a rate too slow or too fast to move real volume, altered mentation, cyanosis. Every one of those markers is absent here: full symmetric chest rise, no accessory muscle use, alert, warm, dry, and pink. A mask squeezed against an awake, anxious patient's face also cannot pace them into a slower rate. It fights their own effort, risks gastric distention, and can drive carbon dioxide even lower, making the symptoms worse rather than better.

Encourage the patient to take deeper and faster breaths until the symptoms resolve: Deeper and faster breathing is what the complaint seems to ask for, and that surface match is the trap: this patient already has a very high minute volume, and the feeling of being unable to get a full breath is produced by the low carbon dioxide level that over-breathing created. Coaching the rate and depth upward drives carbon dioxide down further and intensifies the symptoms; the fix runs in the opposite direction, slowing the rate so carbon dioxide can climb back toward normal.

Have the patient breathe into a paper bag to control the rate: Rebreathing into a paper bag is the answer that was taught for hyperventilation syndrome for decades, which is exactly why it survives as a distractor. It has been abandoned because it is not safe: if the fast breathing is compensating for a hypoxic or metabolic cause (pulmonary embolism, asthma, acidosis) then limiting oxygen and forcing carbon dioxide back in makes a sick patient sicker. The key reaches the same goal of slowing the rate without ever restricting the oxygen available to a patient whose cause is not yet confirmed.

Deliver rescue breaths only, without chest compressions: Rescue breaths alone is the correct treatment for a real and distinct patient, namely respiratory arrest with a pulse, where the patient is not breathing but the heart is still circulating blood, so ventilation is the only thing missing. The question closes that door with one line, a 10-second carotid check revealing no pulse, and that finding is exactly the discriminator between respiratory arrest and cardiac arrest. The key beats it because ventilating a patient with no circulation oxygenates blood that is going nowhere, and compressions are what move it.

Insert an oropharyngeal airway and apply an NRB: An oropharyngeal airway with an NRB is right for the unresponsive patient who has a pulse and is breathing adequately, where the job is to hold the airway open and enrich the oxygen. An NRB only works if the patient generates the inspiratory effort to pull from it, and agonal gasps do not, and there is no circulation here to carry oxygen anywhere regardless. The key beats it because this is passive management for a patient who needs the most active intervention there is.

Reassess for a pulse again in one minute before starting compressions: The instinct behind waiting is not baseless, since pulse checks are genuinely unreliable and providers do miss weak pulses. That is the exact reason the rule caps the check at 10 seconds and says that if you are not sure you start compressions, rather than telling you to check again in a minute. A minute without compressions is a minute without perfusion, and compressions started on a patient who turns out to have a pulse cause far less harm than compressions withheld from a patient who does not.

Continue to monitor because the respiratory rate is within normal limits: Continuing to monitor is correct when both rate and depth are adequate and the mental status is stable, because then trending is genuinely the intervention. The trap is treating 14 per minute as proof of adequacy when the rate is only half the equation, and this patient's chest barely moves with each breath. The key supplies the volume the patient is missing, while watching a failing ventilation supplies nothing and lets the carbon dioxide keep climbing.

Apply an NRB and reassess after immobilizing the spine: An NRB is right for a spontaneously breathing patient who moves adequate volume but is hypoxemic, because it raises the oxygen concentration of each breath the patient takes. It cannot make a breath bigger, so it does nothing about retained carbon dioxide, which is what is driving the intracranial pressure up in a head-injured patient. Deferring to immobilize the spine first also inverts the priority order, and the key fixes the deficit that is actually present, since oxygen corrects oxygenation but only positive pressure corrects ventilation.

Insert a nasopharyngeal airway and monitor breathing: A nasopharyngeal airway is the correct adjunct for an unresponsive patient with a mechanically obstructed upper airway, and it is tolerated at a level of consciousness where an oral airway would not be. Nothing in this question describes obstruction, with no snoring, gurgling, or stridor mentioned, so there is no obstruction for it to relieve, and in a head-injured patient a nasal airway also carries the standard caution about mid-face and skull base injury. An adjunct keeps a path open but does not move gas through it, and the key wins because an open airway with a tidal volume this small is still inadequate ventilation.

Auscultate the breath sounds on the right side: Auscultating breath sounds on the right side is reasonable ongoing assessment, but it delays sealing a life threat that's already been found and needs to be treated the moment it's identified.

Begin positive pressure ventilations with a BVM: Beginning positive pressure ventilations doesn't address the open wound letting air into the pleural space, sealing the wound is the immediate life-threat intervention here.

Place a bulky gauze dressing over the wound: A bulky gauze dressing without being occlusive doesn't stop air from continuing to move through the chest wall defect: the seal specifically needs to be airtight to stop the sucking chest wound from continuing to draw air in.

Crying increases the rate of the respirations: Crying increasing the respiratory rate doesn't explain why breathing specifically improves with crying: the rate change is a side effect, not the actual mechanism relieving the distress.

The lower airways open more fully during crying: The lower airways opening more fully during crying isn't what's happening here. This infant's problem is upper airway blockage from nasal secretions, not a lower airway process.

Secretions drain from the lungs when the infant cries: Secretions draining from the lungs when the infant cries doesn't describe what's actually occurring: the secretions are blocking the nostrils, not sitting in the lungs, and crying doesn't drain them from the nose.

Tension pneumothorax: recognized by absent breath sounds with hypotension and jugular vein distention, not simply by the hissing sound of air moving through a wound. That sound is the sign of the open chest wall defect itself.

Flail chest: recognized by paradoxical chest wall movement from multiple rib fractures, not by the sound of air moving through a penetrating wound.

Hemothorax: recognized by diminished breath sounds with shock from blood collecting in the chest, not by an audible hissing sound as air moves through a wound with each breath.

Give additional naloxone until the patient is fully awake: Giving additional naloxone until the patient is fully awake chases full arousal rather than the actual treatment goal, which is adequate breathing: already achieved at 14/min with adequate chest rise.

Resume positive pressure ventilations with a BVM: Resuming positive pressure ventilations isn't needed. This patient is now breathing adequately on their own.

Insert an oropharyngeal airway before moving the patient: Inserting an oropharyngeal airway isn't appropriate for a patient who is drowsy but responds to a loud voice, since that level of responsiveness likely still has a gag reflex.

Listen over the center of the sternum in one location: Listening over the center of the sternum in one location gives a single sound that can't be compared against anything: breath sounds only carry information when one side is compared against the other at matching landmarks.

Listen through the clothing to save time: Listening through the clothing to save time muffles and adds extra sound, distorting exactly the comparison the EMT needs to make.

Listen only on the side where the discomfort is reported: Listening only on the side where the discomfort is reported can miss a finding developing on the opposite side, comparing both sides is what catches an asymmetric problem the patient hasn't noticed yet.

Assist the patient with a prescribed albuterol metered-dose inhaler: An albuterol metered-dose inhaler doesn't address the fluid overload driving this presentation. This is cardiogenic pulmonary edema, not primarily bronchospasm.

Continue high-flow oxygen by NRB and transport rapidly: Continuing high-flow oxygen by NRB alone isn't sufficient for this severity: an alert, cooperative patient in pulmonary edema benefits from positive pressure support that an NRB can't provide.

Begin positive pressure ventilations at 12/min with a BVM at 15 L/min: BVM ventilations are reserved for inadequate respiratory effort or a declining mental status. This patient is following commands and breathing on their own, which makes CPAP the better fit.