CSLB General Building (B) — All Questions
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What is the normal resting respiratory rate for a healthy adult?
- a.12 to 20 breaths per minute✓
- b.20 to 30 breaths per minute
- c.6 to 10 breaths per minute
- d.30 to 40 breaths per minute
A healthy adult at rest breathes about 12 to 20 times per minute. Rates persistently above or below this range suggest respiratory distress and warrant closer assessment and possible ventilatory support.
Which airway adjunct is contraindicated in a patient with an intact gag reflex?
- a.Nasopharyngeal airway
- b.Oropharyngeal airway✓
- c.Nasal cannula
- d.Bag-valve mask
An oropharyngeal (oral) airway stimulates the gag reflex and can cause vomiting or laryngospasm if the reflex is intact. It should only be used in patients who are unresponsive with no gag reflex.
A nonrebreather mask should generally be run at what oxygen flow rate?
- a.2 to 4 L/min
- b.4 to 6 L/min
- c.10 to 15 L/min✓
- d.1 to 2 L/min
A nonrebreather mask requires 10 to 15 L/min to keep the reservoir bag inflated and deliver a high oxygen concentration (roughly 80 to 90 percent). Lower flow rates fail to keep the reservoir filled between breaths.
A nasal cannula can deliver oxygen concentrations in approximately what range?
- a.80 to 90 percent
- b.60 to 70 percent
- c.50 to 60 percent
- d.24 to 44 percent✓
At 1 to 6 L/min a nasal cannula delivers roughly 24 to 44 percent oxygen. It is best for patients needing low-concentration oxygen who cannot tolerate a mask.
What is the correct first step when a responsive adult is choking and cannot speak, cough, or breathe?
- a.Deliver abdominal thrusts (Heimlich maneuver)✓
- b.Perform a blind finger sweep
- c.Begin chest compressions immediately
- d.Lay the patient supine and start rescue breaths
A responsive adult with a complete airway obstruction should receive abdominal thrusts until the object is expelled or the patient becomes unresponsive. Blind finger sweeps are avoided because they can push the object deeper.
How should you size an oropharyngeal airway before insertion?
- a.From the tip of the nose to the earlobe
- b.From the corner of the mouth to the earlobe (or angle of the jaw)✓
- c.From the chin to the sternum
- d.From the front teeth to the back of the throat by estimate
An oral airway is measured from the corner of the mouth to the earlobe or angle of the mandible. A properly sized airway holds the tongue forward without obstructing the airway.
Which finding best indicates adequate ventilation while using a bag-valve mask?
- a.A tight mask seal alone
- b.Squeezing the bag rapidly
- c.Visible, gentle rise and fall of the chest with each breath✓
- d.Gastric distention developing
Effective BVM ventilation is confirmed by visible chest rise with each squeeze. Gastric distention suggests air is entering the stomach from ventilating too fast or forcefully.
What maneuver is preferred to open the airway of an unresponsive patient with suspected cervical spine injury?
- a.Head-tilt/chin-lift
- b.Sniffing position with neck extension
- c.Recovery position roll
- d.Jaw-thrust maneuver✓
The jaw-thrust maneuver opens the airway while keeping the head and neck in a neutral, in-line position. This minimizes spinal movement compared with the head-tilt/chin-lift.
A patient breathing 6 times per minute with shallow effort is best managed by an EMT with:
- a.Positive-pressure ventilation with a bag-valve mask and supplemental oxygen✓
- b.A nasal cannula at 2 L/min
- c.A nonrebreather mask only
- d.Encouraging the patient to breathe faster
A rate of 6 with shallow depth produces inadequate minute volume, so the patient needs assisted positive-pressure ventilation, not just passive oxygen. A BVM with oxygen restores adequate tidal volume and rate.
Stridor, a high-pitched sound heard on inspiration, most commonly indicates:
- a.Lower airway fluid
- b.Upper airway obstruction or narrowing✓
- c.Normal breathing
- d.Pneumothorax
Stridor is produced by turbulent airflow through a narrowed upper airway, such as from swelling or a foreign body. It signals a potentially serious airway threat requiring prompt attention.
Which patient is the best candidate for a nasopharyngeal airway?
- a.A patient with suspected skull base fracture and clear fluid from the nose
- b.A fully alert patient with no distress
- c.A semiconscious patient with an intact gag reflex who needs airway support✓
- d.A patient in cardiac arrest with severe facial trauma
A nasopharyngeal airway is tolerated by patients with an intact gag reflex, making it useful for semiconscious patients. It is avoided with suspected basilar skull fracture because of the risk of intracranial misplacement.
What is the appropriate ventilation rate for an apneic adult with a pulse (rescue breathing)?
- a.1 breath every 2 seconds
- b.1 breath every 15 seconds
- c.1 breath every 30 seconds
- d.1 breath every 6 seconds (about 10 per minute)✓
For an adult in respiratory arrest with a pulse, deliver one breath about every 6 seconds, roughly 10 breaths per minute. Each breath should be given over about one second with visible chest rise.
Cyanosis (bluish skin, lips, or nail beds) is a sign of:
- a.Inadequate oxygenation✓
- b.Excellent perfusion
- c.Hyperventilation only
- d.Normal skin in cold weather with no clinical concern
Cyanosis reflects poor oxygenation of the blood and is a late, serious sign of hypoxia. It requires immediate airway management and oxygen therapy.
When suctioning an adult's airway, you should apply suction for no longer than:
- a.30 seconds at a time
- b.15 seconds at a time✓
- c.60 seconds at a time
- d.2 minutes at a time
Suction an adult for no more than 15 seconds per attempt because suctioning also removes oxygen and can cause hypoxia. Reoxygenate the patient between attempts.
Agonal respirations in an unresponsive patient should be treated as:
- a.Normal, adequate breathing
- b.A reason to give only a nasal cannula
- c.Inadequate breathing requiring ventilatory support✓
- d.A sign the patient is improving
Agonal (gasping) respirations are ineffective and do not provide adequate ventilation, often occurring around cardiac arrest. The patient needs assisted ventilation and, if pulseless, CPR.
A patient with a history of COPD is in severe respiratory distress with low oxygen saturation. The EMT should:
- a.Withhold oxygen entirely to avoid suppressing respiratory drive
- b.Give only room air
- c.Give a nasal cannula at 1 L/min regardless of distress
- d.Provide high-concentration oxygen and support ventilation as needed✓
Never withhold needed oxygen from a hypoxic patient because of COPD concerns. Treat hypoxia with high-concentration oxygen and assist ventilations if breathing is inadequate.
Which sound suggests fluid in the lower airways, such as in pulmonary edema?
- a.Crackles (rales)✓
- b.Stridor
- c.Snoring
- d.Silence with good chest rise
Crackles, or rales, are produced by air moving through fluid in the alveoli and small airways. They are commonly heard in pulmonary edema and some pneumonias.
The primary purpose of the recovery position for an unresponsive, breathing patient without trauma is to:
- a.Increase oxygen concentration in the blood
- b.Help keep the airway open and allow drainage of secretions✓
- c.Reduce the heart rate
- d.Warm the patient
The lateral recovery position lets the tongue fall forward and secretions or vomit drain from the mouth, protecting the airway. It is used for unresponsive patients who are breathing adequately with no suspected spinal injury.
Accessory muscle use, nasal flaring, and tripod positioning are signs of:
- a.Adequate breathing
- b.A fully compensated patient with no distress
- c.Increased work of breathing / respiratory distress✓
- d.Cardiac arrest
These findings show the patient is working hard to breathe and is in respiratory distress. Early recognition allows oxygen therapy and ventilatory support before respiratory failure.
What oxygen flow rate is typically used with a bag-valve mask to maximize delivered oxygen concentration?
- a.2 L/min
- b.4 L/min
- c.6 L/min
- d.15 L/min✓
A BVM connected to an oxygen reservoir at 15 L/min can deliver nearly 100 percent oxygen. Adequate flow keeps the reservoir bag full so each ventilation delivers high-concentration oxygen.