Nancy Caroline's Emergency Care in the Streets, 9th
Edition TEST BANK | Verified Chapters 1-53 | LATEST
UPDATED 2026/27
EMS Systems, Operations & Airway Management
Q1: You are dispatched to a motor vehicle collision on a busy highway. As you approach
the scene, you notice traffic is moving at highway speeds just a few feet away from the
wreckage. What is your first priority?
A. Establish incident command immediately
B. Request fire department support for traffic control
C. Ensure your own safety by parking the ambulance in a protected position
D. Grab your trauma bag and run to the patient
Correct Answer: C
Rationale: Scene safety is always the first priority; you cannot help the patient if you
become a victim yourself, so positioning the ambulance to block traffic (creating a safety
zone) is the critical first step.
Q2: Which of the following is the most accurate definition of "medical direction" in the
EMS system?
A. The physician who provides online orders for a specific patient
B. The system of physician oversight that ensures patient care meets a standard
C. The written protocols that guide paramedic practice in the field
D. The process of transferring care at the emergency department
Correct Answer: B
Rationale: Medical direction encompasses the entire system of oversight, both online
(direct orders) and offline (protocols and review), designed to ensure consistent,
high-quality patient care.
Q3: You are treating a 45-year-old male with difficulty breathing. You decide to assist his
ventilations with a bag-valve-mask (BVM). Which indicator is the best sign that you are
providing adequate ventilation?
A. The patient’s chest rises with each squeeze
B. The pulse oximeter reads 100%
C. The patient’s skin color remains pink
D. You feel resistance when squeezing the bag
Correct Answer: A
Rationale: Visible chest rise is the primary physical confirmation that air is entering the
lungs; pulse oximetry and skin color are lagging indicators of oxygenation/ventilation
status.
,Q4: During an intubation attempt, you visualize the vocal cords but the tube passes into
the esophagus. You recognize this immediately because:
A. You do not see the tube pass between the cords
B. You hear gurgling sounds over the epigastrium
C. The capnography waveform is absent
D. The patient begins to vomit
Correct Answer: C
Rationale: While you might see the tube pass the wrong way, quantitative waveform
capnography is the gold standard for confirmation; if the tube is in the esophagus, no
CO2 will be detected, resulting in a flatline waveform.
Q5: When applying a non-rebreather mask at 15 L/min to a patient experiencing chest
pain, you notice the reservoir bag completely deflates during inspiration. What should
you do?
A. Increase the oxygen flow rate to 25 L/min
B. Switch to a nasal cannula at 4 L/min
C. Check the mask fit for leaks and ensure the flow rate is sufficient
D. Instruct the patient to breathe slower
Correct Answer: C
Rationale: The reservoir bag should remain partially inflated during inspiration; deflation
suggests the patient is drawing in more air than the oxygen supply is delivering or there
is a leak, requiring an assessment of flow and fit.
Q6: You are transporting a patient with a tracheostomy tube who is showing signs of
respiratory distress. You attempt suctioning but the catheter meets resistance. What is
your most appropriate action?
A. Apply continuous suction while withdrawing the catheter
B. Twist the catheter gently to bypass the obstruction
C. Remove the inner cannula if it is a dual-cannula tube
D. Increase the suction pressure to maximum
Correct Answer: C
Rationale: Resistance often indicates a mucus plug in the inner cannula; since many
trach tubes have a removable inner cannula, removing and replacing it is the quickest
way to clear the airway without traumatizing the tissue.
Q7: According to the NREMT skill sheets and Nancy Caroline's text, what is the correct
ratio of compressions to ventilations for adult CPR performed by two healthcare
providers?
A. 15:2
B. 30:2
C. 30:1
,D. 15:1
Correct Answer: B
Rationale: The current AHA and NREMT standard for adult CPR is 30 compressions to
2 ventilations, regardless of whether there are one or two rescuers.
Q8: You are responding Code 3 to an emergency. As you approach an intersection, the
traffic light is red for you. What is the legally correct action?
A. Proceed through the intersection if you have your lights and siren on
B. Slow down, come to a complete stop, and proceed when safe
C. Proceed through the intersection at the posted speed limit
D. Use the PA system to clear traffic and drive through
Correct Answer: B
Rationale: Even with lights and sirens, state traffic laws generally require emergency
vehicles to come to a complete stop at red lights and stop signs before proceeding
safely.
Q9: Which of the following describes the "click" sound often heard when using a
disposable blade for endotracheal intubation?
A. The blade locking into the handle
B. The epiglottis lifting
C. The stylet striking the endotracheal tube
D. The vocal cords being traumatized
Correct Answer: A
Rationale: Many disposable intubation blades feature a locking mechanism that makes
a distinct click when it engages into the handle, ensuring it is secure for the procedure.
Q10: A 65-year-old female is unconscious and breathing shallowly. Her SpO2 is 88% on
room air. You have an oral airway in place and are ventilating with a BVM. You notice
the stomach is getting distended. What is the most likely cause?
A. The airway is too small
B. You are ventilating too fast or with too much force
C. The patient has a diaphragmatic injury
D. The oral airway is blocking the trachea
Correct Answer: B
Rationale: Gastric distension usually occurs during BLM ventilation when air is forced
down the esophagus due to excessive pressure or rapid ventilations, which prevents the
glottis from opening properly.
Q11: You arrive at a scene where a hazardous materials spill has occurred. There are
multiple victims on the ground near a overturned truck with a placard displaying a flame
, symbol. Which zone describes the area where you should stage your equipment and
dress in PPE?
A. Hot Zone
B. Warm Zone
C. Cold Zone
D. Exclusion Zone
Correct Answer: C
Rationale: The Cold Zone (or Support Zone) is the area free of contamination where
command, staging, and medical triage occur; personnel enter the Warm Zone after
donning appropriate PPE.
Q12: When using a continuous positive airway pressure (CPAP) device for a patient in
severe respiratory distress from pulmonary edema, which parameter is most critical to
monitor?
A. The patient's systolic blood pressure
B. The fit of the mask straps
C. The patient's oral temperature
D. The noise level of the device
Correct Answer: A
Rationale: CPAP increases intrathoracic pressure which can decrease venous return
and cardiac output, potentially causing hypotension; therefore, monitoring blood
pressure is essential to ensure patient tolerance.
Q13: During a mass casualty incident (MCI), you are assigned to the Treatment area. A
patient walks up to you with a broken arm and is talking clearly. You tag him according
to the START triage system. What color tag should he receive?
A. Red
B. Yellow
C. Green
D. Black
Correct Answer: C
Rationale: In START triage, patients who are able to walk (ambulatory) are triaged first
and tagged "Green" (Minor) as they are generally the lowest priority for immediate
life-saving intervention.
Q14: Which of the following statements regarding documentation is correct?
A. Documentation is only for legal protection of the paramedic
B. If a treatment was ineffective, it should be omitted from the report
C. Accurate and timely documentation is a form of patient care communication
D. You should never change an entry, even if you made a mistake
Correct Answer: C
Edition TEST BANK | Verified Chapters 1-53 | LATEST
UPDATED 2026/27
EMS Systems, Operations & Airway Management
Q1: You are dispatched to a motor vehicle collision on a busy highway. As you approach
the scene, you notice traffic is moving at highway speeds just a few feet away from the
wreckage. What is your first priority?
A. Establish incident command immediately
B. Request fire department support for traffic control
C. Ensure your own safety by parking the ambulance in a protected position
D. Grab your trauma bag and run to the patient
Correct Answer: C
Rationale: Scene safety is always the first priority; you cannot help the patient if you
become a victim yourself, so positioning the ambulance to block traffic (creating a safety
zone) is the critical first step.
Q2: Which of the following is the most accurate definition of "medical direction" in the
EMS system?
A. The physician who provides online orders for a specific patient
B. The system of physician oversight that ensures patient care meets a standard
C. The written protocols that guide paramedic practice in the field
D. The process of transferring care at the emergency department
Correct Answer: B
Rationale: Medical direction encompasses the entire system of oversight, both online
(direct orders) and offline (protocols and review), designed to ensure consistent,
high-quality patient care.
Q3: You are treating a 45-year-old male with difficulty breathing. You decide to assist his
ventilations with a bag-valve-mask (BVM). Which indicator is the best sign that you are
providing adequate ventilation?
A. The patient’s chest rises with each squeeze
B. The pulse oximeter reads 100%
C. The patient’s skin color remains pink
D. You feel resistance when squeezing the bag
Correct Answer: A
Rationale: Visible chest rise is the primary physical confirmation that air is entering the
lungs; pulse oximetry and skin color are lagging indicators of oxygenation/ventilation
status.
,Q4: During an intubation attempt, you visualize the vocal cords but the tube passes into
the esophagus. You recognize this immediately because:
A. You do not see the tube pass between the cords
B. You hear gurgling sounds over the epigastrium
C. The capnography waveform is absent
D. The patient begins to vomit
Correct Answer: C
Rationale: While you might see the tube pass the wrong way, quantitative waveform
capnography is the gold standard for confirmation; if the tube is in the esophagus, no
CO2 will be detected, resulting in a flatline waveform.
Q5: When applying a non-rebreather mask at 15 L/min to a patient experiencing chest
pain, you notice the reservoir bag completely deflates during inspiration. What should
you do?
A. Increase the oxygen flow rate to 25 L/min
B. Switch to a nasal cannula at 4 L/min
C. Check the mask fit for leaks and ensure the flow rate is sufficient
D. Instruct the patient to breathe slower
Correct Answer: C
Rationale: The reservoir bag should remain partially inflated during inspiration; deflation
suggests the patient is drawing in more air than the oxygen supply is delivering or there
is a leak, requiring an assessment of flow and fit.
Q6: You are transporting a patient with a tracheostomy tube who is showing signs of
respiratory distress. You attempt suctioning but the catheter meets resistance. What is
your most appropriate action?
A. Apply continuous suction while withdrawing the catheter
B. Twist the catheter gently to bypass the obstruction
C. Remove the inner cannula if it is a dual-cannula tube
D. Increase the suction pressure to maximum
Correct Answer: C
Rationale: Resistance often indicates a mucus plug in the inner cannula; since many
trach tubes have a removable inner cannula, removing and replacing it is the quickest
way to clear the airway without traumatizing the tissue.
Q7: According to the NREMT skill sheets and Nancy Caroline's text, what is the correct
ratio of compressions to ventilations for adult CPR performed by two healthcare
providers?
A. 15:2
B. 30:2
C. 30:1
,D. 15:1
Correct Answer: B
Rationale: The current AHA and NREMT standard for adult CPR is 30 compressions to
2 ventilations, regardless of whether there are one or two rescuers.
Q8: You are responding Code 3 to an emergency. As you approach an intersection, the
traffic light is red for you. What is the legally correct action?
A. Proceed through the intersection if you have your lights and siren on
B. Slow down, come to a complete stop, and proceed when safe
C. Proceed through the intersection at the posted speed limit
D. Use the PA system to clear traffic and drive through
Correct Answer: B
Rationale: Even with lights and sirens, state traffic laws generally require emergency
vehicles to come to a complete stop at red lights and stop signs before proceeding
safely.
Q9: Which of the following describes the "click" sound often heard when using a
disposable blade for endotracheal intubation?
A. The blade locking into the handle
B. The epiglottis lifting
C. The stylet striking the endotracheal tube
D. The vocal cords being traumatized
Correct Answer: A
Rationale: Many disposable intubation blades feature a locking mechanism that makes
a distinct click when it engages into the handle, ensuring it is secure for the procedure.
Q10: A 65-year-old female is unconscious and breathing shallowly. Her SpO2 is 88% on
room air. You have an oral airway in place and are ventilating with a BVM. You notice
the stomach is getting distended. What is the most likely cause?
A. The airway is too small
B. You are ventilating too fast or with too much force
C. The patient has a diaphragmatic injury
D. The oral airway is blocking the trachea
Correct Answer: B
Rationale: Gastric distension usually occurs during BLM ventilation when air is forced
down the esophagus due to excessive pressure or rapid ventilations, which prevents the
glottis from opening properly.
Q11: You arrive at a scene where a hazardous materials spill has occurred. There are
multiple victims on the ground near a overturned truck with a placard displaying a flame
, symbol. Which zone describes the area where you should stage your equipment and
dress in PPE?
A. Hot Zone
B. Warm Zone
C. Cold Zone
D. Exclusion Zone
Correct Answer: C
Rationale: The Cold Zone (or Support Zone) is the area free of contamination where
command, staging, and medical triage occur; personnel enter the Warm Zone after
donning appropriate PPE.
Q12: When using a continuous positive airway pressure (CPAP) device for a patient in
severe respiratory distress from pulmonary edema, which parameter is most critical to
monitor?
A. The patient's systolic blood pressure
B. The fit of the mask straps
C. The patient's oral temperature
D. The noise level of the device
Correct Answer: A
Rationale: CPAP increases intrathoracic pressure which can decrease venous return
and cardiac output, potentially causing hypotension; therefore, monitoring blood
pressure is essential to ensure patient tolerance.
Q13: During a mass casualty incident (MCI), you are assigned to the Treatment area. A
patient walks up to you with a broken arm and is talking clearly. You tag him according
to the START triage system. What color tag should he receive?
A. Red
B. Yellow
C. Green
D. Black
Correct Answer: C
Rationale: In START triage, patients who are able to walk (ambulatory) are triaged first
and tagged "Green" (Minor) as they are generally the lowest priority for immediate
life-saving intervention.
Q14: Which of the following statements regarding documentation is correct?
A. Documentation is only for legal protection of the paramedic
B. If a treatment was ineffective, it should be omitted from the report
C. Accurate and timely documentation is a form of patient care communication
D. You should never change an entry, even if you made a mistake
Correct Answer: C
