CFRN Practice Test Exam 2026 Questions and
Answers
Exam
During transport in a high-altitude environment, a transport nurse notes a decrease in
the patient's oxygen saturation. Which of the following gas laws is most likely
responsible? - __100% CORRECT ANSWER AS Dalton's
refers to the partial pressure of oxygen. As altitude increases, the partial pressure
decreases meaning less oxygen is available
A patient receiving mechanical ventilation is noted to have an increased respiratory rate
after engine start. The flight nurse recognizes the PRIORITY intervention is to
administer - __100% CORRECT ANSWER AS When the engine starts up, the patient
experiences vibration, a normal flight stressor. The patient might require more sedation
with the increased sensory input. _____ASTNA Patient Transport: Principles and
Practice, 6th Ed. (2024), p. 57
The flight crew responds to the scene of a motor vehicle crash in which an unrestrained
driver has been extricated from the vehicle. The patient is tachycardic, has a shortened
and externally rotated leg, and is bleeding from the urethral meatus. The nurse suspects
a - __100% CORRECT ANSWER AS A pelvic fracture can cause severe blood loss,
resulting in hypotension and tachycardia. Assessment findings may include shortening
of the affected leg, external rotation of the affected leg, and bleeding from the urethral
meatus. A crushed femoral head may include shortening and external rotation of the
affected leg; however, it is not likely to cause bleeding from the meatus. A posterior hip
dislocation will not cause bleeding at the urethral meatus. A kidney injury may cause
hematuria, but will not cause a shortened and externally rotated leg. _____Reference:
Trauma Nursing Core Course, 8th ed., p. 148-149
Following a prolonged bag-mask ventilation, a pediatric patient is intubated and
mechanically ventilated. The flight nurse inserts a nasogastric tube. Improvement of
which of the following would BEST indicate that the procedure resulted in the desired
effect? - __100% CORRECT ANSWER AS PIP would best indicate the procedure resulted
in the desired effect. Gastric insufflation is an expected byproduct of prolonged bag-
mask ventilation of the pediatric patient. If the patient is being volume ventilated, the PIP
will decrease with gastric decompression due to the inflated stomach not allowing full
diaphragm excursion during the inhalation phase. Normal pulse oximetry can occur in
the presence of an insufflated stomach. I:E ratio is unrelated to gastric tube placement.
ETCO2 may or may not change with the placement of a gastric tube. _____Reference:
ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 498
,A flight team is dispatched to transport a patient with circumferential full-thickness burns
to the chest. The patient is intubated and placed on a ventilator. The flight nurse notes
the peak inspiratory pressure to be 45 cm H2O. Which of the following is the BEST
intervention for this finding? - __100% CORRECT ANSWER AS Due to the loss of
elasticity of the tissue following a burn, it may become difficult to ventilate a patient.
Performing escharotomies will enable effective ventilation. Although suctioning the
patient may help with oxygenation, it will not change the lung compliance. As this is a
burn patient with bilateral breath sounds, a tube thoracotomy is not indicated at this
point. Changing the mode to pressure control will not change the decreased lung
compliance caused by the circumferential burns to the chest. _____Reference: ASTNA
Patient Transport: Principles and Practice, 5th Ed. (2018), p. 282
The flight nurse observes that a patient receiving mechanical ventilation has developed
worsening COPD. Ventilator settings are as follows:
Mode: volume controlRate 16 breaths/minTidal volume 500 mLI:E 1:1FiO2 60%PEEP 5
cm H2OIdeal body weight: 65 kg
The MOST appropriate action for the nurse to take is to:
decrease the FiO2 to 30%. - __100% CORRECT ANSWER AS The patient with an
obstructive disease pathway benefits from longer exhalation times and lower volumes.
The volume should be 6-8 ml/kg. While FiO2 can make a difference, I:E is the primary
setting change that should occur. _____Reference: ASTNA Patient Transport:
Principles and Practice, 5th Ed. (2018), p. 192
Treatment for acute decompression illness includes which of the following? - __100%
CORRECT ANSWER AS Rapid descent along with 100% oxygen is the initial treatment for
acute decompression illness. 250 mg acetazolamide (Diamox) slow IV push is the
treatment for acute mountain sickness. It is not a treatment for acute decompression
illness. Climbing back to an acceptable altitude is used for barodontalgia or ear block
and not acute decompression illness. Positive pressure ventilation would not have any
effect on the cause of acute decompression illness. _____Reference: ASTNA Patient
Transport: Principles and Practice, 5th Ed. (2018), p. 41
A transport nurse observes blood in the catheter connection tubing of a patient receiving
intra-aortic balloon pump (IABP) therapy. The nurse should FIRST - __100% CORRECT
ANSWER AS The presence of blood in the catheter connection tubing is the hallmark of
balloon rupture. It requires immediate cessation of pumping and removal of the IABP.
Continued use of a ruptured balloon can lead to helium gas embolization, a potentially
fatal event. The balloon is most likely ruptured. Although intact balloons that are not
actively pumping should be intermittently, manually inflated according to the
manufacturer's directions to prevent clot formation, manual inflation of a ruptured
balloon will inject gas into the aorta through the defect in the balloon. Flushing and re-
zeroing of the arterial line are appropriate only if the balloon is intact. These measures
will not clear blood in the catheter tubing. Although the desired action in the presence of
,balloon rupture is to prevent gas pumping into the balloon, the correct course of action
is to cease pumping, not merely clamp the connection tubing. _____Reference: ASTNA
Patient Transport: Principles and Practice, 5th Ed. (2018), p. 331
The flight nurse is transporting a patient who sustained a rattlesnake envenomation and
was treated with 8 vials of antivenin prior to transport. During the flight, the patient
develops difficulty breathing and vital signs are as follows:
BP 70/42 mmHg HR 123 beats/minRR 28 breaths/minO2 Sat: 95% on room air
The nurse should recognize that the patient is experiencing which type of shock? -
__100% CORRECT ANSWER AS Distributive shock is characterized by decreased tissue
perfusion from antigen-antibody reactions that cause histamine to be released
systemically and hypotension results. The patient has no source of bleeding or history
that would indicate fluid loss resulting in hemorrhagic or hypovolemic shock. There is
nothing in the history to indicate obstructive shock. _____Reference: AACN Procedure
Manual for High Acuity, Progressive and Critical Care, 7th Ed. (2017), p. 291
A 4-month-old infant is being transferred to a trauma center. The parent reported that
the infant fell down a flight of stairs. The infant is intubated, comatose, and exhibiting
signs of seizure activity. The transport nurse should suspect - __100% CORRECT
ANSWER AS The nurse should suspect a non-accidental injury because a 4-month-old
infant does not have the ability to walk or crawl. The other options are not indicated by
the parent's report. _____Reference: Wong's Nursing Care of Infants and Children, 11th
Ed. (2019), p. 343
The flight nurse is transporting a patient who has a traumatic brain injury. Which of the
following should the nurse continue to monitor to assess for increasing intracranial
pressure? - __100% CORRECT ANSWER AS The five major components of a
neurological exam are level of consciousness, motor function, pupillary function,
respiratory function and vital signs. Alterations to respiratory function can indicate acute
worsening of a brain injury. Temperature changes (such as poikilothermia) may develop
over time and do not warrant life-saving interventions. Pronator drift is not affected by
intracranial pressure. _____Reference: Critical Care Nursing: Diagnosis &
Management, 8th Ed. (2018), p. 588
A child is being transferred due to a head injury following an impact with a car. During
the transport, the child becomes anxious and tachycardic. The nurse should anticipate
this is due to - __100% CORRECT ANSWER AS The nurse should anticipate other
sources of bleeding. Hypotension is rarely seen in isolated head injures. When
hypotension is seen in multi-system trauma patient, hypotension/hemorrhage should
always be ruled out and treated. Hypotension is most often a result of secondary acute
hemorrhage, impaired autonomic nervous system control, iatrogenically from
medication use, or less commonly from spinal cord injury or acute diabetes insipidus. If
euvolemia does not correct hypotension, infusions of norepinephrine or phenylephrine
, should be initiated to maintain adequate mean arterial pressure and cerebral perfusion
pressure. Anxiousness and tachycardia are natural responses of a child in this situation.
However, the critical nurse should have a deeper understanding and suspicion of
hypovolemia related to secondary acute hemorrhage. Application of a traction splint
may cause anxiety in a pediatric patient, but an acute change should always be
suspected to be the result of something more sinister such as hemorrhage. Hypotension
is rarely seen in isolated head injuries such as shock from cranial hemorrhage.
_____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p.
240
An infant with dehydration and sepsis is being transported for admission to the ICU.
Which of the following findings would indicate the need for further fluid resuscitation? -
__100% CORRECT ANSWER AS Tachycardia is an early sign of hypovolemia. Infants
can only increase cardiac output by increasing heart rate. They cannot increase stroke
volume. A flat fontanelle is incorrect because in a dehydrated infant the fontanelle would
be sunken rather than flat. A flat fontanelle is a normal finding. A urine output here is
incorrect because a urine output of 2 mL/kg/hr indicates normal fluid volume status.
Apneic episodes are incorrect because apneic episodes are not an indication of volume
depletion. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed.
(2018), p. 524
The flight nurse is preparing a patient who has circumferential burns on the abdomen
for a long-distance transport in a fixed-wing aircraft. The nurse should recognize that the
PRIORITY intervention is to - __100% CORRECT ANSWER AS During transport the
stomach and other hollow organs will expand. With the burns sustained, this could
cause abdominal compartment syndrome. The stomach should be decompressed with
a nasogastric tube. It is not necessary to intubate the patient or obtain blood products.
Pain medications are not the priority but should be considered. _____Reference:
ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 372
The flight crew is on an interfacility transport of a patient with a diagnosis of septic
shock and systemic inflammatory response syndrome. The patient has received two
boluses of Lactated Ringers 30 ml/kg. The next appropriate action would be: - __100%
CORRECT ANSWER AS Several randomized trials and a meta-analysis have suggested
that norepinephrine (5-30 mcg/min) is associated with improved efficacy and lower rates
of adverse effects when used as the first line vasopressor in septic shock. Each of the
other pressors may be considered if max dose norepinephrine is ineffective.
_____Reference: Rosen's Emergency Medicine: Concepts & Clinical Practice, 9th
Edition (2018), p. 73
The flight nurse is transporting a patient with an intrarenal acute kidney injury. A finding
consistent with this diagnosis is - __100% CORRECT ANSWER AS A urine osmolality of
1500 mOsm/kg is elevated outside the normal range and is indicative of volume excess
and intrarenal acute kidney injury (AKI). Intrarenal AKI would lead to volume overload;
dry mucous membranes are seen with volume deficit. Intrarenal kidney injury would
Answers
Exam
During transport in a high-altitude environment, a transport nurse notes a decrease in
the patient's oxygen saturation. Which of the following gas laws is most likely
responsible? - __100% CORRECT ANSWER AS Dalton's
refers to the partial pressure of oxygen. As altitude increases, the partial pressure
decreases meaning less oxygen is available
A patient receiving mechanical ventilation is noted to have an increased respiratory rate
after engine start. The flight nurse recognizes the PRIORITY intervention is to
administer - __100% CORRECT ANSWER AS When the engine starts up, the patient
experiences vibration, a normal flight stressor. The patient might require more sedation
with the increased sensory input. _____ASTNA Patient Transport: Principles and
Practice, 6th Ed. (2024), p. 57
The flight crew responds to the scene of a motor vehicle crash in which an unrestrained
driver has been extricated from the vehicle. The patient is tachycardic, has a shortened
and externally rotated leg, and is bleeding from the urethral meatus. The nurse suspects
a - __100% CORRECT ANSWER AS A pelvic fracture can cause severe blood loss,
resulting in hypotension and tachycardia. Assessment findings may include shortening
of the affected leg, external rotation of the affected leg, and bleeding from the urethral
meatus. A crushed femoral head may include shortening and external rotation of the
affected leg; however, it is not likely to cause bleeding from the meatus. A posterior hip
dislocation will not cause bleeding at the urethral meatus. A kidney injury may cause
hematuria, but will not cause a shortened and externally rotated leg. _____Reference:
Trauma Nursing Core Course, 8th ed., p. 148-149
Following a prolonged bag-mask ventilation, a pediatric patient is intubated and
mechanically ventilated. The flight nurse inserts a nasogastric tube. Improvement of
which of the following would BEST indicate that the procedure resulted in the desired
effect? - __100% CORRECT ANSWER AS PIP would best indicate the procedure resulted
in the desired effect. Gastric insufflation is an expected byproduct of prolonged bag-
mask ventilation of the pediatric patient. If the patient is being volume ventilated, the PIP
will decrease with gastric decompression due to the inflated stomach not allowing full
diaphragm excursion during the inhalation phase. Normal pulse oximetry can occur in
the presence of an insufflated stomach. I:E ratio is unrelated to gastric tube placement.
ETCO2 may or may not change with the placement of a gastric tube. _____Reference:
ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 498
,A flight team is dispatched to transport a patient with circumferential full-thickness burns
to the chest. The patient is intubated and placed on a ventilator. The flight nurse notes
the peak inspiratory pressure to be 45 cm H2O. Which of the following is the BEST
intervention for this finding? - __100% CORRECT ANSWER AS Due to the loss of
elasticity of the tissue following a burn, it may become difficult to ventilate a patient.
Performing escharotomies will enable effective ventilation. Although suctioning the
patient may help with oxygenation, it will not change the lung compliance. As this is a
burn patient with bilateral breath sounds, a tube thoracotomy is not indicated at this
point. Changing the mode to pressure control will not change the decreased lung
compliance caused by the circumferential burns to the chest. _____Reference: ASTNA
Patient Transport: Principles and Practice, 5th Ed. (2018), p. 282
The flight nurse observes that a patient receiving mechanical ventilation has developed
worsening COPD. Ventilator settings are as follows:
Mode: volume controlRate 16 breaths/minTidal volume 500 mLI:E 1:1FiO2 60%PEEP 5
cm H2OIdeal body weight: 65 kg
The MOST appropriate action for the nurse to take is to:
decrease the FiO2 to 30%. - __100% CORRECT ANSWER AS The patient with an
obstructive disease pathway benefits from longer exhalation times and lower volumes.
The volume should be 6-8 ml/kg. While FiO2 can make a difference, I:E is the primary
setting change that should occur. _____Reference: ASTNA Patient Transport:
Principles and Practice, 5th Ed. (2018), p. 192
Treatment for acute decompression illness includes which of the following? - __100%
CORRECT ANSWER AS Rapid descent along with 100% oxygen is the initial treatment for
acute decompression illness. 250 mg acetazolamide (Diamox) slow IV push is the
treatment for acute mountain sickness. It is not a treatment for acute decompression
illness. Climbing back to an acceptable altitude is used for barodontalgia or ear block
and not acute decompression illness. Positive pressure ventilation would not have any
effect on the cause of acute decompression illness. _____Reference: ASTNA Patient
Transport: Principles and Practice, 5th Ed. (2018), p. 41
A transport nurse observes blood in the catheter connection tubing of a patient receiving
intra-aortic balloon pump (IABP) therapy. The nurse should FIRST - __100% CORRECT
ANSWER AS The presence of blood in the catheter connection tubing is the hallmark of
balloon rupture. It requires immediate cessation of pumping and removal of the IABP.
Continued use of a ruptured balloon can lead to helium gas embolization, a potentially
fatal event. The balloon is most likely ruptured. Although intact balloons that are not
actively pumping should be intermittently, manually inflated according to the
manufacturer's directions to prevent clot formation, manual inflation of a ruptured
balloon will inject gas into the aorta through the defect in the balloon. Flushing and re-
zeroing of the arterial line are appropriate only if the balloon is intact. These measures
will not clear blood in the catheter tubing. Although the desired action in the presence of
,balloon rupture is to prevent gas pumping into the balloon, the correct course of action
is to cease pumping, not merely clamp the connection tubing. _____Reference: ASTNA
Patient Transport: Principles and Practice, 5th Ed. (2018), p. 331
The flight nurse is transporting a patient who sustained a rattlesnake envenomation and
was treated with 8 vials of antivenin prior to transport. During the flight, the patient
develops difficulty breathing and vital signs are as follows:
BP 70/42 mmHg HR 123 beats/minRR 28 breaths/minO2 Sat: 95% on room air
The nurse should recognize that the patient is experiencing which type of shock? -
__100% CORRECT ANSWER AS Distributive shock is characterized by decreased tissue
perfusion from antigen-antibody reactions that cause histamine to be released
systemically and hypotension results. The patient has no source of bleeding or history
that would indicate fluid loss resulting in hemorrhagic or hypovolemic shock. There is
nothing in the history to indicate obstructive shock. _____Reference: AACN Procedure
Manual for High Acuity, Progressive and Critical Care, 7th Ed. (2017), p. 291
A 4-month-old infant is being transferred to a trauma center. The parent reported that
the infant fell down a flight of stairs. The infant is intubated, comatose, and exhibiting
signs of seizure activity. The transport nurse should suspect - __100% CORRECT
ANSWER AS The nurse should suspect a non-accidental injury because a 4-month-old
infant does not have the ability to walk or crawl. The other options are not indicated by
the parent's report. _____Reference: Wong's Nursing Care of Infants and Children, 11th
Ed. (2019), p. 343
The flight nurse is transporting a patient who has a traumatic brain injury. Which of the
following should the nurse continue to monitor to assess for increasing intracranial
pressure? - __100% CORRECT ANSWER AS The five major components of a
neurological exam are level of consciousness, motor function, pupillary function,
respiratory function and vital signs. Alterations to respiratory function can indicate acute
worsening of a brain injury. Temperature changes (such as poikilothermia) may develop
over time and do not warrant life-saving interventions. Pronator drift is not affected by
intracranial pressure. _____Reference: Critical Care Nursing: Diagnosis &
Management, 8th Ed. (2018), p. 588
A child is being transferred due to a head injury following an impact with a car. During
the transport, the child becomes anxious and tachycardic. The nurse should anticipate
this is due to - __100% CORRECT ANSWER AS The nurse should anticipate other
sources of bleeding. Hypotension is rarely seen in isolated head injures. When
hypotension is seen in multi-system trauma patient, hypotension/hemorrhage should
always be ruled out and treated. Hypotension is most often a result of secondary acute
hemorrhage, impaired autonomic nervous system control, iatrogenically from
medication use, or less commonly from spinal cord injury or acute diabetes insipidus. If
euvolemia does not correct hypotension, infusions of norepinephrine or phenylephrine
, should be initiated to maintain adequate mean arterial pressure and cerebral perfusion
pressure. Anxiousness and tachycardia are natural responses of a child in this situation.
However, the critical nurse should have a deeper understanding and suspicion of
hypovolemia related to secondary acute hemorrhage. Application of a traction splint
may cause anxiety in a pediatric patient, but an acute change should always be
suspected to be the result of something more sinister such as hemorrhage. Hypotension
is rarely seen in isolated head injuries such as shock from cranial hemorrhage.
_____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p.
240
An infant with dehydration and sepsis is being transported for admission to the ICU.
Which of the following findings would indicate the need for further fluid resuscitation? -
__100% CORRECT ANSWER AS Tachycardia is an early sign of hypovolemia. Infants
can only increase cardiac output by increasing heart rate. They cannot increase stroke
volume. A flat fontanelle is incorrect because in a dehydrated infant the fontanelle would
be sunken rather than flat. A flat fontanelle is a normal finding. A urine output here is
incorrect because a urine output of 2 mL/kg/hr indicates normal fluid volume status.
Apneic episodes are incorrect because apneic episodes are not an indication of volume
depletion. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed.
(2018), p. 524
The flight nurse is preparing a patient who has circumferential burns on the abdomen
for a long-distance transport in a fixed-wing aircraft. The nurse should recognize that the
PRIORITY intervention is to - __100% CORRECT ANSWER AS During transport the
stomach and other hollow organs will expand. With the burns sustained, this could
cause abdominal compartment syndrome. The stomach should be decompressed with
a nasogastric tube. It is not necessary to intubate the patient or obtain blood products.
Pain medications are not the priority but should be considered. _____Reference:
ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 372
The flight crew is on an interfacility transport of a patient with a diagnosis of septic
shock and systemic inflammatory response syndrome. The patient has received two
boluses of Lactated Ringers 30 ml/kg. The next appropriate action would be: - __100%
CORRECT ANSWER AS Several randomized trials and a meta-analysis have suggested
that norepinephrine (5-30 mcg/min) is associated with improved efficacy and lower rates
of adverse effects when used as the first line vasopressor in septic shock. Each of the
other pressors may be considered if max dose norepinephrine is ineffective.
_____Reference: Rosen's Emergency Medicine: Concepts & Clinical Practice, 9th
Edition (2018), p. 73
The flight nurse is transporting a patient with an intrarenal acute kidney injury. A finding
consistent with this diagnosis is - __100% CORRECT ANSWER AS A urine osmolality of
1500 mOsm/kg is elevated outside the normal range and is indicative of volume excess
and intrarenal acute kidney injury (AKI). Intrarenal AKI would lead to volume overload;
dry mucous membranes are seen with volume deficit. Intrarenal kidney injury would
