Deck 15: Airway Management and Ventilation

Question 1

Moderate hypoxemia is indicated with a pulse oximeter reading of ________ percent.

A) 86 to 90
B) 95 to 100
C) 81 to 85
D) 90 to 94

Answer 1

86 to 90

Question 2

The preferred depolarizing neuromuscular agent for rapid sequence intubation is:

A) pancuronium.
B) midazolam.
C) succinylcholine.
D) vecuronium.

Answer 2

succinylcholine.

Question 3

A peak flow meter measures:

A) inspiratory reserve volume.
B) tidal volume.
C) the force of expiratory volume.
D) respiratory efficacy during forced expiration.

Answer 3

respiratory efficacy during forced expiration.

Question 4

Which of the following is an advantage of the two-person method of bag-valve-mask ventilation?

A) Reduces the risk of gastric distension
B) Provides tidal volumes of 1,500 to 1,700 mL
C) Delivers a higher concentration of oxygen
D) Easier to maintain a seal between the patient's face and the mask

Question 5

Which of the following is the correct order of events after an endotracheal tube has been properly inserted?

A) Inflate the cuff with 5 to 10 mL of air, secure the tube, listen for equal breath sounds bilaterally, and listen for breath sounds over the epigastrium.
B) Inflate the cuff with 5 to 10 mL of air, auscultate the epigastrium and then the lungs, and secure the tube.
C) Secure the tube, listen for breath sounds over the epigastrium, listen for equal breath sounds bilaterally, and inflate the cuff with 5 to 10 mL of air.
D) Inflate the cuff with 5 to 10 mL of air, listen for breath sounds over the epigastrium, listen for equal breath sounds bilaterally, and secure the tube.

Question 6

All of the following are indications for endotracheal intubation, EXCEPT:

A) a heart rate over 100.
B) respiratory arrest.
C) cardiac arrest.
D) airway swelling.

Question 7

Applying posteriorly directed pressure on the cricoid cartilage to facilitate endotracheal intubation is also referred to as:

A) digital intubation.
B) cricoid pressure.
C) retrograde intubation.
D) cricothyrotomy.

Question 8

When swallowing occurs, the structure that occludes the tracheal opening to prevent aspiration of food and liquid is the:

A) cricoid cartilage.
B) epiglottis.
C) pyriform fossa.
D) uvula.

Question 9

Progressively deeper, faster breathing alternating gradually with shallow, slower breathing is called:

A) Cheyne-Stokes respirations.
B) Kussmaul's respirations.
C) Biot's respirations.
D) agonal respirations.

Question 10

Which of the following is the most common cause of airway obstruction?

A) Foreign bodies
B) Food
C) Upper airway edema
D) Tongue

Question 11

Of the normal tidal volume for the average 70-kg adult, what amount of air (in mL) is NOT available for gas exchange?

A) 50
B) 100
C) 150
D) 250

Question 12

What is the normal partial pressure of oxygen (in torr) in the arterial blood?

A) 35 to 45
B) 50 to 75
C) 80 to 100
D) 100 to 150

Question 13

Which of the following is an objective technique to verify proper endotracheal tube placement?

A) Direct visualization
B) Esophageal detector device
C) Tube misting
D) Auscultation

Question 14

A musical, squeaking, or whistling sound that may be heard on inspiration or expiration while auscultating lung fields is known as:

A) crackles.
B) stridor.
C) rhonchi.
D) wheezing.

Question 15

A properly placed ________ effectively isolates the trachea for ventilation and protection from aspiration.

A) dual lumen airway
B) endotracheal tube
C) laryngeal mask airway
D) King LTD airway

Question 16

The automatic transport ventilator is contraindicated for all of the following intubated patients, EXCEPT:

A) a 17-year-old gunshot victim.
B) a 4-year-old near-drowning victim.
C) a 56-year-old patient in pulmonary edema.
D) a 34-year-old patient with adult respiratory distress syndrome.

Question 17

In an adult, the narrowest part of the airway is the:

A) trachea.
B) cricoid cartilage.
C) hypopharynx.
D) glottis.

Question 18

The patient with COPD may benefit from oxygen delivery through a Venturi mask because:

A) oxygen concentration is controlled more carefully.
B) it delivers intermittent positive pressure to the airway.
C) it both protects the airway and delivers oxygen.
D) it delivers the highest oxygen concentration possible.

Question 19

During spontaneous breathing, which of the following reflexes prevents overexpansion of the lungs?

A) Cheyne-Stokes
B) Hering-Breuer
C) Apneustic
D) Cushing's

Question 20

Which of the following interferes with ventilation in the presence of a flail segment?

A) The ability to generate positive intrathoracic pressure is impaired.
B) Intrathoracic pressure increases on the affected side.
C) Intrathoracic pressure decreases on the affected side.
D) The ability to generate negative intrathoracic pressure is impaired.

Question 21

Which of the following manual airway maneuvers should be used when you are caring for a patient with a suspected cervical spine injury?

A) Sellick's
B) Modified jaw-thrust
C) Jaw/tongue lift
D) Head-tilt/chin-lift

Question 22

What percentage of oxygen is delivered by a simple face mask?

A) 60 to 80
B) 95 to 100
C) 40 to 60
D) 80 to 90

Question 23

Which of the following devices is known as a dual-lumen airway?

A) Combitube
B) Endotracheal tube
C) Laryngeal mask airway
D) King LTD airway

Question 24

The hypoxic drive is stimulated by:

A) high PaCO₂.
B) low PaO₂.
C) high PaO₂.
D) low PaCO₂.

Question 25

In which of the following conditions should you suspect pulmonary shunting?

A) A foreign body in the right mainstem bronchus
B) Pneumonia
C) Pulmonary embolism
D) All of the above

Question 26

End-tidal colorimetric capnography measures:

A) carbon dioxide in exhaled air.
B) the partial pressure of carbon dioxide in arterial blood.
C) the amount of carbon dioxide dissolved in plasma.
D) the percentage of hemoglobin saturated with carbon dioxide.

Question 27

When you are intubating a stoma site, how far beyond the distal cuff (in cm) should you insert the endotracheal tube?

A) 1 to 2
B) 3 to 4
C) 2 to 3
D) 4 to 5

Question 28

What is the highest flow rate on a demand valve device (in liters per minute)?

A) 30
B) 20
C) 15
D) 40

Question 29

A high-pitched inspiratory noise caused by a partial upper airway obstruction is called:

A) stridor.
B) dysphonia.
C) rhonchi.
D) wheezing.

Question 30

When using a colorimetric end-tidal carbon dioxide detector, the absence of carbon dioxide in exhaled air after six breaths indicates that the endotracheal tube has been placed:

A) in the right mainstem bronchus.
B) in the esophagus.
C) in the left mainstem bronchus.
D) in the trachea.

Question 31

At the end of exhalation, the intrathoracic pressure is:

A) significantly less than atmospheric pressure.
B) slightly less than atmospheric pressure.
C) greater than atmospheric pressure.
D) equal to atmospheric pressure.

Question 32

What is visualized with a class 3 Mallampati score?

A) Entire tonsil
B) Upper half of the tonsil fossa
C) Soft and hard palate
D) Only the hard palate

Question 33

Which of the following mechanisms is responsible for hypoxemia in the patient with a pulmonary embolism?

A) Pulmonary shunting
B) Pulsus paradoxus
C) Lower airway obstruction
D) Atelectasis

Question 34

Shallow, slow, or infrequent breathing, indicating severe ICP buildup and brain anoxia, is known as:

A) Kussmaul's respirations.
B) grunting.
C) Biot's respirations.
D) agonal respirations.

Question 35

A drop in blood pressure of greater than 10 torr during inspiration is called:

A) pulsus paradoxus.
B) pulsus obliterans.
C) pulsus tardus.
D) pulsus alternans.

Question 36

An attempt at endotracheal intubation must not interrupt ventilations for more than ________ seconds.

A) 10
B) 15
C) 20
D) 30

Question 37

A(n) ________ may be used to facilitate nasotracheal intubation.

A) uncuffed endotracheal tube
B) malleable stylette
C) lighted stylette
D) Endotrol tube

Question 38

The reading obtained by the use of a pulse oximeter reflects the:

A) amount of saturated hemoglobin per deciliter of blood.
B) amount of oxygen dissolved in the blood.
C) ratio of unsaturated hemoglobin to saturated hemoglobin.
D) partial pressure of oxygen in capillary blood.

Question 39

Which of the following serves as an important visual landmark when performing endotracheal intubation under direct visualization?

A) Cricothyroid membrane
B) Cricoid cartilage
C) Thyroid cartilage
D) Posterior cartilages

Question 40

Which of the following is NOT a structure of the upper airway?

A) Larynx
B) Trachea
C) Hypopharynx
D) Nasopharynx

Question 41

The maximum flow rate to be used with a nasal cannula is ________ liters per minute.

A) 10
B) 6
C) 8
D) 4

Question 42

The simplest airway management technique in a patient without suspected cervical spine injury is the:

A) head-tilt/chin-lift maneuver.
B) modified jaw-thrust maneuver.
C) use of an oropharyngeal airway.
D) Sellick's maneuver.

Question 43

The aspiration of vomitus into the lungs may result in:

A) tissue damage.
B) pulmonary edema.
C) pneumonia.
D) all of the above.

Question 44

A fine, bubbling sound heard on inspiration and associated with fluid in the alveoli and terminal bronchioles is called:

A) bronchovesicular sounds.
B) rales (crackles).
C) rhonchi.
D) pleural friction.

Question 45

When you are suctioning an adult patient, the onset of bradycardia is most likely due to:

A) hypercarbia.
B) hypoxia.
C) stimulation of the vagus nerve.
D) increased intracranial pressure.

Question 46

A portable suction device should generate a flow rate of ________ liters per minute when the tube is open.

A) 20
B) 30
C) 40
D) 50

Question 47

Which of the following is a disadvantage of pulse oximetry?

A) Tissue hypoxia may be present even with a normal SaO₂ reading.
B) Pulse oximetry cannot differentiate between hemoglobin bound to oxygen and hemoglobin bound to carbon monoxide.
C) Pulse oximetry gives no information about the amount of carbon dioxide in the blood.
D) All of the above are disadvantages.

Question 48

In which of the following patients would a Combitube dual-lumen airway be used with caution?

A) A 28-year-old man who is in cardiac arrest after his kayak capsized, trapping him under water for several minutes
B) A 40-year-old woman who has taken an overdose of tricyclic antidepressants and is unresponsive to all stimuli
C) A 59-year-old man with a history of chronic alcoholism who was found in cardiac arrest at a homeless shelter
D) A 16-year-old woman who is unresponsive following a motor vehicle collision in which she was ejected, sustaining traumatic brain injury

Question 49

When a portion of the lung is unavailable for gas exchange, yet pulmonary circulation continues in that area of the lung, a condition known as ________ results.

A) pulsus paradoxus
B) ventilation/perfusion mismatch
C) atelectasis
D) eupnea

Question 50

The movement of oxygen from the alveoli to the blood in the pulmonary capillaries depends on:

A) facilitated transport by way of the hemoglobin molecule.
B) active transport of oxygen from an area of lower concentration to an area of higher concentration.
C) diffusion of oxygen from an area of higher concentration to an area of lower concentration.
D) osmosis of the H₂O molecule across the respiratory membrane, where oxygen dissociates from hydrogen.

Question 51

When a bag-valve ventilation device is used with supplemental oxygen, it delivers an oxygen concentration of ________ percent.

A) 40
B) 90
C) 60
D) 21

Question 52

Without adequate airway maintenance and ventilation, the patient can succumb to brain injury or death in how many minutes?

A) 4
B) 10
C) 6
D) 12

Question 53

Which of the following increases the risk of foreign body airway obstruction?

A) Age
B) Alcohol consumption
C) Dentures
D) All of the above

Question 54

Physiologically, the term respiration refers to the:

A) exchange of gases at the alveolar-capillary interface.
B) mechanical process that moves air into and out of the lungs.
C) exchange of all gases, nutrients, and wastes at the cellular level.
D) exchange of gases at the cellular level.

Question 55

The major drawback of mouth-to-mouth ventilations is:

A) an oxygen level in the rescuer's exhaled air of only 10 to 12 percent.
B) potential exposure of the rescuer to body fluids.
C) inability to achieve adequate tidal volumes for ventilation.
D) a high level of carbon dioxide in the rescuer's exhaled air.

Question 56

The tip of a curved laryngoscope blade is placed correctly:

A) at the junction of the hard and soft palates.
B) at the glottic opening.
C) under the epiglottis.
D) in the vallecular.

Question 57

The bifurcation of the trachea is called the:

A) glottic opening.
B) hilum.
C) cricoid cartilage.
D) carina.

Question 58

Which of the following basic airway adjuncts prevents the tongue from falling back to occlude the airway?

A) Yankauer catheter
B) Laryngeal mask airway
C) Nasal cannula
D) Oropharyngeal airway

Question 59

As the thoracic cavity begins to expand, the intrathoracic pressure:

A) does not change.
B) is greater than atmospheric pressure.
C) is the same as atmospheric pressure.
D) is less than atmospheric pressure.

Question 60

The MOST common indication for a surgical cricothyrotomy is:

A) massive facial or neck trauma.
B) failed rapid sequence intubation.
C) status seizures with trismus.
D) foreign body airway obstruction.

Question 61

Insertion of an endotracheal tube too far is likely to result in ventilation of:

A) the right lung only.
B) the left lung only.
C) only the lower lobes of both lungs.
D) neither lung.

Question 62

In which of the following conditions is insertion of a nasogastric tube contraindicated?

A) Patient having a gag reflex
B) Patient with facial fractures
C) Patient awake and alert
D) All of the above

Question 63

When correctly placed, the tip of a straight laryngoscope blade should be:

A) under the epiglottis.
B) at the uvula.
C) at the soft palate.
D) in the vallecula.

Question 64

What is the MOST commonly aspirated material?

A) Vomit
B) Blood
C) Pus
D) Saliva

Question 65

You are managing a 29-year-old male patient who was shot in the head. There is a gurgling noise in the airway. The patient is breathing spontaneously at 42 breaths per minute and has a heart rate of 110 and a systolic and diastolic pressure of 102/82. What airway intervention should be performed first on this patient?

A) Head-tilt/chin-lift maneuver
B) Suctioning the airway
C) Insertion of an oropharyngeal airway
D) Endotracheal intubation

Question 66

Which of the following best suggests an esophageal intubation?

A) Color change from purple to yellow with a colorimetric ETCO₂ detector
B) Free return of air when aspirating with an esophageal detector device
C) Gurgling sounds over the epigastrium with each ventilation delivered
D) Maintaining a pulse oximetry reading of 80 to 85 percent

Question 67

Which of the following statements regarding needle cricothyrotomy is FALSE?

A) Upon removal of the needle, the secured catheter allows for direct tracheal suctioning.
B) High pressure during jet ventilation may cause a pneumothorax.
C) Perforation of the esophagus may occur if the needle is advanced too far.
D) It is the least invasive of the surgical procedures and can be initiated quickly.

Question 68

When providing rescue breathing to an apneic patient using a pocket face mask, each breath should be delivered with ________ of air.

A) 6-8 mL/kg
B) 10 mL/kg
C) 15 mL/kg
D) 2-4 mL/kg

Question 69

When performing tracheobronchial suctioning, what should be the maximum amount of suction time?

A) 15 seconds
B) 20 seconds
C) 10 seconds
D) 5 seconds

Question 70

Which of the following about the use of a dual-lumen airway device is TRUE?

A) It is not recommended for trauma patients.
B) It may be used for adult and pediatric patients.
C) It may be inserted in patients with a gag reflex.
D) Insertion requires no direct visualization.

Question 71

Which of the following statements about manual airway maneuvers is TRUE?

A) They require specialized equipment.
B) They are often neglected by EMTs and paramedics.
C) They are contraindicated in trauma patients.
D) They are difficult to learn.

Question 72

In which of the following instances might digital intubation NOT be indicated?

A) The airway is blocked by a foreign body.
B) The patient has copious secretions.
C) Your equipment fails.
D) Patient position does not allow for visualization.

Question 73

Chemoreceptors could be stimulated when which one of the following chemical imbalances occurs?

A) Decreased pH
B) Increased bicarbonate
C) Decreased renin
D) Increased nitrogen

Question 74

You are managing a 29-year-old male patient who was shot in the head. There is a gurgling noise in the airway. The patient is breathing spontaneously at 42 breaths per minute and has a heart rate of 110 and a systolic and diastolic pressure of 102/82. The correct rate of assisted ventilation for this patient is ________ breaths per minute.

A) 6
B) 12
C) 14
D) 18

Question 75

When intubating using a lighted stylet, you see a dim, indistinct light in the throat. You have MOST likely intubated the:

A) esophagus.
B) left mainstem bronchus.
C) trachea.
D) right mainstem bronchus.

Question 76

In which of the following situations would you expect end-tidal carbon dioxide levels to be very low, despite a patent airway?

A) Room air PPV
B) Hyperthermia
C) Hypoventilation
D) Cardiac arrest

Question 77

Which of the following may complicate airway management procedures in the pediatric patient?

A) The trachea narrows at the cricoid cartilage.
B) The tongue occupies a greater proportion of space.
C) The epiglottis is larger and floppier than in an adult.
D) All of the above are possible complications.

Question 78

The respiratory rate may be greater than normal because of:

A) alcoholic beverage ingestion.
B) the use of medications such as diazepam or morphine.
C) being asleep or nearly asleep.
D) acidosis.

Question 79

The tip of the endotracheal tube for the pediatric patient should be inserted no more than ________ cm below the vocal cords.

A) 1 to 2
B) 3 to 4
C) 2 to 3
D) 4 to 5

Question 80

During a respiratory assessment, the absence of breath sounds may indicate:

A) a pneumothorax.
B) a pulmonary embolism.
C) flail chest.
D) bronchitis.