22 Airway, Respiration & Ventilation Practice Questions & Answers

1. 1. A 58-year-old is found unresponsive with snoring respirations at 8 breaths per minute and shallow chest rise. No trauma is suspected. What is the MOST appropriate immediate action?

   • A.Insert a nasopharyngeal airway and transport
   • B.Apply a non-rebreather mask at 15 L/min
   • C.Perform a head-tilt/chin-lift and begin bag-valve-mask ventilation✓ Answer
   • D.Place the patient in the recovery position and monitor

   Snoring indicates the tongue is occluding the airway, and a rate of 8/min with shallow rise is inadequate breathing. You must first open the airway manually (head-tilt/chin-lift, no trauma) and then provide positive-pressure ventilation with a BVM. A non-rebreather does not correct inadequate ventilation.

   Source: National EMS Education Standards — Airway Management; AHA BLS: inadequate breathing requires positive-pressure ventilationReport a problem with this question

2. 2. A patient with a suspected cervical spine injury after a diving accident is unresponsive with an obstructed airway. Which maneuver should you use FIRST to open the airway?

   • A.Jaw-thrust maneuver✓ Answer
   • B.Log-roll to the recovery position
   • C.Head-tilt/chin-lift
   • D.Immediate nasopharyngeal airway insertion

   When spinal trauma is suspected, the jaw-thrust maneuver opens the airway without extending the neck, minimizing movement of the cervical spine. The head-tilt/chin-lift moves the neck and is reserved for patients with no suspected trauma.

   Source: National EMS Education Standards — Airway; AHA guidelines: jaw-thrust for suspected spinal injuryReport a problem with this question

3. 3. You are ventilating an adult apneic patient who has a pulse. What is the correct ventilation rate?

   • A.1 breath every 10 seconds (6/min)
   • B.1 breath every 2-3 seconds (20-30/min)
   • C.1 breath every 5-6 seconds (10-12/min)✓ Answer
   • D.As fast as possible to maximize oxygen

   For an adult with a pulse who is apneic or breathing inadequately, ventilate at 10-12 breaths per minute, which is 1 breath every 5-6 seconds. Ventilating too fast causes gastric distension and reduces cardiac output.

   Source: AHA Guidelines — rescue breathing for adult with pulse: 1 breath every 6 seconds (10/min), 10-12/min rangeReport a problem with this question

4. 4. A 4-year-old child with a pulse is in respiratory arrest. According to current AHA guidance, how often should you deliver ventilations with a BVM?

   • A.1 breath every 10 seconds
   • B.1 breath every 2-3 seconds (20-30/min)✓ Answer
   • C.1 breath every 5-6 seconds
   • D.1 breath every 8 seconds

   The 2020 AHA update raised the rescue-breathing rate for infants and children with a pulse to 20-30 breaths per minute, which is 1 breath every 2-3 seconds. This is faster than the adult rate because children have higher metabolic oxygen demand.

   Source: AHA 2020 Guidelines — pediatric/infant rescue breathing with pulse: 20-30 breaths/minReport a problem with this question

5. 5. An oropharyngeal airway (OPA) is contraindicated in which of the following patients?

   • A.An apneic patient being ventilated with a BVM
   • B.An unresponsive patient with no gag reflex
   • C.A responsive patient with an intact gag reflex✓ Answer
   • D.A deeply unconscious overdose patient with no gag reflex

   An OPA is only used in patients with no gag reflex. In a patient with an intact gag reflex it can trigger vomiting, aspiration, or laryngospasm, so it is contraindicated; a nasopharyngeal airway is used instead.

   Source: National EMS Education Standards — Airway adjuncts: OPA requires absent gag reflexReport a problem with this question

6. 6. How is a nasopharyngeal airway (NPA) correctly sized before insertion?

   • A.From the chin to the sternal notch
   • B.From the corner of the mouth to the earlobe
   • C.From the tip of the nose to the earlobe, diameter matching the nostril✓ Answer
   • D.From the center of the lips to the angle of the jaw

   An NPA is measured from the tip of the nose to the earlobe for length, and its diameter should match the patient's nostril (roughly the patient's little finger). Correct sizing ensures the tip sits in the posterior pharynx without being too long or too short.

   Source: National EMS Education Standards — NPA sizing: nose-tip to earlobeReport a problem with this question

7. 7. An NPA is specifically contraindicated in a patient with which finding?

   • A.An intact gag reflex
   • B.A history of asthma
   • C.Snoring respirations
   • D.Suspected basilar skull fracture✓ Answer

   An NPA is contraindicated in suspected basilar skull fracture or significant facial trauma because the catheter can be inadvertently passed through the fracture into the cranial vault. An intact gag reflex is actually an indication for an NPA, not a contraindication.

   Source: National EMS Education Standards — NPA contraindication: basilar skull fractureReport a problem with this question

8. 8. You hear loud gurgling as you prepare to ventilate an unresponsive patient. What should you do NEXT?

   • A.Insert an OPA and begin ventilating immediately
   • B.Apply a nasal cannula at 6 L/min
   • C.Suction the airway before ventilating✓ Answer
   • D.Increase the ventilation rate to clear the fluid

   Gurgling means there is fluid (secretions, blood, or vomit) in the airway. You must suction before ventilating or inserting an adjunct, otherwise positive-pressure ventilation would drive the fluid into the lungs and cause aspiration.

   Source: National EMS Education Standards — Suctioning indicated before ventilation when fluid presentReport a problem with this question

9. 9. What is the maximum time you should apply suction during a single pass in an adult patient?

   • A.30 seconds
   • B.5 seconds
   • C.10 seconds
   • D.15 seconds✓ Answer

   In an adult, suction for a maximum of 15 seconds per pass (child 10 seconds, infant 5 seconds). Suctioning removes oxygen along with secretions, so prolonged suctioning can worsen hypoxia; pre-oxygenate before and ventilate after.

   Source: National EMS Education Standards — Suction time limits: adult 15s / child 10s / infant 5sReport a problem with this question

10. 10. A conscious patient with mild shortness of breath has an SpO2 of 92% and cannot tolerate a mask. Which oxygen delivery device and flow rate is MOST appropriate?

    • A.Bag-valve-mask at 15 L/min
    • B.Nasal cannula at 1-6 L/min✓ Answer
    • C.Non-rebreather mask at 15 L/min
    • D.Simple face mask at 4 L/min

    A nasal cannula at 1-6 L/min delivers roughly 24-44% oxygen and is appropriate for mild distress or a patient who cannot tolerate a mask. The patient is breathing adequately with only mild hypoxia, so a BVM (for inadequate breathing) is not indicated.

    Source: National EMS Education Standards — Oxygen devices: nasal cannula 1-6 L/min ~24-44%Report a problem with this question

11. 11. A non-rebreather mask is the appropriate choice for which patient?

    • A.An apneic patient with no respirations
    • B.A patient with slow, shallow, inadequate breathing
    • C.A patient breathing adequately but showing signs of hypoxia✓ Answer
    • D.A patient who is fully alert with an SpO2 of 99%

    A non-rebreather at 10-15 L/min delivers 80-90+% oxygen and is used for a patient who is breathing adequately (moving enough air on their own) but has signs of hypoxia. A patient breathing inadequately or apneic needs positive-pressure ventilation with a BVM, not a non-rebreather.

    Source: National EMS Education Standards — Non-rebreather for adequate breathing with hypoxiaReport a problem with this question

12. 12. You are ventilating an adult with a BVM but the chest is not rising. What should you do FIRST?

    • A.Immediately begin chest compressions
    • B.Switch to a nasal cannula
    • C.Reposition the head and check the mask seal✓ Answer
    • D.Squeeze the bag harder and faster

    If the chest does not rise, the most common causes are an improper head position or a poor mask seal. Reposition the airway and re-establish the seal first, then check for an obstruction and suction if needed. Squeezing harder and faster causes gastric distension without fixing the problem.

    Source: AHA BLS — troubleshooting BVM: reposition airway and check mask sealReport a problem with this question

13. 13. A patient in severe respiratory distress from asthma is wheezing loudly. Within EMT scope, what medication assistance is appropriate?

    • A.Give oral aspirin
    • B.Administer a diuretic
    • C.Assist with the patient's prescribed albuterol inhaler✓ Answer
    • D.Administer intravenous epinephrine

    Wheezing indicates lower-airway constriction. Within EMT scope, you can assist the patient in using their own prescribed albuterol metered-dose inhaler or nebulizer, a beta-2 agonist that relaxes bronchial smooth muscle. IV medications are outside EMT scope.

    Source: National EMS Scope of Practice — EMT may assist with prescribed MDI/nebulizer (albuterol)Report a problem with this question

14. 14. A 70-year-old with CHF is anxious, sitting upright, and has crackles in both lungs with an SpO2 of 85% but is alert and breathing on his own. Which intervention is a key EMT tool for this patient?

    • A.Continuous positive airway pressure (CPAP)✓ Answer
    • B.Withhold oxygen due to his age
    • C.Oropharyngeal airway insertion
    • D.Immediate BVM ventilation

    CPAP is a key EMT tool for an alert, cooperative, spontaneously breathing patient in moderate-to-severe distress from CHF/pulmonary edema. It improves oxygenation and reduces the need for intubation. The patient is alert and breathing on his own, so BVM is not yet indicated.

    Source: National EMS Education Standards — CPAP indications: alert, spontaneously breathing CHF/pulmonary edemaReport a problem with this question

15. 15. CPAP is contraindicated in which of the following situations?

    • A.A patient in respiratory distress from pulmonary edema who is alert
    • B.An anxious patient who can follow commands
    • C.A cooperative COPD patient in moderate distress
    • D.A hypotensive patient with altered mental status✓ Answer

    CPAP requires an alert, cooperative patient who is breathing on their own and can protect their airway. It is contraindicated in hypotension/shock, altered mental status, respiratory arrest, or vomiting. A hypotensive patient with altered mental status meets those contraindications.

    Source: National EMS Education Standards — CPAP contraindications: hypotension, altered mental status, arrest, vomitingReport a problem with this question

16. 16. A responsive adult suddenly cannot speak, cough, or breathe and is clutching his throat during dinner. What is the correct intervention?

    • A.Give 5 back slaps only
    • B.Perform a blind finger sweep
    • C.Perform abdominal thrusts (Heimlich maneuver)✓ Answer
    • D.Encourage him to keep coughing

    Inability to speak, cough, or breathe signals a severe (complete) airway obstruction. In a responsive adult, perform abdominal thrusts until the object is expelled or the patient becomes unresponsive. Encouraging coughing is only for a mild obstruction with good air exchange.

    Source: AHA BLS — severe FBAO in responsive adult: abdominal thrustsReport a problem with this question

17. 17. A 6-month-old infant has a sudden, severe airway obstruction and cannot cry or breathe. What is the correct technique?

    • A.Blind finger sweep of the mouth
    • B.Abdominal thrusts (Heimlich maneuver)
    • C.5 back slaps followed by 5 chest thrusts, repeated✓ Answer
    • D.Chest compressions at 100/min

    For a responsive infant with a severe obstruction, deliver 5 back slaps followed by 5 chest thrusts, repeating until the object is expelled or the infant becomes unresponsive. Abdominal thrusts are not used in infants because of the risk of internal organ injury.

    Source: AHA BLS — infant severe FBAO: 5 back slaps + 5 chest thrustsReport a problem with this question

18. 18. When positioning a young child's airway for ventilation, why should you avoid hyperextending the neck?

    • A.Hyperextension is only a concern in adults
    • B.It prevents the OPA from being inserted
    • C.The large occiput and soft trachea can kink and occlude the airway✓ Answer
    • D.Children have a smaller tongue than adults

    Young children have a proportionally large occiput and a soft, flexible trachea. Hyperextending the neck can kink and collapse the airway, so a neutral or slight sniffing position is used, often with padding under the shoulders. Children actually have a larger tongue relative to the mouth, not smaller.

    Source: National EMS Education Standards — Pediatric airway: avoid hyperextension, neutral/sniffing positionReport a problem with this question

19. 19. A patient found unresponsive has a respiratory rate of 6/min with pinpoint pupils after a suspected opioid overdose. What should you do FIRST?

    • A.Administer naloxone and wait
    • B.Support ventilations with a BVM, then give naloxone✓ Answer
    • C.Place the patient in the recovery position
    • D.Apply a nasal cannula at 4 L/min

    The immediate life threat in opioid overdose is respiratory depression. A rate of 6/min is inadequate, so support ventilations with a BVM first to correct hypoxia, then administer naloxone. Oxygenation and ventilation always take priority over the antidote.

    Source: National EMS Scope of Practice — opioid overdose: ventilate first, then naloxoneReport a problem with this question

20. 20. A patient is breathing 22 times per minute but each breath moves very little air, with cyanosis and altered mental status. This patient is BEST described as being in:

    • A.Respiratory failure requiring positive-pressure ventilation✓ Answer
    • B.Adequate breathing that needs only monitoring
    • C.Mild distress requiring a nasal cannula
    • D.Normal breathing for his age

    A fast rate alone does not mean adequate breathing. Very shallow breaths with cyanosis and altered mental status indicate inadequate tidal volume and failing gas exchange, which is respiratory failure. This requires positive-pressure ventilation with a BVM, not just supplemental oxygen.

    Source: National EMS Education Standards — inadequate breathing: shallow tidal volume despite rate needs PPVReport a problem with this question

21. 21. Which statement about the difference between ventilation and respiration is correct?

    • A.Ventilation refers to oxygen binding to hemoglobin
    • B.Respiration only occurs in the nose
    • C.Ventilation and respiration mean exactly the same thing
    • D.Ventilation is the movement of air in and out; respiration is gas exchange✓ Answer

    Ventilation is the mechanical movement of air into and out of the lungs, while respiration is the exchange of oxygen and carbon dioxide at the alveoli and cells. A patient can ventilate (move air) yet fail to oxygenate, such as in carbon monoxide poisoning, which is why the terms are distinct.

    Source: National EMS Education Standards — Respiratory physiology: ventilation vs respirationReport a problem with this question

22. 22. A patient with COPD is severely hypoxic with an SpO2 of 84% and increasing confusion. What is the correct oxygen approach?

    • A.Give high-flow oxygen and support ventilation as needed✓ Answer
    • B.Limit oxygen to 1 L/min regardless of SpO2
    • C.Withhold oxygen to protect his hypoxic drive
    • D.Give no oxygen and transport quickly

    The old 'hypoxic drive' teaching that oxygen should be withheld from COPD patients is outdated. You must never withhold oxygen from a hypoxic patient; give high-flow oxygen to correct the hypoxia and support ventilation if breathing becomes inadequate, while monitoring the patient.

    Source: Current AHA/EMS guidance — never withhold oxygen from a hypoxic patient (hypoxic drive myth)Report a problem with this question

Practice questions modeled on the National EMS Education Standards and NREMT cognitive-exam content areas. Not medical advice and not affiliated with or endorsed by the National Registry of Emergency Medical Technicians (NREMT) or NHTSA. Always follow your instructor, medical director, and local protocols. Study the official materials at nremt.org. Official NREMT →