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: A rate of 32/min might look like something to take over, but full symmetric chest rise with no accessory muscle use and an alert, warm, dry, pink presentation mean this breathing is adequate. Bagging an awake patient fights their own effort, risks gastric distention, and drives carbon dioxide even lower, worsening the symptom BVM is meant to relieve.

Encourage the patient to take deeper and faster breaths until the symptoms resolve: Breathing deeper and faster matches what the complaint of not getting a full breath seems to call for, but that sensation is caused by the low carbon dioxide the current rate of 32/min already created. Pushing the rate and depth up further drives carbon dioxide down more and intensifies the tingling and air hunger instead of fixing it.

Have the patient breathe into a paper bag to control the rate: Rebreathing into a paper bag was the old teaching for hyperventilation syndrome, aimed at raising carbon dioxide the same way slower coaching does. It's been dropped because the cause here isn't confirmed benign, and if the rapid rate were compensating for something like a pulmonary embolism or asthma, restricting oxygen would make a sick patient sicker.

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 the right side is a reasonable next step in your assessment, but you already found the life threat: the sucking wound. Stopping to listen before sealing it delays the one intervention that's actually needed right now.

Begin positive pressure ventilations with a BVM: Positive pressure ventilations with a BVM don't close the chest wall defect that's letting air into the pleural space with every breath; ventilating an unsealed wound just pushes more air through the hole and worsens the collapse.

Place a bulky gauze dressing over the wound: A bulky gauze dressing is the right call for padding an evisceration or bulky wound packing, but plain gauze isn't airtight, so it lets air keep moving through the defect on inspiration; this wound needs a specifically occlusive seal, not bulk.

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: An unsealed open wound can progress into tension pneumothorax as trapped air raises pleural pressure, shifting the trachea and dropping blood pressure. This patient's wound is open, hissing with each breath, not absent breath sounds, hypotension, or jugular vein distention. That escalation is the complication you watch for after sealing the wound, not this injury.

Flail chest: shows paradoxical chest wall movement from multiple rib fractures on a segment that moves opposite the rest of the chest during breathing, a finding absent here where the wound instead produces an audible hissing airflow.

Hemothorax: presents with diminished breath sounds and signs of shock as blood collects in the pleural space, not the hissing sound of air moving through a chest wall wound described in this case.

Give additional naloxone until the patient is fully awake: Additional naloxone belongs to a patient who is still hypoventilating after the first dose, since repeat dosing is reserved for an inadequate response. Here the respirations have already recovered to 14/min with adequate chest rise, so chasing full wakefulness treats the sedation instead of the actual goal, which was restoring breathing.

Resume positive pressure ventilations with a BVM: Resuming positive pressure ventilations with a BVM is correct if the rate or depth falls again, but right now the patient is moving air adequately on their own at 14/min, so applying that action now is the right skill in the wrong sequence.

Insert an oropharyngeal airway before moving the patient: An oropharyngeal airway is reserved for a patient without an intact gag reflex; responding to a loud voice signals enough airway protective reflexes that inserting one risks triggering gagging or vomiting.

Listen over the center of the sternum in one location: Listening over the center of the sternum in one location gets picked because sound seems to travel and a central spot feels efficient, but heart and large airway noise dominate there and mask the peripheral lung fields, plus one site gives nothing to compare against for the asymmetry this presentation needs ruled out.

Listen through the clothing to save time: Listening through the clothing to save time appeals when the EMT is trying to move fast on scene, but fabric rustling and muffling distort or hide genuine crackles, wheezes, or diminished sound, so the stethoscope has to reach skin for the finding to be trustworthy.

Listen only on the side where the discomfort is reported: Listening only on the side where the discomfort is reported feels logical since that seems like where the problem lives, but a collapsed lung or fluid buildup can leave that side unremarkable while the opposite side is actually diminished, and skipping the comparison misses exactly the asymmetry auscultation exists to find.

Assist the patient with a prescribed albuterol metered-dose inhaler: An albuterol metered-dose inhaler treats bronchospasm from asthma or COPD, where you'd expect wheezing. This patient has crackles throughout both lung fields from fluid, not bronchoconstriction, so albuterol doesn't touch the underlying problem.

Continue high-flow oxygen by NRB and transport rapidly: Continuing high-flow oxygen by NRB fits a patient whose saturation responds to passive oxygen or who can't tolerate a mask seal. Here the SpO₂ of 84% on the NRB proves it isn't enough, and CPAP is the next necessary step, not a rapid transport without escalating support.

Begin positive pressure ventilations at 12/min with a BVM at 15 L/min: Positive pressure ventilation with a BVM is for inadequate respiratory effort, apnea, or a declining mental status. This patient is following commands and generating their own respirations, so BVM jumps ahead of CPAP, which is the correct tool at this stage.