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NREMT AIRWAY EXAM WITH ANSWERS
You and your partner Xavier arrive at a sushi bar to a call of a man choking. You find him sitting in a back booth, very pale and diaphoretic. He tells you in a whisper that he has a chunk of fish caught in his throat. What would you do next? - Correct answer Encourage him to cough it up. The ability to speak signifies that it is likely high enough in the airway to cough up Unless his airway is completely blocked, you should not attempt Heimlich thrusts. If he can speak there is a chance he can work the obstruction out himself. What must you do first before inserting an oral airway? - Correct answer Measure it measure oral airways from the corner of the mouth to the earlobe or jawline. You are dispatched to a possible cardiac arrest. You arrive 10 minutes from the time of the call. You and your partner enter the residence to find a man in his 50's lying supine on the living room floor. His wife says that he "just collapsed" while eating dinner. Which of the following treatment choices is most appropriate at this time according to AHA Guidelines? - Correct answer Perform 30 compressions and then look inside the mouth before attempting to ventilate When a patient collapses while eating you should always suspect a possible Foreign Body Airway Obstruction. A visual check of the mouth with each airway opening/ventilation cycle is now recommended by AHA. AHA guidelines now recommend attaching the AED and attempting to defibrillate as soon as you have one available. If someone has audible inspiratory stridor they may have - Correct answer An upper airway obstruction Stridor on inspiration = upper airway obstruction, life threatening Stridor on exhalation = lower airway restriction.
You have an unconscious patient. What do you do? - Correct answer ABCs, History taking, Rapid full body scan ABCs are part of the primary survey, which is then followed by history taking, and then the secondary assessment. A rapid full body scan is the first step of the secondary assessment. When someone has an upper airway obstruction you may hear sounds like? - Correct answer High pitched wheezing when they breath in Upper airway obstructions are often characterized by high pitched sounds when the patient inhales. You and your partner Sue have just arrived on scene to an unknown injury/ illness. You see a man lying against the side of a convenience store who appears unconscious. One of the witnesses tells you that the man was standing there and then just fell over hitting his head on the building and sliding down into the sitting position. As you check his pulse and respirations you find that he is breathing shallow at about 10 per minute, and his pulse is rapid. What would you do first for this patient? - Correct answer Maintain c spine and move him to a supine position, then open his airway fall = c-spine and airway A call has come in for a possible drowning. You and your partner respond to a public swimming pool a few blocks from the station. A 9-year-old boy apparently slipped while running, hit his head on the edge of the pool, and fell in. He has no pulse and he is not breathing. What would be your best choice of action? - Correct answer Take manual stabilization of the boy's head and neck while additional rescuers ventilate at about 13 breaths per minute and provide at least 100 compressions per minute. two person health care provider CPR performed on a child should be done at a 15:2 ratio (13 breaths a min). A child is breathing at 32 breaths per minute. This would be considered ______________. - Correct answer above range Child respiration rates = 20 and 30.
symptoms persist longer than 15 minutes = treat as Cerebrovascular Accident (stroke). The final diagnosis of TIA is made if the symptoms resolve within 24 hours. You arrive on scene with your partner to a call of "man down". You pull into the driveway of the house in a very exclusive part of town. In the driveway a man is lying face up with his eyes closed. After making sure the scene is safe, what actions will help you gather the most information in the shortest period of time? - Correct answer Check his pulse with your hand while you put your ear near his mouth and look down at the sternum for chest rise You are assessing an 84 year old man. Upon auscultation of the lungs you discover crackles or rale sounds. He is complaining of chest pain and congestion. These signs and symptoms can indicate? - Correct answer Left ventricular failure crackles, chest pain, congestion = left ventricular failure. The pump portion of the heart is unable to pump efficiently and fluid begins to back up into the lungs. During an assessment of a 78 year old woman you find her skin to be cool, moist, and pale. What would you suspect? - Correct answer Hypoperfusion Pale, Cool, skin = lack of oxygen (hypoperfusion) A 57 year old woman is complaining of chest pain. Her blood pressure is 109/88 and her respirations are at 22 per minute. What condition does the patient's blood pressure indicate? - Correct answer Low pulse pressure The pulse pressure is the difference between the systolic and diastolic measurements of the blood pressure. 109 systolic - 88 diastolic = 21 mmHg. In trauma a low pulse pressure suggests significant blood loss. If the pulse pressure is extremely low, i.e. 25 mmHg or less, the cause may be low stroke volume, as in Congestive Heart Failure and/or shock. A low pulse pressure can also be caused by aortic valve stenosis and cardiac tamponade. The three basic causes of shock are? - Correct answer Poor pump function, fluid loss, and vessel dilation
The basic causes of shock are poor heart function, loss of blood and fluid, and dilation of vessels. You are called to the scene of a man down. Dispatch reports the man is pulseless and bystanders are doing CPR. According to the NREMT Cardiac Arrest Management/AED skill sheet, which of the following sequences is appropriate? - Correct answer Complete one cycle of CPR, Attach the AED, Have everyone stand clear during rhythm check one cycle of CPR should be performed prior to attaching AED Which of the following choices is a normal systolic blood pressure in a child? - Correct answer Greater than 70 mm Hg child's systolic blood pressure = 80-110 mm Hg You are treating a female patient who is complaining of chest pain. She is diaphoretic with a blood pressure of 98/50. You have her medications on board which includes a prescription for nitroglycerin. Medical control has instructed you to administer 1 nitroglycerin tablet sublingually. How would you respond? - Correct answer Repeat the vital signs to medical control and ask if they still wish to have you administer the nitroglycerin with the blood pressure that low Administering nitroglycerin is contraindicated in patients with a blood pressure of less than 100 (Systolic) You and your partner whom you have been working with for two years are called to a house where a woman is having chest pain and complaining of shortness of breath. She is diaphoretic and has a pulse of 110, respirations of 22, and a blood pressure of 140/80. She says she has no cardiac or respiratory history. You should? - Correct answer Perform your assessment, put her on O2 at 15 lpm, and transport Upon assessment of a 55 year old male, you find his blood pressure to be 124/75 his pulse is 122 and his respirations are 18. It would be stated that this man is? - Correct answer Tachycardic A pulse over 100 = Tachycardic.
location of the injury, he may be losing blood internally. His pulse is too slow as well The man with the pulse of 48 and a knife wound to the lower right quadrant suggests internal bleeding which would lower the blood pressure. What is a hemorrhage? - Correct answer Severe bleeding Hemorrhage or severe bleeding is the leading cause of shock or hypoperfusion. During shock, the blood vessels contract, making the skin ______. - Correct answer Cool The skin gets cool during shock. What is a burn that involves the epidermis and the dermis but no underlying tissue? - Correct answer Partial thickness burn Superficial is just the epidermis, secondary or partial thickness is epidermis and dermis. Your patient has suffered a chainsaw vs. leg injury. His wife who is a nurse tells dispatch that he has lost about 400 mL of blood. You know that a person can lose approximately___________ before they are in any real danger. - Correct answer 500 mL Approximately 500 mL. A small child can die from blood loss of 300 mL. With regard to the SAMPLE history, a patient's pale skin would be considered __________. - Correct answer A sign If you can visibly witness it, then it is a sign. A patient would have to give you a symptom verbally or otherwise. Checking the brachial pulse should be done where on the body? - Correct answer The cubital fossa The brachial pulse can be felt on the medial aspect of the elbow in the crease (cubital fossa). The brachial can also be assessed on the medial
side of the arm, between the bicep and tricep, in between the elbow and the armpit. You and your partner Antone arrive on scene to find a woman in her 30's lying on a couch. Which of the following would determine your next actions? - Correct answer The patient's level of consciousness Whether or not a person is conscious or unconscious would determine what you do next. Determining LOC, comes even before ABC's. The outer most layer of skin tissue is called? - Correct answer The epidermis The epidermis is the outer layer. Inside that is the dermis and further below that is the subcutaneous layer. Which question would help you determine the patient's chief complaint? - Correct answer What can I do for you? You arrive on scene to find a female patient actively having contractions every 10-12 minutes apart. A visual inspection of the patient reveals no visible crowning. Which stage of labor would you consider this patient to be in? - Correct answer 1st stage of labor The first stage of labor is dilation of the cervix. This can have contractions at varying intervals, and can also have some blood spotting or the breaking of the 'waters'. It ends when the cervix is fully dilated. The second stage of labor begins at that point and continues until the baby has been fully delivered. The third stage is the delivery of the umbilicus and placenta. The fourth stage is usually referred to as the period of time after delivery of the placenta and is not referenced in all textbooks. In the pre-hospital setting it is difficult to know if your patient is still in the first or second stage of labor since we don't check for cervical dilation. One good way to know is to understand that the urge to push comes after the cervix is dilated, so this is a great indicator that the patient has moved beyond stage 1 and is now in stage 2. The femoral artery is located where in relation to the carotid artery? - Correct answer Inferior
approach the woman who is in the tripod position. Her breathing is rapid and shallow. She states her ribs hurt after being struck with a punch from her husband. You should? - Correct answer Treat the patient if the situation appears safe and inform law enforcement of the possible assault when the time is appropriate If you believe the scene to be safe and begin treating the patient, it would be prudent to inform the police of the supposed attack. Communication on the radio is a very important part of the EMS system, and messages should be: - Correct answer In plain English Speaking as simply as possible, in plain English, is recommended over using codes and radio cliches. Words like "yes" and "no" are hard to distinguish and should be substituted with "affirmative" and "negative" or something easier to understand. What authority has jurisdiction over radio transmissions made during a call? - Correct answer FCC The FCC or Federal Communications Commission has jurisdiction. Repeaters are used to: - Correct answer Repeaters are used to transfer communications from one frequency to another thereby furthering communication. When transmitting a number with two or more digits you should say the whole number first, followed by: - Correct answer Saying each number individually Proper radio transmission protocols would call for saying each number individually as in, "seventy five - seven five." Which of the following would be a sign that CPR may not be necessary? - Correct answer Stiff neck and jaw A stiff neck and jaw may be a sign of rigor mortis and CPR would not be initiated if the patient were pulseless and apneic as well as having rigor mortis. Remember to assess for rigor mortis in at least 2 joints. The other answer choices would all be indications of a possible need to begin CPR.
You have requested helicopter transportation of a critical burn patient. The remote nature of the accident will force the helicopter to land on an incline. From which direction should you approach the helicopter? - Correct answer The downhill side Approaching from the downhill side of the helicopter is the safest route in this situation. What should be done to a French tip catheter after suctioning a patient's airway? - Correct answer Flush with sterile water in preparation for additional suctioning Anticipating the need for additional suctioning should be followed by cleansing of the catheter with sterile water. Expressed consent is? - Correct answer Authorization by the patient for you to treat them Expressed means the conscious patient has authorized you to give them aid. It should also be informed consent with details of treatments, alternatives, and potential risks of all treatments. A train derailment has caused two tanker cars to explode and several others to begin leaking an unknown gas. The size of the affected area is large and crosses several county lines. According to NIMS, this type of MCI would benefit most from a: - Correct answer Unified Command Systems can involve many different agencies such as EMS, Fire Departments, Law Enforcement, City Managers, County Commissioners, etc. What is the area of hazardous contamination known as? - Correct answer Hot zone An area of contamination is referred to as the hot zone. A motor vehicle accident has occurred right in front of your ambulance and requires the patients to be extricated. Your first choice of location to accomplish the rapid extrication should be the? - Correct answer The door
department is not there yet and there is smoke and flames showing from both cars. You can hear people crying and cars are already driving around the wreckage to get past the scene. What steps should you take? - Correct answer Get the fire department en route, establish a safety zone and assist in keeping traffic a safe distance away Scene safety before all else in this case. The best thing you can do for everybody is assist in keeping the accident from getting even larger with traffic and crowd control until the proper authorities get there and you can administer medical attention in a safe environment. A normal respiratory rate for an adult is ____ while a normal respiratory rate for a newborn is ____. - Correct answer 12 to 20 and 30 to 60 This is the best of the given answer choices. Under 12 is too low of an RR for adults and above 20 is considered high. Newborns breathe faster than adults. Under 30 would be too low for a newborn. Note: Some newer study materials are suggesting a range of 12 to 24 for adults. This may be to allow for the fact that many people you deal with are under stress and might have a slightly elevated "normal" rate. COPD patients can even be over 24. Check with your instructor and the study material your class uses to verify these figures as you prepare for the test. What is the first thing you should do before inserting a nasopharyngeal airway? - Correct answer Select the correct size Before the airway can be inserted, the correct size needs to be selected. If the wrong size is inserted the airway may not be effective. A nasopharyngeal airway can be used on a patient with or without a gag reflex. Emergency care for patients who are not breathing adequately but have a pulse includes all of the following except ____. - Correct answer CPR If the patient is not breathing adequately but still has a pulse, CPR is not needed. CPR will be required if a person loses their pulse. You arrive on scene to find a young woman who is having trouble talking. She has hives and is starting to gasp for air. Her friend says she was just stung by a bee. Your immediate actions should include all of the following
except ____. - Correct answer assess the bee sting for signs of an infection Epinephrine is used to treat anaphylactic shock, and should be administered. The patient's airway may be compromised due to swelling, so airway support is essential. Supplemental oxygen should also be administered. There is no need to assess the bee sting for infection at this point as that is not immediately life-threatening. You're called to a home and find an unresponsive male. Family members said he "passed out." You assess the scene to be safe. The next thing you should do is: - Correct answer Simultaneously check for a pulse and breathing In an unresponsive person, you may have to initiate CPR. It's essential to check to determine if a patient has a pulse and is breathing. Other vital signs and measurements, such as a BP, blood sugar, and temperature can be obtained at a later point. Wheezing can be described as ____. - Correct answer a high-pitched whistling sound Wheezing is produced by narrowing or obstruction of the lower airways, which often causes a high-pitched, whistling sound as the air travels through the narrowed space. Stridor is another sound that can often be heard even without a stethoscope and can indicate an obstruction, but it is a brassy, crowing sound. You are on scene with a 44-year-old female who is complaining of feeling anxious and states, "I can't breathe." You should do the following: - Correct answer Assess her respiratory rate and rhythm, check her oxygen saturation, and listen to her lungs. The patient is breathing since she is talking. There is no need to manually ventilate her at this time. You should perform a respiratory assessment including checking oxygenation. When assessing breathing, tidal volume refers to ____. - Correct answer the depth of the breath
The patient is not ventilating adequately. A RR of 4 is too low and he needs ventilatory support. Placing a nonrebreather or nasal cannula will not be sufficient since he has a poor spontaneous respiratory effort. While the "grunting* may be an indicator of an obstruction, it would not be a reason to withhold manual ventilation. The lungs are made up of how many lobes? - Correct answer 5 You arrive on scene to a car accident and are treating a 35-year-old patient. He is unresponsive and not breathing. You should open his airway by ____. - Correct answer doing the jaw thrust maneuver The patient was in a car accident and injuries are not entirely known. The jaw thrust technique should be used to open the airway if a cervical injury is suspected You have a patient who has a history of asthma and is having shortness of breath. The patient has a doctor's prescription to take 4 puffs of an Albuterol MDI every four hours as needed. Your local EMS policies allow you to help a patient self administer the MDI. What side effect should you watch for from the MDI? - Correct answer increased heart rate Albuterol, a bronchodilator used to treat asthma, may cause cardiovascular side effects such as increased heart rate. You have an unresponsive patient with an intact gag reflex. You attempt to place a nasal airway in his right nostril, but you meet resistance and cannot insert. You should ____. - Correct answer try the other nostril and be sure you have lubricated the device You do not want to use the wrong size airway or it will not be effective. Never force the airway in. An oral airway will not be tolerated with a patient with an intact gag reflex. You're treating an adult patient who is wearing a nonrebreather. The reservoir bag collapses on inspiration. What action(s) should you take? - Correct answer Make sure the bag is connected to an O2 source and the flow is at least 10 LPM.
A non-rebreather should be used with an oxygen flow rate high enough to inflate the reservoir bag, which is a minimum of 10 LPM. Switching to a nasal cannula will not deliver the same FIO2. The rate or depth a person inhales does not cause the reservoir bag to collapse. Symptoms of asthma most often include ____. - Correct answer wheezing, shortness of breath, and coughing Asthma causes a constriction of the airways and increased mucus production, which often causes shortness of breath, wheezing breath sounds, and a cough. Fever, vomiting, confusion, and a runny nose are not typical. The upper airway does not include which of the following? the trachea the jaw the larynx the tongue - Correct answer the trachea The trachea is located in the lower airway, which consists of the trachea and lungs The lobes of the lungs are made up of millions of alveoli, which are tiny air sacs. What purpose do the alveoli serve? - Correct answer This is where the gas exchange between oxygen and carbon dioxide occurs. The function of alveoli is to exchange the oxygen and carbon dioxide molecules to and from the bloodstream. You arrive on scene and find a 46-year-old male with difficulty breathing and an altered level of consciousness. He is tachypneic, pale, diaphoretic, and has tachycardia. What are your patient's respirations per minute? - Correct answer greater than 20 An adult's normal respiratory rate is between 12-20 breaths per minute. Anything greater than 20 is considered tachypnea. Your patient is a 32-year-old female who is unconscious without a gag reflex. You ask your partner to hand you an oropharyngeal airway to assist with maintaining the patient's airway. How do you measure for the correct
seat, with a sudden onset of difficulty breathing, sore throat, and a high fever. As you approach the patient, you notice she is in the tripod position on her mom's lap, she looks very ill, and is drooling. What problem do you suspect and how would you treat her? - Correct answer Epiglottitis. The best treatment is to treat the patient gently and do not cause them to cry. Transport in a position of comfort with high-flow oxygen, if tolerated. Transport rapidly, but quietly, so as not to alarm the child. symptoms of epiglottitis: sudden onset of difficulty breathing, sore throat, and high fever, accompanied by the patient looking very ill, drooling, and in the tripod position. dont place anything in the mouth You are presented with a three-year-old male who was witnessed by his babysitter putting a small plastic toy in his mouth. When she tried to take it out, it got pushed farther down his airway. The patient is conscious and coughing forcefully. What is the best course of action? - Correct answer Encourage the child to continue coughing. If there is not a complete airway obstruction and the child is breathing on their own, provide supplemental oxygen and transport in the position of comfort. You are a volunteer EMT alone on scene of a vehicle accident, and are performing one-rescuer CPR on a 10-year-old male who was ejected from a vehicle traveling 70 mph. What is the ratio of compressions to ventilations? - Correct answer 30: 2 What is the time frame in which cardiogenic shock can occur after an acute myocardial infarction (AMI)? - Correct answer immediately and up to 24 hours after onset of AMI Cardiogenic shock is a condition in which the heart suddenly cannot pump enough blood to meet the demands of the body. It typically occurs within 24 hours of an AMI. It is important to know the signs and symptoms of cardiogenic shock, as without prompt treatment it often proves fatal. ____ is when the heart muscles are not strong enough to accomplish the job of pumping blood throughout the body. - Correct answer Congestive heart failure (CHF)
congestive heart failure (CHF): ventricular heart muscle cannot pump blood through atria, creating fluid stasis to pulmonary veins Compare acute myocardial infarction and dissecting aortic aneurysm pain. - Correct answer Acute myocardial infarction pain feels like tightness/pressure, while dissecting aortic aneurysm pain is a ripping/tearing sensation. Vital signs should be assessed at least every ____ minutes for a patient in unstable condition. - Correct answer 5 The average concentration of oxygen in a titration for treatment is between ____. - Correct answer 95% - 99% below 94% = require support and assistance. Delivering oxygen at a 95- 99% level would be appropriate. Which could be a reason that acetylsalicylic acid (ASA) was not administered to a patient in a cardiovascular emergency? - Correct answer stomach ulcer, bleeding condition, documented allergy All of these would be reasons a patient would not be administered ASA. However, if the patient has a history of a bleeding condition or stomach ulcers, contact medical control. You may be advised to give ASA if the cardiovascular emergency is greater than the risks of the bleeding condition and ulcers. An EMT is asked by a patient to help administer his prescribed nitroglycerin tablet. Which of the following is most appropriate? - Correct answer Apply gloves, check the medication expiration date, verify the prescription ownership, and administer the medication. The administration of nitroglycerin by an EMT requires direction from medical control or a standing order, but which of these should you immediately note as a contraindication for the administration of this drug? - Correct answer patient taking medication for erectile dysfunction Medications for erectile dysfunction and nitroglycerin can interact with fatal results. nitroglycerin is often prescribed to reduce the pain of angina attacks and the patient's systolic blood pressure should be over 100 for administration.
