NYS EMT State Written – New York State
Department of Health (NYSDOH) Bureau of EMS
Section I: Airway, Respiration, and Ventilation
Question 1
You are called to assist a 68-year-old male patient who is experiencing severe
respiratory distress. He is sitting upright in the tripod position and cannot speak
more than two words at a time. His skin is pale, cool, and diaphoretic. Which of
the following is the BEST immediate intervention?
A) Administer high-flow oxygen via non-rebreather mask at 15 L/min
B) Assist ventilations with a bag-valve-mask device and supplemental oxygen
C) Place the patient supine and begin CPR
D) Administer an albuterol nebulizer treatment
Correct Answer: B
Rationale: The patient is showing signs of severe respiratory distress with
impending respiratory failure—tripod positioning, inability to speak in full
sentences, and diaphoresis indicate significant work of breathing. When a patient
cannot maintain adequate ventilation, the priority is to assist ventilations with a
BVM. A non-rebreather mask (A) delivers oxygen but does not assist with the
mechanical work of breathing. Supine positioning (C) would worsen this patient's
ability to breathe. Albuterol (D) may be indicated for bronchospasm but is not the
initial priority when the patient shows signs of respiratory failure. The BVM
provides positive-pressure ventilation to support the patient's failing respiratory
effort .
Question 2
A 45-year-old female patient has a stoma and is apneic. What is the MOST
appropriate method to ventilate this patient?
A) Use a pediatric mask over the stoma
B) Use an adult BVM with a mask placed over both the mouth and stoma
,C) Use a BVM with a mask placed directly over the stoma only
D) Perform mouth-to-stoma ventilations without any equipment
Correct Answer: C
Rationale: For a patient with a tracheostomy stoma who is apneic,
ventilations should be delivered directly through the stoma using a BVM with a
pediatric mask that fits over the stoma site. Covering both the mouth and stoma
(B) can allow air to escape through the upper airway and reduce effective
ventilation through the tracheostomy. Mouth-to-stoma ventilation (D) is possible
but not the preferred method when equipment is available. A pediatric mask over
the stoma provides the best seal for effective ventilation .
Question 3
An adult patient is suctioned for 15 seconds and the airway is still not clear. What
should the EMT do next?
A) Continue suctioning until the airway is clear
B) Stop suctioning, ventilate for 30-60 seconds, then suction again
C) Stop suctioning and immediately begin CPR
D) Switch to a larger suction catheter
Correct Answer: B
Rationale: The maximum suctioning time for an adult patient is 15 seconds
per attempt. If the airway is not clear after 15 seconds, the provider should stop
suctioning, re-oxygenate and ventilate the patient for 30-60 seconds, and then
attempt suctioning again. Prolonged suctioning can cause hypoxia, bradycardia,
and cardiac arrest. Continuing suctioning (A) beyond 15 seconds increases the risk
of hypoxia. CPR (C) is not indicated unless the patient is in cardiac arrest.
Switching catheter sizes (D) does not address the need to re-oxygenate between
attempts .
,Question 4
Which of the following is the MOST reliable indicator of adequate ventilation in an
intubated patient?
A) Skin color improvement
B) Pulse oximetry reading of 95%
C) Bilateral chest rise and fall
D) End-tidal CO₂ monitoring
Correct Answer: D
Rationale: End-tidal CO₂ monitoring is the most reliable indicator of proper
endotracheal tube placement and adequate ventilation. While bilateral chest rise
(C) is a good sign, it can be misleading due to gastric insufflation or esophageal
intubation causing chest movement. Skin color (A) and pulse oximetry (B) are
delayed indicators and can be affected by other factors such as peripheral
perfusion. Capnography provides immediate confirmation of proper tube
placement and ventilation adequacy .
Question 5
A 6-year-old child is choking and cannot speak or cough. The child is conscious.
What is the MOST appropriate intervention?
A) Perform abdominal thrusts
B) Perform chest thrusts
C) Perform back blows and chest thrusts
D) Perform blind finger sweeps
Correct Answer: C
Rationale: For a conscious choking child (1-8 years), the recommended
sequence is alternating back blows and chest thrusts. Abdominal thrusts (A) are
not recommended for children under 8 years due to the risk of abdominal organ
injury. Chest thrusts alone (B) do not follow the complete recommended
sequence. Blind finger sweeps (D) are contraindicated as they can push the
obstruction deeper into the airway .
, Question 6
A 72-year-old patient has vomited and aspirated. The EMT notes gurgling sounds
on inspiration. The MOST appropriate action is:
A) Place the patient in the recovery position
B) Suction the airway
C) Perform abdominal thrusts
D) Administer oxygen via non-rebreather mask
Correct Answer: B
Rationale: Gurgling sounds indicate fluid in the airway, which requires
immediate suctioning to clear the airway and prevent aspiration. Placing the
patient in the recovery position (A) is appropriate to prevent further aspiration
but does not clear the current obstruction. Abdominal thrusts (C) are for foreign
body airway obstruction, not fluid. Oxygen administration (D) is important but
should follow airway clearance .
Question 7
Which of the following is a CONTRAINDICATION for using a nasopharyngeal
airway?
A) Suspected skull fracture with CSF leak
B) Unconscious patient
C) Gag reflex present
D) Epistaxis
Correct Answer: A
Rationale: Nasopharyngeal airways are contraindicated in patients with
suspected skull fracture, particularly basilar skull fractures, as the airway could be
inadvertently placed into the cranial cavity through the fracture site. Signs of
basilar skull fracture include raccoon eyes, Battle's sign, and CSF rhinorrhea. An
unconscious patient (B) is actually an indication for an NPA. A gag reflex (C) may
Department of Health (NYSDOH) Bureau of EMS
Section I: Airway, Respiration, and Ventilation
Question 1
You are called to assist a 68-year-old male patient who is experiencing severe
respiratory distress. He is sitting upright in the tripod position and cannot speak
more than two words at a time. His skin is pale, cool, and diaphoretic. Which of
the following is the BEST immediate intervention?
A) Administer high-flow oxygen via non-rebreather mask at 15 L/min
B) Assist ventilations with a bag-valve-mask device and supplemental oxygen
C) Place the patient supine and begin CPR
D) Administer an albuterol nebulizer treatment
Correct Answer: B
Rationale: The patient is showing signs of severe respiratory distress with
impending respiratory failure—tripod positioning, inability to speak in full
sentences, and diaphoresis indicate significant work of breathing. When a patient
cannot maintain adequate ventilation, the priority is to assist ventilations with a
BVM. A non-rebreather mask (A) delivers oxygen but does not assist with the
mechanical work of breathing. Supine positioning (C) would worsen this patient's
ability to breathe. Albuterol (D) may be indicated for bronchospasm but is not the
initial priority when the patient shows signs of respiratory failure. The BVM
provides positive-pressure ventilation to support the patient's failing respiratory
effort .
Question 2
A 45-year-old female patient has a stoma and is apneic. What is the MOST
appropriate method to ventilate this patient?
A) Use a pediatric mask over the stoma
B) Use an adult BVM with a mask placed over both the mouth and stoma
,C) Use a BVM with a mask placed directly over the stoma only
D) Perform mouth-to-stoma ventilations without any equipment
Correct Answer: C
Rationale: For a patient with a tracheostomy stoma who is apneic,
ventilations should be delivered directly through the stoma using a BVM with a
pediatric mask that fits over the stoma site. Covering both the mouth and stoma
(B) can allow air to escape through the upper airway and reduce effective
ventilation through the tracheostomy. Mouth-to-stoma ventilation (D) is possible
but not the preferred method when equipment is available. A pediatric mask over
the stoma provides the best seal for effective ventilation .
Question 3
An adult patient is suctioned for 15 seconds and the airway is still not clear. What
should the EMT do next?
A) Continue suctioning until the airway is clear
B) Stop suctioning, ventilate for 30-60 seconds, then suction again
C) Stop suctioning and immediately begin CPR
D) Switch to a larger suction catheter
Correct Answer: B
Rationale: The maximum suctioning time for an adult patient is 15 seconds
per attempt. If the airway is not clear after 15 seconds, the provider should stop
suctioning, re-oxygenate and ventilate the patient for 30-60 seconds, and then
attempt suctioning again. Prolonged suctioning can cause hypoxia, bradycardia,
and cardiac arrest. Continuing suctioning (A) beyond 15 seconds increases the risk
of hypoxia. CPR (C) is not indicated unless the patient is in cardiac arrest.
Switching catheter sizes (D) does not address the need to re-oxygenate between
attempts .
,Question 4
Which of the following is the MOST reliable indicator of adequate ventilation in an
intubated patient?
A) Skin color improvement
B) Pulse oximetry reading of 95%
C) Bilateral chest rise and fall
D) End-tidal CO₂ monitoring
Correct Answer: D
Rationale: End-tidal CO₂ monitoring is the most reliable indicator of proper
endotracheal tube placement and adequate ventilation. While bilateral chest rise
(C) is a good sign, it can be misleading due to gastric insufflation or esophageal
intubation causing chest movement. Skin color (A) and pulse oximetry (B) are
delayed indicators and can be affected by other factors such as peripheral
perfusion. Capnography provides immediate confirmation of proper tube
placement and ventilation adequacy .
Question 5
A 6-year-old child is choking and cannot speak or cough. The child is conscious.
What is the MOST appropriate intervention?
A) Perform abdominal thrusts
B) Perform chest thrusts
C) Perform back blows and chest thrusts
D) Perform blind finger sweeps
Correct Answer: C
Rationale: For a conscious choking child (1-8 years), the recommended
sequence is alternating back blows and chest thrusts. Abdominal thrusts (A) are
not recommended for children under 8 years due to the risk of abdominal organ
injury. Chest thrusts alone (B) do not follow the complete recommended
sequence. Blind finger sweeps (D) are contraindicated as they can push the
obstruction deeper into the airway .
, Question 6
A 72-year-old patient has vomited and aspirated. The EMT notes gurgling sounds
on inspiration. The MOST appropriate action is:
A) Place the patient in the recovery position
B) Suction the airway
C) Perform abdominal thrusts
D) Administer oxygen via non-rebreather mask
Correct Answer: B
Rationale: Gurgling sounds indicate fluid in the airway, which requires
immediate suctioning to clear the airway and prevent aspiration. Placing the
patient in the recovery position (A) is appropriate to prevent further aspiration
but does not clear the current obstruction. Abdominal thrusts (C) are for foreign
body airway obstruction, not fluid. Oxygen administration (D) is important but
should follow airway clearance .
Question 7
Which of the following is a CONTRAINDICATION for using a nasopharyngeal
airway?
A) Suspected skull fracture with CSF leak
B) Unconscious patient
C) Gag reflex present
D) Epistaxis
Correct Answer: A
Rationale: Nasopharyngeal airways are contraindicated in patients with
suspected skull fracture, particularly basilar skull fractures, as the airway could be
inadvertently placed into the cranial cavity through the fracture site. Signs of
basilar skull fracture include raccoon eyes, Battle's sign, and CSF rhinorrhea. An
unconscious patient (B) is actually an indication for an NPA. A gag reflex (C) may
