10 free Paramedic practice questions: Critical Care and Interfacility Transport

Administer diphenhydramine and continue the transfusion: Diphenhydramine with continued transfusion is the right response to a mild allergic transfusion reaction, meaning urticaria and itching alone, with no fever and no hemodynamic change, where the transfusion may be paused, treated and resumed. This patient's findings are different in exactly the ways that matter: fever at 101.8, low back pain, and a pressure of 88/54. Those are hemolysis, not histamine, so this option treats the least dangerous possibility while leaving the cause running into the vein.

Slow the transfusion rate and continue monitoring: Slowing the rate and monitoring is the correct response to transfusion-associated circulatory overload, where the problem is the speed and volume rather than the product itself. It does not fit a hemolytic reaction, where the dose of incompatible cells determines severity, so a slower rate still delivers them and still worsens the injury. The key removes the cause completely; this option only reduces it and waits.

Complete the unit rapidly and reassess at the receiving facility: Finishing the unit and sorting it out at the hospital has surface appeal when transport is short, and there are interventions that reasonably get completed en route. This is the most harmful choice available here, because it delivers the entire remaining volume of incompatible product as fast as possible into a patient who is already hypotensive and febrile, maximizing hemolysis and renal injury. Every principle behind the key is inverted.

A developing tension pneumothorax: A tension pneumothorax genuinely does drop the EtCO₂ and flatten the chest rise, and it belongs at the top of the list for a ventilated patient who deteriorates suddenly, but it comes with unilateral absent breath sounds, jugular venous distention, tracheal deviation, and hypotension, and it alarms in the other direction. As the affected side collapses, the ventilator has to push against it, so the peak pressure rises. The question reports a low-pressure alarm, which is the finding that sends the paramedic to the circuit rather than to the chest.

A mucus plug in the endotracheal tube: a real and common cause of a sudden alarm with falling chest rise and a falling EtCO₂, so the presentation overlaps at first glance. The clinching difference is again the direction of the pressure: an obstruction means the ventilator is pushing a set volume against a blockage, so the peak inspiratory pressure climbs. Low pressure with low exhaled volume is a gas-escaping problem, not a gas-blocked problem, so a plug does not explain this alarm.

Bronchospasm from an airway irritant: raises resistance in the small airways and would come with wheezing, and it is a fair answer for a ventilated patient with a rising airway pressure. It belongs to the same can't-get-in family as the mucus plug and alarms high for the same reason. The key belongs to the can't-keep-it-in family, and reading which alarm fired tells the paramedic which family to search before ever laying hands on the patient.

Add a strap across the upper back and shoulders: A strap across the upper back and shoulders is standard, appropriate securing for an agitated patient lying supine on a stretcher, where it keeps the patient from sitting up without touching the chest's ability to expand. Applied to a patient who is already face down, it adds a second compressive load directly onto the part of the chest that cannot expand in the first place, which is the precise mechanism behind restraint asphyxia. The key removes the restriction while this choice deepens it, so they move in opposite directions on the finding that is killing the patient.

Continue transport and monitor the patient closely: Close monitoring is the correct answer for a properly restrained supine patient whose vital signs are stable, because the risk in that situation is a change over time and monitoring is what detects it. Here monitoring only documents a deterioration it cannot reverse, and a respiratory rate of 36 with a saturation of 93% in a young patient on room air is a body already failing to keep up. The key removes the mechanical cause, and no amount of watching changes a mechanical restriction.

Loosen the wrist restraints and continue transport: Checking and adjusting limb restraints is required care, since a restraint that is too tight compromises distal circulation, and loosening it is right when the wrists are cool, cyanotic, or pulseless. Loosening the wrists while the patient stays face down leaves the chest exactly as compressed as it was, and it also gives back the control that made the restraint necessary. The key targets the actual source of the danger, which is the prone position and the load on the torso, not the tension at the wrist.

Hold the patient on scene until the weather improves: Holding on scene for weather is defensible only when there is no ground option or when nothing about the patient is time-critical: an extrication still in progress, for instance, where the patient cannot be moved yet. Neither applies here: ground transport is available and the patient is critically injured. Waiting spends the one resource that is actually being consumed, which is time, in exchange for a change in conditions that may never come, while the key starts closing the 50-minute gap immediately.

Request a second service without stating the turndown: Calling a second service is legitimate on its own: a different operator may fly a different aircraft from a different base under different local conditions, and there is no rule against asking. The defect is the omission built into this option. A service that is not told about the prior turndown is being asked to make a safety decision with information deliberately withheld, which is how a second crew ends up launching into the weather the first crew refused. If a second service is called, the earlier turndown is disclosed, and either way the ground unit should already be moving.

Ask the pilot to reconsider and attempt the flight: Asking the pilot to reconsider feels like advocating for the patient, which is what makes it the most tempting wrong answer. Pilots are intentionally kept blind to patient condition precisely so that no argument about how sick the patient is can weigh on a weather call. Pressing for a second look reintroduces exactly the pressure that the blindness was designed to remove, and it still does not move the patient any closer to the trauma center. The key accepts the turndown as final and spends the time on transport instead.

Reduce the positive end-expiratory pressure setting: Positive end-expiratory pressure is reduced for a specific clinical reason: hypotension from impaired venous return, or a concern about barotrauma, as a deliberate, titrated decision on a patient who is showing a problem with it. Nothing in this question says the current setting is causing harm, and lowering it routinely before a transport gives up alveolar recruitment on a patient whose settings are working, which shows up as worsening hypoxemia an hour down the road. The key changes nothing about the patient's care and instead checks the one supply that cannot be replenished en route.

Increase the delivered oxygen concentration to 100%: Turning the oxygen up to 100% is the right move for pre-oxygenation before a procedure or for a patient who is deteriorating and needs the reserve. Applied routinely to a two-hour transfer, it multiplies oxygen consumption, which makes the cylinder-duration problem worse rather than better: the two options touch the same supply from opposite ends. Oxygen concentration is titrated to the patient's saturation, not raised as a departure ritual.

Ventilate the patient with a BVM device: A BVM is the mandatory backup for a ventilated patient, and confirming that one is on board is genuinely part of the pre-departure check. That much of the option is right. Using it as the plan for the whole trip is not: it surrenders the controlled rate, tidal volume, and positive end-expiratory pressure the patient is already established on, and it occupies a provider's hands for two hours. The key is the item that actually cannot be fixed once the doors close.

Begin chest compressions for pulselessness: Chest compressions are indicated when the patient is truly unresponsive with no signs of life and the pump is not working, meaning no hum and an alarming controller. Starting them here means treating expected findings as an arrest in a patient who is awake enough to be described as weak and confused. Compressions on a running device also risk dislodging the outflow cannula, so the key establishes whether this patient is actually perfusing before anyone begins.

Obtain an automated blood pressure reading: An automated cuff works by detecting oscillations produced by pulsatile flow, which is the one thing this circulation does not generate, so it typically fails to read or returns an unreliable number. Reaching for it is understandable because it is the routine tool, but a failed or falsely low automated reading in a device patient invites exactly the wrong conclusion. The key uses a method that does not depend on pulsatility at all.

Disconnect and reconnect the device controller: Cycling the controller is a troubleshooting step for a device that is alarming or has stopped, and it is done in consultation with the patient's device coordinator, who should be contacted early on any call like this. This controller has no alarms, is on power, and the pump is audibly running, so there is nothing to reset, and interrupting a functioning pump can stop the circulation outright. The key assesses the patient, while this option risks creating the arrest it is meant to prevent.

Dextrose 50% at 1 milliliter per kilogram: Dextrose 50% is the adult concentration, the correct drug at five times the strength this patient can tolerate. That hypertonicity is what damages small veins, shifts fluid across the fragile vessels of the neonatal brain, and carries the intraventricular hemorrhage risk, and 1 mL/kg of it is not a recognized neonatal dose. Right molecule and wrong concentration is the most common way this item is missed, and the key matches both the concentration and the volume to the patient's age.

Dextrose 25% at 4 milliliters per kilogram: Dextrose 25% is the pediatric concentration used in older infants and children, so it is a real preparation with a real indication, just not in a 2-day-old. Neonates specifically step down to 10%, and 4 mL/kg of a 25% solution delivers about five times the grams of glucose the key does. The trap is that it looks like a sensible middle ground between the adult and neonatal options, when the correct choice is set by the patient's age rather than by splitting the difference.

Glucagon at 0.5 milligrams intramuscularly: Glucagon works by mobilizing stored glycogen from the liver, which is why it is useful in an adult diabetic with no vascular access. A 2-day-old has minimal glycogen to begin with and has spent the last half hour burning through it trying to stay warm, so there is very little left for glucagon to release. The key supplies glucose directly rather than asking a depleted liver to produce it.

Remove the sheath and apply a pressure dressing: Removing the sheath and dressing the site is what the receiving facility does under controlled conditions, with staff, monitoring, and a plan for sustained pressure. Pulling it in a moving ambulance opens the arteriotomy fully by removing the object partially plugging it, and sheath removal carries a well-described vagal response that this already tachycardic, borderline hypotensive patient cannot absorb. The key achieves hemostasis without enlarging the defect.

Flex the hip to slow the flow of blood through the vessel: Flexing the hip is exactly backwards. Patients with a femoral sheath are kept with the leg straight and the head of the bed low precisely because hip flexion kinks the sheath, disrupts the puncture site, and promotes bleeding. Flexion is a maneuver that opens this bleed rather than slowing it. There is also no vascular mechanism by which bending a hip reduces flow through an arterial puncture the way direct compression does.

Apply a tourniquet to the thigh above the swelling: A thigh tourniquet is the right tool for exsanguinating extremity hemorrhage when you can place it proximal to the bleeding and get circumferential occlusion. A common femoral puncture in the groin is proximal to any usable tourniquet site, so this is junctional hemorrhage by definition, and junctional bleeding is managed with direct or purpose-built junctional pressure. Placing a tourniquet below the bleeding point occludes outflow to a leg while doing nothing at all to the vessel that is actually bleeding.

A leak in the circuit is causing repeated breath delivery: A circuit leak is a genuine and common transport ventilator problem, and hunting for one is a reasonable early step in any ventilator troubleshooting. A leak announces itself with an exhaled tidal volume lower than the set volume and usually a falling peak inspiratory pressure or a low-pressure alarm, and this question hands you the opposite, with exhaled tidal volume matching the set volume and peak pressure unchanged, so the circuit is intact. The key beats it because condensate explains the extra breaths while leaving volumes and pressures normal, which is exactly the pattern described.

The patient is breathing above the set rate: A patient breathing above the set rate is by far the most common reason a total rate exceeds a set rate, and on nearly any other call this would be the answer. The long-acting neuromuscular blocker given immediately before departure is the clinching finding that rules it out, because a paralyzed patient has no diaphragmatic effort available to trigger with. The key beats it by explaining the same auto-triggering pattern using the one source of a trigger signal that paralysis does not remove, which is water in the circuit.

The endotracheal tube has migrated into a mainstem bronchus: A tube that has migrated into a mainstem bronchus is a real hazard in transport, especially with movement and repositioning, and it deserves a place on the differential. It presents with a rising peak inspiratory pressure as the set volume is forced into one lung and with unilaterally diminished breath sounds, neither of which is described here, and it has no mechanism at all for increasing the ventilator's rate. The key beats it because the abnormality being explained is the rate itself, and tube depth does not touch the trigger.

Request that the aircraft descend to a lower altitude: Requesting a lower altitude slows further expansion of the trapped air but doesn't evacuate the air that's already causing tension physiology right now.

Increase the positive end-expiratory pressure: Increasing positive end-expiratory pressure doesn't address a developing tension pneumothorax and can actually worsen intrathoracic pressure in this situation.

Disconnect the patient from the ventilator and ventilate manually: Disconnecting from the ventilator and manually ventilating doesn't relieve the trapped, expanding air causing the tension: decompression is what's needed.