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Free NREMT practice questionsFree Paramedic practice questions · Airway, Respiration & Ventilation

10 free Paramedic practice questions: Advanced Airway Management and Rapid Sequence Intubation Concepts

These are real questions from the same bank the app draws from. Each one is written to the NREMT Paramedic content specifications and kept inside the Paramedic scope of practice. Pick an answer and you get the full rationale, including why the other three options are wrong.

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Question 1 of 10

A 61-year-old patient in septic shock has a decreasing level of consciousness and needs the airway secured. The vital signs are BP 78/44, P 132, R 30, and SpO₂ 88% on high-flow oxygen. What should be done before the induction agent is given?

Show the answer and rationale

Correct answer · Give a fluid bolus, have a vasopressor ready, and reduce the induction dose

This patient is in septic shock, with a pressure of 78/44 and a pulse of 132. Induction drugs drop the tone in the blood vessels. Positive pressure ventilation cuts down the blood returning to the heart. This patient's pressure is already low. Together they can put this patient into cardiac arrest from the drug instead of from the disease. Resuscitate before you intubate. Give a fluid bolus, and have a vasopressor drawn up and running if needed. Lower the induction dose, because a patient in shock needs less of the drug than the usual dose.

Why the others are wrong

Withhold the paralytic and attempt an awake look with topical anesthesia alone: An awake look with topical anesthesia alone does nothing for the low blood pressure. Without the paralytic, you also give up the conditions that make success on the first try likely. This patient cannot handle a second attempt.

Increase the oxygen flow and defer the airway until the emergency department: The level of consciousness is falling, and the SpO₂ is 88% on high-flow oxygen. Turning up the oxygen does not protect the airway. Waiting until the emergency department leaves an unprotected airway in a patient who is still getting worse.

Give the full induction dose so the airway is secured before the pressure falls: Giving the full dose to get the tube in before the pressure falls sounds faster. In a patient with no reserve, a full dose is what is most likely to stop the heart. Getting the tube in fast does not keep a systolic pressure of 78 from falling after a full dose.

Question 2 of 10

An intubated patient is moved from a bed to the stretcher. Immediately afterward the previously rectangular capnography waveform drops to zero and stays there. Which action is most appropriate?

Show the answer and rationale

Correct answer · Reassess the tube and the patient immediately

This patient has a displaced tube until you prove otherwise. Reassess the tube and the patient immediately. The waveform was rectangular before the move and dropped to zero right after it. A transfer from the bed to the stretcher can dislodge a tube, and a tube in the esophagus gives an absent waveform. Loss of the waveform can also mean a disconnection or an arrest. Check the tube and the circuit, watch for chest rise, listen over the epigastrium and both lung fields, and check for a pulse.

Why the others are wrong

Increase the ventilation rate and recheck in one minute: This waveform vanished right after a move, so you check the tube before you change anything. More rate does nothing for a tube that is no longer in the trachea.

Document the change and continue the transport: The waveform dropped to zero right after the move and stayed there. A vanished waveform gets immediate reassessment, not a note in the chart.

Replace the capnography sensor and recheck the tracing: D does not work because the waveform vanished the moment the patient moved, which points at the tube. Displacement comes first in DOPE, and equipment comes last. Replacing the sensor first delays finding a dislodged tube.

Question 3 of 10

A 67-year-old patient in cardiac arrest has received several minutes of BVM ventilation, and the abdomen is now visibly distended. The crew carries both a first generation and a second generation supraglottic airway. Which feature of the second generation device most directly addresses this patient's risk?

Show the answer and rationale

Correct answer · A channel that opens into the esophagus for a gastric tube

This patient has gastric distention from bag-mask ventilation. Several minutes of BVM ventilation pushed air down the esophagus, past the lower esophageal sphincter, and into the stomach instead of the lungs. That's why the abdomen is now visibly distended. Air trapped in the stomach raises the pressure inside the stomach. The full stomach pushes up on the diaphragm and sets the patient up to regurgitate and aspirate. A second generation supraglottic airway has a channel that opens into the esophagus. You pass a gastric tube down that channel to let the air out and drain the stomach away from the glottis. Emptying the stomach makes the patient easier to ventilate and lowers the aspiration risk.

Why the others are wrong

A wider ventilation lumen that lowers airway resistance: A wider ventilation lumen is a real second generation feature. The wider lumen lowers the resistance when you ventilate. The lumen size does nothing for the air in the stomach or the aspiration risk.

A larger cuff that seals the trachea below the cords: A cuff that seals the trachea below the cords describes an endotracheal tube. No supraglottic airway, first or second generation, seals below the cords. A supraglottic airway sits above the larynx.

A reinforced tip that resists kinking during compressions: A reinforced tip helps the device hold up during CPR and handling. The reinforced tip does not let the stomach air out or lower the aspiration risk.

Question 4 of 10

A 38-year-old patient with extensive burns across the chest, abdomen, and both arms from a house fire has increasing stridor, soot in the mouth, and a falling SpO₂. The service authorizes rapid sequence intubation, and the crew carries both a depolarizing and a nondepolarizing paralytic. Which consideration applies to the paralytic choice in this patient?

Show the answer and rationale

Correct answer · Succinylcholine is avoided because it shifts potassium

Succinylcholine is avoided in this patient because succinylcholine shifts potassium. Succinylcholine raises the potassium for a short time in every patient who gets it. This patient has extensive burns across the chest, the abdomen, and both arms. In a patient with extensive burns, that extra potassium can cause a life-threatening dysrhythmia or cardiac arrest. A burn is a reason not to use succinylcholine at all. Use a nondepolarizing agent like rocuronium instead. Rocuronium gives you good intubating conditions without the potassium shift. The paralysis lasts much longer, so you have to manage the airway and ventilation until it wears off.

Why the others are wrong

Succinylcholine is preferred because of its short duration: In a patient with extensive burns, the same dose of succinylcholine can cause a deadly rise in potassium. The short duration, which lets a patient who cannot be intubated wake up and breathe again, does not make it safe here.

Either agent is acceptable within the first 24 hours: This patient has extensive burns, and with burns succinylcholine is avoided at any point, including the first 24 hours. Only the nondepolarizing agent is acceptable here.

A nondepolarizing agent is avoided because of its duration: With extensive burns, the nondepolarizing agent is the preferred paralytic, not the one to avoid. Its longer duration means you keep the airway and ventilation going for the whole time it lasts, a trade-off you manage.

Question 5 of 10

A 5-year-old patient with massive facial trauma cannot be intubated, and ventilation with a BVM and with a supraglottic airway has both failed. The SpO₂ is 61% and falling. A surgical rescue airway is required. Which route is appropriate at this age?

Show the answer and rationale

Correct answer · A percutaneous needle cricothyrotomy

A percutaneous needle cricothyrotomy is the surgical rescue airway for a 5-year-old. In a young child, the cricothyroid membrane is small and soft. The cricoid cartilage is the only complete ring holding a child's airway open. A scalpel through the membrane can destroy the cricoid ring and make a false passage instead of an airway. A needle cricothyrotomy avoids cutting the ring and gets oxygen in fast. The needle only oxygenates and does not ventilate, so carbon dioxide climbs while the saturation comes back up. The needle buys you time to reach a definitive airway.

Why the others are wrong

An open surgical cricothyrotomy through the membrane: An open surgical cricothyrotomy is the surgical rescue airway for an older child or an adult. In a 5-year-old, the cricothyroid membrane is too small to cut safely. The cricoid cartilage right below the membrane is the child's only complete ring, and an open cut can destroy the ring.

A cuffed tube passed blindly through the nose: A blind nasotracheal tube is guided by air moving through the tube, so the technique needs a patient who is breathing on their own. Significant facial trauma rules out a tube passed through the nose, and this child has massive facial trauma. Nasotracheal intubation is also contraindicated in pediatric patients.

A tracheostomy placed below the cricoid cartilage: A tracheostomy below the cricoid cartilage would spare the ring. A tracheostomy is a surgical operation done in a hospital, not a rescue airway you do on scene. Cricothyrotomy is the surgical airway in the paramedic scope of practice, and this child is desaturating at 61% and needs an airway now.

Question 6 of 10

A 58-year-old patient has a rapidly expanding neck hematoma after a fall, with worsening stridor and decreasing responsiveness. Two laryngoscopy attempts fail to reveal any glottic structures. A supraglottic airway is inserted, but there is no chest rise and no waveform on capnography. Positive pressure ventilations with a BVM and an oropharyngeal airway also produce no chest rise, and the SpO₂ has fallen from 88% to 71%. What should the paramedic do next?

Show the answer and rationale

Correct answer · Perform a surgical cricothyrotomy

This is a failed airway in its most urgent form. You cannot intubate and you cannot oxygenate, so the next step is a surgical cricothyrotomy. Two laryngoscopy attempts failed. The supraglottic airway gave no chest rise and no waveform. The BVM with an oropharyngeal airway gave no chest rise either. Meanwhile the SpO₂ has dropped from 88% to 71%. Every failed airway algorithm ends in a surgical airway at this point. An expanding neck hematoma distorts the anatomy of the neck. Another look with the laryngoscope will not fix distorted anatomy. Every extra attempt uses up oxygen this patient does not have. Make the call early and go to the surgical airway now.

Why the others are wrong

Reposition the supraglottic airway: Repositioning a supraglottic airway is worth trying when the device has not already failed. This one already gave no chest rise and no waveform on capnography. The supraglottic airway is not ventilating at all.

Attempt a third laryngoscopy: A third laryngoscopy uses more of an oxygen reserve that is already falling fast. Two attempts already failed against anatomy the hematoma has distorted. Another attempt will not change that anatomy.

Increase the ventilation rate with the BVM: A faster BVM rate only helps if each breath is moving air. These breaths produce no chest rise at all. More breaths that move no air do not help this patient.

Question 7 of 10

A 27-year-old patient was stung by a wasp 10 minutes ago and now has raised welts across the trunk, swelling of the lips and tongue, and audible stridor. The patient can speak only in single words. The vital signs are BP 82/50, P 128, and R 28, with SpO₂ 90% on high-concentration oxygen. What is the most appropriate next action?

Show the answer and rationale

Correct answer · Administer epinephrine intramuscularly

This patient is in anaphylaxis. An allergic reaction stays in the skin with mild symptoms. Anaphylaxis spreads to another body system. This patient has two more systems involved. The stridor and the swollen lips and tongue are the airway. A blood pressure of 82/50 with a pulse of 128 is the circulation. Epinephrine is the only drug here that treats both. Alpha-1 effects tighten the dilated, leaking blood vessels. The blood pressure comes up, and the swelling that is closing off the airway goes down. Beta-2 effects relax the muscle around the bronchioles and slow the release of more chemicals from the mast cells. Give epinephrine IM into the lateral thigh. The IM route absorbs fast and reliably, without the dysrhythmia risk of an IV push in a patient who still has a pulse. Diphenhydramine and albuterol only help after epinephrine, and neither one works fast enough while the tongue is closing off the airway.

Why the others are wrong

Administer diphenhydramine intravenously: Diphenhydramine does nothing for the histamine already causing the stridor and the blood pressure of 82/50. Diphenhydramine is an H1 antihistamine that blocks histamine at the receptor and blunts the next round of effects. The antihistamine also takes far longer to work than this airway has. Both drugs get given, and diphenhydramine comes after epinephrine.

Administer nebulized albuterol: Stridor is a high-pitched sound from swelling at or above the vocal cords, and albuterol treats bronchospasm in the lower airway. A nebulized beta-2 drug does not shrink swelling in the larynx and tongue. Albuterol also does nothing for the low blood pressure, which is the other half of what is killing this patient. Albuterol can be added after epinephrine if the patient is wheezing.

Perform rapid sequence intubation: Paralyzing a patient whose glottis is already narrowed by swelling can turn a partly blocked airway into a cannot intubate, cannot ventilate emergency. RSI also does nothing for the shock. Give epinephrine first to reverse the swelling, and keep the airway plan ready in case epinephrine does not work.

Question 8 of 10

A paramedic responds for a 71-year-old patient with a long-standing tracheostomy who has increasing difficulty breathing. The patient is restless, and the skin is pale. Ventilation through the tracheostomy tube with a BVM device meets high resistance and produces no chest rise. A suction catheter passes only a short distance into the tube before meeting an obstruction, and suctioning does not improve ventilation. What should the paramedic do next?

Show the answer and rationale

Correct answer · Remove the inner cannula and reattempt ventilation

This tracheostomy tube is blocked, and the blockage is inside the tube itself. The BVM meets high resistance and gives no chest rise. High resistance with no chest rise tells you the tube is blocked, not out of place. The suction catheter only passes a short distance before it hits the obstruction. A catheter that stops that short tells you the blockage is inside the tube near the top, not down in the trachea or a bronchus. In a long-standing tracheostomy, the most common cause is dried secretions crusted onto the inner cannula. The inner cannula is a removable liner inside the tube, made to be taken out and cleaned. Pulling the inner cannula takes seconds and needs no equipment. You can put the inner cannula back in. The outer cannula stays in place and holds the stoma open. When the tube will not pass a catheter and will not take a breath, pull the inner cannula before you try anything more aggressive.

Why the others are wrong

Instill sterile saline and suction the tube again: The catheter already hit a firm obstruction, and suctioning already failed to improve ventilation. Repeating the suction leaves a restless, pale patient without ventilation. Saline instillation is not supported as a way to break up a plug, and saline can push debris further in. Pulling the inner cannula takes the whole plug out with it.

Ventilate through the mouth and nose with a mask: This tube can likely be fixed in seconds by pulling the inner cannula, so going to mask ventilation first only adds a delay. Ventilating from above is the workaround for a tube you cannot fix. It only works when the upper airway still connects the pharynx to the trachea, which a patient with a total laryngectomy does not have. You also have to cover the stoma, or the air escapes out of the stoma.

Remove the entire tracheostomy tube from the stoma: Pulling the outer cannula can cost you the stoma tract. If the tract closes, you may not be able to get an airway back in. Pull the inner cannula first, and pull the whole tube only if the obstruction stays or the tube is clearly displaced into a false passage.

Question 9 of 10

A paramedic is unable to intubate a patient who was eating a large meal immediately before collapsing and who has already vomited once. BVM ventilation is producing adequate chest rise, and a supraglottic airway will be placed as a rescue device. Which feature of the device is most important in this patient?

Show the answer and rationale

Correct answer · A channel that allows gastric drainage

This patient has a full stomach and a high risk of aspiration. The patient ate a large meal right before collapsing and has already vomited once. BVM ventilation has also been pushing air into the stomach with every breath. The stomach is full, swollen with air, and bringing contents back up. No supraglottic airway seals off the trachea. Vomit that comes up can still get into the trachea. A gastric drainage channel lets you pass a tube into the stomach. Through that tube you vent the trapped air and suction out the contents before they get past the seal. Draining the stomach lowers the risk of aspiration. Venting the air also takes pressure off the diaphragm, so ventilation gets easier.

Why the others are wrong

An inflatable cuff that seals the hypopharynx: A cuff that seals the hypopharynx is what lets any supraglottic airway ventilate. Without a seal, air leaks around the device instead of going to the lungs. Every supraglottic airway already has a cuff like this. The cuff stops air from escaping upward. The cuff does nothing about vomit coming up from the stomach below the device.

A color-coded sizing scale based on weight: A weight-based color scale helps you pick the right size. The wrong size causes leaks or poor seating in any patient. Sizing matters for every patient and has nothing to do with this patient's full stomach. A color scale does nothing about the vomit already coming up the esophagus.

A reinforced tube that resists kinking: A kink-resistant tube protects against the tube bending closed when the head turns during movement or transport. A kinked tube is a real problem once the device is in. This patient's problem is already happening, because the patient has already vomited. Draining the stomach matters more than guarding against a kink that has not happened.

Question 10 of 10

A 70-year-old patient with a history of a total laryngectomy is found unresponsive and apneic with an opening in the anterior neck. A first responder is ventilating with a BVM device over the mouth and nose, and the chest does not rise. The airway has been repositioned and the mouth is clear of fluid and debris. What is the most appropriate next action?

Show the answer and rationale

Correct answer · Ventilate through the neck opening

This patient had a total laryngectomy, and every breath has to go through the neck opening. A total laryngectomy removes the larynx. The surgeon brings the cut end of the trachea out to the skin as a permanent stoma. After that surgery, the mouth and nose no longer connect to the lungs. That is why the chest does not rise with the BVM over the mouth and nose. A breath given at the face cannot reach the lungs, no matter how good the mask seal or the technique is. Seal an infant or pediatric mask over the stoma and ventilate. If you need to ventilate for a long time, pass an endotracheal tube a short way into the stoma. A tracheostomy is different. With a tracheostomy, the upper airway still connects to the trachea, and breaths from above can still work.

Why the others are wrong

Perform a jaw-thrust maneuver and reattempt: Surgery removed the path between this patient's mouth and trachea, so there is nothing for a jaw thrust to open. A jaw thrust treats the tongue falling back in an unresponsive patient, the most common reason a chest will not rise. Opening the throat does nothing for the lungs here.

Insert an oropharyngeal airway and reattempt: An oral airway only helps if the mouth leads to the lungs, and after a total laryngectomy it does not. The oral airway holds the tongue off the back of the throat, and this airway was already repositioned with the mouth clear.

Suction the mouth and reattempt: The mouth is already clear of fluid and debris, so there is nothing to suction. Another attempt through the face fails the same way, because the mouth no longer leads to the lungs. Only moving the breaths to the stoma changes the outcome.

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