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 flow at 2 liters per minute by nasal cannula is built for a patient whose oxygen is already adequate and just needs support. An SpO₂ of 79% is severe hypoxemia, and starving it to protect a respiratory drive that may not even be blunted treats a theoretical risk over a documented one.

Give high-concentration oxygen and hold the saturation at 100 percent: Pushing oxygen to hold the SpO₂ of 79% at 100 percent gets the first move right, since this hypoxemia needs high-concentration oxygen. The target is what breaks it: this COPD patient's normal baseline sits below yours, so chasing 100 percent overshoots the need and leaves nothing to titrate against once oxygenation improves.

Delay oxygen until end-tidal carbon dioxide can be measured: Waiting on end-tidal carbon dioxide before treating oxygen answers a monitoring question, not the one in front of you. An SpO₂ of 79% needs oxygen now; capnography gets applied alongside treatment, never ahead of it.

Increase the ventilation rate and recheck in one minute: A faster ventilation rate is the fix for a persistently low or shallow waveform, not an absent one. Here the trace is flat at zero, not diminished, so more breaths just push air into wherever the tube currently sits, worsening things if it's esophageal.

Document the change and continue the transport: Documenting and continuing belongs to a call where the waveform stays normal and confirmation only needs a note. A capnogram that flatlines right after a move is an emergency, not a charting event, so transport waits for reassessment first.

Replace the capnography sensor and recheck the tracing: Swapping the sensor fits a genuine problem: a disconnected line, condensation, or a faulty capnography module can also flatten a waveform, but the timing here, immediately after moving the patient, points straight at tube displacement, not hardware. Chasing the sensor first delays finding a dislodged airway, so the patient and tube get checked before the equipment does.

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 ventilation rate for an infant or child with a pulse, working out to 20 to 30 breaths per minute. This patient is 55 years old, an adult, so that rate stacks breaths and drives intrathoracic pressure too high for the population it is meant for.

One breath every 10 seconds: gives only 6 breaths per minute, a rate too slow to clear carbon dioxide in an adult already failing to move adequate air on their own. It treats the airway as open when the real problem is inadequate ventilation that needs a faster, not slower, assisted rate.

One breath every 4 seconds: 15 breaths per minute, closer to the target than the other wrong options, easy to land on if you round the interval down. It still overshoots the rate for an adult respiratory failure patient with a pulse, keeping intrathoracic pressure elevated longer than the 6 second interval allows and cutting venous return.

A wider ventilation lumen that lowers airway resistance: A wider ventilation lumen is a real second generation feature, and it does lower the work of pushing gas through the device, but that's a ventilation efficiency benefit. It answers a question about airway resistance, not the distension and aspiration risk this patient's abdomen is showing you.

A larger cuff that seals the trachea below the cords: No supraglottic airway, first or second generation, seals the trachea below the cords; that's a description of an endotracheal tube's cuff, not how any SGA seats. The device sits above the larynx, so this segment describes the wrong category of airway entirely.

A reinforced tip that resists kinking during compressions: A reinforced tip that resists kinking is a durability feature that helps the device survive CPR and handling, but it does nothing to vent the gastric air causing this patient's distension or lower the resulting aspiration risk.

Succinylcholine is preferred because of its short duration: Succinylcholine's short duration is a genuine advantage when you need a quick return of spontaneous respiration or a fast reassessment of a difficult airway. The burned muscle across the chest, abdomen, and arms means that same dose can trigger a lethal potassium surge, so the speed advantage never gets used.

Either agent is acceptable within the first 24 hours: This option leans on the true fact that succinylcholine's hyperkalemia risk in burns builds over the first one to three days as receptors proliferate, so a very fresh burn can seem lower risk, but receptor changes start within hours, and with burns this extensive, no point in the first 24 hours is safe for this agent.

A nondepolarizing agent is avoided because of its duration: A longer duration is a real management burden, since you have to sustain sedation and ventilation until the agent wears off, but that is a workload issue, not a reason to withhold it. With this much burn surface and airway swelling already narrowing the airway, the nondepolarizing agent is the one this patient needs.

An open surgical cricothyrotomy through the membrane: An open surgical cricothyrotomy is the surgical airway drilled into you as the go-to rescue, so your hands go there by habit. In this five-year-old, the cricothyroid membrane is too small and cartilaginous to cut safely, and the cricoid cartilage below it is the child's only complete tracheal ring, so this route is reserved for older patients, not this one.

A cuffed tube passed blindly through the nose: A blind nasotracheal tube has appeal here because it seems to route around a destroyed face entirely, and it is a real technique in a spontaneously breathing adult. This patient is failing ventilation with an SpO2 of 61% and falling, is not breathing adequately on their own, and has massive facial trauma, all of which make a blind nasal pass unusable and contraindicated in a child this age.

A tracheostomy placed below the cricoid cartilage: Placing a tracheostomy below the cricoid cartilage does sound like the way to spare the ring the needle technique is also protecting. A tracheostomy is a controlled surgical procedure done in an operating room, not a maneuver you perform at the bedside on a desaturating child at 61% with seconds to act.

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.