1. Which of the following statements regarding normal gas exchange in the lungs is correct?
The oxygen content in the alveoli is highest during the exhalation phase
Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries
The actual exchange of oxygen and carbon dioxide occurs in the capillaries
Blood that returns to the lungs from the body has a low carbon dioxide content

2. Which of the following structures is NOT found in the upper airway?
Larynx
Pharynx
Bronchus
oropharynx

3. The leaf shaped structure located superior to the larynx is called the:
Epiglottis
Vallecula
Cricoid ring
Thyroid cartilage

4. The ______ cartilage is a firm ring that forms the inferior part of the larynx.
Cricoid
Thyroid
Laryngeal
Pyriform

5. Structures of the lower airway includes all of the following EXCEPT the:
Alveoli
Trachea
Epiglottis
bronchioles

6. The actual exchange of oxygen and carbon dioxide occurs in the:
Bronchioles
Alveolar sacs
Apex of the lung
Pulmonary capillaries

7. Which of the structures is contained within the mediastinum?
Lungs
Larynx
Bronchioles
Esophagus

8. The physical act of moving air into and out of the lungs is called:
Diffusion
Ventilation
Respiration
oxygenation

9. Inhalation occurs when the:
Diaphragm and intercostal muscles relax and cause an increase in intrathoracic pressure
Diaphragm and intercostal muscles ascend and cause an increase in intrathoracic pressure
Diaphragm and intercostal muscles contract and cause a decrease in intrathoracic pressure
Diaphragm ascends and the intercostal muscles contract, causing a decrease in intrathoracic pressure.

10. The diaphragm functions as an involuntary muscle when a person:
Sleeps
Coughs
Takes a deep breath
Holds his or her breath

11. The partial pressure of oxygen in the alveoli is ______mm Hg, while the partial pressure of carbon dioxide in the alveoli is ______mmHg.
70, 28
88, 30
90, 50
104, 40

12. Tidal volume is defined as the volume of air that:
Is moved through the lungs in a single minute
Moves into or out of the lungs in a single breath
Remains in the lungs following a complete exhalation
Is forced into the lungs as a result of positive pressure

13. What is the minute volume of a patient with a tidal volume of 500 mL, a dead space volume of 150 mL, and a respiratory rate of 16 breaths/min?
5,600 mL
6,000 mL
7,400 mL
8,000 mL

14. Which of the following factors will cause a decreased minute volume in an adult?
Shallow breathing
Increased tidal volume
Respirations of 20 breaths/min
Slight decrease in respiratory rate

15. In contrast to inhalation, exhalation:
Requires muscular effort to effectively expel air from the lungs
Is a passive process caused by increased intrathoracic pressure
Occurs when the diaphragm lowers and expels air from the lungs
Is an active process caused by decreased intrathoracic pressure

16. Hypoxia is MOST accurately defined as:
Low venous oxygen levels
A decrease in arterial oxygen levels
An increase in carbon dioxide in the blood
Inadequate oxygen to the tissues and cells

17. The hypoxic drive-the primary stimulus to breathe for patients with certain chronic respiratory diseases-is influenced by:
High blood oxygen levels
Low blood oxygen levels
Low blood carbon dioxide levels
High blood carbon dioxide levels

18. Which of the following is a late sign of hypoxia?
Anxiety
Cyanosis
Tachycardia
restlessness

19. Which of the following statements regarding oxygenation and ventilation is correct?
In carbon monoxide (CO) poisoning, ventilation is impaired because CO binds to oxygen very quickly
Oxygenation is the movement of air into and out of the lungs, whereas ventilation is the exchange of gases
In mines or confined places, where the oxygen levels are low, ventilation may continue despite adequate oxygenation
Oxygenation without adequate ventilation can occur in climbers who quickly ascend to an altitude of lower atmospheric pressure

20. Each cell of the body combines nutrients and oxygen and produces energy and waste products through a process called:
Respiration
Ventilation
Metabolism
oxygenation

21. The process of exchanging oxygen and carbon dioxide between the alveoli and the blood capillaries is called:
External respiration
Cellular metabolism
Pulmonary ventilation
Alveolar ventilation

22. Gas exchange in the lungs is facilitated by:
Adequate amounts of surfactant
Water or blood within the alveoli
Surfactant-destroying organisms
Pulmonary capillary constriction

23. In the presence of oxygen, the mitochondria of the cells convert glucose into energy through a process called:
Perfusion
Respiration
Aerobic metabolism
Anaerobic metabolism

24. Without adequate oxygen, the body’s cells:
Rely solely on glucose, which is completely converted into adenosine triphosphate (ATP)
Cease metabolism altogether, resulting in carbon dioxide accumulation in the blood
Begin to metabolize fat, resulting in the production and accumulation of ketoacids
Incompletely convert glucose into energy, and lactic acid accumulates in the blood

25. The primary waste product of aerobic metabolism is:
Lactic acid
Pyruvic acid
Carbon dioxide
Adenosine triphosphate

26. Central chemoreceptors located in the medulla provide feedback to increase the rate and depth of breathing when they sense:
Slight elevation in carbon dioxide or a decrease in the pH of the cerebrospinal fluid
Slight decreases in carbon dioxide and an increase in the pH of the cerebrospinal fluid
Decreased levels of oxygen in the blood and an increase in the pH of the cerebrospinal fluid
Increased levels of oxygen in the blood and a decrease in the pH of the cerebrospinal fluid

27. A ventilation/perfusion (V/Q ratio) mismatch occurs when:
Ventilation is inadequate due to a traumatic injury or medical condition, which results in an impairment in pulmonary gas exchange
A disruption in blood flow inhibits the exchange of oxygen and carbon dioxide in the lungs, even though the alveoli are filled with fresh oxygen
Ventilation is compromised, resulting in the accumulation of carbon dioxide in the bloodstream, alveoli, and the tissues and cells of the body
A traumatic injury or medical condition impairs the body’s ability to effectively bring oxygen into the lungs and remove carbon dioxide from the body.

28. If ventilation is impaired, carbon dioxide levels in the bloodstream will increase. This condition is called:
Acidosis
Hypoxia
Hypoxemia
hypercabia

29. Intrapulmonary shunting occurs when:
The presence of pulmonary surfactant causes a decrease in alveolar surface tension, thus impairing the exchange of gases in the lungs
A decrease in respiratory rate and depth causes carbon dioxide accumulation in the alveoli and an overall decrease in blood oxygen levels
Blood coming from the right side of the heart bypasses nonfunctional alveoli and returns to the left side of the heart in an unoxygenated state.
Any impairment in circulatory function causes a reduced ability for oxygen and carbon dioxide to diffuse across the alveolar-capillary membrane

30. An adult at rest should have a respiratory rate that ranges between:
8 and 15 breaths/min
10 and 18 breaths/min
12 and 20 breaths/min
16 and 24 breaths/min

31. Which of the following patients is breathing adequately?
A conscious male with respirations of 19 breaths/min and pink skin
A conscious female with facial cyanosis and rapid, shallow respirations
A conscious male with respirations of 18 breaths/min and reduced tidal volume
An unconscious 52 year old female with snoring respirations and cool, pale skin

32. Which of the following statements regarding breathing adequacy is correct ?
Patients with a grossly irregular breathing pattern usually do not require assisted ventilations
The single most reliable sign of breathing adequacy in the adult is her or her respiratory rate
Patients breathing shallowly may require assisted ventilation despite a normal respiratory rate
A patient with slow respirations and adequate depth will experience an increase in minute volume

33. Which of the following would NOT cause a decrease in tidal volume?
Shallow breathing
Deep respirations
Irregular breathing
Agonal respirations

34. Irregular respirations characterized by an increasing rate and depth of breathing followed by periods of apnea are called:
Ataxic respirations
Agonal respirations
Eupneic respirations
Cheyne-stokes respirations

35. An unconscious patient found in a prone position must be placed in a supine position in case he or she:
Requires cardiopulmonary resuscitation-CPR
Begins to vomit
Regains consciousness
Has increased tidal volume

36. You are dispatched to a residence where a middle-aged man was found unconscious in his front yard. There are no witnesses who can tell you what happened. You find him in a prone position, his eyes are closed and he is not moving. Your FIRST action should be to:
Palpate for the presence of a carotid pulse
Log roll him as a unit to a supine position
Assess the rate and quality of his breathing
Open his airway with a jaw-thrust maneuver

37. What is the MOST common cause of airway obstruction in an unconscious patient?
Vomitus
The tongue
Blood clots
Aspirated fluid

38. In which of the following patients would the head-tilt-chin lift maneuver be the MOST appropriate method of opening the airway?
A 24 year old male who is found unconscious at the base of a tree
A 37 year old female who is found unconscious in her bed
A 45 year old male who is semiconscious after falling 20 feet
A 50 year old male who is unconscious following head trauma

39. The jaw-thrust maneuver is used to open the airway of patients with suspected:
Mandibular fractures
Upper airway swelling
Cervical spine injuries
Copious oral secretions

40. Which of the following patients would MOST likely require insertion of an oropharyngeal airway?
A 33 year old semiconscious patient with reduced tidal volume
A 40 year old unconscious patient with slow, shallow respirations
A 51 year old confused patient with severly labored respirations
A 64 year old conscious patient with rapid and deep respirations

41. A 19 year old female is found unconscious by her roommate
A 19 year old female is found unconscious by her roommate. Your primary assessment reveals that her breathing is inadequate. As you insert an oropharyngeal airway, she begins to gag violently. You should:
Continue to insert the airway as you suction her oropharynx
Remove the airway and be prepared to suction her oropharynx
Insert the airway no further but leave it in place as a bite block
Select a smaller oropharyngeal airway and attempt to insert it

42. To select the proper size oropharyngeal airway, you should measure from the:
Corner of the mouth to the earlobe
Center of the mouth to the posterior ear
Corner of the mouth to the superior ear
Angle of the jaw to the center of the mouth

43. The nasopharyngeal airway is MOST beneficial because it:
Can effectively stabilize fractured nasal bones if it is inserted properly
Is generally well tolerated in conscious patients with an intact gag reflex
Effectively maintains the airway of a patient in cardiopulmonary arrest
Can maintain a patent airway in a semiconscious patient with a gag reflex

44. The MOST serious complication associated with using a nasopharyngeal airway in a patient with trauma to the head or face is:
Fracturing the septum
Damaging the turbinates
Penetrating the cranium
Causing severe bleeding

45. A nasopharyngeal airway is inserted:
With the bevel facing the septum in inserted into the right nare
Into the larger nostril with the tip pointing away from the septum
With the bevel pointing downward if inserted into the left nare
Into the smaller nostril with the tip following the roof of the nose

46. A 71 year old male is semiconscious following a sudden, severe headache. There is vomitus on his face and his respirations are slow and shallow. The EMT must immediately:
Insert a nasopharyngeal airway
Preform oropharyngeal suctioning
Apply oxygen via a nonrebreathing mask
Assist the patient’s ventilations with a bag-mask device

47. When testing a mechanical suctioning unit, you should turn on the device, clamp the tubing, and ensure that it generates a vacuum pressure of more than:
100 mmHg
200 mmHg
300 mmHg
400 mmHg

48. The MOST significant complication associated with ororpharyngeal suctioning is:
Oral abrasion from vigorous suctioning
Hypoxia due to prolonged suction attempts
Clogging of the catheter with thick secretions
Vomiting from stimulating the anterior airway

49. Proper technique for suctioning the oropharynx of an adult patient include:
Continuously suctioning patients with copious oral secretions
Suctioning while withdrawing the catheter from the oropharynx
Removing large, solid objects with a tonsil-tip suction catheter
Suctioning for up to 1 minute if the patient is well oxygenated

50. You have inserted an oral airway and are ventilating an apneic woman with a bag-mask device. She suddenly begins regurgitating large amounts of vomit. You should:
Perform a finger sweep of her mouth
Insert a nasal airway and then suction her mouth
Roll her onto her side and remove the oral airway
Remove the oral airway and suction her oropharynx

51. A 23 year old male experienced severe head trauma after his motorcyle collided with an oncoming truck. He is unconscious, has rapid and shallow breathing, and has copious bloody secretions in his mouth. How should you manage his airway?
Suction his oropharynx with a rigid catheter until all secretions are removed
Insert a nasopharyngeal airway and provide suction and assisted ventilations
Alternate 15 seconds of oral suctioning with 2 minutes of assisted ventilations
Provide continuous ventilations with a bag-mask device to minimize hypoxia

52. Which of the following patients should you place in the recovery position?
A 19 year old conscious male with a closed head injury and normal respirations
A 24 year old unconscious female who overdosed and has a reduced tidal volume
A 31 year old semiconscious male with low blood sugar and adequate breathing
A 40 year old conscious female with a possible neck injury and regular respirations

53. Which of the following organs or tissues can survive the longest without oxygen?
Muscle
Heart
Liver
Kidneys

54. The purpose of the pin-indexing system that has been established for compressed gas cylinders is to:
Ensure that the correct regulator is used for the cylinder
Help you determine what type of oxygen regulator to use
Prevent destroying or stripping the threads on the cylinder
Reduce the cylinder pressure to a safe and more useful range

55. The pressure of gas in a full cylinder of oxygen is approximately _____ pounds per square inch (psi)
500
1,000
1,500
2,000

56. Which of the following oxygen flowmeters is NOT affected by gravity and can be used in any position when attached to an oxygen cylinder?
Vertical-position flowmeter
Bourdon-gauge flowmeter
Ball-and-flow flowmeter
Pressure-compensated flowmeter

57. An oxygen cylinder should be taken out of service and refilled when the pressure inside it is less than:
200 psi
500 psi
1,000 psi
1,500 psi

58. Which of the following statements regarding oxygen is correct?
Oxygen cylinders must always remain in an upright position
Oxygen is flammable and may explode if under high pressure
Oxygen supports the combustion process and may cause a fire
Oxygen is most safely administered in an enclosed environment

59. A patient who is suspected of being hypoxic and is breathing adequately should be given supplemental oxygen with a
Nasal cannula
Nonrebreathing mask
Bag-mask device
Mouth-to-mask device

60. With a good mask-to-face seal and an oxygen flow rate of 15 L/min, the nonrebreathing mask is capable of delivering up to ____% inspired oxygen 70 80 90
100

61. Prior to applying a nonrebreathing mask on a patient, you must ensure that the:
One-way valve is sealed
Flow rate is set at 6 L/min
Reservoir bag is fully inflated
Patient has reduced tidal volume

62. At a flow rate of 6 L/min, a nasal cannula can deliver am approximate oxygen concentration of up to:
24%
35%
44%
52%

63. The nasal cannula is MOST appropriately used in the prehospital setting:
When the patient cannot tolerate a nonrebreathing mask
If the patient’s nasopharynx is obstructed by secretions
If long-term supplemental oxygen administration is required
When the patient breathes primarily through his or her mouth

64. The main advantage of the Ventri mask is:
The ability to adjust the percentage of inspired oxygen when caring for a critically ill or injured patient
The use of its fine adjustment capabilities in the long-term management of physiologically stable patients
That it does not contain an oxygen reservoir, so the same percentage of oxygen can consistently be administered
The ability to adjust the amount of oxygen administered to the patient by increasing the flow rate on the regulator

65. A 51 year old female presents with a sudden onset of difficulty breathing. She is conscious and alert and able to speak in complete sentences. Her respirations are 22 breaths/min and regular. You should
Administer 100% oxygen via a nonrebreathing mask
Insert a nasal airway in case her mental status decreases
Perform a secondary assessment and then begin treatment
Assist her breathing with a bag-mask device and 100% oxygen

66. What occurs when a patient is breathing very rapidly and shallowly?
Minute volume increases because of a marked increase in both tidal volume and respiratory rate
Air moves primarily in the anatomic dead space and does not participate in pulmonary gas exchange
Air is forcefully drawn into the lungs due to the negative pressure created by the rapid respirations
The majority of tidal volume reaches the lungs and diffuses across the alveolar-capillary membrane

67. As the single EMT managing an apneic patient’s airway, the preferred initial method of providing ventilations is the:
Mouth-to-mouth technique
One-person bag-mask device
Manually triggered ventilation device
Mouth-to-mask technique with a one way valve

68. You and your partner are treating a 66 year old man who experienced a sudden onset of respiratory distress. He is conscious but is unable to follow simple verbal commands. Further assessment reveals that his breathing is severely labored and his oxygen saturation is 80%. You should:
Attempt to insert an oropharyngeal airway
Assist his ventilations with a bag-mask device
Apply a continuous positive airway pressure (CPAP) device and monitor his breathing
Apply high-flow oxygen via nonrebreathing mask

69. Which of the following statements regarding postive-pressure ventilations is correct?
Positive-pressure ventilation allow blood to naturally be pulled back to the heart from the body
With positive-pressure ventilation, more volume is required to have the same effects as normal breathing
To prevent hypotension, the EMT should increase the rate and force of positive-pressure ventilation
Unlike negative-pressure ventilation, positive-pressure ventilation does not affect the esophageal opening pressure

70. How does positive-pressure ventilation affect cardiac output?
There is no effect on cardiac output because positive-pressure ventilation is the act of normal breathing
It decreases intrathoracic pressure, which facilitates venous return to the heart and increases cardiac output
It causes pressure in the chest to decrease, which increases stroke volume and cardiac output
It increases intrathoracic pressure, which decreases venous return to the heart and causes a decrease in cardiac output

71. Reevaluate the rate and volume of your ventilations
You are ventilating a 40 year old uninjured man who is apneic but has a pulse. When your partner reassesses his blood pressure, he notes that it has decreased significantly from previous readings. You elevate the patient’s legs, but this action has no effect. You should:
Reevaluate the rate and volume of your ventilations
Perform a head-to-toe assessment to look for bleeding
Increase the volume of your ventilations and reassess his blood pressure
Ensure that you are delivering one breath every 3 to 5 seconds

72. You are performing mouth-to-mask ventilations with oxygen connected and set at a flow rate of 15 L/min. What percentage of oxygen is your patient receiving?
45%
55%
65%
75%

73. Begin ventilation using the mouth-to-mask technique
You and your partner are caring for a critically injured patient. Your partner is controlling severe bleeding from the patient’s lower extremities as you attempt ventiliations with a bag-mask device. After repositioning the mask several times, you are unable to effectively ventilate the patient. You should:
Begin ventilation using the mouth-to-mask technique
Hyperextend the patient’s head and reattempt ventilations
Continue attempted ventilations and transport immediately
Suction the patient’s airway for 30 seconds and reattempt ventilations

74. Which of the following statements regarding the one-person bag-mask technique is correct?
Bag-mask ventilations should be delivered every 2 seconds when the device is being operated by one person
The C-clamp method of holding the mask to the face is not effective when ventilating a patient with a bag-mask device
Adequate tidal volume is often difficult to achieve when one EMT is operating the bag-mask device
The bag-mask device delivers more tidal volume and a higher oxygen concentration than the mouth-to-mask technique

75. Despite your attempts to coach a conscious young female’s respirationss, she continues to hyperventilate with a marked reduction in tidal volume. You should
Restrain her and provide ventilatory assistance
Insert a nasopharyngeal airway and give oxygen
Explain to her that you will assist her ventilations
Ventilate her at the rate at which she is breathing

76. All of the following will help minimize the risk of gastric distention when ventilating an apneic patient with a bag-mask device, EXCEPT
Delivering each breath over 1 second
Ensuring the appropriate airway position
Ventilating the patient at the appropriate rate
Increasing the amount of delivered tidal volume

77. Which of the following is the MOST reliable indicator of adequately performed bag-mask ventilations in an apneic adult with a pulse?
20 breaths/min being delivered to the adult
Decreased compliance when squeezing the bag
An adult’s heart rate that is consistently increasing
Adequate rise of the chest when squeezing the bag

78. On which of the following patients would it be MOST appropriate to use the flow-restricted, oxygen-powered ventilation device?
An 8 year old female with respiratory failure
A 21 year old male with traumatic cardiac arrest
A 38 year old apneic female with blunt chest trauma
A 59 year old male with chronic obstructive pulmonary disease (COPD)

79. How does CPAP improve oxygenation and ventilation in patients with certain respiratory problems?
It forces the alveoli open and pushes more oxygen across the alveolar membrane
It pushes thick, infected pulmonary secretions into isolated areas of lung tissue
It decreases intrathoracic pressure, which allows more room for the lungs to expand
It prevents alveolar collapse by pushing air into the lungs during the inhalation phase

80. CPAP is indicated for patients who:
Have signs of pneumonia but are breathing adequately
Are unresponsive and have signs of inadequate ventilation
Have pulmonary edema and can follow verbal commands
Are hypotensive and have a marked reduction in tidal volume

81. You are ventilating a patient with a stoma; however, air is escaping from the mouth and nose. To prevent this, you should:
Thrust the jaw forward
Seal the mouth and nose
Ventilate with less pressure
Thoroughly suction the stoma

82. A 37 year old male has a apparent foreign body airway-obstruction
A 37 year old male has a apparent foreign body airway-obstruction. He is conscious and alert and is coughing forcefully. His skin is pink, warm and moist. The MOST appropriate treatment for this patient includes:
A series of back blows and chest thrusts
Finger sweeps to remove the obstruction
Performing a series of abdominal thrusts
Encouraging him to cough and transporting

83. While eating dinner, your partner suddenly grabs his throat and has a panicked look on his face. He has a weak cough, faint inspiratory stridor, and cyanosis around the lips. You should:
Encourage him to cough as forcefully as he can
Deliver up to five back blows and reassess him
Place him in a supine position and open his airway
Stand behind him and administer abdominal thrusts

84. Which of the following is NOT a possible cause of airway obstruction?
Relaxation of the tongue
Aspirated vomitus
Shallow breathing
Foreign objects

85. You are ventilating an apneic woman with a bag-mask device
You are ventilating an apneic woman with a bag-mask device. She has dentures, which are tight-fitting. Adequate chest rise is present with each ventilation, and the patient’s oxygen saturation reads 96%. When you reassess the patency of her airway, you note that her dentures are now loose, although your ventilations are still producing adequate chest rise. You should:
Remove her dentures, resume ventilations, and assess for adequate chest rise
Attempt to replace her dentures so that they fit tightly and resume ventilations
Leave her dentures in place, but carefully monitor her for an airway obstruction
Remove her dentures at once and increase the rate and volume of your ventilations