2026 Paramedic Clinical Judgment Study Guide:
Practice Questions with Answer Explanations
Airway • Cardiology • Trauma • Medical
Emergencies • Operations • Clinical Scenarios •
Exam Preparation
Domain 1: Airway, Respiration & Ventilation (Questions 1–18)
Question 1. A 55-year-old male is found unresponsive with snoring respirations.
What is the FIRST action?
A) Insert an OPA
B) Apply high-flow oxygen
C) Open the airway using head-tilt–chin-lift or jaw-thrust
D) Begin bag-valve-mask ventilation
Rationale: The first priority is to open the airway to relieve obstruction from the
tongue. Snoring indicates partial airway obstruction. Manual maneuvers are the
initial intervention before adjuncts.
Question 2. A patient has stridor. This finding most likely indicates:
A) Upper airway obstruction
B) Lower airway infection
C) Cardiac arrest
D) Hypotension
Rationale: Stridor is a high-pitched inspiratory sound indicating obstruction at the
larynx or trachea. It is an upper airway emergency requiring immediate
intervention.
Question 3. Which of the following indicates effective bag-valve-mask (BVM)
ventilation?
,A) High oxygen pressure
B) Misting of the mask and visible chest rise
C) Gastric distension
D) Audible leak around the mask
Rationale: Effective BVM ventilation is confirmed by visible chest rise, misting
of the mask, and improvement in oxygen saturation. Gastric distension suggests
over-ventilation or poor technique.
Question 4. A patient requires intubation. Which device provides direct
visualization of the vocal cords?
A) Supraglottic airway
B) Bag-valve-mask
C) Laryngoscope with Macintosh blade
D) Nasopharyngeal airway
Rationale: Direct laryngoscopy with a Macintosh (curved) or Miller (straight)
blade allows visualization of the vocal cords for endotracheal tube placement.
Question 5. A paramedic is performing rapid sequence intubation (RSI). Which
medication provides sedation and amnesia?
A) Rocuronium
B) Succinylcholine
C) Etomidate
D) Naloxone
Rationale: Etomidate is a rapid-onset sedative-hypnotic commonly used for RSI
induction. Rocuronium and succinylcholine are paralytics. Naloxone is an opioid
antagonist.
Question 6. Which of the following is a contraindication to succinylcholine?
A) Asthma
B) Hyperkalemia
, C) Hypertension
D) Tachycardia
Rationale: Succinylcholine can cause fatal hyperkalemia in patients with burns,
crush injuries, denervation, or pre-existing hyperkalemia. It is contraindicated in
these populations.
Question 7. What is the recommended initial tidal volume for lung-protective
ventilation in ARDS?
A) 10 mL/kg actual body weight
B) 6 mL/kg predicted body weight
C) 12 mL/kg ideal body weight
D) 8 mL/kg actual body weight
Rationale: The ARDSNet protocol recommends 6 mL/kg predicted body weight
to reduce ventilator-induced lung injury and improve survival.
Question 8. A patient on a ventilator suddenly develops high peak airway
pressures with a normal plateau pressure. What is the most likely cause?
A) Pneumothorax
B) Bronchospasm or mucus plugging
C) Pulmonary edema
D) ARDS
Rationale: A high peak pressure with a normal plateau pressure indicates
increased airway resistance, commonly from bronchospasm, mucus plugging, or
endotracheal tube kinking.
Question 9. What is the purpose of positive end-expiratory pressure (PEEP)?
A) To increase respiratory rate
B) To recruit collapsed alveoli and improve oxygenation
C) To decrease cardiac output
D) To increase tidal volume
Practice Questions with Answer Explanations
Airway • Cardiology • Trauma • Medical
Emergencies • Operations • Clinical Scenarios •
Exam Preparation
Domain 1: Airway, Respiration & Ventilation (Questions 1–18)
Question 1. A 55-year-old male is found unresponsive with snoring respirations.
What is the FIRST action?
A) Insert an OPA
B) Apply high-flow oxygen
C) Open the airway using head-tilt–chin-lift or jaw-thrust
D) Begin bag-valve-mask ventilation
Rationale: The first priority is to open the airway to relieve obstruction from the
tongue. Snoring indicates partial airway obstruction. Manual maneuvers are the
initial intervention before adjuncts.
Question 2. A patient has stridor. This finding most likely indicates:
A) Upper airway obstruction
B) Lower airway infection
C) Cardiac arrest
D) Hypotension
Rationale: Stridor is a high-pitched inspiratory sound indicating obstruction at the
larynx or trachea. It is an upper airway emergency requiring immediate
intervention.
Question 3. Which of the following indicates effective bag-valve-mask (BVM)
ventilation?
,A) High oxygen pressure
B) Misting of the mask and visible chest rise
C) Gastric distension
D) Audible leak around the mask
Rationale: Effective BVM ventilation is confirmed by visible chest rise, misting
of the mask, and improvement in oxygen saturation. Gastric distension suggests
over-ventilation or poor technique.
Question 4. A patient requires intubation. Which device provides direct
visualization of the vocal cords?
A) Supraglottic airway
B) Bag-valve-mask
C) Laryngoscope with Macintosh blade
D) Nasopharyngeal airway
Rationale: Direct laryngoscopy with a Macintosh (curved) or Miller (straight)
blade allows visualization of the vocal cords for endotracheal tube placement.
Question 5. A paramedic is performing rapid sequence intubation (RSI). Which
medication provides sedation and amnesia?
A) Rocuronium
B) Succinylcholine
C) Etomidate
D) Naloxone
Rationale: Etomidate is a rapid-onset sedative-hypnotic commonly used for RSI
induction. Rocuronium and succinylcholine are paralytics. Naloxone is an opioid
antagonist.
Question 6. Which of the following is a contraindication to succinylcholine?
A) Asthma
B) Hyperkalemia
, C) Hypertension
D) Tachycardia
Rationale: Succinylcholine can cause fatal hyperkalemia in patients with burns,
crush injuries, denervation, or pre-existing hyperkalemia. It is contraindicated in
these populations.
Question 7. What is the recommended initial tidal volume for lung-protective
ventilation in ARDS?
A) 10 mL/kg actual body weight
B) 6 mL/kg predicted body weight
C) 12 mL/kg ideal body weight
D) 8 mL/kg actual body weight
Rationale: The ARDSNet protocol recommends 6 mL/kg predicted body weight
to reduce ventilator-induced lung injury and improve survival.
Question 8. A patient on a ventilator suddenly develops high peak airway
pressures with a normal plateau pressure. What is the most likely cause?
A) Pneumothorax
B) Bronchospasm or mucus plugging
C) Pulmonary edema
D) ARDS
Rationale: A high peak pressure with a normal plateau pressure indicates
increased airway resistance, commonly from bronchospasm, mucus plugging, or
endotracheal tube kinking.
Question 9. What is the purpose of positive end-expiratory pressure (PEEP)?
A) To increase respiratory rate
B) To recruit collapsed alveoli and improve oxygenation
C) To decrease cardiac output
D) To increase tidal volume
