CFRN PRACTICE QUESTIONS AND
CORRECT DETAILED ANSWERS
LATEST REVISION
A patient receiving mechanical ventilation is noted to have an increased respiratory rate after
engine start. The flight nurse recognizes the PRIORITY intervention is to administer - ANS -When
the engine starts up, the patient experiences vibration, a normal flight stressor. The patient
might require more sedation with the increased sensory input. _____ASTNA Patient Transport:
Principles and Practice, 6th Ed. (2024), p. 57
During transport in a high-altitude environment, a transport nurse notes a decrease in the
patient's oxygen saturation. Which of the following gas laws is most likely responsible? - ANS -
Dalton's
refers to the partial pressure of oxygen. As altitude increases, the partial pressure decreases
meaning less oxygen is available
The flight crew responds to the scene of a motor vehicle crash in which an unrestrained driver
has been extricated from the vehicle. The patient is tachycardic, has a shortened and externally
rotated leg, and is bleeding from the urethral meatus. The nurse suspects a - ANS -A pelvic
fracture can cause severe blood loss, resulting in hypotension and tachycardia. Assessment
findings may include shortening of the affected leg, external rotation of the affected leg, and
bleeding from the urethral meatus. A crushed femoral head may include shortening and
external rotation of the affected leg; however, it is not likely to cause bleeding from the meatus.
A posterior hip dislocation will not cause bleeding at the urethral meatus. A kidney injury may
cause hematuria, but will not cause a shortened and externally rotated leg. _____Reference:
Trauma Nursing Core Course, 8th ed., p. 148-149
Following a prolonged bag-mask ventilation, a pediatric patient is intubated and mechanically
ventilated. The flight nurse inserts a nasogastric tube. Improvement of which of the following
would BEST indicate that the procedure resulted in the desired effect? - ANS -PIP would best
indicate the procedure resulted in the desired effect. Gastric insufflation is an expected
byproduct of prolonged bag-mask ventilation of the pediatric patient. If the patient is being
volume ventilated, the PIP will decrease with gastric decompression due to the inflated stomach
not allowing full diaphragm excursion during the inhalation phase. Normal pulse oximetry can
,occur in the presence of an insufflated stomach. I:E ratio is unrelated to gastric tube placement.
ETCO2 may or may not change with the placement of a gastric tube. _____Reference: ASTNA
Patient Transport: Principles and Practice, 5th Ed. (2018), p. 498
A flight team is dispatched to transport a patient with circumferential full-thickness burns to the
chest. The patient is intubated and placed on a ventilator. The flight nurse notes the peak
inspiratory pressure to be 45 cm H2O. Which of the following is the BEST intervention for this
finding? - ANS -Due to the loss of elasticity of the tissue following a burn, it may become difficult
to ventilate a patient. Performing escharotomies will enable effective ventilation. Although
suctioning the patient may help with oxygenation, it will not change the lung compliance. As
this is a burn patient with bilateral breath sounds, a tube thoracotomy is not indicated at this
point. Changing the mode to pressure control will not change the decreased lung compliance
caused by the circumferential burns to the chest. _____Reference: ASTNA Patient Transport:
Principles and Practice, 5th Ed. (2018), p. 282
The flight nurse observes that a patient receiving mechanical ventilation has developed
worsening COPD. Ventilator settings are as follows:
Mode: volume controlRate 16 breaths/minTidal volume 500 mLI:E 1:1FiO2 60%PEEP 5 cm
H2OIdeal body weight: 65 kg
The MOST appropriate action for the nurse to take is to:
decrease the FiO2 to 30%. - ANS -The patient with an obstructive disease pathway benefits from
longer exhalation times and lower volumes. The volume should be 6-8 ml/kg. While FiO2 can
make a difference, I:E is the primary setting change that should occur. _____Reference: ASTNA
Patient Transport: Principles and Practice, 5th Ed. (2018), p. 192
Treatment for acute decompression illness includes which of the following? - ANS -Rapid
descent along with 100% oxygen is the initial treatment for acute decompression illness. 250 mg
acetazolamide (Diamox) slow IV push is the treatment for acute mountain sickness. It is not a
treatment for acute decompression illness. Climbing back to an acceptable altitude is used for
barodontalgia or ear block and not acute decompression illness. Positive pressure ventilation
would not have any effect on the cause of acute decompression illness. _____Reference: ASTNA
Patient Transport: Principles and Practice, 5th Ed. (2018), p. 41
A transport nurse observes blood in the catheter connection tubing of a patient receiving intra-
aortic balloon pump (IABP) therapy. The nurse should FIRST - ANS -The presence of blood in the
catheter connection tubing is the hallmark of balloon rupture. It requires immediate cessation
,of pumping and removal of the IABP. Continued use of a ruptured balloon can lead to helium
gas embolization, a potentially fatal event. The balloon is most likely ruptured. Although intact
balloons that are not actively pumping should be intermittently, manually inflated according to
the manufacturer's directions to prevent clot formation, manual inflation of a ruptured balloon
will inject gas into the aorta through the defect in the balloon. Flushing and re-zeroing of the
arterial line are appropriate only if the balloon is intact. These measures will not clear blood in
the catheter tubing. Although the desired action in the presence of balloon rupture is to prevent
gas pumping into the balloon, the correct course of action is to cease pumping, not merely
clamp the connection tubing. _____Reference: ASTNA Patient Transport: Principles and Practice,
5th Ed. (2018), p. 331
The flight nurse is transporting a patient who sustained a rattlesnake envenomation and was
treated with 8 vials of antivenin prior to transport. During the flight, the patient develops
difficulty breathing and vital signs are as follows:
BP 70/42 mmHg HR 123 beats/minRR 28 breaths/minO2 Sat: 95% on room air
The nurse should recognize that the patient is experiencing which type of shock? - ANS -
Distributive shock is characterized by decreased tissue perfusion from antigen-antibody
reactions that cause histamine to be released systemically and hypotension results. The patient
has no source of bleeding or history that would indicate fluid loss resulting in hemorrhagic or
hypovolemic shock. There is nothing in the history to indicate obstructive shock.
_____Reference: AACN Procedure Manual for High Acuity, Progressive and Critical Care, 7th Ed.
(2017), p. 291
A 4-month-old infant is being transferred to a trauma center. The parent reported that the
infant fell down a flight of stairs. The infant is intubated, comatose, and exhibiting signs of
seizure activity. The transport nurse should suspect - ANS -The nurse should suspect a non-
accidental injury because a 4-month-old infant does not have the ability to walk or crawl. The
other options are not indicated by the parent's report. _____Reference: Wong's Nursing Care of
Infants and Children, 11th Ed. (2019), p. 343
The flight nurse is transporting a patient who has a traumatic brain injury. Which of the
following should the nurse continue to monitor to assess for increasing intracranial pressure? -
ANS -The five major components of a neurological exam are level of consciousness, motor
function, pupillary function, respiratory function and vital signs. Alterations to respiratory
function can indicate acute worsening of a brain injury. Temperature changes (such as
poikilothermia) may develop over time and do not warrant life-saving interventions. Pronator
, drift is not affected by intracranial pressure. _____Reference: Critical Care Nursing: Diagnosis &
Management, 8th Ed. (2018), p. 588
A child is being transferred due to a head injury following an impact with a car. During the
transport, the child becomes anxious and tachycardic. The nurse should anticipate this is due to
- ANS -The nurse should anticipate other sources of bleeding. Hypotension is rarely seen in
isolated head injures. When hypotension is seen in multi-system trauma patient,
hypotension/hemorrhage should always be ruled out and treated. Hypotension is most often a
result of secondary acute hemorrhage, impaired autonomic nervous system control,
iatrogenically from medication use, or less commonly from spinal cord injury or acute diabetes
insipidus. If euvolemia does not correct hypotension, infusions of norepinephrine or
phenylephrine should be initiated to maintain adequate mean arterial pressure and cerebral
perfusion pressure. Anxiousness and tachycardia are natural responses of a child in this
situation. However, the critical nurse should have a deeper understanding and suspicion of
hypovolemia related to secondary acute hemorrhage. Application of a traction splint may cause
anxiety in a pediatric patient, but an acute change should always be suspected to be the result
of something more sinister such as hemorrhage. Hypotension is rarely seen in isolated head
injuries such as shock from cranial hemorrhage. _____Reference: ASTNA Patient Transport:
Principles and Practice, 5th Ed. (2018), p. 240
An infant with dehydration and sepsis is being transported for admission to the ICU. Which of
the following findings would indicate the need for further fluid resuscitation? - ANS -Tachycardia
is an early sign of hypovolemia. Infants can only increase cardiac output by increasing heart
rate. They cannot increase stroke volume. A flat fontanelle is incorrect because in a dehydrated
infant the fontanelle would be sunken rather than flat. A flat fontanelle is a normal finding. A
urine output here is incorrect because a urine output of 2 mL/kg/hr indicates normal fluid
volume status. Apneic episodes are incorrect because apneic episodes are not an indication of
volume depletion. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed.
(2018), p. 524
The flight nurse is preparing a patient who has circumferential burns on the abdomen for a
long-distance transport in a fixed-wing aircraft. The nurse should recognize that the PRIORITY
intervention is to - ANS -During transport the stomach and other hollow organs will expand.
With the burns sustained, this could cause abdominal compartment syndrome. The stomach
should be decompressed with a nasogastric tube. It is not necessary to intubate the patient or
obtain blood products. Pain medications are not the priority but should be considered.
_____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 372
The flight crew is on an interfacility transport of a patient with a diagnosis of septic shock and
systemic inflammatory response syndrome. The patient has received two boluses of Lactated
CORRECT DETAILED ANSWERS
LATEST REVISION
A patient receiving mechanical ventilation is noted to have an increased respiratory rate after
engine start. The flight nurse recognizes the PRIORITY intervention is to administer - ANS -When
the engine starts up, the patient experiences vibration, a normal flight stressor. The patient
might require more sedation with the increased sensory input. _____ASTNA Patient Transport:
Principles and Practice, 6th Ed. (2024), p. 57
During transport in a high-altitude environment, a transport nurse notes a decrease in the
patient's oxygen saturation. Which of the following gas laws is most likely responsible? - ANS -
Dalton's
refers to the partial pressure of oxygen. As altitude increases, the partial pressure decreases
meaning less oxygen is available
The flight crew responds to the scene of a motor vehicle crash in which an unrestrained driver
has been extricated from the vehicle. The patient is tachycardic, has a shortened and externally
rotated leg, and is bleeding from the urethral meatus. The nurse suspects a - ANS -A pelvic
fracture can cause severe blood loss, resulting in hypotension and tachycardia. Assessment
findings may include shortening of the affected leg, external rotation of the affected leg, and
bleeding from the urethral meatus. A crushed femoral head may include shortening and
external rotation of the affected leg; however, it is not likely to cause bleeding from the meatus.
A posterior hip dislocation will not cause bleeding at the urethral meatus. A kidney injury may
cause hematuria, but will not cause a shortened and externally rotated leg. _____Reference:
Trauma Nursing Core Course, 8th ed., p. 148-149
Following a prolonged bag-mask ventilation, a pediatric patient is intubated and mechanically
ventilated. The flight nurse inserts a nasogastric tube. Improvement of which of the following
would BEST indicate that the procedure resulted in the desired effect? - ANS -PIP would best
indicate the procedure resulted in the desired effect. Gastric insufflation is an expected
byproduct of prolonged bag-mask ventilation of the pediatric patient. If the patient is being
volume ventilated, the PIP will decrease with gastric decompression due to the inflated stomach
not allowing full diaphragm excursion during the inhalation phase. Normal pulse oximetry can
,occur in the presence of an insufflated stomach. I:E ratio is unrelated to gastric tube placement.
ETCO2 may or may not change with the placement of a gastric tube. _____Reference: ASTNA
Patient Transport: Principles and Practice, 5th Ed. (2018), p. 498
A flight team is dispatched to transport a patient with circumferential full-thickness burns to the
chest. The patient is intubated and placed on a ventilator. The flight nurse notes the peak
inspiratory pressure to be 45 cm H2O. Which of the following is the BEST intervention for this
finding? - ANS -Due to the loss of elasticity of the tissue following a burn, it may become difficult
to ventilate a patient. Performing escharotomies will enable effective ventilation. Although
suctioning the patient may help with oxygenation, it will not change the lung compliance. As
this is a burn patient with bilateral breath sounds, a tube thoracotomy is not indicated at this
point. Changing the mode to pressure control will not change the decreased lung compliance
caused by the circumferential burns to the chest. _____Reference: ASTNA Patient Transport:
Principles and Practice, 5th Ed. (2018), p. 282
The flight nurse observes that a patient receiving mechanical ventilation has developed
worsening COPD. Ventilator settings are as follows:
Mode: volume controlRate 16 breaths/minTidal volume 500 mLI:E 1:1FiO2 60%PEEP 5 cm
H2OIdeal body weight: 65 kg
The MOST appropriate action for the nurse to take is to:
decrease the FiO2 to 30%. - ANS -The patient with an obstructive disease pathway benefits from
longer exhalation times and lower volumes. The volume should be 6-8 ml/kg. While FiO2 can
make a difference, I:E is the primary setting change that should occur. _____Reference: ASTNA
Patient Transport: Principles and Practice, 5th Ed. (2018), p. 192
Treatment for acute decompression illness includes which of the following? - ANS -Rapid
descent along with 100% oxygen is the initial treatment for acute decompression illness. 250 mg
acetazolamide (Diamox) slow IV push is the treatment for acute mountain sickness. It is not a
treatment for acute decompression illness. Climbing back to an acceptable altitude is used for
barodontalgia or ear block and not acute decompression illness. Positive pressure ventilation
would not have any effect on the cause of acute decompression illness. _____Reference: ASTNA
Patient Transport: Principles and Practice, 5th Ed. (2018), p. 41
A transport nurse observes blood in the catheter connection tubing of a patient receiving intra-
aortic balloon pump (IABP) therapy. The nurse should FIRST - ANS -The presence of blood in the
catheter connection tubing is the hallmark of balloon rupture. It requires immediate cessation
,of pumping and removal of the IABP. Continued use of a ruptured balloon can lead to helium
gas embolization, a potentially fatal event. The balloon is most likely ruptured. Although intact
balloons that are not actively pumping should be intermittently, manually inflated according to
the manufacturer's directions to prevent clot formation, manual inflation of a ruptured balloon
will inject gas into the aorta through the defect in the balloon. Flushing and re-zeroing of the
arterial line are appropriate only if the balloon is intact. These measures will not clear blood in
the catheter tubing. Although the desired action in the presence of balloon rupture is to prevent
gas pumping into the balloon, the correct course of action is to cease pumping, not merely
clamp the connection tubing. _____Reference: ASTNA Patient Transport: Principles and Practice,
5th Ed. (2018), p. 331
The flight nurse is transporting a patient who sustained a rattlesnake envenomation and was
treated with 8 vials of antivenin prior to transport. During the flight, the patient develops
difficulty breathing and vital signs are as follows:
BP 70/42 mmHg HR 123 beats/minRR 28 breaths/minO2 Sat: 95% on room air
The nurse should recognize that the patient is experiencing which type of shock? - ANS -
Distributive shock is characterized by decreased tissue perfusion from antigen-antibody
reactions that cause histamine to be released systemically and hypotension results. The patient
has no source of bleeding or history that would indicate fluid loss resulting in hemorrhagic or
hypovolemic shock. There is nothing in the history to indicate obstructive shock.
_____Reference: AACN Procedure Manual for High Acuity, Progressive and Critical Care, 7th Ed.
(2017), p. 291
A 4-month-old infant is being transferred to a trauma center. The parent reported that the
infant fell down a flight of stairs. The infant is intubated, comatose, and exhibiting signs of
seizure activity. The transport nurse should suspect - ANS -The nurse should suspect a non-
accidental injury because a 4-month-old infant does not have the ability to walk or crawl. The
other options are not indicated by the parent's report. _____Reference: Wong's Nursing Care of
Infants and Children, 11th Ed. (2019), p. 343
The flight nurse is transporting a patient who has a traumatic brain injury. Which of the
following should the nurse continue to monitor to assess for increasing intracranial pressure? -
ANS -The five major components of a neurological exam are level of consciousness, motor
function, pupillary function, respiratory function and vital signs. Alterations to respiratory
function can indicate acute worsening of a brain injury. Temperature changes (such as
poikilothermia) may develop over time and do not warrant life-saving interventions. Pronator
, drift is not affected by intracranial pressure. _____Reference: Critical Care Nursing: Diagnosis &
Management, 8th Ed. (2018), p. 588
A child is being transferred due to a head injury following an impact with a car. During the
transport, the child becomes anxious and tachycardic. The nurse should anticipate this is due to
- ANS -The nurse should anticipate other sources of bleeding. Hypotension is rarely seen in
isolated head injures. When hypotension is seen in multi-system trauma patient,
hypotension/hemorrhage should always be ruled out and treated. Hypotension is most often a
result of secondary acute hemorrhage, impaired autonomic nervous system control,
iatrogenically from medication use, or less commonly from spinal cord injury or acute diabetes
insipidus. If euvolemia does not correct hypotension, infusions of norepinephrine or
phenylephrine should be initiated to maintain adequate mean arterial pressure and cerebral
perfusion pressure. Anxiousness and tachycardia are natural responses of a child in this
situation. However, the critical nurse should have a deeper understanding and suspicion of
hypovolemia related to secondary acute hemorrhage. Application of a traction splint may cause
anxiety in a pediatric patient, but an acute change should always be suspected to be the result
of something more sinister such as hemorrhage. Hypotension is rarely seen in isolated head
injuries such as shock from cranial hemorrhage. _____Reference: ASTNA Patient Transport:
Principles and Practice, 5th Ed. (2018), p. 240
An infant with dehydration and sepsis is being transported for admission to the ICU. Which of
the following findings would indicate the need for further fluid resuscitation? - ANS -Tachycardia
is an early sign of hypovolemia. Infants can only increase cardiac output by increasing heart
rate. They cannot increase stroke volume. A flat fontanelle is incorrect because in a dehydrated
infant the fontanelle would be sunken rather than flat. A flat fontanelle is a normal finding. A
urine output here is incorrect because a urine output of 2 mL/kg/hr indicates normal fluid
volume status. Apneic episodes are incorrect because apneic episodes are not an indication of
volume depletion. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed.
(2018), p. 524
The flight nurse is preparing a patient who has circumferential burns on the abdomen for a
long-distance transport in a fixed-wing aircraft. The nurse should recognize that the PRIORITY
intervention is to - ANS -During transport the stomach and other hollow organs will expand.
With the burns sustained, this could cause abdominal compartment syndrome. The stomach
should be decompressed with a nasogastric tube. It is not necessary to intubate the patient or
obtain blood products. Pain medications are not the priority but should be considered.
_____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 372
The flight crew is on an interfacility transport of a patient with a diagnosis of septic shock and
systemic inflammatory response syndrome. The patient has received two boluses of Lactated
