10 free Paramedic practice questions: Advanced Respiratory Emergencies

Increase the nebulizer flow rate and continue the treatment: Turning up the flow produces more mist, not more inhaled drug. The limiting factor is the patient's air movement, and a higher flow rate does nothing about that.

Apply CPAP at 10 cm H₂O and reassess in five minutes: CPAP needs an alert patient who can generate an adequate tidal volume of their own. A patient who cannot speak and is breathing 8 shallow times a minute no longer meets that requirement.

Administer a second nebulized bronchodilator treatment: Repeating the treatment repeats the same failure. The first one is not reaching the airway, and a second one delivered the same way will not either.

Limit oxygen to 2 L/min by nasal cannula and watch mental status: Capping the oxygen at 2 L/min leaves a saturation of 79% uncorrected. Treating the hypoxia is not optional, and the reasoning behind the cap is not a real mechanism.

Give high-concentration oxygen and hold the saturation at 100 percent: Correcting the hypoxia is the right half of this answer, and the target is the wrong half. This patient's normal saturation sits below yours, so pushing the number to 100 percent overshoots what the patient needs and leaves you nothing to titrate against.

Delay oxygen until end-tidal carbon dioxide can be measured: Capnography is useful here, and it is not a reason to delay oxygen. A hypoxic patient gets oxygen while the monitoring is being applied.

Increase the ventilation rate and recheck in one minute: A faster rate delivers more breaths to wherever the tube currently sits, which helps nothing if that place is the esophagus.

Document the change and continue the transport: Documenting and driving is the wait and see answer. A flat capnogram is treated as a misplaced tube, not as a charting entry.

Replace the capnography sensor and recheck the tracing: Blaming the equipment first is the assumption that gets a patient ventilated into a stomach. Rule the tube out before you rule the sensor in.

Wheezes, produced by narrowing of the smaller airways: Wheezes are high-pitched and musical, made by air squeezing through narrowed small airways, and a cough does not clear them the way it moves secretions.

Stridor, produced by narrowing at the level of the larynx: Stridor is a harsh inspiratory sound from upper airway narrowing at the larynx, heard over the neck rather than scattered across the large airways.

Crackles, produced by fluid filling the alveoli: Crackles come from fluid in the alveoli, which is the pulmonary edema picture. This patient has sputum in the large airways instead, and a cough that changes the sound.

One breath every 2 to 3 seconds: the pediatric rate. Delivered to an adult it is roughly triple what is needed and stacks breaths quickly.

One breath every 10 seconds: 6 per minute, which leaves an adult in respiratory failure underventilated and the carbon dioxide climbing.

One breath every 4 seconds: 15 per minute, fast enough to raise intrathoracic pressure and cut venous return.

A wider ventilation lumen that lowers airway resistance: A wider lumen lowers the work of pushing gas through the device, which is a ventilation benefit rather than an aspiration one.

A larger cuff that seals the trachea below the cords: No supraglottic device seals the trachea. The cuff seats above the cords, which is the structural limit of the entire category.

A reinforced tip that resists kinking during compressions: A tip that resists kinking helps the device survive handling, and it does nothing about stomach contents reaching the airway.

Succinylcholine is preferred because of its short duration: The short duration is a real advantage in other patients. In a burn patient it does not offset a potassium shift that can stop the heart.

Either agent is acceptable within the first 24 hours: There is no early safe window to work inside. The contraindication in extensive burns stands from the start.

A nondepolarizing agent is avoided because of its duration: The longer duration is a commitment to manage the airway, not a contraindication, and it is the agent this patient should receive.

An open surgical cricothyrotomy through the membrane: The open cricothyrotomy is the surgical airway you trained on, so it is the first thing your hands reach for. The open technique risks destroying the only complete cartilage ring supporting the airway of a young child and creating a false passage, which is why it is held for older patients.

A cuffed tube passed blindly through the nose: When the face is destroyed, a route that avoids the mouth entirely has an obvious appeal. A blind nasal pass requires a spontaneously breathing patient, is contraindicated in children, and is unusable with massive facial trauma.

A tracheostomy placed below the cricoid cartilage: Going below the cricoid does sound like the way to spare the ring you are trying to protect. A tracheostomy is a surgical procedure performed in an operating room, not a field rescue for an airway failing right now.

Administer oxygen at a fixed 2 L/min by nasal cannula without titrating to the saturation: Locking the flow at a fixed 2 L/min without titrating to the saturation is the same outdated worry in milder form; at a saturation of 84% an arbitrary ceiling can leave the patient hypoxic, and the correct approach titrates the oxygen to the target range rather than to a preset flow rate.

Administer oxygen only if the respiratory rate falls below normal: Oxygen administration in a hypoxic COPD patient is not withheld until the respiratory rate drops; the hypoxic saturation itself is the indication for treatment now.

Administer oxygen to raise the saturation to 100%: Driving the saturation all the way to 100% is not the goal in a known carbon dioxide retainer; the target is a titrated range such as 88-92%, not maximal oxygenation.

The patient is improving, so the current treatment plan should continue without any changes: A quieting chest is genuinely good news in the asthmatic who is improving, and that is the version this option describes, where wheezing fades while the patient speaks in fuller sentences, saturation rises and work of breathing eases. The question gives you the opposite marker in the same sentence: the level of consciousness is decreasing. Quiet chest with deteriorating mental status is the ominous version, and mistaking one for the other is the exact trap being tested.

The patient should be placed on CPAP instead of escalating further: CPAP is an excellent tool and the right answer for the awake, cooperative patient in distress who can maintain their own airway and follow coaching, where splinting the airways open reduces work of breathing. The disqualifier is written into the question, a decreasing level of consciousness. CPAP assists breaths the patient generates and depends on the patient protecting their own airway, and this patient can no longer be relied on for either. It is a step below what is needed, not an alternative to it.

The bronchodilator dose should simply be repeated more frequently without escalating the level of care: Repeating or stacking bronchodilators is legitimate in severe asthma, and in a patient still moving air it is exactly right. The problem is delivery rather than the drug: with a silent chest there is no tidal volume to carry the aerosol to the airways that need it. Right drug, wrong moment, and continuing a failing intervention while consciousness falls is precisely the failure mode the item is built around.