Paramedic Exam Study Prep - Airway and
Breathing
A child in respiratory distress may grunt as the child breathes. This is a result of
(A) increase tidal volume.
(B) an increased respiratory rate.
(C) creating pressure to help maintain open airways.
(D) an indication that the child is tired and will progress to respiratory arrest.
C. Grunting involves exhaling against a partially closed glottis. This creates pressure to
help maintain open lower airways similar to pursed-lip breathing in adults with COPD.
This short low-pitched sound is often mistaken for whimpering and suggests severe
hypoxia.
Respiratory acidosis is caused by
(A) an excess of bicarbonate.
(B) excess carbon dioxide retention.
(C) a loss of bicarbonate.
(D) excess carbon dioxide excretion.
B. Respiratory acidosis is caused by excess carbon dioxide retention.
Scenario:
You are using an end-tidal carbon dioxide detector as a tool to assist for proper
endotracheal intubation placement.
Question:
The absence of carbon dioxide in exhaled air indicates the endotracheal tube has
been
(A) placed in the right mainstem bronchus.
(B) correctly placed in the trachea.
(C) placed in the esophagus.
(D) placed in the left mainstem bronchus.
C. The absence of carbon dioxide likely indicates that the endotracheal tube has been
placed in the esophagus. Verifying correct endotracheal tube placement is absolutely
essential. ETCO2 is only one method to assist in verification.
Scenario:
You are using an end-tidal carbon dioxide detector as a tool to assist for proper
endotracheal intubation placement.
Question:
Your next action is to
,(A) deflate the cuff, pull the endotracheal tube back 2 cm, and reassess
placement.
(B) secure the endotracheal tube and confirm correct placement by auscultation.
(C) inflate the distal cuff with 7-10 cc of air and secure the endotracheal tube.
(D) remove the endotracheal tube and provide several ventilations prior to
attempting intubation again.
D. The endotracheal tube is likely placed in the esophagus. Your next action is to
remove the endotracheal tube and provide several ventilations with supplemental
oxygen prior to attempting another intubation.
Which of the following drugs is used for rapid sequence intubation?
(A) Vecuronium
(B) Succinylcholine
(C) Lidocaine and atropine
(D) All of the above
D. All of the above. Vecuronium is a common nondepolarizing neuromuscular blocker.
Lidocaine is commonly used in RSI to prevent dysrhythmias associated with stimulation
of the glottis associated with intubation. Atropine is often administered to decrease the
incidence of bradycardia associated with the administration of succinylcholine.
You are called for a 54-year-old woman who is unconscious. Your assessment
reveals the patient to be apneic and pulseless. Initial management of this
patient's airway should include
(A) assisted ventilation with a bag-valve device at 6-10 LPM.
(B) assisted ventilation with a nonrebreather mask at 10-15 LPM.
(C)immediate nasotracheal intubation and ventilation with a bag-valve device.
(D) insertion of an oropharyngeal airway and ventilation with a bag-valve device.
D. Of the choice listed, insertion of an oropharyngeal airway and ventilating with a bag-
valve device is the best answer. (A). is incorrect because it utilizes a nonrebreather
mask to assist ventilations. nonrebreather are not designed for or capable of assisting
ventilations. (C). is incorrect because an apneic patient cannot be nasotracheally
intubated.
The Esophageal Tracheal Combitube (ETCT) and the pharyngotracheal lumen
airway (PTL) are similar because
(A) neither requires assessment for accurate placement.
(B)both require manipulation of the head and neck for insertion.
(C)neither is inserted blindly.
(D) None of the above.
D. None of the above are correct. (A). is in correct because both devices require
assessment for accurate placement. With the PTL you begin ventilation though a short
tube (the one without the stylet); with the Combitube, you begin ventilation through a
longer blue tube. If chest rise and presence of breath sounds are not observe, you must
switch immediately to the other ventilation port and reassess. (B). is incorrect because
both are inserted in the neutral position and no manipulation of the head and neck is
required for insertion. (C). is incorrect because both devices are inserted blindly.
,Breath sounds such as crackles and rhonchi that are not normally heard are
defined as ----- breath sounds.
(A) bronchial
(B) adventitious
(C) vesicular
(D) bronchovesicular
B. Adventitious breath sounds are considered abnormal sounds such as crackles and
rhonchi.
Which of the following correctly describes the flow of air from outside the body
into the trachea?
(A) Nose, nasopharynx, laryngopharynx, oropharynx, larynx, trachea
(B) Nose, nasopharynx, larynx, laryngopharynx, oropharynx, trachea
(C) Nose, nasal cavities, nasopharynx, oropharynx, laryngopharynx, larynx,
trachea
(D) Nose, nasal cavities, laryngopharynx, nasopharynx, oropharynx, larynx,
trachea
C. This is a simple anatomy and physiology question. The nose, nasal cavities,
nasopharynx, oropharynx, larynx, and trachea correctly described the flow of air.
You are called for an unresponsive 29-year-old man. Bystanders report he has
been drinking heavily all day. Assessment reveals the patient to be responsive
only to painful stimuli. His breathing is shallow at a rate of four times per minute.
How would you manage this patient?
(A) Nasal cannula at 2-4 LPM
(B) Simple face mask at 4-6 LPM
(C) Nonrebreather mask at 10-15 LPM
(D) Bag-valve device with a reservoir at 10-15 LPM
D. Breathing must be supported with a bag-valve device with supplemental high-flow
oxygen. This patient's breathing is too slow and too shallow to receive enough oxygen
for proper gas exchange to take place.
The normal arterial pH range in the human body is
(A) 7.0-7.15
(B) 7.15-7.35
(C) 7.35-7.45
(D) 7.45-7.80
C. The normal arterial pH range in the human body is: 7.35-7.45.
You have orally intubated a patient. While your partner ventilates the patient with
a bag-valve device, you assess for proper placement. Auscultation reveals
sounds heard over the right chest and an absence of breath sounds over the left
chest. Your best course of action would be to
(A) hyperventilate the patient and prepare the equipment necessary for a surgical
cricothyrotomy.
, (B) deflate the endotracheal tube cuff, withdraw the tube 2 cm and reevaluate
breath sounds, and reinflate the cuff.
(C) deflate the endotracheal tube cuff, remove the endotracheal tube, and
hyperventilate the patient with a bag-valve device.
(D) insert a large diameter needle into the fourth or fifth intercostal space,
midaxillary line.
B. This patient was most likely intubated in the right mainstem bronchus. Deflating the
endotracheal tube cuff, withdrawing the tube slightly, reinflating the cuff, and
reevaluating breath sounds is the proper procedure when a right mainstem bronchus
intubation is suspected.
The Sellick maneuver
(A) is used to clear a foreign body airway obstruction in an infant or child.
(B) is used to clear blood or mucus from an endotracheal tube or the
nasopharynx.
(C) may be used to minimize gastric distention and facilitate placement of an
endotracheal tube into the glottic opening.
(D) is the preferred method for opening the airway of an unconscious patient
when cervical spine injury is suspected.
C. Posterior pressure exerted on the cricoid cartilage (the sellick maneuver) will
effectively compress the esophagus, minimizing the potential for gastric distention. This
maneuver will also reposition the vocal cord for clearer visualization of anatomic
structures.
The area where the trachea divides into the right and left mainstem bronchi is
known as the
(A) pleura.
(B) xiphoid process.
(C) carina.
(D) sternal angle.
C. This is a basic anatomy and physiology question. The area where the trachea divides
into the right and left mainstem bronchi is known as the carina.
The administration of which of the following may result in a decrease in the
respiratory rate?
(A) Nubain
(B) Diltazem
(C) Cordarone
(D) Morphine sulphate
D. Morphine is an opiate that can cause central nervous system depression.
Administration may result in a decrease in the respiratory rate. Patients receiving
morphine must be monitored closely for respiratory depression.
The anatomical structure between the base of the tongue and the epiglottis into
which the tip of the curved blade (Macintosh blade) is placed during orotracheal
intubation is the
Breathing
A child in respiratory distress may grunt as the child breathes. This is a result of
(A) increase tidal volume.
(B) an increased respiratory rate.
(C) creating pressure to help maintain open airways.
(D) an indication that the child is tired and will progress to respiratory arrest.
C. Grunting involves exhaling against a partially closed glottis. This creates pressure to
help maintain open lower airways similar to pursed-lip breathing in adults with COPD.
This short low-pitched sound is often mistaken for whimpering and suggests severe
hypoxia.
Respiratory acidosis is caused by
(A) an excess of bicarbonate.
(B) excess carbon dioxide retention.
(C) a loss of bicarbonate.
(D) excess carbon dioxide excretion.
B. Respiratory acidosis is caused by excess carbon dioxide retention.
Scenario:
You are using an end-tidal carbon dioxide detector as a tool to assist for proper
endotracheal intubation placement.
Question:
The absence of carbon dioxide in exhaled air indicates the endotracheal tube has
been
(A) placed in the right mainstem bronchus.
(B) correctly placed in the trachea.
(C) placed in the esophagus.
(D) placed in the left mainstem bronchus.
C. The absence of carbon dioxide likely indicates that the endotracheal tube has been
placed in the esophagus. Verifying correct endotracheal tube placement is absolutely
essential. ETCO2 is only one method to assist in verification.
Scenario:
You are using an end-tidal carbon dioxide detector as a tool to assist for proper
endotracheal intubation placement.
Question:
Your next action is to
,(A) deflate the cuff, pull the endotracheal tube back 2 cm, and reassess
placement.
(B) secure the endotracheal tube and confirm correct placement by auscultation.
(C) inflate the distal cuff with 7-10 cc of air and secure the endotracheal tube.
(D) remove the endotracheal tube and provide several ventilations prior to
attempting intubation again.
D. The endotracheal tube is likely placed in the esophagus. Your next action is to
remove the endotracheal tube and provide several ventilations with supplemental
oxygen prior to attempting another intubation.
Which of the following drugs is used for rapid sequence intubation?
(A) Vecuronium
(B) Succinylcholine
(C) Lidocaine and atropine
(D) All of the above
D. All of the above. Vecuronium is a common nondepolarizing neuromuscular blocker.
Lidocaine is commonly used in RSI to prevent dysrhythmias associated with stimulation
of the glottis associated with intubation. Atropine is often administered to decrease the
incidence of bradycardia associated with the administration of succinylcholine.
You are called for a 54-year-old woman who is unconscious. Your assessment
reveals the patient to be apneic and pulseless. Initial management of this
patient's airway should include
(A) assisted ventilation with a bag-valve device at 6-10 LPM.
(B) assisted ventilation with a nonrebreather mask at 10-15 LPM.
(C)immediate nasotracheal intubation and ventilation with a bag-valve device.
(D) insertion of an oropharyngeal airway and ventilation with a bag-valve device.
D. Of the choice listed, insertion of an oropharyngeal airway and ventilating with a bag-
valve device is the best answer. (A). is incorrect because it utilizes a nonrebreather
mask to assist ventilations. nonrebreather are not designed for or capable of assisting
ventilations. (C). is incorrect because an apneic patient cannot be nasotracheally
intubated.
The Esophageal Tracheal Combitube (ETCT) and the pharyngotracheal lumen
airway (PTL) are similar because
(A) neither requires assessment for accurate placement.
(B)both require manipulation of the head and neck for insertion.
(C)neither is inserted blindly.
(D) None of the above.
D. None of the above are correct. (A). is in correct because both devices require
assessment for accurate placement. With the PTL you begin ventilation though a short
tube (the one without the stylet); with the Combitube, you begin ventilation through a
longer blue tube. If chest rise and presence of breath sounds are not observe, you must
switch immediately to the other ventilation port and reassess. (B). is incorrect because
both are inserted in the neutral position and no manipulation of the head and neck is
required for insertion. (C). is incorrect because both devices are inserted blindly.
,Breath sounds such as crackles and rhonchi that are not normally heard are
defined as ----- breath sounds.
(A) bronchial
(B) adventitious
(C) vesicular
(D) bronchovesicular
B. Adventitious breath sounds are considered abnormal sounds such as crackles and
rhonchi.
Which of the following correctly describes the flow of air from outside the body
into the trachea?
(A) Nose, nasopharynx, laryngopharynx, oropharynx, larynx, trachea
(B) Nose, nasopharynx, larynx, laryngopharynx, oropharynx, trachea
(C) Nose, nasal cavities, nasopharynx, oropharynx, laryngopharynx, larynx,
trachea
(D) Nose, nasal cavities, laryngopharynx, nasopharynx, oropharynx, larynx,
trachea
C. This is a simple anatomy and physiology question. The nose, nasal cavities,
nasopharynx, oropharynx, larynx, and trachea correctly described the flow of air.
You are called for an unresponsive 29-year-old man. Bystanders report he has
been drinking heavily all day. Assessment reveals the patient to be responsive
only to painful stimuli. His breathing is shallow at a rate of four times per minute.
How would you manage this patient?
(A) Nasal cannula at 2-4 LPM
(B) Simple face mask at 4-6 LPM
(C) Nonrebreather mask at 10-15 LPM
(D) Bag-valve device with a reservoir at 10-15 LPM
D. Breathing must be supported with a bag-valve device with supplemental high-flow
oxygen. This patient's breathing is too slow and too shallow to receive enough oxygen
for proper gas exchange to take place.
The normal arterial pH range in the human body is
(A) 7.0-7.15
(B) 7.15-7.35
(C) 7.35-7.45
(D) 7.45-7.80
C. The normal arterial pH range in the human body is: 7.35-7.45.
You have orally intubated a patient. While your partner ventilates the patient with
a bag-valve device, you assess for proper placement. Auscultation reveals
sounds heard over the right chest and an absence of breath sounds over the left
chest. Your best course of action would be to
(A) hyperventilate the patient and prepare the equipment necessary for a surgical
cricothyrotomy.
, (B) deflate the endotracheal tube cuff, withdraw the tube 2 cm and reevaluate
breath sounds, and reinflate the cuff.
(C) deflate the endotracheal tube cuff, remove the endotracheal tube, and
hyperventilate the patient with a bag-valve device.
(D) insert a large diameter needle into the fourth or fifth intercostal space,
midaxillary line.
B. This patient was most likely intubated in the right mainstem bronchus. Deflating the
endotracheal tube cuff, withdrawing the tube slightly, reinflating the cuff, and
reevaluating breath sounds is the proper procedure when a right mainstem bronchus
intubation is suspected.
The Sellick maneuver
(A) is used to clear a foreign body airway obstruction in an infant or child.
(B) is used to clear blood or mucus from an endotracheal tube or the
nasopharynx.
(C) may be used to minimize gastric distention and facilitate placement of an
endotracheal tube into the glottic opening.
(D) is the preferred method for opening the airway of an unconscious patient
when cervical spine injury is suspected.
C. Posterior pressure exerted on the cricoid cartilage (the sellick maneuver) will
effectively compress the esophagus, minimizing the potential for gastric distention. This
maneuver will also reposition the vocal cord for clearer visualization of anatomic
structures.
The area where the trachea divides into the right and left mainstem bronchi is
known as the
(A) pleura.
(B) xiphoid process.
(C) carina.
(D) sternal angle.
C. This is a basic anatomy and physiology question. The area where the trachea divides
into the right and left mainstem bronchi is known as the carina.
The administration of which of the following may result in a decrease in the
respiratory rate?
(A) Nubain
(B) Diltazem
(C) Cordarone
(D) Morphine sulphate
D. Morphine is an opiate that can cause central nervous system depression.
Administration may result in a decrease in the respiratory rate. Patients receiving
morphine must be monitored closely for respiratory depression.
The anatomical structure between the base of the tongue and the epiglottis into
which the tip of the curved blade (Macintosh blade) is placed during orotracheal
intubation is the
