2026/2027
Air Methods Critical Care Transport
Exam Preparation and Study Guide
2026/2027: Comprehensive Review
for Flight Paramedics and Critical
Care Clinicians
Question 1
A nurse is reviewing arterial blood gas (ABG) results for a patient with acute
respiratory distress syndrome (ARDS):
pH: 7.35
PaCO₂: 26 mmHg
PaO₂: 95 mmHg
HCO₃⁻: 22 mEq/L
Which value is most important to report to the physician?
A. pH
B. PaCO₂
C. HCO₃⁻
D. PaO₂
Correct Answer: B. PaCO₂
Rationale: The PaCO₂ is significantly below the normal range of 35–45 mmHg,
indicating respiratory alkalosis likely due to hyperventilation. In ARDS patients, this
may signal worsening respiratory compensation or ventilator imbalance. While pH,
HCO₃⁻, and PaO₂ are within acceptable or near-normal limits, the abnormal PaCO₂
requires immediate clinical attention and possible ventilator adjustment.
Question 2
A nurse is positioning a patient with ARDS in the prone position. Which outcomes
are expected? (Select all that apply.)
A. Decreased atelectasis
B. Reduced need for intubation
C. Mobilization of secretions
D. Decreased pleural pressure
E. Increased response to corticosteroids
,2026/2027
Correct Answer: A, C, D
Rationale: Prone positioning improves oxygenation by redistributing lung perfusion
and reducing compression on the posterior lung fields. This decreases atelectasis,
enhances secretion drainage, and reduces pleural pressure. It does not eliminate the
need for intubation, nor does it influence pharmacologic response to corticosteroids.
Question 3
A ventilated patient with ARDS requires 80% FiO₂. What is the most appropriate
nursing action?
A. Increase oxygen delivery further
B. Request hemoglobin level
C. Request arterial blood gas analysis
D. Perform endotracheal suctioning
Correct Answer: C. Request arterial blood gas analysis
Rationale: High FiO₂ requirements indicate severe gas exchange impairment. ABGs
provide accurate information on oxygenation and ventilation status. Hemoglobin
levels and suctioning may be relevant but do not evaluate oxygenation adequacy as
precisely as ABGs.
Question 4
A malnourished patient develops refeeding syndrome after TPN initiation. Which
findings are expected? (Select all that apply.)
A. Impaired mental status
B. Insulin resistance
C. Seizures
D. Persistent weight loss
E. Constipation
Correct Answer: A, B, C
Rationale: Refeeding syndrome occurs due to rapid electrolyte shifts (especially
phosphate, potassium, and magnesium) after nutritional replenishment. This causes
neurological and metabolic instability such as confusion, seizures, and insulin
dysregulation. Weight loss and constipation are not defining features of the syndrome.
Question 5
,2026/2027
Which findings indicate respiratory failure in a patient with ARDS? (Select all that
apply.)
A. SpO₂ 94% on room air
B. PaO₂ < 60 mmHg
C. pH 7.35
D. PaCO₂ > 50 mmHg
E. RR 16/min
Correct Answer: B, D
Rationale: Respiratory failure is characterized by severe hypoxemia (PaO₂ < 60
mmHg) and/or hypercapnia (PaCO₂ > 50 mmHg). Normal oxygen saturation, pH, and
respiratory rate do not indicate failure.
Question 6
Which nursing diagnosis is most appropriate for a patient with ARDS?
A. Ineffective thermoregulation
B. Impaired urinary elimination
C. Ineffective tissue perfusion
D. Disturbed body image
Correct Answer: C. Ineffective tissue perfusion
Rationale: ARDS causes severe hypoxemia due to impaired gas exchange, leading to
poor oxygen delivery to tissues. Tissue perfusion is directly compromised. Other
options are unrelated to the primary pathophysiology.
Question 7
A patient presents with tracheal deviation to the right after chest trauma. What is the
priority intervention?
A. Right chest tube insertion
B. Left chest tube insertion
C. Immediate intubation
D. Tracheostomy
Correct Answer: B. Left chest tube insertion
Rationale: Tracheal deviation away from the affected side indicates tension
pneumothorax on the opposite side. Since deviation is to the right, the problem is on
the left, requiring immediate chest decompression via chest tube insertion.
, 2026/2027
Question 8
Which medication is most appropriate for rapid sequence intubation?
A. Modafinil
B. Phentermine
C. Etomidate
D. Zolpidem
Correct Answer: C. Etomidate
Rationale: Etomidate is a fast-acting sedative commonly used during rapid sequence
intubation due to its rapid onset and short duration. The other medications are
stimulants or sedatives inappropriate for airway control.
Question 9
Which ABG finding suggests severe respiratory failure in ARDS?
A. PaO₂ 65 mmHg
B. PaCO₂ 45 mmHg
C. PaO₂ 45 mmHg
D. pH 7.40
Correct Answer: C. PaO₂ 45 mmHg
Rationale: A PaO₂ below 60 mmHg indicates respiratory failure; 45 mmHg reflects
severe hypoxemia requiring urgent intervention.
Question 10
Which statement best describes ARDS?
A. Excess mucus production in alveoli
B. Chronic airway obstruction
C. Pleural air accumulation
D. Increased alveolar-capillary permeability
Correct Answer: D. Increased alveolar-capillary permeability
Rationale: ARDS is caused by inflammation leading to leaky alveolar-capillary
membranes and fluid accumulation in alveoli, impairing oxygen exchange.
Question 11
Air Methods Critical Care Transport
Exam Preparation and Study Guide
2026/2027: Comprehensive Review
for Flight Paramedics and Critical
Care Clinicians
Question 1
A nurse is reviewing arterial blood gas (ABG) results for a patient with acute
respiratory distress syndrome (ARDS):
pH: 7.35
PaCO₂: 26 mmHg
PaO₂: 95 mmHg
HCO₃⁻: 22 mEq/L
Which value is most important to report to the physician?
A. pH
B. PaCO₂
C. HCO₃⁻
D. PaO₂
Correct Answer: B. PaCO₂
Rationale: The PaCO₂ is significantly below the normal range of 35–45 mmHg,
indicating respiratory alkalosis likely due to hyperventilation. In ARDS patients, this
may signal worsening respiratory compensation or ventilator imbalance. While pH,
HCO₃⁻, and PaO₂ are within acceptable or near-normal limits, the abnormal PaCO₂
requires immediate clinical attention and possible ventilator adjustment.
Question 2
A nurse is positioning a patient with ARDS in the prone position. Which outcomes
are expected? (Select all that apply.)
A. Decreased atelectasis
B. Reduced need for intubation
C. Mobilization of secretions
D. Decreased pleural pressure
E. Increased response to corticosteroids
,2026/2027
Correct Answer: A, C, D
Rationale: Prone positioning improves oxygenation by redistributing lung perfusion
and reducing compression on the posterior lung fields. This decreases atelectasis,
enhances secretion drainage, and reduces pleural pressure. It does not eliminate the
need for intubation, nor does it influence pharmacologic response to corticosteroids.
Question 3
A ventilated patient with ARDS requires 80% FiO₂. What is the most appropriate
nursing action?
A. Increase oxygen delivery further
B. Request hemoglobin level
C. Request arterial blood gas analysis
D. Perform endotracheal suctioning
Correct Answer: C. Request arterial blood gas analysis
Rationale: High FiO₂ requirements indicate severe gas exchange impairment. ABGs
provide accurate information on oxygenation and ventilation status. Hemoglobin
levels and suctioning may be relevant but do not evaluate oxygenation adequacy as
precisely as ABGs.
Question 4
A malnourished patient develops refeeding syndrome after TPN initiation. Which
findings are expected? (Select all that apply.)
A. Impaired mental status
B. Insulin resistance
C. Seizures
D. Persistent weight loss
E. Constipation
Correct Answer: A, B, C
Rationale: Refeeding syndrome occurs due to rapid electrolyte shifts (especially
phosphate, potassium, and magnesium) after nutritional replenishment. This causes
neurological and metabolic instability such as confusion, seizures, and insulin
dysregulation. Weight loss and constipation are not defining features of the syndrome.
Question 5
,2026/2027
Which findings indicate respiratory failure in a patient with ARDS? (Select all that
apply.)
A. SpO₂ 94% on room air
B. PaO₂ < 60 mmHg
C. pH 7.35
D. PaCO₂ > 50 mmHg
E. RR 16/min
Correct Answer: B, D
Rationale: Respiratory failure is characterized by severe hypoxemia (PaO₂ < 60
mmHg) and/or hypercapnia (PaCO₂ > 50 mmHg). Normal oxygen saturation, pH, and
respiratory rate do not indicate failure.
Question 6
Which nursing diagnosis is most appropriate for a patient with ARDS?
A. Ineffective thermoregulation
B. Impaired urinary elimination
C. Ineffective tissue perfusion
D. Disturbed body image
Correct Answer: C. Ineffective tissue perfusion
Rationale: ARDS causes severe hypoxemia due to impaired gas exchange, leading to
poor oxygen delivery to tissues. Tissue perfusion is directly compromised. Other
options are unrelated to the primary pathophysiology.
Question 7
A patient presents with tracheal deviation to the right after chest trauma. What is the
priority intervention?
A. Right chest tube insertion
B. Left chest tube insertion
C. Immediate intubation
D. Tracheostomy
Correct Answer: B. Left chest tube insertion
Rationale: Tracheal deviation away from the affected side indicates tension
pneumothorax on the opposite side. Since deviation is to the right, the problem is on
the left, requiring immediate chest decompression via chest tube insertion.
, 2026/2027
Question 8
Which medication is most appropriate for rapid sequence intubation?
A. Modafinil
B. Phentermine
C. Etomidate
D. Zolpidem
Correct Answer: C. Etomidate
Rationale: Etomidate is a fast-acting sedative commonly used during rapid sequence
intubation due to its rapid onset and short duration. The other medications are
stimulants or sedatives inappropriate for airway control.
Question 9
Which ABG finding suggests severe respiratory failure in ARDS?
A. PaO₂ 65 mmHg
B. PaCO₂ 45 mmHg
C. PaO₂ 45 mmHg
D. pH 7.40
Correct Answer: C. PaO₂ 45 mmHg
Rationale: A PaO₂ below 60 mmHg indicates respiratory failure; 45 mmHg reflects
severe hypoxemia requiring urgent intervention.
Question 10
Which statement best describes ARDS?
A. Excess mucus production in alveoli
B. Chronic airway obstruction
C. Pleural air accumulation
D. Increased alveolar-capillary permeability
Correct Answer: D. Increased alveolar-capillary permeability
Rationale: ARDS is caused by inflammation leading to leaky alveolar-capillary
membranes and fluid accumulation in alveoli, impairing oxygen exchange.
Question 11
