10 free EMT practice questions: Respiratory Emergencies & Airway Management

Difficulty breathing: tells you the patient is in trouble and is the reason to move urgently, so it is never a finding to dismiss. It is also the one symptom shared by every respiratory emergency: asthma, pulmonary edema, pneumothorax, and angioedema all produce it, so it cannot point to a location. The key uses a finding that only upper airway narrowing produces, which is what the question is asking for.

Whispered speech: a legitimate severity marker; how many words a patient can string together is one of the fastest bedside measures of air movement, and a whisper means very little is moving. It changes with anything limiting airflow or vocal cord motion, upper or lower, so it grades how bad this is without saying where the narrowing sits. The key names the location; this finding names only the degree.

Facial and lip swelling: shows where the swelling is visible externally, and it is exactly why you should suspect the tongue and airway are involved. It is the reason this patient gets treated as an airway emergency. Visible swelling on the outside is not evidence of where airflow is actually obstructed; a patient can have facial swelling with a completely patent airway. The key is a finding produced by air moving past the narrowing itself, which is direct evidence rather than inference.

No supplemental oxygen, since the patient denies significant distress: Taking the patient's own report seriously is good practice, and there are absolutely patients with mild complaints who need no oxygen at all. It fails here because the question deliberately puts the subjective and objective findings in conflict and then tells you which is which: the patient denies distress, but the lips are cyanotic and consciousness is slipping. When those two disagree, the physical findings win, and withholding oxygen on the strength of the complaint leaves a hypoxic patient hypoxic.

Nasal cannula titrated to effect: A nasal cannula is the right device for mild hypoxia, for a patient who will not tolerate a mask, and for titrating gently toward a target saturation in someone with chronic lung disease. Its ceiling is low-flow, low-concentration delivery, which is not sized to a patient who is already cyanotic and losing alertness. The key starts high because the deficit is large; you can always titrate down once the color and mental status recover.

Assist ventilations with a BVM: Assisting ventilations is the answer when the bellows are failing: an inadequate rate, poor tidal volume, apnea, or agonal breathing. This patient is at 22 with no noticeably increased effort and is speaking in full sentences, which is a lot of air movement and tells you ventilation is not the failing component. Oxygenation is, so the key targets that directly, while keeping in mind that continued deterioration in mental status would change the answer.

Deliver back blows, since the patient is at higher risk due to the underlying lung disease: Back blows are correct for a choking infant under one year, paired with chest thrusts, and appear in severe-obstruction sequences for older patients in many systems. What rules them out here is the effective cough, intervening on a patient who is still moving air risks dislodging a partially obstructing object into a fully obstructing position. Underlying lung disease changes how much reserve this patient has, not the air-movement rule that decides whether you intervene at all.

Assume the cough is from the patient's baseline COPD and continue the assessment: Attributing a chronic cough and chronic diffuse wheezing to baseline chronic obstructive pulmonary disease is entirely reasonable when nothing has changed. Two details say something changed: the cough started suddenly on a bite of food, and the family, who know this patient's baseline, report it sounds different. Writing off a new, sudden, food-associated change as baseline disease is how a foreign body gets missed until the patient goes silent.

Perform abdominal thrusts due to the patient's underlying lung disease: Abdominal thrusts become the right answer the moment this patient stops moving air, goes silent, cannot speak, or turns cyanotic. Right now the patient is speaking in short phrases and is pink, so the criterion for thrusts is not met. This option and the key sit on the same treatment ladder; the key is simply the rung that matches current air movement, and thrusts are what you escalate to the second that changes.

Presence of inspiratory stridor: Inspiratory stridor correctly tells you the obstruction is in the upper airway, which is a genuinely useful piece of information and part of why this child is sick. It just does not discriminate, because croup is the textbook cause of pediatric stridor and epiglottitis produces it as well. A finding shared by both candidates on the differential can never be the discriminator between them.

Presence of fever without other signs: Fever is present in both conditions, and in croup it is often the first thing a parent notices. The option's own premise also does not match the question. This child has fever alongside drooling, stridor, a muffled voice, and tripoding, so the fever is anything but isolated. Fever narrows the field to an infectious cause and stops there, which is not far enough to change management.

Tripod positioning during breathing: Tripod positioning is a real and important finding: the child is instinctively holding the airway in its most open position, and you should never force them out of it. It occurs in croup, in epiglottitis, and in severe asthma alike, because it is a response to any high work of breathing rather than to one specific infection. It tells you how hard the child is working, not which disease is making them work, so it cannot settle the question.

Position the child upright for transport: Positioning a patient upright for transport suits a responsive patient with a partial obstruction who is still moving air. You let them hold the position they choose and get moving. This child is unresponsive and not breathing, which is an arrest situation managed on a firm flat surface, not in a seat. Packaging first spends the minutes that decide this outcome and delays the compressions that are the only thing likely to move the object.

Assist ventilations with a BVM: BVM ventilation is exactly right for an unresponsive, apneic patient whose airway is open, an overdose, a head injury, a respiratory arrest with a pulse. The question hands you the reason it will not work: a witnessed foreign body lodged in the airway means air has nowhere to go. Squeezing the bag against a complete obstruction wastes time and can force air into the stomach, raising the aspiration risk without delivering any oxygen.

Insert an oropharyngeal airway and ventilate: An oropharyngeal airway holds the tongue off the back of the throat, which is the right fix for the most common airway obstruction in an unresponsive patient. It does nothing for an object sitting below it, and sliding a rigid device in can push a foreign body further down. The key starts compressions, which is the maneuver that can actually generate the pressure needed to expel the grape, and looks for the object where it can be safely removed.

Assist ventilations with a BVM: BVM ventilation is correct when rate or tidal volume fails, meaning respirations too slow, too fast, or too shallow to move air. A decreased level of consciousness by itself is not that trigger, and this patient is at 16 per minute with good, equal chest rise. Forcing positive pressure on a patient who is already ventilating adequately risks gastric insufflation and vomiting, and the key supports the part that is actually failing, which is the airway rather than the breathing.

Insert an oropharyngeal airway and begin ventilating: An oropharyngeal airway is the right adjunct for a deeply unresponsive patient with no gag reflex, and in that patient it holds the tongue forward better than a nasal airway does. This patient still withdraws to pain and vocalizes, so enough protective reflex remains that an OPA is likely to be gagged out or provoke vomiting. This option also adds ventilation the patient does not need, so it gets both the adjunct choice and the breathing assessment wrong at once.

Apply an NRB without an airway adjunct: An NRB is a reasonable oxygen device for a patient with an intact airway who needs a higher concentration, and oxygen may well be part of this patient's care. A mask does nothing to hold an airway open, though, because a tongue that falls back obstructs just as completely with 15 liters flowing over it. The key addresses the mechanical obstruction risk first, since a patent airway is the prerequisite for any oxygen device to accomplish anything.

It reduces airway swelling over several hours: Reducing swelling over several hours describes an anti-inflammatory medication's slower action, a different mechanism from albuterol's fast bronchodilating effect.

It thins mucus so it can be coughed up: Thinning mucus is not albuterol's mechanism: its action is on the smooth muscle of the bronchioles, not on mucus consistency.

It sedates the patient to reduce anxiety-driven breathing: Albuterol is a bronchodilator with no sedating properties; it does not act on anxiety or sedation.

The child is improving in response to the oxygen therapy and should continue the current treatment unchanged: The declining level of consciousness with reduced respiratory effort indicates failure, not a response to therapy; continuing the current treatment without escalation misses the deterioration.

The child has responded well to the oxygen and can be weaned off the supplemental oxygen during transport: Weaning oxygen is only considered in a patient who is genuinely improving; this child's decreasing responsiveness shows worsening, so supplemental oxygen must continue while the EMT prepares to assist ventilations.

The child is calming in response to the mother's reassurance, and the slower breathing reflects improving oxygenation: A parent's reassurance does not explain a falling level of consciousness; a slower respiratory rate with declining responsiveness in a sick child signals fatigue and impending respiratory failure, not improving oxygenation.

Apply high-flow oxygen by NRB to achieve an oxygen saturation of 98% or greater: Forcing the oxygen saturation to 98% or greater with an NRB overshoots for a patient with COPD whose baseline saturation runs lower; titrating to clinical response is the correct approach rather than chasing a fixed high target.

Withhold supplemental oxygen to avoid suppressing the patient's hypoxic respiratory drive: Withholding oxygen out of fear of suppressing the hypoxic respiratory drive is based on an outdated and debunked idea: current EMS teaching does not support withholding needed oxygen from a hypoxic patient.

Place the patient supine and begin positive pressure ventilations with a BVM: This patient is upright by choice, speaking in short phrases, and moving air; supine positioning and positive pressure ventilations are reserved for inadequate breathing and would work against the position that supports this patient's respiratory effort.

Acute COPD exacerbation with bronchospasm: A COPD exacerbation is the answer in a patient with known chronic lung disease whose breathing has worsened past baseline, and the lungs tell you so: wheezing, rhonchi, prolonged expiration, diminished air movement. This patient has clear and equal lung sounds and no chronic lung disease in the history. You also would not explain an onset five days after knee surgery with a disease that has been present for years.

Community-acquired pneumonia with pleuritic pain: Pneumonia is right when infection has filled alveoli, and it announces itself with fever, a productive cough, and focal crackles or rhonchi over the involved area, usually building across a day or more. This question removes both halves specifically: the patient denies cough and fever, and the lungs are clear. That is the clean split: pneumonia puts something in the alveoli that you can hear and that makes the patient febrile, while an embolism blocks blood upstream of alveoli that stay clear.

Anxiety attack with hyperventilation syndrome: Anxiety and panic can absolutely produce tachypnea, tachycardia, and chest discomfort, and this is the most dangerous distractor in the set because it is the one that gets a real embolism dismissed. Anxiety does not lower oxygen saturation, hyperventilating tends to push it up, so the 94% on room air is the objective finding anxiety cannot explain. Add a major risk factor five days old and calling this panic means missing a diagnosis that can kill within the hour.