NCOEMS Exam 2 Questions With Complete
Solutions 100% Correct!!!
North Carolina Office of Emergency Medical Services Credentialing Examination
Q1: A 45-year-old patient is found unresponsive with agonal respirations. After confirming
scene safety and applying BSI, the first action according to BLS/ACLS protocols is:
A. Attach AED pads immediately
B. Check for carotid pulse for no more than 10 seconds [CORRECT]
C. Begin chest compressions without pulse check
D. Insert an oropharyngeal airway
Correct Answer: B
Rationale: Correct because the BLS algorithm requires assessment of responsiveness
followed by pulse check (carotid, no more than 10 seconds); compressions begin if no pulse
is felt or pulse is present but <60 bpm with signs of poor perfusion.
Q2: A patient with a history of COPD presents with severe respiratory distress, cyanosis, and
diminished breath sounds bilaterally. Capnography demonstrates a "shark fin" waveform.
The most appropriate initial intervention is:
A. High-flow oxygen via non-rebreather at 15 LPM
B. CPAP with nebulized bronchodilators [CORRECT]
C. Immediate endotracheal intubation
D. Needle decompression bilateral chest
Correct Answer: B
Rationale: Correct because shark fin capnography waveform indicates obstructive airway
disease (COPD/asthma); CPAP reduces work of breathing and alveolar collapse while
bronchodilators (albuterol/ipratropium) address bronchospasm.
Q3: During CPR on an intubated patient, the ETCO2 reading suddenly drops from 38 mmHg
to 4 mmHg. The most likely cause is:
A. Return of spontaneous circulation
B. Hyperventilation by the ventilator
C. Esophageal intubation [CORRECT]
,D. Therapeutic hypothermia induction
Correct Answer: C
Rationale: Correct because ETCO2 near zero after intubation indicates esophageal placement
or complete circuit disconnect; immediate reconfirmation with direct laryngoscopy and
waveform capnography is required before compressions resume.
Q4: The proper insertion depth for an oropharyngeal airway (OPA) in an adult is determined
by:
A. Measuring from the earlobe to the corner of the mouth
B. Measuring from the corner of the mouth to the angle of the jaw [CORRECT]
C. Measuring from the tip of the nose to the earlobe
D. Inserting until resistance is met at the hard palate
Correct Answer: B
Rationale: Correct because OPA sizing is determined by measuring from the corner of the
mouth to the angle of the jaw; an improperly sized OPA can cause airway obstruction,
gagging, or trauma to the oropharynx.
Q5: A 58-year-old patient in cardiac arrest has been intubated. The paramedic confirms ETT
placement with waveform capnography showing ETCO2 of 12 mmHg. The most appropriate
action is:
A. Extubate and reintubate immediately
B. Continue high-quality CPR; ETCO2 <20 mmHg during CPR indicates poor perfusion and
compression quality [CORRECT]
C. Administer sodium bicarbonate
D. Increase ventilation rate to 20 breaths per minute
Correct Answer: B
Rationale: Correct because ETCO2 <20 mmHg during CPR indicates inadequate perfusion
from poor compression quality, not esophageal intubation (which shows near-zero ETCO2);
focus on improving compression depth, rate, and recoil.
Q6: A patient with severe facial trauma and copious oral bleeding requires airway
management. The most appropriate initial airway adjunct is:
A. Oropharyngeal airway
B. Nasopharyngeal airway
,C. Supraglottic airway (King LT or iGel) [CORRECT]
D. Endotracheal intubation without suction
Correct Answer: C
Rationale: Correct because severe facial trauma with bleeding contraindates blind
nasopharyngeal insertion (risk of basilar skull fracture); a supraglottic airway provides
definitive airway protection without visualization of the vocal cords in a blood-filled field.
Q7: During rapid sequence intubation (RSI), the proper sequence of medication
administration is:
A. Sedative, then paralytic, then intubate [CORRECT]
B. Paralytic, then sedative, then intubate
C. Intubate, then sedative, then paralytic
D. Sedative and paralytic simultaneously
Correct Answer: A
Rationale: Correct because RSI follows the sequence: preoxygenation, pretreatment
(optional), induction/sedation (etomidate, ketamine, midazolam), paralysis (succinylcholine or
rocuronium), intubation, and post-intubation management; sedative must precede paralytic
to prevent awareness.
Q8: A patient with acute pulmonary edema presents with respiratory rate of 32, SpO2 84%,
and bilateral crackles. The patient is alert and hemodynamically stable. The most appropriate
intervention is:
A. Immediate endotracheal intubation
B. CPAP at 5-10 cmH2O with nitroglycerin [CORRECT]
C. High-flow nasal cannula only
D. Needle decompression
Correct Answer: B
Rationale: Correct because CPAP reduces preload and afterload while recruiting alveoli in
cardiogenic pulmonary edema; nitroglycerin further reduces preload; intubation is reserved
for altered mental status or CPAP failure.
Q9: A patient requires needle cricothyrotomy due to a "can't intubate, can't ventilate"
scenario. The proper needle insertion site is:
A. Midline, through the cricothyroid membrane, angled 45 degrees caudad [CORRECT]
, B. Lateral to the thyroid cartilage, perpendicular to skin
B. Through the thyroid cartilage itself
D. Between the tracheal rings at the sternal notch
Correct Answer: A
Rationale: Correct because needle cricothyrotomy accesses the airway through the
cricothyroid membrane (between thyroid and cricoid cartilages); the needle is inserted at a
45-degree angle caudad (toward feet) to follow the tracheal lumen.
Q10: A paramedic is ventilating an adult patient with a BVM. The recommended ventilation
rate is:
A. 20-24 breaths per minute
B. 10-12 breaths per minute [CORRECT]
C. 6-8 breaths per minute
D. 30 breaths per minute
Correct Answer: B
Rationale: Correct because adult BVM ventilation rate is 10-12 breaths per minute (1 breath
every 5-6 seconds); hyperventilation increases intrathoracic pressure, reduces venous
return, and worsens outcomes in cardiac arrest.
Q11: A patient with a suspected basilar skull fracture presents with Battle's sign and raccoon
eyes. The contraindicated airway adjunct is:
A. Oropharyngeal airway
B. Nasopharyngeal airway [CORRECT]
C. Supraglottic airway
D. Endotracheal intubation
Correct Answer: B
Rationale: Correct because nasopharyngeal airway insertion in basilar skull fracture risks
entering the cranial vault through a fractured cribriform plate; oropharyngeal or supraglottic
airways are safer alternatives.
Q12: Capnography waveform showing a gradual rise in ETCO2 from 35 mmHg to 55 mmHg
over 10 minutes in an intubated patient most likely indicates:
A. Hyperventilation
Solutions 100% Correct!!!
North Carolina Office of Emergency Medical Services Credentialing Examination
Q1: A 45-year-old patient is found unresponsive with agonal respirations. After confirming
scene safety and applying BSI, the first action according to BLS/ACLS protocols is:
A. Attach AED pads immediately
B. Check for carotid pulse for no more than 10 seconds [CORRECT]
C. Begin chest compressions without pulse check
D. Insert an oropharyngeal airway
Correct Answer: B
Rationale: Correct because the BLS algorithm requires assessment of responsiveness
followed by pulse check (carotid, no more than 10 seconds); compressions begin if no pulse
is felt or pulse is present but <60 bpm with signs of poor perfusion.
Q2: A patient with a history of COPD presents with severe respiratory distress, cyanosis, and
diminished breath sounds bilaterally. Capnography demonstrates a "shark fin" waveform.
The most appropriate initial intervention is:
A. High-flow oxygen via non-rebreather at 15 LPM
B. CPAP with nebulized bronchodilators [CORRECT]
C. Immediate endotracheal intubation
D. Needle decompression bilateral chest
Correct Answer: B
Rationale: Correct because shark fin capnography waveform indicates obstructive airway
disease (COPD/asthma); CPAP reduces work of breathing and alveolar collapse while
bronchodilators (albuterol/ipratropium) address bronchospasm.
Q3: During CPR on an intubated patient, the ETCO2 reading suddenly drops from 38 mmHg
to 4 mmHg. The most likely cause is:
A. Return of spontaneous circulation
B. Hyperventilation by the ventilator
C. Esophageal intubation [CORRECT]
,D. Therapeutic hypothermia induction
Correct Answer: C
Rationale: Correct because ETCO2 near zero after intubation indicates esophageal placement
or complete circuit disconnect; immediate reconfirmation with direct laryngoscopy and
waveform capnography is required before compressions resume.
Q4: The proper insertion depth for an oropharyngeal airway (OPA) in an adult is determined
by:
A. Measuring from the earlobe to the corner of the mouth
B. Measuring from the corner of the mouth to the angle of the jaw [CORRECT]
C. Measuring from the tip of the nose to the earlobe
D. Inserting until resistance is met at the hard palate
Correct Answer: B
Rationale: Correct because OPA sizing is determined by measuring from the corner of the
mouth to the angle of the jaw; an improperly sized OPA can cause airway obstruction,
gagging, or trauma to the oropharynx.
Q5: A 58-year-old patient in cardiac arrest has been intubated. The paramedic confirms ETT
placement with waveform capnography showing ETCO2 of 12 mmHg. The most appropriate
action is:
A. Extubate and reintubate immediately
B. Continue high-quality CPR; ETCO2 <20 mmHg during CPR indicates poor perfusion and
compression quality [CORRECT]
C. Administer sodium bicarbonate
D. Increase ventilation rate to 20 breaths per minute
Correct Answer: B
Rationale: Correct because ETCO2 <20 mmHg during CPR indicates inadequate perfusion
from poor compression quality, not esophageal intubation (which shows near-zero ETCO2);
focus on improving compression depth, rate, and recoil.
Q6: A patient with severe facial trauma and copious oral bleeding requires airway
management. The most appropriate initial airway adjunct is:
A. Oropharyngeal airway
B. Nasopharyngeal airway
,C. Supraglottic airway (King LT or iGel) [CORRECT]
D. Endotracheal intubation without suction
Correct Answer: C
Rationale: Correct because severe facial trauma with bleeding contraindates blind
nasopharyngeal insertion (risk of basilar skull fracture); a supraglottic airway provides
definitive airway protection without visualization of the vocal cords in a blood-filled field.
Q7: During rapid sequence intubation (RSI), the proper sequence of medication
administration is:
A. Sedative, then paralytic, then intubate [CORRECT]
B. Paralytic, then sedative, then intubate
C. Intubate, then sedative, then paralytic
D. Sedative and paralytic simultaneously
Correct Answer: A
Rationale: Correct because RSI follows the sequence: preoxygenation, pretreatment
(optional), induction/sedation (etomidate, ketamine, midazolam), paralysis (succinylcholine or
rocuronium), intubation, and post-intubation management; sedative must precede paralytic
to prevent awareness.
Q8: A patient with acute pulmonary edema presents with respiratory rate of 32, SpO2 84%,
and bilateral crackles. The patient is alert and hemodynamically stable. The most appropriate
intervention is:
A. Immediate endotracheal intubation
B. CPAP at 5-10 cmH2O with nitroglycerin [CORRECT]
C. High-flow nasal cannula only
D. Needle decompression
Correct Answer: B
Rationale: Correct because CPAP reduces preload and afterload while recruiting alveoli in
cardiogenic pulmonary edema; nitroglycerin further reduces preload; intubation is reserved
for altered mental status or CPAP failure.
Q9: A patient requires needle cricothyrotomy due to a "can't intubate, can't ventilate"
scenario. The proper needle insertion site is:
A. Midline, through the cricothyroid membrane, angled 45 degrees caudad [CORRECT]
, B. Lateral to the thyroid cartilage, perpendicular to skin
B. Through the thyroid cartilage itself
D. Between the tracheal rings at the sternal notch
Correct Answer: A
Rationale: Correct because needle cricothyrotomy accesses the airway through the
cricothyroid membrane (between thyroid and cricoid cartilages); the needle is inserted at a
45-degree angle caudad (toward feet) to follow the tracheal lumen.
Q10: A paramedic is ventilating an adult patient with a BVM. The recommended ventilation
rate is:
A. 20-24 breaths per minute
B. 10-12 breaths per minute [CORRECT]
C. 6-8 breaths per minute
D. 30 breaths per minute
Correct Answer: B
Rationale: Correct because adult BVM ventilation rate is 10-12 breaths per minute (1 breath
every 5-6 seconds); hyperventilation increases intrathoracic pressure, reduces venous
return, and worsens outcomes in cardiac arrest.
Q11: A patient with a suspected basilar skull fracture presents with Battle's sign and raccoon
eyes. The contraindicated airway adjunct is:
A. Oropharyngeal airway
B. Nasopharyngeal airway [CORRECT]
C. Supraglottic airway
D. Endotracheal intubation
Correct Answer: B
Rationale: Correct because nasopharyngeal airway insertion in basilar skull fracture risks
entering the cranial vault through a fractured cribriform plate; oropharyngeal or supraglottic
airways are safer alternatives.
Q12: Capnography waveform showing a gradual rise in ETCO2 from 35 mmHg to 55 mmHg
over 10 minutes in an intubated patient most likely indicates:
A. Hyperventilation
