FISDAP PARAMEDIC FINAL
2026/2027 Practice Questions
and Rationales NREMT-Style
actual!!!
SECTION 1: AIRWAY MANAGEMENT AND RESPIRATORY EMERGENCIES
Question 1: A 34-year-old male skier is evacuated from an altitude of 11,500 feet after a rapid ascent
two days prior. He presents with severe dyspnea, anxiety, productive cough with pink frothy sputum,
and rales bilaterally in all lung fields. His SpO2 is 74% on room air. Which intervention represents the
definitive treatment for this condition?
A. Administer high-flow oxygen via non-rebreather mask and monitor for improvement at altitude
B. Apply CPAP at 10 cmH2O and continue administration of furosemide 40 mg IV
C. Initiate immediate descent to lower altitude combined with high-flow oxygen administration
D. Administer acetazolamide 500 mg IV and maintain the patient at current altitude
Correct ANSWER: C
Rationale:
Option A: Incorrect. While high-flow oxygen is beneficial, remaining at altitude will not resolve the
underlying pathophysiology of High-Altitude Pulmonary Edema (HAPE). This is only temporizing.
Option B: Incorrect. CPAP may help oxygenation temporarily, but furosemide is inappropriate because
HAPE is noncardiogenic pulmonary edema, not cardiogenic. Diuretics can worsen the patient's volume
status.
,Option C: Correct. Immediate descent combined with high-flow oxygen is the definitive treatment for
HAPE. HAPE is caused by hypoxic pulmonary vasoconstriction leading to uneven capillary stress failure,
and descent addresses the underlying hypoxic environment.
Option D: Incorrect. Acetazolamide is used for prevention of acute mountain sickness but is not the
definitive treatment for established HAPE. Maintaining current altitude will allow the condition to
worsen.
Question 2: Paramedics arrive to find an unresponsive 68-year-old male with gurgling respirations and
audible secretions in the oropharynx. Which is the FIRST action the paramedic should take before
placing any airway adjunct?
A. Insert an oropharyngeal airway to maintain airway patency
B. Suction the oropharynx to clear secretions before any airway adjunct placement
C. Position the patient in the left lateral recumbent position to drain secretions
D. Preoxygenate the patient with a bag-valve mask for 30 seconds
Correct ANSWER: B
Rationale:
Option A: Incorrect. Inserting an OPA without first suctioning would push secretions deeper into the
airway and increase aspiration risk. The airway must be cleared first.
Option B: Correct. Suctioning the oropharynx BEFORE placement of any airway adjunct is the correct
first action. Gurgling respirations indicate liquid secretions or vomitus in the airway that must be
removed to prevent aspiration and allow effective ventilation.
Option C: Incorrect. While positioning can help, the immediate priority is to clear the airway through
suctioning. Positioning alone does not remove existing secretions.
Option D: Incorrect. Preoxygenation with BVM before suctioning would force secretions deeper into the
tracheobronchial tree, increasing aspiration risk. Suctioning must come first.
Question 3: A 16-year-old female with a history of asthma presents with severe respiratory distress.
Initially she had audible wheezing, but on your arrival the wheezing has stopped and breath sounds are
absent bilaterally with minimal chest movement. SpO2 is 82%. What does this presentation indicate,
and what is the appropriate intervention?
A. The patient is improving because wheezing has resolved; continue albuterol nebulizer
B. The patient has developed a tension pneumothorax requiring immediate needle decompression
C. The patient has impending respiratory failure requiring immediate bag-valve mask ventilation
D. The patient has fatigued and requires BiPAP to reduce the work of breathing
Correct ANSWER: C
Rationale:
,Option A: Incorrect. The disappearance of wheezing with silent breath sounds does NOT indicate
improvement. This "silent chest" occurs because airflow is so severely restricted that wheezing can no
longer be produced, indicating impending respiratory failure.
Option B: Incorrect. Tension pneumothorax would present with unilateral findings (unilateral absent
breath sounds, tracheal deviation, hypotension), not bilateral silent chest.
Option C: Correct. Disappearance of wheezing with silent breath sounds in asthma indicates impending
respiratory failure, not improvement. Immediate bag-valve mask ventilation with 100% oxygen is
required, often necessitating positive pressure to overcome severe bronchoconstriction.
Option D: Incorrect. While the patient has fatigued, BiPAP is not appropriate for impending respiratory
failure with SpO2 of 82% and minimal chest movement. The patient needs immediate positive pressure
ventilation with BVM.
Question 4: After successful endotracheal intubation of a 55-year-old cardiac arrest patient, what is the
GOLD STANDARD method for continuous confirmation of endotracheal tube placement throughout
transport?
A. Auscultation of bilateral breath sounds and epigastric sounds every 5 minutes
B. Continuous waveform capnography with quantitative EtCO2 monitoring
C. Continuous pulse oximetry and observation of chest wall movement
D. Esophageal detector device (bulb syringe) verification every 10 minutes
Correct ANSWER: B
Rationale:
Option A: Incorrect. Auscultation and chest observation are unreliable and intermittent methods. They
cannot provide continuous confirmation and are subject to human error, especially in noisy transport
environments.
Option B: Correct. Continuous waveform capnography is the gold standard for confirming and
monitoring endotracheal tube placement. Quantitative waveform capnography detects exhaled CO2
from the trachea and immediately indicates tube displacement with a characteristic rectangular
waveform during ventilation.
Option C: Incorrect. Pulse oximetry does not confirm tube placement because SpO2 may remain normal
for several minutes after esophageal intubation. Chest wall observation is unreliable and intermittent.
Option D: Incorrect. Esophageal detector devices are useful as adjuncts but cannot provide continuous
monitoring. They are typically used as initial confirmation methods, not for ongoing verification.
Question 5: A 72-year-old female is being ventilated via bag-valve mask by a paramedic after suffering
respiratory arrest. At what rate should ventilations be delivered to this adult patient to avoid gastric
distention and hyperventilation?
A. 8-10 breaths per minute (one breath every 6-8 seconds)
, B. 10-12 breaths per minute (one breath every 5-6 seconds)
C. 12-15 breaths per minute (one breath every 4-5 seconds)
D. 15-20 breaths per minute (one breath every 3-4 seconds)
Correct ANSWER: B
Rationale:
Option A: Incorrect. While this rate would avoid hyperventilation, it may not provide adequate
ventilation for an adult patient in respiratory arrest.
Option B: Correct. Adult bag-valve mask ventilations should be delivered at 10-12 breaths per minute, or
one breath every 5-6 seconds. This rate provides adequate oxygenation and ventilation without causing
gastric distention (which occurs with rapid insufflation), hyperventilation (which causes cerebral
vasoconstriction and worsens outcomes), or increased intrathoracic pressure that diminishes cardiac
output.
Option C: Incorrect. This rate is too fast and can cause gastric distention, hyperventilation, and increased
intrathoracic pressure that reduces cardiac output.
Option D: Incorrect. This rate is far too rapid and will definitely cause gastric distention, severe
hyperventilation, cerebral vasoconstriction, and significantly reduced cardiac output due to increased
intrathoracic pressure.
Question 6: A 28-year-old male presents with severe respiratory distress, hypotension (BP 84/52), JVD,
tracheal deviation to the right, and absent breath sounds on the left side after a stab wound to the left
chest. Which intervention is indicated, and at what anatomical location?
A. Needle decompression at the 2nd intercostal space, midclavicular line on the left side
B. Needle decompression at the 4th-5th intercostal space, midaxillary line on the left side
C. Tube thoracostomy at the 5th intercostal space, midaxillary line on the left side
D. Occlusive dressing taped on three sides over the stab wound
Correct ANSWER: A
Rationale:
Option A: Correct. This patient presents with the classic triad of tension pneumothorax: decreased
breath sounds on the affected side, tracheal deviation AWAY from the affected side, and hypotension
with JVD. The traditional decompression site is the 2nd intercostal space at the midclavicular line on the
affected (left) side using a 14-gauge or larger needle. While the 4th-5th ICS midaxillary approach is
increasingly recommended by some guidelines, the FISDAP/NREMT standard for paramedic examination
remains the 2nd ICS midclavicular approach.
Option B: Incorrect. While the 4th-5th ICS midaxillary (the "TAC" site) is increasingly recommended by
TCCC/NTMB guidelines for trauma patients, the FISDAP/NREMT standard for paramedic examination
remains the 2nd ICS midclavicular approach.
2026/2027 Practice Questions
and Rationales NREMT-Style
actual!!!
SECTION 1: AIRWAY MANAGEMENT AND RESPIRATORY EMERGENCIES
Question 1: A 34-year-old male skier is evacuated from an altitude of 11,500 feet after a rapid ascent
two days prior. He presents with severe dyspnea, anxiety, productive cough with pink frothy sputum,
and rales bilaterally in all lung fields. His SpO2 is 74% on room air. Which intervention represents the
definitive treatment for this condition?
A. Administer high-flow oxygen via non-rebreather mask and monitor for improvement at altitude
B. Apply CPAP at 10 cmH2O and continue administration of furosemide 40 mg IV
C. Initiate immediate descent to lower altitude combined with high-flow oxygen administration
D. Administer acetazolamide 500 mg IV and maintain the patient at current altitude
Correct ANSWER: C
Rationale:
Option A: Incorrect. While high-flow oxygen is beneficial, remaining at altitude will not resolve the
underlying pathophysiology of High-Altitude Pulmonary Edema (HAPE). This is only temporizing.
Option B: Incorrect. CPAP may help oxygenation temporarily, but furosemide is inappropriate because
HAPE is noncardiogenic pulmonary edema, not cardiogenic. Diuretics can worsen the patient's volume
status.
,Option C: Correct. Immediate descent combined with high-flow oxygen is the definitive treatment for
HAPE. HAPE is caused by hypoxic pulmonary vasoconstriction leading to uneven capillary stress failure,
and descent addresses the underlying hypoxic environment.
Option D: Incorrect. Acetazolamide is used for prevention of acute mountain sickness but is not the
definitive treatment for established HAPE. Maintaining current altitude will allow the condition to
worsen.
Question 2: Paramedics arrive to find an unresponsive 68-year-old male with gurgling respirations and
audible secretions in the oropharynx. Which is the FIRST action the paramedic should take before
placing any airway adjunct?
A. Insert an oropharyngeal airway to maintain airway patency
B. Suction the oropharynx to clear secretions before any airway adjunct placement
C. Position the patient in the left lateral recumbent position to drain secretions
D. Preoxygenate the patient with a bag-valve mask for 30 seconds
Correct ANSWER: B
Rationale:
Option A: Incorrect. Inserting an OPA without first suctioning would push secretions deeper into the
airway and increase aspiration risk. The airway must be cleared first.
Option B: Correct. Suctioning the oropharynx BEFORE placement of any airway adjunct is the correct
first action. Gurgling respirations indicate liquid secretions or vomitus in the airway that must be
removed to prevent aspiration and allow effective ventilation.
Option C: Incorrect. While positioning can help, the immediate priority is to clear the airway through
suctioning. Positioning alone does not remove existing secretions.
Option D: Incorrect. Preoxygenation with BVM before suctioning would force secretions deeper into the
tracheobronchial tree, increasing aspiration risk. Suctioning must come first.
Question 3: A 16-year-old female with a history of asthma presents with severe respiratory distress.
Initially she had audible wheezing, but on your arrival the wheezing has stopped and breath sounds are
absent bilaterally with minimal chest movement. SpO2 is 82%. What does this presentation indicate,
and what is the appropriate intervention?
A. The patient is improving because wheezing has resolved; continue albuterol nebulizer
B. The patient has developed a tension pneumothorax requiring immediate needle decompression
C. The patient has impending respiratory failure requiring immediate bag-valve mask ventilation
D. The patient has fatigued and requires BiPAP to reduce the work of breathing
Correct ANSWER: C
Rationale:
,Option A: Incorrect. The disappearance of wheezing with silent breath sounds does NOT indicate
improvement. This "silent chest" occurs because airflow is so severely restricted that wheezing can no
longer be produced, indicating impending respiratory failure.
Option B: Incorrect. Tension pneumothorax would present with unilateral findings (unilateral absent
breath sounds, tracheal deviation, hypotension), not bilateral silent chest.
Option C: Correct. Disappearance of wheezing with silent breath sounds in asthma indicates impending
respiratory failure, not improvement. Immediate bag-valve mask ventilation with 100% oxygen is
required, often necessitating positive pressure to overcome severe bronchoconstriction.
Option D: Incorrect. While the patient has fatigued, BiPAP is not appropriate for impending respiratory
failure with SpO2 of 82% and minimal chest movement. The patient needs immediate positive pressure
ventilation with BVM.
Question 4: After successful endotracheal intubation of a 55-year-old cardiac arrest patient, what is the
GOLD STANDARD method for continuous confirmation of endotracheal tube placement throughout
transport?
A. Auscultation of bilateral breath sounds and epigastric sounds every 5 minutes
B. Continuous waveform capnography with quantitative EtCO2 monitoring
C. Continuous pulse oximetry and observation of chest wall movement
D. Esophageal detector device (bulb syringe) verification every 10 minutes
Correct ANSWER: B
Rationale:
Option A: Incorrect. Auscultation and chest observation are unreliable and intermittent methods. They
cannot provide continuous confirmation and are subject to human error, especially in noisy transport
environments.
Option B: Correct. Continuous waveform capnography is the gold standard for confirming and
monitoring endotracheal tube placement. Quantitative waveform capnography detects exhaled CO2
from the trachea and immediately indicates tube displacement with a characteristic rectangular
waveform during ventilation.
Option C: Incorrect. Pulse oximetry does not confirm tube placement because SpO2 may remain normal
for several minutes after esophageal intubation. Chest wall observation is unreliable and intermittent.
Option D: Incorrect. Esophageal detector devices are useful as adjuncts but cannot provide continuous
monitoring. They are typically used as initial confirmation methods, not for ongoing verification.
Question 5: A 72-year-old female is being ventilated via bag-valve mask by a paramedic after suffering
respiratory arrest. At what rate should ventilations be delivered to this adult patient to avoid gastric
distention and hyperventilation?
A. 8-10 breaths per minute (one breath every 6-8 seconds)
, B. 10-12 breaths per minute (one breath every 5-6 seconds)
C. 12-15 breaths per minute (one breath every 4-5 seconds)
D. 15-20 breaths per minute (one breath every 3-4 seconds)
Correct ANSWER: B
Rationale:
Option A: Incorrect. While this rate would avoid hyperventilation, it may not provide adequate
ventilation for an adult patient in respiratory arrest.
Option B: Correct. Adult bag-valve mask ventilations should be delivered at 10-12 breaths per minute, or
one breath every 5-6 seconds. This rate provides adequate oxygenation and ventilation without causing
gastric distention (which occurs with rapid insufflation), hyperventilation (which causes cerebral
vasoconstriction and worsens outcomes), or increased intrathoracic pressure that diminishes cardiac
output.
Option C: Incorrect. This rate is too fast and can cause gastric distention, hyperventilation, and increased
intrathoracic pressure that reduces cardiac output.
Option D: Incorrect. This rate is far too rapid and will definitely cause gastric distention, severe
hyperventilation, cerebral vasoconstriction, and significantly reduced cardiac output due to increased
intrathoracic pressure.
Question 6: A 28-year-old male presents with severe respiratory distress, hypotension (BP 84/52), JVD,
tracheal deviation to the right, and absent breath sounds on the left side after a stab wound to the left
chest. Which intervention is indicated, and at what anatomical location?
A. Needle decompression at the 2nd intercostal space, midclavicular line on the left side
B. Needle decompression at the 4th-5th intercostal space, midaxillary line on the left side
C. Tube thoracostomy at the 5th intercostal space, midaxillary line on the left side
D. Occlusive dressing taped on three sides over the stab wound
Correct ANSWER: A
Rationale:
Option A: Correct. This patient presents with the classic triad of tension pneumothorax: decreased
breath sounds on the affected side, tracheal deviation AWAY from the affected side, and hypotension
with JVD. The traditional decompression site is the 2nd intercostal space at the midclavicular line on the
affected (left) side using a 14-gauge or larger needle. While the 4th-5th ICS midaxillary approach is
increasingly recommended by some guidelines, the FISDAP/NREMT standard for paramedic examination
remains the 2nd ICS midclavicular approach.
Option B: Incorrect. While the 4th-5th ICS midaxillary (the "TAC" site) is increasingly recommended by
TCCC/NTMB guidelines for trauma patients, the FISDAP/NREMT standard for paramedic examination
remains the 2nd ICS midclavicular approach.
