TPATC EXAM
A+
Air & Surface Transport Nurses Association Aligned Content Domains
A+ 5 100%
QUESTIONS VERIFIED EXAM DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
■ Airway, Mechanical Ventilation & Transport Physiology (Questions 1–15)
■ Shock, Hemorrhage Control & Circulation (Questions 16–30)
■ Neurologic, Thoracic & Abdominal Trauma (Questions 31–45)
■ Special Populations: Pediatrics, Pregnancy, Burns & MSK (Questions 46–60)
■ Safety, Legal Aspects, Assessment & General Trauma Principles (Questions 61–75)
STUVIAACTUALEXAM
Passing Score: 80% | 1 Mark per Question | Application / Analysis Level
, Airway, Mechanical Ventilation & Transport Physiology
Q1. A 34-year-old male with multisystem trauma is being prepared for RSI prior to rotor-wing transport. Blood
pressure is 78/42 mm Hg after 1 L crystalloid. The transport team must select induction and paralyzing agents.
A. Etomidate 0.3 mg/kg and succinylcholine 1.5 mg/kg
B. Ketamine 1–2 mg/kg and rocuronium 1.2 mg/kg
C. Propofol 2 mg/kg and vecuronium 0.1 mg/kg
D. Midazolam 0.3 mg/kg and succinylcholine 1 mg/kg
Correct Answer: B
Rationale: In hypotensive trauma patients, ketamine supports blood pressure through catecholamine release and is preferred
for induction. Rocuronium provides reliable paralysis without the hyperkalemia risk of succinylcholine in potential crush or
burn injury. Etomidate can blunt adrenal response; propofol and high-dose midazolam worsen hypotension.
Q2. During a fixed-wing interfacility transfer at 8,000 ft cabin altitude, a spontaneously breathing patient with
facial fractures develops progressive stridor and oxygen desaturation despite supplemental oxygen. Bag-mask
ventilation is difficult.
A. Increase cabin altitude to improve oxygenation
B. Attempt video laryngoscopy with bougie assistance
C. Administer nebulized epinephrine and continue observation
D. Perform immediate surgical cricothyrotomy
Correct Answer: D
Rationale: Facial trauma with progressive stridor and failed bag-mask ventilation indicates a 'cannot intubate, cannot
oxygenate' situation. Surgical cricothyrotomy is the definitive rescue airway. Continuing non-invasive efforts or changing cabin
altitude delays a life-saving intervention.
Q3. A mechanically ventilated trauma patient develops sudden hypotension and rising peak airway pressures
shortly after takeoff. Lung sounds are diminished on the right; trachea is midline. The most likely mechanism is:
A. Decreased venous return from positive-pressure ventilation combined with hypovolemia
B. Pulmonary embolism from prolonged immobilization
C. Left mainstem intubation causing left-sided collapse
D. Anaphylaxis to recent blood products
Correct Answer: A
Rationale: Positive-pressure ventilation increases intrathoracic pressure, reducing venous return. In a hypovolemic trauma
patient this effect is magnified and can produce acute hypotension. The midline trachea and unilateral findings make tension
pneumothorax less likely than simple volume effects; PE and anaphylaxis are less immediately related to the timing of takeoff.
Q4. A patient with a closed head injury is being transported at cabin altitude equivalent to 7,500 ft. The pulse
oximeter reads 91% on 4 L nasal cannula. The most appropriate next action is:
A. Administer a fluid bolus to improve perfusion
B. Ignore the reading because pulse oximeters are inaccurate at altitude
C. Descend to a lower cabin altitude if operationally feasible and increase FiO2
D. Begin hyperventilation to raise oxygen saturation
Correct Answer: C
Rationale: Lower cabin altitude increases partial pressure of oxygen and is the most direct physiologic intervention.
Increasing FiO2 is complementary. Pulse oximeters remain useful; fluid boluses do not correct hypoxemia from reduced
ambient PO2; hyperventilation is reserved for acute herniation and does not primarily raise SpO2.
TPATC EXAM 2026/2027 | Page 2 | STUVIAACTUALEXAM
, Q5. Continuous waveform capnography during transport shows a sudden drop in ETCO2 from 38 mm Hg to 18
mm Hg accompanied by hypotension. The most likely cause is:
A. Metabolic alkalosis from citrate in blood products
B. Sensor disconnection from the endotracheal tube
C. Massive pulmonary embolism or sudden decrease in cardiac output
D. Hyperventilation from anxiety
Correct Answer: C
Rationale: An abrupt fall in ETCO2 with hemodynamic instability indicates a sudden reduction in pulmonary blood flow,
classically from PE or profound shock/cardiac output drop. Simple hyperventilation lowers ETCO2 more gradually;
disconnection produces loss of waveform entirely; metabolic alkalosis does not cause this acute pattern.
Q6. A trauma patient with suspected ARDS is placed on a transport ventilator. Initial settings produce high
plateau pressures >30 cm H2O. The preferred adjustment is:
A. Reduce tidal volume to 6 mL/kg ideal body weight and accept permissive hypercapnia
B. Increase tidal volume to 10 mL/kg ideal body weight
C. Increase respiratory rate to 30 breaths/min without changing volume
D. Switch to pressure-support mode with zero PEEP
Correct Answer: A
Rationale: Lung-protective ventilation (6 mL/kg IBW) with plateau pressure limit ≤30 cm H2O is standard for ARDS and
trauma-related lung injury. Permissive hypercapnia is accepted if pH remains tolerable. Higher volumes increase barotrauma
risk; zero PEEP promotes derecruitment.
Q7. A patient with severe facial and neck burns arrives at a remote clinic. Attempts at orotracheal intubation fail
twice. The transport team’s next airway action should be:
A. Blind nasotracheal intubation
B. Needle cricothyrotomy as a bridge to surgical airway
C. Repeat orotracheal intubation with a larger blade
D. Place a laryngeal mask airway and transport immediately
Correct Answer: B
Rationale: After failed intubation attempts in a patient with anticipated difficult anatomy (burns, edema), needle
cricothyrotomy can provide temporary oxygenation while preparations for definitive surgical cricothyrotomy are completed.
Repeated oral attempts increase trauma; nasotracheal routes are contraindicated with midface injury; LMA is a temporary
bridge but not preferred when surgical airway is clearly indicated.
Q8. An agitated, combative trauma patient requires preoxygenation before RSI. Standard non-rebreather mask is
poorly tolerated. The most effective preoxygenation strategy is:
A. Immediate paralysis without preoxygenation
B. Four vital-capacity breaths of room air
C. Bag-mask ventilation with cricoid pressure for 3 minutes
D. Delayed sequence intubation with ketamine while applying high-flow nasal oxygen
Correct Answer: D
Rationale: Delayed sequence intubation using ketamine allows a combative patient to tolerate high-flow oxygen or
non-rebreather, maximizing oxygen reserves before paralysis. Skipping preoxygenation risks desaturation; room-air breaths
are inadequate; forced bagging in an uncooperative patient risks aspiration.
TPATC EXAM 2026/2027 | Page 3 | STUVIAACTUALEXAM
A+
Air & Surface Transport Nurses Association Aligned Content Domains
A+ 5 100%
QUESTIONS VERIFIED EXAM DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
■ Airway, Mechanical Ventilation & Transport Physiology (Questions 1–15)
■ Shock, Hemorrhage Control & Circulation (Questions 16–30)
■ Neurologic, Thoracic & Abdominal Trauma (Questions 31–45)
■ Special Populations: Pediatrics, Pregnancy, Burns & MSK (Questions 46–60)
■ Safety, Legal Aspects, Assessment & General Trauma Principles (Questions 61–75)
STUVIAACTUALEXAM
Passing Score: 80% | 1 Mark per Question | Application / Analysis Level
, Airway, Mechanical Ventilation & Transport Physiology
Q1. A 34-year-old male with multisystem trauma is being prepared for RSI prior to rotor-wing transport. Blood
pressure is 78/42 mm Hg after 1 L crystalloid. The transport team must select induction and paralyzing agents.
A. Etomidate 0.3 mg/kg and succinylcholine 1.5 mg/kg
B. Ketamine 1–2 mg/kg and rocuronium 1.2 mg/kg
C. Propofol 2 mg/kg and vecuronium 0.1 mg/kg
D. Midazolam 0.3 mg/kg and succinylcholine 1 mg/kg
Correct Answer: B
Rationale: In hypotensive trauma patients, ketamine supports blood pressure through catecholamine release and is preferred
for induction. Rocuronium provides reliable paralysis without the hyperkalemia risk of succinylcholine in potential crush or
burn injury. Etomidate can blunt adrenal response; propofol and high-dose midazolam worsen hypotension.
Q2. During a fixed-wing interfacility transfer at 8,000 ft cabin altitude, a spontaneously breathing patient with
facial fractures develops progressive stridor and oxygen desaturation despite supplemental oxygen. Bag-mask
ventilation is difficult.
A. Increase cabin altitude to improve oxygenation
B. Attempt video laryngoscopy with bougie assistance
C. Administer nebulized epinephrine and continue observation
D. Perform immediate surgical cricothyrotomy
Correct Answer: D
Rationale: Facial trauma with progressive stridor and failed bag-mask ventilation indicates a 'cannot intubate, cannot
oxygenate' situation. Surgical cricothyrotomy is the definitive rescue airway. Continuing non-invasive efforts or changing cabin
altitude delays a life-saving intervention.
Q3. A mechanically ventilated trauma patient develops sudden hypotension and rising peak airway pressures
shortly after takeoff. Lung sounds are diminished on the right; trachea is midline. The most likely mechanism is:
A. Decreased venous return from positive-pressure ventilation combined with hypovolemia
B. Pulmonary embolism from prolonged immobilization
C. Left mainstem intubation causing left-sided collapse
D. Anaphylaxis to recent blood products
Correct Answer: A
Rationale: Positive-pressure ventilation increases intrathoracic pressure, reducing venous return. In a hypovolemic trauma
patient this effect is magnified and can produce acute hypotension. The midline trachea and unilateral findings make tension
pneumothorax less likely than simple volume effects; PE and anaphylaxis are less immediately related to the timing of takeoff.
Q4. A patient with a closed head injury is being transported at cabin altitude equivalent to 7,500 ft. The pulse
oximeter reads 91% on 4 L nasal cannula. The most appropriate next action is:
A. Administer a fluid bolus to improve perfusion
B. Ignore the reading because pulse oximeters are inaccurate at altitude
C. Descend to a lower cabin altitude if operationally feasible and increase FiO2
D. Begin hyperventilation to raise oxygen saturation
Correct Answer: C
Rationale: Lower cabin altitude increases partial pressure of oxygen and is the most direct physiologic intervention.
Increasing FiO2 is complementary. Pulse oximeters remain useful; fluid boluses do not correct hypoxemia from reduced
ambient PO2; hyperventilation is reserved for acute herniation and does not primarily raise SpO2.
TPATC EXAM 2026/2027 | Page 2 | STUVIAACTUALEXAM
, Q5. Continuous waveform capnography during transport shows a sudden drop in ETCO2 from 38 mm Hg to 18
mm Hg accompanied by hypotension. The most likely cause is:
A. Metabolic alkalosis from citrate in blood products
B. Sensor disconnection from the endotracheal tube
C. Massive pulmonary embolism or sudden decrease in cardiac output
D. Hyperventilation from anxiety
Correct Answer: C
Rationale: An abrupt fall in ETCO2 with hemodynamic instability indicates a sudden reduction in pulmonary blood flow,
classically from PE or profound shock/cardiac output drop. Simple hyperventilation lowers ETCO2 more gradually;
disconnection produces loss of waveform entirely; metabolic alkalosis does not cause this acute pattern.
Q6. A trauma patient with suspected ARDS is placed on a transport ventilator. Initial settings produce high
plateau pressures >30 cm H2O. The preferred adjustment is:
A. Reduce tidal volume to 6 mL/kg ideal body weight and accept permissive hypercapnia
B. Increase tidal volume to 10 mL/kg ideal body weight
C. Increase respiratory rate to 30 breaths/min without changing volume
D. Switch to pressure-support mode with zero PEEP
Correct Answer: A
Rationale: Lung-protective ventilation (6 mL/kg IBW) with plateau pressure limit ≤30 cm H2O is standard for ARDS and
trauma-related lung injury. Permissive hypercapnia is accepted if pH remains tolerable. Higher volumes increase barotrauma
risk; zero PEEP promotes derecruitment.
Q7. A patient with severe facial and neck burns arrives at a remote clinic. Attempts at orotracheal intubation fail
twice. The transport team’s next airway action should be:
A. Blind nasotracheal intubation
B. Needle cricothyrotomy as a bridge to surgical airway
C. Repeat orotracheal intubation with a larger blade
D. Place a laryngeal mask airway and transport immediately
Correct Answer: B
Rationale: After failed intubation attempts in a patient with anticipated difficult anatomy (burns, edema), needle
cricothyrotomy can provide temporary oxygenation while preparations for definitive surgical cricothyrotomy are completed.
Repeated oral attempts increase trauma; nasotracheal routes are contraindicated with midface injury; LMA is a temporary
bridge but not preferred when surgical airway is clearly indicated.
Q8. An agitated, combative trauma patient requires preoxygenation before RSI. Standard non-rebreather mask is
poorly tolerated. The most effective preoxygenation strategy is:
A. Immediate paralysis without preoxygenation
B. Four vital-capacity breaths of room air
C. Bag-mask ventilation with cricoid pressure for 3 minutes
D. Delayed sequence intubation with ketamine while applying high-flow nasal oxygen
Correct Answer: D
Rationale: Delayed sequence intubation using ketamine allows a combative patient to tolerate high-flow oxygen or
non-rebreather, maximizing oxygen reserves before paralysis. Skipping preoxygenation risks desaturation; room-air breaths
are inadequate; forced bagging in an uncooperative patient risks aspiration.
TPATC EXAM 2026/2027 | Page 3 | STUVIAACTUALEXAM
