As you begin ventilating an unresponsive apneic man, you hear gurgling in his upper airway. Your MOST immediate action should be to:

• A: quickly turn the patient onto his side so secretions can drain.
• B: suction the patient’s airway for no longer than 15 seconds.
• C: reposition the patient’s airway and continue ventilations.
• D: squeeze the bag-mask device with less force and reassess.

An elderly woman with COPD presents with a decreased level of consciousness, cyanosis to her face and neck, and labored respirations. Her pulse is rapid and weak and her oxygen saturation is 76%. You should:

• A: insert a nasal airway and give her oxygen via a nonrebreathing mask.
• B: avoid high-flow oxygen because this may cause her to stop breathing.
• C: assist her ventilations with a bag-mask device and high-flow oxygen.
• D: apply oxygen via nasal cannula and reassess her respiratory status.

A 56-year-old man has labored, shallow breathing at a rate of 28 breaths/min. He is responsive to pain only. You should:

• A: ventilate him with a bag-mask device at a rate of 30 breaths/min.
• B: suction his mouth for 15 seconds and insert an oropharyngeal airway.
• C: insert a nasopharyngeal airway and begin assisting his ventilations.
• D: place him on his side and administer oxygen via nonrebreathing mask.

How should treat an unresponsive, uninjured patient with respirations of 16 breaths/min and good chest expansion?

• A: Jaw-thrust maneuver and frequent suctioning
• B: Oropharyngeal suctioning and assisted ventilations
• C: Suctioning as needed and artificial ventilations
• D: Airway adjunct and oxygen via nonrebreathing mask

You are administering oxygen to a woman with asthma who took two puffs of her prescribed inhaler without relief prior to your arrival. Your next action should be to:

• A: contact medical control for further advice.
• B: provide immediate transport to the hospital.
• C: confirm that her inhaler is prescribed to her.
• D: administer one more puff from the inhaler.

Agonal respirations are not adequate because they are:

• A: the result of an increase in tidal volume.
• B: infrequent, gasping respiratory efforts.
• C: associated with a prolonged inhalation phase.
• D: characterized by a rapid, irregular pattern.

The active, muscular part of breathing is called:

• A: inhalation.
• B: expiration.
• C: ventilation.
• D: respiration.

ou are ventilating an apneic 50-year-old woman with a bag-mask device. After squeezing the bag and noting visible chest rise, you should:

• A: suction the airway for up to 15 seconds.
• B: allow the patient to completely exhale.
• C: reopen the airway and ventilate again.
• D: squeeze the bag again in 3 seconds.

A patient with a mild foreign body airway obstruction:

• A: is typically not cyanotic.
• B: has progressive difficulty breathing.
• C: has a low oxygen saturation.
• D: presents with a weak cough.

Patients with a hypoxic drive:

• A: are stimulated to breathe by low oxygen levels in the blood.
• B: rarely become cyanotic because of high blood oxygen levels.
• C: may hypoventilate if given low concentrations of oxygen.
• D: are accustomed to low levels of carbon dioxide in the blood.

Which of the following describes the correct method for inserting a nasopharyngeal airway?

• A: Apply firm, gentle pressure if you meet resistance during insertion.
• B: Rotate the device as you insert it into the right nostril.
• C: Insert the device with the bevel facing the septum.
• D: Insert the device with the bevel facing the lateral part of the nose.

When ventilating an apneic patient, you note decreased ventilatory compliance. This means that:

• A: fluid is occupying the alveoli.
• B: the upper airway is blocked.
• C: you meet no resistance when ventilating.
• D: the lungs are difficult to ventilate.

Which of the following patients has signs of inadequate breathing?

• A: A 50-year-old woman with respirations of 12 breaths/min and pink, dry skin
• B: A 41-year-old woman with shallow respirations of 14 breaths/min
• C: A 30-year-old man with respirations of 12 breaths/min with adequate depth
• D: A 60-year-old man with clear and equal breath sounds bilaterally

Snoring respirations in an unresponsive patient are usually the result of:

• A: swelling of the upper airway structures.
• B: collapse of the trachea during breathing.
• C: foreign body airway obstruction.
• D: upper airway obstruction by the tongue.

In which of the following situations should the jaw-thrust maneuver be used?

• A: In a patient with apnea with no signs of trauma
• B: In a patient who is in need of frequent suctioning
• C: When the mechanism of injury is unclear
• D: In any patient who is in cardiac arrest

Which of the following devices should NOT be used in an unresponsive apneic patient with blunt chest trauma?

• A: Oral airway
• B: Oxygen-powered ventilator
• C: Bag-mask device
• D: Nasal airway

Which of the following is the preferred initial method for providing artificial ventilations to an apneic adult?

• A: Flow-restricted, oxygen-powered ventilation device
• B: Two-person bag-valve-mask technique with 100% oxygen
• C: One-person bag-valve-mask technique with 100% oxygen
• D: Mouth-to-mask technique with supplemental oxygen

During your assessment of an unresponsive adult female, you determine that she is apneic. You should:

• A: deliver two rescue breaths.
• B: place an oropharyngeal airway.
• C: assess for a carotid pulse.
• D: begin chest compressions.

An elderly man is found lying unresponsive next to his bed. The patient's wife did not witness the events that led to his unresponsiveness. You should:

• A: grasp the angles of the lower jaw and lift.
• B: tilt the head back and lift up the chin.
• C: assess the patient’s respirations.
• D: apply 100% supplemental oxygen.

Signs of inadequate breathing in an unresponsive patient include:

• A: an irregular pulse.
• B: cyanotic oral mucosa.
• C: symmetrical chest rise.
• D: warm, moist skin.

A 50-year-old man, who fell approximately 20 feet and landed on a hard surface, is semiconscious. You should:

• A: gently tilt the patient’s head back to assess for breathing.
• B: check for a carotid pulse if the patient is breathing rapidly.
• C: begin positive-pressure ventilations with a bag-mask device.
• D: stabilize his head while performing the jaw-thrust maneuver.

Sonorous respirations are MOST rapidly corrected by:

• A: initiating assisted ventilations.
• B: correctly positioning the head.
• C: suctioning the oropharynx.
• D: inserting an oropharyngeal airway.

A reduction in tidal volume would MOST likely occur from:

• A: accessory muscle use.
• B: unequal chest expansion.
• C: increased minute volume.
• D: flaring of the nostrils.

Which of the following airway sounds indicates a lower airway obstruction?

• A: Stridor
• B: Gurgling
• C: Wheezing
• D: Crowing

Which of the following occurs during positive-pressure ventilation?

• A: Oxygen is pulled into the lungs
• B: Blood is drawn back to the heart
• C: The esophagus remains closed
• D: Intrathoracic pressure increases

A patient has severe facial injuries, inadequate breathing, and copious secretions coming from the mouth. How should this situation be managed?

• A: Alternate suctioning for 15 seconds and ventilations for 2 minutes.
• B: Provide artificial ventilations and suction for 30 seconds as needed.
• C: Insert an oropharyngeal airway and suction until the secretions clear.
• D: Turn the patient to the side and provide continuous oral suctioning.

After an initial attempt to ventilate an unresponsive apneic patient fails, you reposition the patient's head and reattempt ventilation without success. You should next:

• A: perform chest compressions, open the airway, and look in the mouth.
• B: turn the patient onto his side and deliver 5 to 10 back slaps.
• C: administer 5 to 10 abdominal thrusts and reattempt to ventilate.
• D: perform continuous chest compressions until ALS personnel arrive.

Which of the following processes occurs during inhalation?

• A: The intercostal muscles and diaphragm both contract.
• B: The diaphragm descends and the intercostal muscles relax.
• C: The diaphragm contracts and the intercostal muscles relax.
• D: The intercostal muscles relax and the diaphragm descends.

During your assessment of a trauma patient, you note massive facial injuries, weak radial pulses, and clammy skin. What should be your MOST immediate concern?

• A: Applying 100% supplemental oxygen
• B: Potential obstruction of the airway
• C: Providing rapid transport to a trauma center
• D: Internal bleeding and severe shock

Which of the following statements regarding the head tilt-chin lift maneuver is correct?

• A: It should be used on all unresponsive patients that you encounter.
• B: It should be used in conjunction with an appropriate airway adjunct.
• C: It is the technique of choice for patients with potential spinal injury.
• D: It can only be used in conjunction with an oropharyngeal airway.

Which of the following processes occurs during cellular/capillary gas exchange?

• A: The cells give up oxygen to the capillaries.
• B: The capillaries give up carbon dioxide to the cells.
• C: The capillaries give up oxygen to the cells.
• D: The cells receive carbon dioxide from the capillaries.

When ventilating an unresponsive apneic adult with a bag-mask device, you should ensure that:

• A: ventilations occur at a rate of 20 breaths/min.
• B: an airway adjunct has been inserted.
• C: you are positioned alongside the patient.
• D: manually occlude the pop-off relief valve.

While providing initial ventilations to an apneic adult with a bag-mask device, you note minimal rise of the chest. You should:

• A: increase the volume of your ventilations.
• B: attach an oxygen reservoir to the bag-mask device.
• C: suction the airway for up to 15 seconds.
• D: switch to a smaller mask for the bag-mask device.

Which of the following injuries or conditions should be managed FIRST?

• A: Bilateral fractures of the femurs
• B: Fluid drainage from both ears
• C: A large open abdominal wound
• D: Bleeding within the oral cavity

The MOST effective way to determine if you are providing adequate volume during artificial ventilation is:

• A: checking the pupils for increased reactivity.
• B: assessing the pulse for an improving heart rate.
• C: assessing the chest for adequate rise.
• D: checking the skin for improvement of cyanosis.

While managing a patient with acute shortness of breath, you prepare and apply a nonrebreathing mask set at 12 L/min. The patient pulls the mask away from his face, stating that it is smothering him. You should:

• A: inform the patient that refusing oxygen may result in his death.
• B: reassure the patient and apply a nasal cannula instead.
• C: increase the oxygen flow and reapply the mask.
• D: securely tape the oxygen mask to the patient’s face.

A male patient overdosed on several drugs and is unresponsive with shallow breathing and facial cyanosis. As you continue your assessment, the patient suddenly vomits. You should:

• A: begin assisting his ventilations.
• B: suction his oropharynx at once.
• C: insert an oropharyngeal airway.
• D: turn the patient onto his side.

Which of the following patients is the BEST candidate for an oropharyngeal airway?

• A: An unresponsive patient with uncontrolled oropharyngeal bleeding
• B: A semiconscious patient who ingested a large quantity of aspirin
• C: An unresponsive trauma patient with blood draining from the nose
• D: Any patient that you suspect of being acutely hypoxemic

A 22-year-old male has a shard of glass impaled in his cheek. You look inside his mouth and see minor bleeding. The patient is conscious and alert with adequate breathing. You should:

• A: carefully stabilize the shard of glass and allow him to suction his own mouth.
• B: remove the shard of glass and place gauze in his mouth to control the bleeding.
• C: carefully remove the shard of glass in the same direction that it entered.
• D: be prepared for severe bleeding as you carefully remove the shard of glass.

In what position would you expect a patient with severe dyspnea to be in?

• A: Supine
• B: Prone
• C: Lateral recumbent
• D: Fowler’s

A middle-aged woman presents with acute shortness of breath. Her breathing is labored and she is able to speak in broken sentences. You should:

• A: deliver humidified oxygen and administer an inhaled bronchodilator.
• B: place her supine and assist her ventilations with a bag-mask device.
• C: ensure that her oxygen saturation does not fall below 85 percent.
• D: administer high-flow oxygen and assess the quality of her breathing.

Clinically, reduced tidal volume would MOST likely present with respirations that are:

• A: deep.
• B: shallow.
• C: eupneic.
• D: slow.

A 40-year-old man is conscious, but has an increased rate of breathing. You should:

• A: assess the regularity and quality of breathing.
• B: immediately insert a nasopharyngeal airway.
• C: apply 100% oxygen via nonrebreathing mask.
• D: assist his ventilations with a bag-mask device.

When attaching an oxygen regulator to a D cylinder and preparing it for use, you should recall that:

• A: the cylinder should be taken out of service and refilled when it contains less than 1,000 psi.
• B: a pressure-compensated flowmeter should be used when lying the oxygen cylinder down.
• C: the cylinder must remain in a standing position at all times or it will not deliver any oxygen.
• D: oxygen supports combustion and should not be used where sparks are easily generated.

To obtain the MOST reliable assessment of a patient's tidal volume, you should:

• A: look at the rise of the chest.
• B: count the respiratory rate.
• C: assess for retractions.
• D: listen for airway noises.

Tidal volume is defined as the:

• A: amount of air inhaled or exhaled per breath.
• B: total volume of air that the lungs are capable of holding.
• C: volume of air moved in and out of the lungs each minute.
• D: volume of air that remains in the upper airway.

Prior to applying a nonrebreathing mask on a patient with difficulty breathing, you should:

• A: prefill the reservoir bag to ensure delivery of 100% oxygen.
• B: set the flow rate to no more than 10 liters per minute.
• C: insert a nasopharyngeal airway to maintain airway patency.
• D: perform a complete exam to assess the degree of hypoxia.

In which of the following situations would you MOST likely encounter agonal gasps?

• A: Any patient who is unresponsive due to hypoxia
• B: Significant hypoxemia, regardless of the cause
• C: Shortly after becoming unresponsive and pulseless
• D: Occlusion of the posterior pharynx by the tongue

Prescribed inhalers, such as albuterol (Ventolin), relieve respiratory distress by:

• A: relaxing the smooth muscle of the bronchioles.
• B: dilating the large mainstem bronchi of the airway.
• C: constricting the bronchioles in the lungs.
• D: contracting the smaller airways in the lungs.

The process of loading oxygen molecules onto hemoglobin molecules in the bloodstream is called:

• A: respiration.
• B: oxygenation.
• C: diffusion.
• D: ventilation.

A 60-year-old woman is experiencing severe respiratory distress. When you ask her a question, she can only say two words at a time. Treatment for her should include:

• A: applying a nonrebreathing mask set at 15 L/min.
• B: insertion of a nasopharyngeal airway.
• C: applying a nasal cannula set at 2 to 6 L/min.
• D: assisted ventilation with a bag-mask device.

A young woman who overdosed on heroin is unresponsive with slow, shallow breathing. As you attempt to insert an oropharyngeal airway, she begins to gag. You should:

• A: remove the oropharyngeal airway and be prepared to suction her mouth.
• B: make sure you are using the most appropriate size of oropharyngeal airway.
• C: suction the patient’s oropharynx as you insert a nasopharyngeal airway.
• D: place her on her side until she stops gagging and then suction her mouth.

While ventilating an apneic patient with a bag-mask device, you note minimal rise of the chest each time you squeeze the bag. You should:

• A: squeeze the bag harder to ensure delivery of adequate tidal volume.
• B: suction the patient’s mouth for 15 seconds and reattempt ventilations.
• C: evaluate the mask-to-face seal and the position of the patient's head.
• D: ensure that the reservoir is properly attached to the bag-mask device.

When ventilating a patient with apnea with a pocket mask device, each breath should be delivered over:

• A: 2 seconds.
• B: 1 second.
• C: 4 seconds.
• D: 3 seconds.

A 60-year-old woman presents with acute respiratory distress. She is conscious and alert, but restless. Her respiratory rate is 26 breaths/min with adequate chest expansion, and her breath sounds are clear to auscultation bilaterally. Which of the following is the MOST appropriate treatment for this patient?

• A: A nasopharyngeal airway and assisted ventilations
• B: Supplemental oxygen with a nonrebreathing mask
• C: A nasal cannula with the flowmeter set at 4 to 6 L/min
• D: A nasopharyngeal airway and supplemental oxygen

An unresponsive young man has shallow, gurgling respirations at a rate of 8 breaths/min. Initial treatment should include:

• A: oxygen via nonrebreathing mask.
• B: positive-pressure ventilations.
• C: suctioning of the oropharynx.
• D: oropharyngeal airway insertion.

After an adult cardiac arrest patient has been intubated by a paramedic, you are providing ventilations as your partner performs chest compressions. When ventilating the patient, you should:

• A: deliver each breath over 1 second at a rate of 8 to 10 breaths/min.
• B: hyperventilate the patient to maximize carbon dioxide elimination.
• C: deliver each breath over 2 seconds at a rate of 12 to 15 breaths/min.
• D: deliver 2 breaths during a brief pause in chest compressions.

During the inhalation phase of breathing:

• A: the diaphragm and intercostal muscles contract and ascend.
• B: the muscles in between the ribs relax, which lifts the ribs up and out.
• C: pressure within the thorax decreases and air is drawn into the lungs.
• D: air passively enters the lungs as pressure within the thorax increases.

If a 29-year-old male presents with a respiratory rate of 26 breaths/min, you should:

• A: apply the pulse oximeter and assess his oxygen saturation.
• B: begin assisting his ventilations with a bag-mask device.
• C: apply oxygen via a nonrebreathing mask and take his vital signs.
• D: evaluate his mental status and the depth of his respirations.

All of the following would cause an increased level of carbon dioxide in the arterial blood, EXCEPT:

• A: reduced tidal volume.
• B: slow, shallow breathing.
• C: short exhalation phase.
• D: deep, rapid breathing.

You are ventilating an apneic adult female with a bag-mask device and high-flow oxygen. Her pulse rate is 130 beats/min and she has cyanosis to her face and chest. The MOST reliable indicator of adequately performed ventilations in this patient is:

• A: slight dissipation of her cyanosis.
• B: a decrease in her heart rate to 90 beats/min.
• C: decreased compliance with each ventilation.
• D: noted abdominal rise with each ventilation.

You receive a call for a 49-year-old woman who passed out. The patient's husband tells you that they were watching TV when the incident occurred. No trauma was involved. The patient is semiconscious and has cyanosis to her lips. After opening her airway with the head tilt-chin lift maneuver, you should:

• A: begin ventilation assistance.
• B: assess her respiratory effort.
• C: insert a nasopharyngeal airway.
• D: insert an oropharyngeal airway.

Occasional, irregular breaths that may be observed in a cardiac arrest patient are called:

• A: Cheyne-Stokes respirations.
• B: Biot respirations.
• C: ataxic respirations.
• D: agonal gasps.

At the peak of the inspiratory phase, the alveoli in the lungs contain:

• A: equal levels of oxygen and carbon dioxide.
• B: more oxygen than carbon dioxide.
• C: high quantities of carbon dioxide.
• D: minimal levels of oxygen and carbon dioxide.

A 22-year-old man crashed his motorcycle into a tree. He is found approximately 20 feet away from his bike and is responsive to pain only. He is not wearing a helmet. You are unable to effectively open his airway with the jaw-thrust maneuver. What should you do?

• A: Insert an oral airway and assess his breathing.
• B: Suction his oropharynx and reattempt the jaw-thrust.
• C: Apply high-flow oxygen and assess his carotid pulse.
• D: Carefully tilt his head back and lift up on his chin.

Which of the following is the MOST correct technique for ventilating an apneic adult who has a pulse?

• A: Deliver each breath over 1 second at a rate of 8 to 10 breaths/min.
• B: Ventilate at a rate of 15 breaths/min and look for visible chest rise.
• C: Hyperventilate at a rate between 20 and 24 breaths/min.
• D: Deliver each breath over 1 second at a rate of 10 to 12 breaths/min.

You are performing abdominal thrusts on a 19-year-old male with a severe airway obstruction when he becomes unresponsive. After lowering him to the ground and placing him in a supine position, you should:

• A: open his airway and look inside his mouth.
• B: assess for a carotid pulse for up to 10 seconds.
• C: continue abdominal thrusts until ALS arrives.
• D: begin CPR, starting with chest compressions.

Which of the following clinical findings is MOST consistent with a chronic history of a respiratory disease?

• A: Impaired mental status
• B: An irregular pulse
• C: Use of accessory muscles
• D: A barrel-shaped chest

You are administering oxygen at 15 L/min to a patient with respiratory distress. If you are using a D cylinder (cylinder constant, 0.16), which reads 1,500 psi, how long will it take before you need to replace the oxygen cylinder?

• A: 18 minutes
• B: 14 minutes
• C: 9 minutes
• D: 11 minutes

You are dispatched to a residence for an elderly female who has possibly suffered a stroke. You find her lying supine in her bed. She is semiconscious; has vomited; and has slow, irregular breathing. You should:

• A: administer high-flow oxygen and place her on her side.
• B: perform a head tilt-chin lift and insert an oral airway.
• C: manually open her airway and suction her oropharynx.
• D: insert a nasal airway and begin assisting her breathing.

You are assessing a middle-aged male who is experiencing respiratory distress. The patient has a history of emphysema and hypertension. He appears fatigued; has weak retractions; and labored, shallow breathing. Your MOST immediate action should be to:

• A: assess his oxygen saturation with a pulse oximeter.
• B: administer oxygen with a nonrebreathing mask.
• C: assist his ventilations with a bag-mask device.
• D: auscultate his breath sounds to detect wheezing.

The lower airway begins at the:

• A: larynx.
• B: cricoid cartilage.
• C: epiglottis.
• D: trachea.

An inaccurate pulse oximetry reading may be caused by:

• A: excessive red blood cell production.
• B: a heart rate greater than 100 beats/min.
• C: severe peripheral vasoconstriction.
• D: heat illnesses, such as heat stroke.

Which of the following signs or symptoms is indicative of cerebral hypoxia?

• A: Diffuse wheezing on exhalation
• B: Chief complaint of dyspnea
• C: Heart rate greater than 120 beats/min
• D: Decreased level of consciousness

A patient who is breathing with reduced tidal volume would MOST likely have:

• A: a respiratory rate of 14 breaths/min.
• B: shallow respirations.
• C: warm, moist skin.
• D: a prolonged inhalation phase.

A nonrebreathing mask is MOST appropriate to use on patients who:

• A: are cyanotic and have a low oxygen saturation.
• B: are breathing less than 12 times per minute.
• C: are semiconscious and breathing shallowly.
• D: have an adequate rate and depth of breathing.

The tidal volume of an unresponsive patient is rapidly assessed by:

• A: counting the patient's respiratory rate.
• B: auscultating his or her lung sounds.
• C: observing for chest rise during inhalation.
• D: evaluating for the presence of cyanosis.

A 60-year-old female is found unresponsive. She is cyanotic, is making a snoring sound while she breathes, and has a slow respiratory rate. You should:

• A: insert an airway adjunct.
• B: ventilate her with a bag-mask device.
• C: suction her airway for 15 seconds.
• D: manually open her airway.

Ventilation is defined as the:

• A: volume of air inhaled into the lungs in a single breath.
• B: movement of air into and out of the lungs.
• C: exchange of oxygen and carbon dioxide at the cell level.
• D: elimination of carbon dioxide from the body.

Oxygen that is administered through a nasal cannula would be of LEAST benefit to a patient who:

• A: is breathing greater than 12 times per minute.
• B: has COPD and an oxygen saturation of 94%.
• C: breathes through his or her mouth.
• D: is in need of long-term oxygen therapy.

Which of the following yields the lowest minute volume?

• A: Respiratory rate of 16 breaths/min; tidal volume of 400 mL
• B: Respiratory rate of 10 breaths/min; tidal volume of 500 mL
• C: Respiratory rate of 14 breaths/min; tidal volume of 300 mL
• D: Respiratory rate of 12 breaths/min; tidal volume of 500 mL

To ensure you deliver the highest concentration of oxygen with a nonrebreathing mask, you should:

• A: set the flow rate to at least 10 to 12 L/min.
• B: cover the flapper valves on the oxygen mask.
• C: make sure that the reservoir bag is preinflated.
• D: securely fasten the mask to the patient’s face.

The MOST appropriate treatment for a semiconscious patient with slow, shallow respirations includes:

• A: a nasopharyngeal airway and assisted ventilation with a bag-mask device.
• B: an oropharyngeal airway and assisted ventilation with a bag-mask device.
• C: a nasopharyngeal airway and high-flow oxygen via a nonrebreathing mask.
• D: an oropharyngeal airway and high-flow oxygen via a nonrebreathing mask.

An unresponsive apneic patient’s chest fails to rise after two ventilation attempts. You should:

• A: reposition the head and reattempt to ventilate.
• B: immediately proceed to chest compressions.
• C: attempt to ventilate again using more volume.
• D: suction the airway and reattempt ventilations.

During your initial attempt to ventilate an unresponsive apneic patient, you meet resistance and do not see the patient’s chest rise. You should:

• A: begin CPR, starting with chest compressions.
• B: suction the airway for no longer than 15 seconds.
• C: assume that a foreign body is blocking the airway.
• D: reposition the head and reattempt to ventilate.

You are assessing an elderly man with respiratory distress. He is coughing up bloody sputum and has an oxygen saturation of 85%. You auscultate his breath sounds and hear coarse crackles in all lung fields. This patient MOST likely has:

• A: congestive heart failure.
• B: decompensated asthma.
• C: severe bacterial pneumonia.
• D: acute onset emphysema.

What is the function of pulmonary surfactant?

• A: It facilitates the production of mucous, which is expelled during coughing.
• B: It dilates the bronchioles in the lungs and enhances the flow of air.
• C: It carries fresh oxygen from the lungs to the left side of the heart.
• D: It lubricates the alveolar walls and allows them to expand and recoil.

You are assessing a 66-year-old man who has emphysema and complains of worsened shortness of breath. He is confused, has a heart rate of 120 beats/min, and an oxygen saturation of 89%. Which of the following assessment findings should concern you the MOST?

• A: Low oxygen saturation
• B: Confusion
• C: Worsened shortness of breath
• D: Tachycardia

When suctioning copious secretions from a semiconscious adult’s airway, you should:

• A: apply suction as you carefully insert the catheter into the mouth.
• B: suction for up to 20 seconds while withdrawing the catheter.
• C: use a flexible catheter because it will remove the secretions faster.
• D: avoid touching the back of the airway with the suction catheter.

A young female experienced massive facial trauma and is unresponsive. After several attempts, you are unable to adequately open her airway with the jaw-thrust maneuver. You should:

• A: apply oxygen and reattempt the jaw-thrust maneuver.
• B: carefully tilt her head back and lift up on her chin.
• C: insert a nasopharyngeal airway and apply oxygen.
• D: begin assisting her ventilations with a bag-mask device.

Which of the following would MOST likely occur if an adult patient is breathing at a rate of 45 breaths/min with shallow depth?

• A: The lungs would become hyperinflated, potentially causing a pneumothorax.
• B: Most of his or her inhaled air will not go beyond the anatomic dead space.
• C: The volume of air that reaches the alveoli would increase significantly.
• D: Alveolar minute volume would increase due to the rapid respiratory rate.

The method by which you administer supplemental oxygen to a hypoxic patient depends MOSTLY on the:

• A: suspected underlying cause of the hypoxia.
• B: presence or absence of cyanosis.
• C: severity of hypoxia and adequacy of breathing.
• D: patient’s level of consciousness and heart rate.

An unresponsive 60-year-old male is apneic and has a weak, rapid pulse. His oxygen saturation reads 79%. You should:

• A: ventilate at a rate of 8 to 10 breaths/min, ensuring visible chest rise.
• B: mildly hyperventilate him until his oxygen saturation improves.
• C: deliver one breath over 1 second every 5 to 6 seconds.
• D: use a pocket face mask to deliver 12 to 20 breaths/min

The respiratory system functions by:

• A: sending messages to the diaphragm that cause it to contract.
• B: bringing oxygen into the lungs and eliminating carbon dioxide.
• C: removing carbon dioxide from the cells and returning it to the lungs.
• D: ensuring that adequate oxygen is delivered to the body’s tissues.

A properly placed oropharyngeal airway:

• A: will not stimulate a conscious patient’s gag reflex.
• B: eliminates the need to perform a head tilt-chin lift.
• C: prevents aspiration if the patient regurgitates.
• D: keeps the tongue off of the posterior pharynx.

Which of the following patients obviously needs positive-pressure ventilation assistance?

• A: Responsive to pain only; respiratory rate of 8 breaths/min and shallow
• B: Combative; respiratory rate of 24 breaths/min and deep
• C: Restless; respiratory rate of 12 breaths/min with adequate tidal volume
• D: Semiconscious; respiratory rate of 14 breaths/min and good chest rise

Which of the following ventilation techniques will enable you to provide the greatest tidal volume AND allow you to effectively assess lung compliance?

• A: One-rescuer mouth-to-mask ventilation
• B: One-rescuer bag-mask ventilation
• C: One-rescuer demand valve ventilation
• D: Flow-restricted, oxygen-powered ventilation

Which of the following statements regarding artificial ventilation of an apneic patient who has dentures is correct?

• A: Tight-fitting dentures should be left in place because they facilitate the delivery of adequate tidal volume.
• B: Because of the risk of airway obstruction, the EMT should routinely remove a patient’s dentures.
• C: The EMT should not attempt to remove a patient’s dentures because this may cause an airway obstruction.
• D: If a patient’s dentures are loose, the EMT should use the jaw-thrust maneuver to keep the airway open.

Hypoxia is defined as:

• A: an excess amount of carbon dioxide in arterial blood.
• B: decreased oxygen content in arterial blood.
• C: inadequate oxygen to the body’s cells and tissues.
• D: an absence of oxygen to the vital body organs.

Shallow respirations are an indication of:

• A: increased carbon dioxide removal.
• B: decreased tidal volume.
• C: increased oxygen intake.
• D: increased tidal volume.

In which position should you place an uninjured, unresponsive patient with a respiratory rate of 14 breaths/min and adequate tidal volume?

• A: Full-Fowler’s
• B: Supine
• C: Semi-Fowler’s
• D: Lateral recumbent

An unresponsive patient’s respirations are 26 breaths/min and shallow. The MOST appropriate treatment includes:

• A: a simple face mask set at 10 to 12 L/min.
• B: assisted ventilations with 100% oxygen.
• C: a nasal cannula set at 1 to 6 L/min.
• D: a nonrebreathing mask set at 15 L/min.

If the level of carbon dioxide in the arterial blood increases:

• A: the respiratory rate and depth decrease.
• B: the respiratory rate and depth increase.
• C: a reduction in tidal volume will occur.
• D: the respiratory rate slows significantly.

A patient's skin will MOST likely become cyanotic if he or she has:

• A: an increase in the amount of arterial oxygen.
• B: a decrease in the amount of carbon dioxide.
• C: an overall increase in circulating red blood cells.
• D: a decrease in the amount of arterial oxygen.

A 56-year-old man with a history of heart disease reports pain in the upper midabdominal area. This region of the abdomen is called the:

• A: mediastinum.
• B: retroperitoneum.
• C: epigastrium.
• D: peritoneum.

The chest pain associated with an acute coronary syndrome is often described as:

• A: cramping.
• B: pressure.
• C: sharp.
• D: stabbing.

The automated external defibrillator (AED) should NOT be used in patients who:

• A: have a nitroglycerin patch applied to the skin.
• B: are between 1 and 8 years of age.
• C: are apneic and have a weak carotid pulse.
• D: experienced a witnessed cardiac arrest.

Which of the following assessment findings is LEAST suggestive of cardiac compromise?

• A: Palpable pain to the chest
• B: Nausea and epigastric pain
• C: Rapid, irregular heart rate
• D: Anxiety and pale, cool skin

A 45-year-old woman calls EMS because of severe chest pain. When you arrive, she advises you that she has taken two of her husband’s nitroglycerin (NTG) tablets without relief. What is your MOST appropriate course of action?

• A: Call medical control and request permission to assist the patient with one more NTG tablet.
• B: Apply oxygen, assess the patient's blood pressure, and give a third and final NTG tablet.
• C: Attach the AED, administer 100% oxygen, and contact medical control for advice.
• D: Apply supplemental oxygen and transport the patient to the hospital without delay.

Prior to administering nitroglycerin to a patient with chest pain, you should:

• A: auscultate the patient's breath sounds.
• B: obtain vital signs to detect hypotension.
• C: elevate the patient's lower extremities.
• D: inquire about an allergy to salicylates.

What is the MOST detrimental effect that tachycardia can have on a patient experiencing a cardiac problem?

• A: Increased stress and anxiety
• B: Increased blood pressure
• C: Decreased cardiac functioning
• D: Increased oxygen demand

A 50-year-old man presents with “crushing” chest pain of sudden onset. He is diaphoretic and nauseated. You should:

• A: ask him if he takes nitroglycerin.
• B: perform a complete physical exam.
• C: obtain baseline vital signs.
• D: apply supplemental oxygen.

A 58-year-old man is found unresponsive by his wife. According to his wife, he was complaining of a "dull ache" in his chest the day before, but refused to allow her to call 9-1-1. His blood pressure is 70/50 mm Hg, his pulse is 120 beats/min and weak, and his respirations are 28 breaths/min and labored. Further assessment reveals that his skin is cool, pale, and clammy. You should suspect:

• A: cardiogenic shock.
• B: acute septic shock.
• C: pulmonary embolism.
• D: hypovolemic shock.

After applying the AED to a 56-year-old female in cardiac arrest, you analyze her cardiac rhythm and receive a shock advised message. Emergency medical responders, who arrived at the scene before you, tell you that bystander CPR was not in progress upon their arrival. You should:

• A: detach the AED and prepare for immediate transport.
• B: perform CPR for 2 minutes and then defibrillate.
• C: deliver the shock as indicated followed immediately by CPR.
• D: notify medical control and request permission to cease resuscitation.

In addition to supplemental oxygen, one of the MOST effective way to minimize the detrimental effects associated with acute coronary syndrome is to:

• A: request ALS support for any patient who has chest pain.
• B: transport the patient rapidly, using lights and siren.
• C: give the patient up to four doses of nitroglycerin.
• D: reassure the patient and provide prompt transport.

Common signs and symptoms of a hypertensive emergency include:

• A: chest discomfort, weak pulses, and cool skin.
• B: unequal pupils, irregular pulse, and pallor.
• C: vomiting without nausea and hemiparesis.
• D: ringing in the ears, headache, and epistaxis.

When treating a patient with chest pain, pressure, or discomfort, you should first:

• A: administer supplemental oxygen.
• B: assess the blood pressure and give nitroglycerin.
• C: request an ALS ambulance response to the scene.
• D: place the patient in a position of comfort.

The wall that separates the left and right sides of the heart is called the:

• A: septum.
• B: mediastinum.
• C: pericardium.
• D: carina.

Sudden cardiac arrest in the adult population MOST often is the result of:

• A: respiratory failure.
• B: accidental electrocution.
• C: myocardial infarction.
• D: a cardiac arrhythmia.

The position of comfort for a patient with nontraumatic chest pain MOST commonly is:

• A: supine with the legs elevated slightly.
• B: semisitting.
• C: on the side with the head elevated.
• D: lateral recumbent.

Aspirin may be contraindicated in patients with:

• A: stomach ulcers.
• B: glaucoma.
• C: ibuprofen allergy.
• D: diabetes.

A 56-year-old man is found to be pulseless and apneic. His wife states that he collapsed about 5 minutes ago. As your partner gets the AED from the ambulance, you should:

• A: ask the wife if the patient has a living will.
• B: begin CPR, starting with chest compressions.
• C: provide rescue breaths until the AED is ready.
• D: open the airway and give 2 rescue breaths.

You are treating a 60-year-old man in cardiac arrest. After delivering a shock with the AED and performing CPR for 2 minutes, you achieve return of spontaneous circulation. Your next action should be to:

• A: provide rapid transport to the hospital.
• B: assess his airway and ventilatory status.
• C: remove the AED and apply 100% oxygen.
• D: reanalyze his rhythm for confirmation.

Which of the following questions would be MOST appropriate to ask when assessing a patient with chest pain?

• A: Does the pain radiate to your arm?
• B: Is the pain worse when you take a deep breath?
• C: What does the pain feel like?
• D: Would you describe the pain as sharp?

Chest compression effectiveness is MOST effectively assessed by:

• A: measuring the systolic blood pressure during compressions.
• B: carefully measuring the depth of each compression.
• C: listening for a heartbeat with each compression.
• D: palpating for a carotid pulse with each compression.

Which of the following is the BEST indicator of cardiac output?

• A: Pulse rate and quality
• B: Condition and color of the skin
• C: Quality of the respirations
• D: Systolic blood pressure

A 50-year-old man's implanted defibrillator has fired twice within the last hour. He is conscious and alert and complains of a "sore chest." Further assessment reveals that his chest pain is reproducible to palpation and is localized to the area of his implanted defibrillator. In addition to supplemental oxygen, treatment for him should include:

• A: application of the AED and transport to the hospital.
• B: prompt transport with continuous monitoring en route.
• C: deactivating his defibrillator by running a magnet over it.
• D: up to three doses of nitroglycerin and prompt transport.

You are caring for a 66-year-old woman with severe pressure in her chest. As you administer oxygen to her, your partner should:

• A: gather her medications.
• B: notify medical control.
• C: obtain a SAMPLE history.
• D: obtain a set of vital signs.

Which of the following patients would be the LEAST likely to present with classic signs and symptoms of acute myocardial infarction?

• A: 64-year-old male with renal disease and depression.
• B: 55-year-old female with COPD and frequent infections.
• C: 72-year-old female with diabetes and hypertension.
• D: 59 year-old male with alcoholism and angina pectoris.

The AED analyzes your pulseless and apneic patient's cardiac rhythm and advises that a shock is NOT indicated. You should:

• A: reanalyze the cardiac rhythm for positive confirmation.
• B: resume CPR, starting with chest compressions.
• C: assess for a pulse for no more than 10 seconds.
• D: open the patient's airway and check for breathing.

Which of the following statements regarding the automated external defibrillator (AED) is correct?

• A: AEDs will analyze the patient’s rhythm while CPR is in progress
• B: The AED should be applied to patients at risk for cardiac arrest
• C: The AED should not be used in patients with an implanted defibrillator
• D: AEDs can safely be used in infants and children less than 8 years of age

Which of the following effects does nitroglycerin possess when administered to patients with suspected cardiac chest pain?

• A: Vasoconstriction and increased cardiac oxygen demand
• B: Vasodilation and increased myocardial oxygen supply
• C: Vasoconstriction and increased myocardial workload
• D: Vasodilation and decreased myocardial oxygen supply

Which of the following describes the MOST appropriate method of performing chest compressions on an adult patient in cardiac arrest?

• A: Allow full recoil of the chest after each compression, compress the chest to a depth of 2”, deliver compressions at a rate of at least 80/min
• B: Compress the chest at least 2", allow full recoil of the chest after each compression, minimize interruptions in chest compressions
• C: Minimize interruptions in chest compressions, provide 70% compression time and 30% relaxation time, deliver compressions at a rate of 100/min
• D: Do not interrupt chest compressions for any reason, compress the chest no more than 1 1/2”, allow partial recoil of the chest after each compression

Which of the following chambers of the heart has the thickest walls?

• A: Left ventricle
• B: Right ventricle
• C: Left atrium
• D: Right atrium

Ischemic heart disease is a condition in which:

• A: there is a decrease in blood flow to one or more portions of the heart muscle.
• B: a portion of the heart muscle dies because of a prolonged lack of oxygen.
• C: an acute event leads to a significant decrease in the pumping force of the heart.
• D: the coronary arteries dilate, thus preventing effective blood flow to the heart.

A 65-year-old man has generalized weakness and chest pressure. He has a bottle of prescribed nitroglycerin, but states that he has not taken any of his medication. As your partner prepares to administer oxygen, you should:

• A: assist the patient with his nitroglycerin with medical control approval.
• B: administer up to 325 mg of aspirin if the patient is not allergic to it.
• C: perform a secondary assessment and obtain baseline vital signs.
• D: apply the AED and prepare the patient for immediate transport.

Which of the following structures is the primary pacemaker, which sets the normal rate for the heart?

• A: Bundle of His
• B: Purkinje fibers
• C: Atrioventricular node
• D: Sinoatrial node

The middle, muscular layer of the heart is called the:

• A: pericardium.
• B: epicardium.
• C: myocardium.
• D: endocardium.

Freshly oxygenated blood returns to the heart via the:

• A: pulmonary artery.
• B: aorta.
• C: pulmonary vein.
• D: vena cavae.

Which of the following patients is the BEST candidate for the administration of nitroglycerin?

• A: A woman who has taken three doses of prescribed nitroglycerin without relief of chest pain
• B: A woman with chest pain, prescribed nitroglycerin, and a blood pressure of 102/76 mm Hg
• C: A man with chest pain, expired nitroglycerin spray, and a blood pressure of 110/80 mm Hg
• D: An elderly man with crushing substernal chest pain and a blood pressure of 80/60 mm Hg

Which of the following statements regarding one-rescuer CPR is correct?

• A: The chest should be allowed to fully recoil after each compression.
• B: A compression to ventilation ratio of 15:2 should be delivered.
• C: Ventilations should be delivered over a period of 2 to 3 seconds.
• D: You should assess the patient for a pulse after 3 cycles of CPR.

Which of the following patients would MOST likely present with vague or unusual or symptoms of an acute myocardial infarction?

• A: 66-year-old male with angina
• B: 55-year-old obese female
• C: 75-year-old male with hypertension
• D: 72-year-old female with diabetes

Which of the following is MOST indicative of a primary cardiac problem?

• A: Tachypnea
• B: Sudden fainting
• C: Irregular pulse
• D: Tachycardia

A patient who is experiencing an acute myocardial infarction:

• A: has chest pain or discomfort that does not change with each breath.
• B: most often describes his or her chest pain as being sharp or tearing.
• C: often complains of a different type of pain than a patient with angina.
• D: often experiences relief of his or her chest pain after taking nitroglycerin.

Which of the following is a common side effect of nitroglycerin?

• A: Nausea
• B: Hypertension
• C: Headache
• D: Anxiety

The myocardium receives its blood supply from the coronary arteries that branch directly from the:

• A: aorta.
• B: left atrium.
• C: right ventricle.
• D: vena cava.

While assessing an elderly man who is complaining of chest pain, he suddenly becomes unresponsive. You should immediately:

• A: apply the AED.
• B: assess for breathing.
• C: assess for a pulse.
• D: open the airway.

Your partner has applied the AED to a cardiac arrest patient and has received a shock advised message. While the AED is charging, you should:

• A: cease all contact with the patient until the AED has delivered the shock.
• B: continue chest compressions until your partner tells you to stand clear.
• C: perform rescue breathing only until the AED is charged and ready to shock.
• D: retrieve the airway equipment and prepare to ventilate the patient.

In which of the following patients is nitroglycerin contraindicated?

• A: 41-year-old male with crushing substernal chest pressure, a blood pressure of 160/90 mm Hg, and severe nausea
• B: 58-year-old male with chest pain radiating to the left arm, a blood pressure of 130/64 mm Hg, and prescribed Tegretol
• C: 66-year-old female with chest pressure of 6 hours’ duration, lightheadedness, and a blood pressure of 110/58 mm Hg
• D: 53-year-old male with chest discomfort, diaphoresis, a blood pressure of 146/66 mm Hg, and regular use of Levitra

While assessing a patient with chest pain, you note that his pulse is irregular. This indicates:

• A: a dysfunction in the left side of the patient’s heart
• B: acute myocardial infarction or angina pectoris.
• C: abnormalities in the heart’s electrical conduction system.
• D: high blood pressure that is increasing cardiac workload.

When assessing a patient with a complaint of chest pain, which of the following questions would you ask to assess the "R" in OPQRST?

• A: Is there anything that makes the pain worse?
• B: Is the pain in one place or does it move around?
• C: Did the pain begin suddenly or gradually?
• D: What were you doing when the pain began?

How can you help maximize cardiac output during CPR?

• A: Allow the chest to fully recoil in between compressions
• B: Deliver rescue breaths until the chest expands widely
• C: Compress the chest at a rate of no more than 100/min
• D: Ventilate the patient through an advanced airway device

In patients with heart disease, acute coronary syndrome is MOST often the result of:

• A: coronary artery rupture.
• B: atrial damage.
• C: coronary artery spasm.
• D: atherosclerosis.

A 60-year-old man presents with chest pain and difficulty breathing. He is pale, diaphoretic, and in severe pain. As your partner applies supplemental oxygen, you assess his vital signs. His blood pressure is 180/90 mm Hg, pulse is 110 beats/min and irregular, and respirations are 24 breaths/min and labored. You ask him if has taken any nitroglycerin and he tells you that he does not have any but his wife does. You should:

• A: have him swallow up to four enteric-coated aspirin, continue oxygen therapy, and promptly transport him to the hospital.
• B: transport at once, apply the AED in case he develops cardiac arrest, and monitor his vital signs en route to the hospital.
• C: complete your focused physical examination and prepare the patient for immediate transport to an appropriate hospital.
• D: contact medical control and request permission to assist the patient with up to three doses of his wife’s nitroglycerin.

Aspirin is beneficial to patients experiencing an acute coronary syndrome because it:

• A: effectively relieves their chest pain.
• B: destroys the clot that is blocking a coronary artery.
• C: prevents a clot from getting larger.
• D: decreases cardiac workload by lowering the BP.

Which of the following would clearly be detrimental to a patient in cardiac arrest?

• A: Performing CPR before defibrillation
• B: Using a pocket face mask without high-flow oxygen
• C: Interrupting CPR for more than 10 seconds
• D: Ventilating just until the chest rises

Sudden cardiac arrest in the adult population is MOST often the result of:

• A: an acute stroke.
• B: myocardial infarction.
• C: a cardiac dysrhythmia.
• D: respiratory failure.

Which of the following is an abnormal finding when using the Cincinnati stroke scale to assess a patient who presents with signs of a stroke?

• A: One of the pupils is dilated and does not react to light.
• B: Both arms drift slowly and equally down to the patient’s side.
• C: One arm drifts down compared with the other side.
• D: The patient’s face is symmetrical when he or she smiles.

The pain associated with acute aortic dissection:

• A: typically comes on gradually and progressively worsens.
• B: originates in the epigastrium and radiates down both legs.
• C: is usually preceded by nausea, sweating, and weakness.
• D: is typically described as a stabbing or tearing sensation.

Which of the following describes pulseless electrical activity (PEA)?

• A: The presence of a palpable pulse in the absence of any electrical activity in the heart
• B: A disorganized, chaotic quivering of the heart muscle that does not generate a pulse
• C: Any organized cardiac rhythm, slow or fast, that does not produce a palpable pulse
• D: A rapid cardiac rhythm that does not produce a pulse, but responds to defibrillation

Shortly after assisting a 60-year-old woman with her second nitroglycerin treatment, she tells you that she is lightheaded and feels like she is going to faint. Her symptoms are MOST likely due to:

• A: an irregular heartbeat.
• B: low blood pressure.
• C: nervousness and anxiety.
• D: a drop in her blood sugar.

During your assessment of a 70-year-old man with crushing chest pain, you note that his blood pressure is 80/50 mm Hg. Your MOST important action should be to:

• A: give high-flow oxygen.
• B: keep the patient warm.
• C: assess his oxygen saturation.
• D: transport without delay.

After attaching the AED and pushing the analyze button on an adult patient in cardiac arrest, the AED states that a shock is advised. What cardiac rhythm is the patient MOST likely in?

• A: Pulseless electrical activity
• B: Asystole
• C: Ventricular fibrillation
• D: Ventricular tachycardia

A 66-year-old female presents with an acute onset of confusion, slurred speech, and weakness to her right arm and leg. Her airway is patent and she is breathing adequately. The MOST important initial information to determine regarding this patient is:

• A: her initial blood pressure reading.
• B: whether or not her pupils are equal.
• C: when her symptoms were first noted.
• D: what she was doing when this began.

The energy setting for a biphasic AED:

• A: is manufacturer specific.
• B: must be manually set by the EMT.
• C: is typically 360 joules.
• D: increases by 50 joules with each shock.

Which of the following types of stroke would MOST likely present with a sudden, severe headache?

• A: Thrombotic
• B: Ischemic
• C: Embolic
• D: Hemorrhagic

After administering nitroglycerin to a patient with chest discomfort, it is MOST important for you to:

• A: ask the patient if the discomfort has improved.
• B: reassess his or her blood pressure within 5 minutes.
• C: place the patient supine and elevate his or her legs.
• D: find out how long the discomfort has been present

You should be MOST suspicious that a patient with chest pressure has an underlying cardiac problem if his or her pulse is:

• A: rapid.
• B: slow.
• C: irregular.
• D: bounding.

The MOST important initial treatment for a patient whose cardiac arrest was witnessed is:

• A: defibrillation.
• B: high-quality CPR.
• C: rapid transport.
• D: cardiac drug therapy.

A patient whose artificial pacemaker has failed would MOST likely experience:

• A: hypertension and a headache.
• B: weakness and bradycardia.
• C: dizziness and excessive tachycardia
• D: irreversible ventricular fibrillation.

A middle-aged woman took three of her prescribed nitroglycerin tablets after she began experiencing chest pain. She complains of a bad headache and is still experiencing chest pain. You should assume that:

• A: she has ongoing cardiac ischemia.
• B: her blood pressure is elevated.
• C: her chest pain is not cardiac-related.
• D: her nitroglycerin is no longer potent.

An elderly man in unresponsive and has agonal breathing. You should:

• A: check for a carotid pulse for up to 10 seconds.
• B: perform rescue breathing at 10 to 12 breaths/min.
• C: begin CPR, starting with chest compressions.
• D: open his airway and deliver 2 rescue breaths.

When an error occurs while using the AED, it is MOST often the result of:

• A: excess patient movement during the analyze phase.
• B: battery failure secondary to operator error.
• C: misinterpretation of the patient’s cardiac rhythm.
• D: malfunction of the microchip inside the AED.

Which of the following questions would be the MOST effective in determining if a patient's chest pain radiates away from his or her chest?

• A: Is there anything that makes the pain better or worse?
• B: Is there any other part of your body where you have pain?
• C: Do you also have pain in your arm, jaw, or back?
• D: Does the pain stay in your chest or move anywhere else?

A 60-year-old man is in cardiac arrest. You begin CPR while your partner applies the AED. What should you do if you receive a no shock message?

• A: Ensure that the AED electrodes are properly applied.
• B: Assess for a carotid pulse for up to 10 seconds.
• C: Reanalyze his cardiac rhythm after 30 seconds of CPR.
• D: Resume CPR, starting with chest compressions.

Switching compressors during two-rescuer CPR:

• A: should take no more than 10 seconds to accomplish.
• B: is performed after every 10 to 20 cycles of adult CPR.
• C: is only necessary if the compressor becomes fatigued.
• D: should occur every 2 minutes throughout the arrest

You arrive at the scene shortly after a 55-year-old man collapsed. Two bystanders are performing CPR. Your FIRST action should be to:

• A: insert an oropharyngeal airway and continue CPR
• B: attach the AED and analyze his cardiac rhythm.
• C: stop CPR so you can assess breathing and pulse.
• D: check the effectiveness of the CPR in progress.

In addition to chest pain or discomfort, a patient experiencing an acute coronary syndrome would MOST likely present with:

• A: irregular breathing and low blood pressure.
• B: profound cyanosis, dry skin, and a headache.
• C: ashen skin color, diaphoresis, and anxiety.
• D: severe projectile vomiting and flushed skin.

After defibrillating a man in cardiac arrest, you resume CPR. As you are about to reanalyze his cardiac rhythm 2 minutes later, your partner tells you she can definitely feel a strong carotid pulse. You should:

• A: ask her to obtain a blood pressure reading.
• B: assess the patient’s breathing effort.
• C: continue with the rhythm analysis.
• D: remove the AED pads from the patient’s chest.

Which of the following interventions would the EMT be the LEAST likely to perform while attempting to resuscitate a cardiac arrest patient?

• A: Ventilation with a bag-mask device
• B: Assisting a paramedic with intubation
• C: Insertion of a laryngeal mask airway
• D: Rhythm analysis with the AED

The quickest way to reduce cardiac ischemia in a patient experiencing an acute coronary syndrome is to:

• A: elevate the patient’s legs.
• B: sit or lay the patient down.
• C: keep the patient warm.
• D: give supplemental oxygen.

After delivering one shock with the AED and performing 2 minutes of CPR on a woman in cardiac arrest, you reanalyze her cardiac rhythm and receive a no shock advised message. This means that:

• A: the first shock restored a rhythm and pulse.
• B: her rhythm has deteriorated to asystole.
• C: she is not in a shockable rhythm.
• D: she has electrical activity but no pulse.

Nitroglycerin is contraindicated in all of the following situations, EXCEPT:

• A: the presence of a head injury.
• B: history of cardiac bypass surgery.
• C: recent use of Cialis.
• D: systolic BP of 80 mm Hg.

Which of the following statements regarding ventricular fibrillation (V-Fib) is correct?

• A: In V-Fib, the heart is not pumping any blood and the patient is pulseless.
• B: Loss of consciousness occurs within minutes after the onset of V-Fib.
• C: Patients in V-Fib should be defibrillated after every 60 seconds of CPR.
• D: Any patient in V-Fib must receive CPR for 2 minutes prior to defibrillation

You should suspect that your patient has pulmonary edema if he or she:

• A: has swollen feet and ankles.
• B: has a dry, nonproductive cough.
• C: is hypertensive and tachycardic.
• D: cannot breathe while lying down.

You have analyzed a cardiac arrest patient's rhythm three times with the AED, separated by 2-minute cycles of CPR, and have received no shock messages each time. You should:

• A: request a paramedic unit at the scene.
• B: consider terminating resuscitation.
• C: continue CPR and transport at once.
• D: remove the AED and continue CPR.

Following administration of nitroglycerin to a man with crushing chest pressure, he experiences a significant increase in his heart rate. This is MOST likely the result of:

• A: coronary vasoconstriction.
• B: preexisting hypertension.
• C: a cardiac dysrhythmia.
• D: a drop in blood pressure.

Your assessment of a middle-aged female with chest pressure reveals that she is confused, diaphoretic, and has a blood pressure of 70/50 mm Hg. In caring for this patient, it is MOST important for you to:

• A: request an ALS unit to respond to the scene.
• B: prepare for immediate transport to the hospital.
• C: reassess her vital signs at least every 5 minutes.
• D: assist her with her nitroglycerin if she has any.

Tachycardia can be detrimental to a patient who is experiencing a cardiac problem because it causes:

• A: increased cardiac filling in between beats.
• B: increased cardiac oxygen usage and demand.
• C: an associated increase in breathing difficulty.
• D: a profound decrease in oxygen consumption.

Treatment for a patient with congestive heart failure and shortness of breath may include:

• A: nitroglycerin if his or her systolic BP is greater than 90 mm Hg.
• B: prophylactic suctioning of the airway every 3 to 5 minutes.
• C: positioning the patient supine and elevating his or her legs.
• D: hyperventilation with a bag-mask device and high-flow oxyge

When the vital organs of an 85-year-old patient need additional blood flow, the heart may not be able to meet the increased need because:

• A: stroke volume increases as a person ages.
• B: the patient’s blood vessels become more elastic.
• C: the reserve capacity of the heart is reduced.
• D: blood pressure decreases as a person ages.

When assessing a patient with a possible stroke, you should remember that:

• A: the majority of strokes involve bleeding into the brain tissue.
• B: right-sided weakness indicates a stroke in the right cerebral hemisphere.
• C: fibrinolytic therapy must be given within 6 hours following the stroke.
• D: the patient may be unable to communicate, but can often understand.

You assess an unresponsive 65-year-old man and find that he is apneic and pulseless. The patient's wife tells you that he has an automatic implanted cardiac defibrillator. After initiating CPR, you should:

• A: apply the AED as soon as possible and analyze his cardiac rhythm.
• B: ask the wife why and when he had the automatic defibrillator implanted.
• C: deactivate the implanted defibrillator by running a magnet over it.
• D: avoid using the AED because the implanted defibrillator is more effective.

A middle-aged male was found unresponsive by his wife. When you arrive at the scene, you assess the patient and determine that he is apneic and pulseless. You should:

• A: immediately apply the AED, analyze his cardiac rhythm, deliver a shock if indicated, and begin CPR.
• B: immediately begin CPR, reassess for a carotid pulse after 60 seconds, and then apply the AED.
• C: perform CPR with a compression-to-ventilation ratio of 15:2, apply the AED, and request backup.
• D: begin CPR starting with chest compressions, apply the AED as soon as possible, and request backup.

Which of the following statements regarding sudden cardiac arrest and ventricular fibrillation is correct?

• A: Patients with ventricular fibrillation are typically unconscious, apneic, and have a weak and irregular pulse.
• B: For each minute that defibrillation is delayed, the chance of survival decreases by as much as 10%.
• C: Most patients develop ventricular fibrillation within 10 minutes after the onset of sudden cardiac arrest.
• D: High-quality CPR often reverses ventricular fibrillation if it is initiated within 2 minutes of the onset.

All of the following are components of the Cincinnati stroke scale, EXCEPT:

• A: pupil size.
• B: arm movement.
• C: speech pattern.
• D: facial droop

When performing two-rescuer CPR on a 35-year-old patient whose airway has not been secured with an advanced device, you should:

• A: not attempt to synchronize compressions with ventilations
• B: have your partner pause after 30 compressions as you give 2 breaths.
• C: continue ventilations as the AED analyzes the patient’s cardiac rhythm.
• D: slowly compress the chest to a depth of about 2 inches.

You are assessing a 70-year-old male who complains of pain in both of his legs. He is conscious and alert, has a blood pressure of 160/90 mm Hg, a pulse rate of 110 beats/min, and respirations of 14 breaths/min and unlabored. Further assessment reveals edema to both of his feet and legs and jugular venous distention. This patient's primary problem is MOST likely:

• A: right heart failure.
• B: pulmonary edema.
• C: chronic hypertension.
• D: left heart failure.

After restoring a pulse in a cardiac arrest patient, you begin immediate transport. While en route to the hospital, the patient goes back into cardiac arrest. You should:

• A: analyze the patient’s rhythm with the AED.
• B: tell your partner to stop the ambulance.
• C: begin CPR and proceed to the hospital.
• D: contact medical control for further advice.

You arrive at the scene of a 56-year-old man who collapsed. The patient's wife tells you that he suddenly grabbed his chest and then passed out. Your assessment reveals that he is apneic and pulseless. As your partner begins one-rescuer CPR, you should:

• A: insert an airway adjunct.
• B: obtain a SAMPLE history.
• C: prepare the AED for use.
• D: notify medical control.

Which of the following is the MOST appropriate response when a patient with chest pain asks you if he or she is having a heart attack?

• A: I don’t know, but we will take good care of you.
• B: I believe you are, but only a physician can tell for sure.
• C: Probably not, but we should transport you to be safe.
• D: Yes, so I recommend going to the hospital.

A middle-aged female with a history of hypertension and high cholesterol complains of chest discomfort. She asks you to take her to the hospital where her personal physician practices, which is 15 miles away. Her blood pressure is 130/70 mm Hg, pulse is 84 beats/min and regular, and respirations are 18 breaths/min and unlabored. Which of the following actions is clearly NOT appropriate for this patient?

• A: Allowing her to walk to the ambulance
• B: Contacting her physician via phone
• C: Giving oxygen via nasal cannula
• D: Taking her to her choice hospital

After assisting a patient with his or her prescribed nitroglycerin, you would NOT expect him or her to experience a:

• A: pounding headache.
• B: syncopal episode.
• C: fizzing sensation under the tongue.
• D: burning sensation in the mouth.

During transport of an elderly woman who was complaining of nausea, vomiting, and weakness, she suddenly becomes unresponsive. You should:

• A: feel for a carotid pulse for at least 5 seconds.
• B: open her airway and ensure that it is clear.
• C: analyze her heart rhythm with the AED.
• D: quickly look at her chest for obvious movement.

• A:moist; sterile dressings; warmth; and rapid transport.
• B:dry, sterile dressings; warmth; and rapid transport.
• C:moist; sterile dressings; burn ointment; and rapid transport.
• D:dry; sterile dressings; burn ointment; and rapid transport.

• A:isolated rib fracture.
• B:flail chest.
• C:pulmonary contusion.
• D:pneumothorax.

• A:mottling.
• B:ecchymosis.
• C:hematoma.
• D:cyanosis.

• A:Pedal
• B:Radial
• C:Popliteal
• D:Brachial

• A:femur fractures and crackles in the lungs.
• B:blunt chest trauma and hypotension.
• C:pelvic instability and signs of shock.
• D:any severe injury above the nipple line.

• A:removing the knife, applying an occlusive dressing, and providing rapid transport.
• B:stabilizing the knife, starting CPR, and providing rapid transport.
• C:removing the knife, starting CPR, and providing rapid transport.
• D:stabilizing the knife, applying an occlusive dressing, and providing rapid transport.

• A:Mental status
• B:Pupil size
• C:Blood pressure
• D:Heart rate

• A:hip joint extension and external leg rotation.
• B:lengthening and internal rotation of the leg.
• C:shortening and external rotation of the leg.
• D:a flexed hip joint and inward thigh rotation.

• A:elevate the extremity and apply a tight pressure dressing.
• B:apply a tourniquet proximal to the injury until the bleeding stops.
• C:place additional dressings on the wound until the bleeding stops.
• D:apply pressure to the pulse point that is proximal to the injury.

• A:Your concern for potentially serious injuries
• B:The energy of an object in motion
• C:The product of mass, force of gravity, and height
• D:The way in which traumatic injuries occur

• A:control the bleeding, manipulate the arm to improve circulation, and apply a splint.
• B:apply a tourniquet proximal to the injury and tighten it until the bleeding stops.
• C:apply bulky compression dressings to the wound and splint the extremity.
• D:carefully pack sterile dressings into the wound and fully splint the extremity.

• A:A sling to support the left arm and swathes to maintain downward traction
• B:An air-inflatable splint with the left arm immobilized in the flexed position
• C:A long board splint with the left arm immobilized in the extended position
• D:A sling to support the left arm and swathes to secure the arm to the body

• A:Femur fractures are a common injury when a motorcyclist is ejected from his or her motorcycle.
• B:Internal hemorrhage cannot be controlled in the field and requires prompt surgical intervention.
• C:You should suspect that the patient has a skull fracture and increased intracranial pressure.
• D:You must stop the bleeding from his abrasions immediately or he will die from hypovolemic shock.

• A:give him high-flow oxygen early.
• B:request an ALS ambulance.
• C:rapidly transport him to a trauma center.
• D:keep him warm and elevate his legs.

• A:a critically low blood pressure.
• B:peripheral dilation of the vasculature.
• C:increased blood flow to the skin.
• D:decreased blood flow to the skin.

• A:decreased air movement into one lung.
• B:accumulation of blood in both of the lungs.
• C:shallow breathing secondary to severe pain.
• D:several ribs broken in numerous places.

• A:keep her warm by applying blankets.
• B:take her BP to detect hypotension.
• C:compare her carotid and radial pulses.
• D:look for and control any bleeding.

• A:intraabdominal bleeding.
• B:bleeding within the lungs.
• C:severe myocardial damage.
• D:gastrointestinal bleeding.

• A:spinal injury.
• B:internal bleeding.
• C:airway obstruction.
• D:hyperthermia.

• A:applying moist, sterile dressings to the burned areas and preventing hypothermia.
• B:peeling burned clothing from the skin and removing all rings, necklaces, and bracelets.
• C:covering the burns with dry, sterile dressings and preventing further loss of body heat.
• D:cooling the burns with sterile saline and covering them with dry, sterile burn pads.