FLIGHT NURSE PRE-HIRE EXAM PRACTICE | STUDY GUIDE | TESTBANK | PRACTICE
QUESTIONS & ANSWERS | EXAM PREPARATION | CERTIFICATION EXAM | ADVANCED
REVIEW | COMPREHENSIVE PRACTICE EXAM | LATEST UPDATE 2026/2027
Examiner:
Employer-specific Flight Nursing Recruitment Programs (Pre-Hire Assessments) based on
widely recognized flight nursing competencies, critical care transport standards,
emergency nursing knowledge, trauma care principles, and advanced critical care practice.
TABLE OF CONTENTS
1. Flight Physiology
2. Airway and Mechanical Ventilation
3. Hemodynamic Monitoring
4. Shock and Resuscitation
5. Trauma and Critical Care Transport
6. Cardiac Emergencies
7. Neurologic Emergencies
8. Pediatric and Neonatal Transport
9. Obstetric Emergencies
10. Respiratory Emergencies
11. Pharmacology and Infusions
12. Aircraft Safety and Crew Resource Management
13. Environmental Emergencies
14. Infectious Diseases and PPE
15. Critical Care Procedures
16. Ethical and Legal Considerations
17. Clinical Decision-Making
18. Documentation and Communication
19. Quality Improvement and Risk Management
20. Professional Responsibilities
FLIGHT PHYSIOLOGY || ALTITUDE MEDICINE || CRITICAL CARE TRANSPORT || AIRWAY
MANAGEMENT || MECHANICAL VENTILATION || SHOCK || TRAUMA || HEMODYNAMIC
MONITORING || RAPID SEQUENCE INTUBATION || ECMO || VASOPRESSORS || CARDIAC
EMERGENCIES || PEDIATRIC TRANSPORT || NEONATAL CARE || OBSTETRIC
,EMERGENCIES || CREW RESOURCE MANAGEMENT || AVIATION SAFETY || CLINICAL
JUDGMENT || ADVANCED PHARMACOLOGY || PROFESSIONAL PRACTICE
QUESTION 1.
During rotor-wing transport of a patient with severe traumatic brain injury, the patient's
intracranial pressure is suspected to be increasing despite adequate sedation. Which
intervention is most appropriate to minimize secondary brain injury during transport?
A. Maintain normoxia, avoid hypotension, and ensure appropriate ventilation to prevent
hypo- or hypercapnia.
B. Hyperventilate the patient to a PaCO₂ below 25 mmHg throughout transport.
C. Reduce sedation to permit serial neurologic examinations.
D. Lower mean arterial pressure to decrease cerebral blood flow.
🔴 Correct Answer: A. Maintain normoxia, avoid hypotension, and ensure appropriate
ventilation to prevent hypo- or hypercapnia.
🔵 Explanation: Prevention of secondary brain injury focuses on maintaining adequate
cerebral perfusion, oxygenation, and controlled ventilation. Routine aggressive
hyperventilation is no longer recommended because it may reduce cerebral blood flow
excessively. Reducing sedation may increase intracranial pressure, while hypotension is
strongly associated with worse neurologic outcomes.
QUESTION 2.
A patient receiving norepinephrine develops worsening hypotension immediately after
helicopter ascent. Which physiologic factor most likely contributes to deterioration?
A. Increased oxygen solubility at altitude
B. Reduced inspired oxygen partial pressure combined with critical illness
C. Increased atmospheric pressure improving preload
D. Increased barometric pressure causing vasoconstriction
🔴 Correct Answer: B. Reduced inspired oxygen partial pressure combined with critical
illness.
🔵 Explanation: As altitude increases, atmospheric pressure decreases, reducing inspired
oxygen partial pressure. Critically ill patients often have limited physiologic reserve and may
,decompensate despite supplemental oxygen. The remaining options inaccurately describe
altitude physiology.
QUESTION 3.
A ventilated patient with severe ARDS requires interfacility transport. Which ventilator
parameter should receive the highest priority for continuous reassessment during
transport?
A. Endotracheal tube cuff pressure only
B. Peak inspiratory pressure without regard to tidal volume
C. Lung-protective tidal volume and oxygenation goals
D. Respiratory rate regardless of minute ventilation
🔴 Correct Answer: C. Lung-protective tidal volume and oxygenation goals
🔵 Explanation: Lung-protective ventilation remains a cornerstone of ARDS management
during transport. Appropriate tidal volumes, oxygenation, and plateau pressure
considerations reduce ventilator-induced lung injury. The other parameters are important
but should not supersede overall lung-protective strategy.
QUESTION 4.
A trauma patient develops sudden hypotension, jugular venous distention, and absent
breath sounds on the left during transport. What is the highest-priority intervention?
A. Increase crystalloid infusion
B. Administer sodium bicarbonate
C. Perform synchronized cardioversion
D. Immediately decompress the suspected tension pneumothorax
🔴 Correct Answer: D. Immediately decompress the suspected tension pneumothorax
🔵 Explanation: The clinical findings strongly indicate tension pneumothorax, a rapidly fatal
condition if untreated. Immediate decompression restores venous return and improves
cardiac output. Fluid administration alone or cardioversion does not address the underlying
mechanical obstruction.
, QUESTION 5.
During transport of a patient with septic shock, serum lactate continues to rise despite
adequate fluid resuscitation and increasing vasopressor requirements. What does this
trend most strongly suggest?
A. Improving tissue perfusion
B. Ongoing tissue hypoperfusion despite therapy
C. Resolution of distributive shock
D. Excessive oxygen delivery
🔴 Correct Answer: B. Ongoing tissue hypoperfusion despite therapy
🔵 Explanation: Persistently elevated or rising lactate generally indicates inadequate tissue
perfusion or impaired lactate clearance. In septic shock, this finding warrants reassessment of
resuscitation strategy and underlying causes. The remaining choices are inconsistent with
worsening lactate values.
QUESTION 6.
Which medication is generally preferred as the initial vasopressor for adult septic shock
requiring pharmacologic support during critical care transport?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Phenylephrine
🔴 Correct Answer: C. Norepinephrine
🔵 Explanation: Norepinephrine is widely accepted as the preferred first-line vasopressor for
septic shock because it effectively increases vascular tone while minimizing arrhythmias
compared with dopamine. Epinephrine and phenylephrine have more limited first-line roles
in most situations.
QUESTION 7.
A mechanically ventilated patient develops auto-PEEP during transport. Which adjustment
is most likely to reduce dynamic hyperinflation?
QUESTIONS & ANSWERS | EXAM PREPARATION | CERTIFICATION EXAM | ADVANCED
REVIEW | COMPREHENSIVE PRACTICE EXAM | LATEST UPDATE 2026/2027
Examiner:
Employer-specific Flight Nursing Recruitment Programs (Pre-Hire Assessments) based on
widely recognized flight nursing competencies, critical care transport standards,
emergency nursing knowledge, trauma care principles, and advanced critical care practice.
TABLE OF CONTENTS
1. Flight Physiology
2. Airway and Mechanical Ventilation
3. Hemodynamic Monitoring
4. Shock and Resuscitation
5. Trauma and Critical Care Transport
6. Cardiac Emergencies
7. Neurologic Emergencies
8. Pediatric and Neonatal Transport
9. Obstetric Emergencies
10. Respiratory Emergencies
11. Pharmacology and Infusions
12. Aircraft Safety and Crew Resource Management
13. Environmental Emergencies
14. Infectious Diseases and PPE
15. Critical Care Procedures
16. Ethical and Legal Considerations
17. Clinical Decision-Making
18. Documentation and Communication
19. Quality Improvement and Risk Management
20. Professional Responsibilities
FLIGHT PHYSIOLOGY || ALTITUDE MEDICINE || CRITICAL CARE TRANSPORT || AIRWAY
MANAGEMENT || MECHANICAL VENTILATION || SHOCK || TRAUMA || HEMODYNAMIC
MONITORING || RAPID SEQUENCE INTUBATION || ECMO || VASOPRESSORS || CARDIAC
EMERGENCIES || PEDIATRIC TRANSPORT || NEONATAL CARE || OBSTETRIC
,EMERGENCIES || CREW RESOURCE MANAGEMENT || AVIATION SAFETY || CLINICAL
JUDGMENT || ADVANCED PHARMACOLOGY || PROFESSIONAL PRACTICE
QUESTION 1.
During rotor-wing transport of a patient with severe traumatic brain injury, the patient's
intracranial pressure is suspected to be increasing despite adequate sedation. Which
intervention is most appropriate to minimize secondary brain injury during transport?
A. Maintain normoxia, avoid hypotension, and ensure appropriate ventilation to prevent
hypo- or hypercapnia.
B. Hyperventilate the patient to a PaCO₂ below 25 mmHg throughout transport.
C. Reduce sedation to permit serial neurologic examinations.
D. Lower mean arterial pressure to decrease cerebral blood flow.
🔴 Correct Answer: A. Maintain normoxia, avoid hypotension, and ensure appropriate
ventilation to prevent hypo- or hypercapnia.
🔵 Explanation: Prevention of secondary brain injury focuses on maintaining adequate
cerebral perfusion, oxygenation, and controlled ventilation. Routine aggressive
hyperventilation is no longer recommended because it may reduce cerebral blood flow
excessively. Reducing sedation may increase intracranial pressure, while hypotension is
strongly associated with worse neurologic outcomes.
QUESTION 2.
A patient receiving norepinephrine develops worsening hypotension immediately after
helicopter ascent. Which physiologic factor most likely contributes to deterioration?
A. Increased oxygen solubility at altitude
B. Reduced inspired oxygen partial pressure combined with critical illness
C. Increased atmospheric pressure improving preload
D. Increased barometric pressure causing vasoconstriction
🔴 Correct Answer: B. Reduced inspired oxygen partial pressure combined with critical
illness.
🔵 Explanation: As altitude increases, atmospheric pressure decreases, reducing inspired
oxygen partial pressure. Critically ill patients often have limited physiologic reserve and may
,decompensate despite supplemental oxygen. The remaining options inaccurately describe
altitude physiology.
QUESTION 3.
A ventilated patient with severe ARDS requires interfacility transport. Which ventilator
parameter should receive the highest priority for continuous reassessment during
transport?
A. Endotracheal tube cuff pressure only
B. Peak inspiratory pressure without regard to tidal volume
C. Lung-protective tidal volume and oxygenation goals
D. Respiratory rate regardless of minute ventilation
🔴 Correct Answer: C. Lung-protective tidal volume and oxygenation goals
🔵 Explanation: Lung-protective ventilation remains a cornerstone of ARDS management
during transport. Appropriate tidal volumes, oxygenation, and plateau pressure
considerations reduce ventilator-induced lung injury. The other parameters are important
but should not supersede overall lung-protective strategy.
QUESTION 4.
A trauma patient develops sudden hypotension, jugular venous distention, and absent
breath sounds on the left during transport. What is the highest-priority intervention?
A. Increase crystalloid infusion
B. Administer sodium bicarbonate
C. Perform synchronized cardioversion
D. Immediately decompress the suspected tension pneumothorax
🔴 Correct Answer: D. Immediately decompress the suspected tension pneumothorax
🔵 Explanation: The clinical findings strongly indicate tension pneumothorax, a rapidly fatal
condition if untreated. Immediate decompression restores venous return and improves
cardiac output. Fluid administration alone or cardioversion does not address the underlying
mechanical obstruction.
, QUESTION 5.
During transport of a patient with septic shock, serum lactate continues to rise despite
adequate fluid resuscitation and increasing vasopressor requirements. What does this
trend most strongly suggest?
A. Improving tissue perfusion
B. Ongoing tissue hypoperfusion despite therapy
C. Resolution of distributive shock
D. Excessive oxygen delivery
🔴 Correct Answer: B. Ongoing tissue hypoperfusion despite therapy
🔵 Explanation: Persistently elevated or rising lactate generally indicates inadequate tissue
perfusion or impaired lactate clearance. In septic shock, this finding warrants reassessment of
resuscitation strategy and underlying causes. The remaining choices are inconsistent with
worsening lactate values.
QUESTION 6.
Which medication is generally preferred as the initial vasopressor for adult septic shock
requiring pharmacologic support during critical care transport?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Phenylephrine
🔴 Correct Answer: C. Norepinephrine
🔵 Explanation: Norepinephrine is widely accepted as the preferred first-line vasopressor for
septic shock because it effectively increases vascular tone while minimizing arrhythmias
compared with dopamine. Epinephrine and phenylephrine have more limited first-line roles
in most situations.
QUESTION 7.
A mechanically ventilated patient develops auto-PEEP during transport. Which adjustment
is most likely to reduce dynamic hyperinflation?
