Paramedic Readiness Exam 5 | Focused
Review / NREMT | Academic Year
2026/2027
Section 1: Airway, Respiration, & Ventilation (Questions 1-20)
1. A 68-year-old male with a history of COPD is in severe respiratory distress. He
is conscious but drowsy, with pursed-lip breathing and an SpO2 of 82% on room
air. What is the most appropriate initial oxygen therapy?
A. Apply a non-rebreather mask at 15 Lpm.
B. Apply a nasal cannula at 2-4 Lpm.
C. Assist ventilations with a BVM.
D. Apply a Venturi mask at 28%.
Correct Answer: B
Rationale: For a COPD patient, the primary goal is to maintain an SpO2
between 88-92%. A nasal cannula at 2-4 Lpm provides low-flow, controlled
oxygen. A non-rebreather can easily over-oxygenate and suppress the hypoxic
drive, potentially leading to apnea. The patient is conscious and has an effective,
albeit labored, respiratory effort, so assisted ventilations are not yet indicated.
2. Which of the following findings is the earliest and most reliable indicator of
inadequate breathing in an adult?
A. Cyanosis
B. Altered mental status
C. Accessory muscle use
D. A respiratory rate of 24
Correct Answer: B
Rationale: Altered mental status (restlessness, confusion, drowsiness) is a
sensitive indicator of cerebral hypoxia and/or hypercarbia. It often occurs before
more obvious physical signs like cyanosis (a late sign) or significant accessory
muscle use.
,3. You are performing endotracheal intubation. After passing the tube through
the vocal cords, you inflate the cuff and begin ventilating. Which of the
following is the most reliable method to confirm proper tube placement?
A. Auscultating for equal breath sounds bilaterally.
B. Observing for chest rise and fall.
C. Using a colorimetric end-tidal CO2 detector.
D. Hearing no sounds over the epigastrium.
Correct Answer: C
Rationale: A colorimetric end-tidal CO2 (EtCO2) detector is the most reliable
field method for confirming endotracheal tube placement. It detects the presence
of CO2, which is only produced in significant quantities in the lungs, not the
esophagus. While auscultation and chest rise are important, they are not as
definitive as EtCO2 detection.
4. A patient is in respiratory failure. You have inserted an oropharyngeal airway
(OPA) and are ventilating them with a bag-valve-mask (BVM). The chest does
not rise, and you hear gurgling sounds over the epigastrium. What is the most
likely cause?
A. The OPA is too small.
B. You are ventilating too quickly.
C. The airway is obstructed by fluid.
D. The patient has a pneumothorax.
Correct Answer: C
Rationale: Gurgling sounds over the epigastrium during BVM ventilation
indicate that air is entering the stomach, which is a common result of an
obstructed airway (often by fluids like vomit or blood) that forces air down the
esophagus. The first step is to suction the airway.
5. Which of the following patients would benefit most from CPAP?
A. A 24-year-old with a spontaneous pneumothorax.
B. A 62-year-old with a severe asthma attack and minimal air movement.
C. A 55-year-old with acute pulmonary edema and adequate blood pressure.
D. A 40-year-old with a tracheostomy and copious secretions.
, Correct Answer: C
Rationale: CPAP is highly effective for acute cardiogenic pulmonary edema as
it improves oxygenation by recruiting flooded alveoli and decreases preload and
afterload. It is contraindicated in patients with a pneumothorax, who are not
breathing adequately, or who cannot protect their airway.
6. What is the primary purpose of a nasopharyngeal airway (NPA)?
A. To secure the tongue to prevent it from blocking the airway.
B. To provide a route for deep suctioning.
C. To maintain a patent airway in a patient with an intact gag reflex.
D. To serve as a guide for endotracheal intubation.
Correct Answer: C
Rationale: An NPA is better tolerated than an OPA in patients with an intact
gag reflex because it does not stimulate the posterior pharynx as forcefully. Its
primary purpose is to maintain airway patency by preventing the tongue and soft
tissues from obstructing the posterior oropharynx.
7. A patient with a stoma is in respiratory arrest. How should you ventilate this
patient?
A. Use a pediatric mask over the stoma.
B. Perform a head-tilt, chin-lift and use a BVM over the mouth.
C. Ventilate directly over the stoma with a pediatric or tracheostomy mask.
D. Intubate the stoma with an endotracheal tube.
Correct Answer: C
Rationale: The most direct and effective way to ventilate a patient with a
stoma is to create a seal directly over the stoma. A pediatric mask often fits well.
Ventilating the mouth or nose would be ineffective as the air would not reach the
lungs.
8. What is the correct compression-to-ventilation ratio for a 6-month-old infant
with two rescuers?
A. 30:2
B. 15:2
C. 3:1
D. 5:1
, Correct Answer: B
Rationale: For pediatric patients (infants and children) with two or more
rescuers, the compression-to-ventilation ratio is 15:2. For a single rescuer, it is
30:2. This higher ratio provides more frequent ventilations, which is critical for
pediatric patients who often suffer from primary respiratory arrest.
9. Which of the following is a contraindication for the use of an oropharyngeal
airway (OPA)?
A. The patient is in respiratory arrest.
B. The patient is deeply unresponsive.
C. The patient has an intact gag reflex.
D. The patient has facial trauma.
Correct Answer: C
Rationale: An OPA is contraindicated in a patient with an intact gag reflex, as
it can stimulate the gag reflex, leading to vomiting and aspiration. An NPA is a
better choice for these patients.
10. A patient is exhibiting signs of inadequate breathing. Which of the following
is a sign of inadequate breathing?
A. Respiratory rate of 16
B. Clear and equal breath sounds
C. Shallow chest rise and fall
D. Pink, warm, and dry skin
Correct Answer: C
Rationale: Shallow chest rise and fall indicates that the tidal volume is
inadequate. Even if the respiratory rate is normal, if the volume of air moved is
insufficient, the patient is not breathing adequately.
11. What is the maximum flow rate for a standard nasal cannula?
A. 2 Lpm
B. 6 Lpm
C. 10 Lpm
D. 15 Lpm
Review / NREMT | Academic Year
2026/2027
Section 1: Airway, Respiration, & Ventilation (Questions 1-20)
1. A 68-year-old male with a history of COPD is in severe respiratory distress. He
is conscious but drowsy, with pursed-lip breathing and an SpO2 of 82% on room
air. What is the most appropriate initial oxygen therapy?
A. Apply a non-rebreather mask at 15 Lpm.
B. Apply a nasal cannula at 2-4 Lpm.
C. Assist ventilations with a BVM.
D. Apply a Venturi mask at 28%.
Correct Answer: B
Rationale: For a COPD patient, the primary goal is to maintain an SpO2
between 88-92%. A nasal cannula at 2-4 Lpm provides low-flow, controlled
oxygen. A non-rebreather can easily over-oxygenate and suppress the hypoxic
drive, potentially leading to apnea. The patient is conscious and has an effective,
albeit labored, respiratory effort, so assisted ventilations are not yet indicated.
2. Which of the following findings is the earliest and most reliable indicator of
inadequate breathing in an adult?
A. Cyanosis
B. Altered mental status
C. Accessory muscle use
D. A respiratory rate of 24
Correct Answer: B
Rationale: Altered mental status (restlessness, confusion, drowsiness) is a
sensitive indicator of cerebral hypoxia and/or hypercarbia. It often occurs before
more obvious physical signs like cyanosis (a late sign) or significant accessory
muscle use.
,3. You are performing endotracheal intubation. After passing the tube through
the vocal cords, you inflate the cuff and begin ventilating. Which of the
following is the most reliable method to confirm proper tube placement?
A. Auscultating for equal breath sounds bilaterally.
B. Observing for chest rise and fall.
C. Using a colorimetric end-tidal CO2 detector.
D. Hearing no sounds over the epigastrium.
Correct Answer: C
Rationale: A colorimetric end-tidal CO2 (EtCO2) detector is the most reliable
field method for confirming endotracheal tube placement. It detects the presence
of CO2, which is only produced in significant quantities in the lungs, not the
esophagus. While auscultation and chest rise are important, they are not as
definitive as EtCO2 detection.
4. A patient is in respiratory failure. You have inserted an oropharyngeal airway
(OPA) and are ventilating them with a bag-valve-mask (BVM). The chest does
not rise, and you hear gurgling sounds over the epigastrium. What is the most
likely cause?
A. The OPA is too small.
B. You are ventilating too quickly.
C. The airway is obstructed by fluid.
D. The patient has a pneumothorax.
Correct Answer: C
Rationale: Gurgling sounds over the epigastrium during BVM ventilation
indicate that air is entering the stomach, which is a common result of an
obstructed airway (often by fluids like vomit or blood) that forces air down the
esophagus. The first step is to suction the airway.
5. Which of the following patients would benefit most from CPAP?
A. A 24-year-old with a spontaneous pneumothorax.
B. A 62-year-old with a severe asthma attack and minimal air movement.
C. A 55-year-old with acute pulmonary edema and adequate blood pressure.
D. A 40-year-old with a tracheostomy and copious secretions.
, Correct Answer: C
Rationale: CPAP is highly effective for acute cardiogenic pulmonary edema as
it improves oxygenation by recruiting flooded alveoli and decreases preload and
afterload. It is contraindicated in patients with a pneumothorax, who are not
breathing adequately, or who cannot protect their airway.
6. What is the primary purpose of a nasopharyngeal airway (NPA)?
A. To secure the tongue to prevent it from blocking the airway.
B. To provide a route for deep suctioning.
C. To maintain a patent airway in a patient with an intact gag reflex.
D. To serve as a guide for endotracheal intubation.
Correct Answer: C
Rationale: An NPA is better tolerated than an OPA in patients with an intact
gag reflex because it does not stimulate the posterior pharynx as forcefully. Its
primary purpose is to maintain airway patency by preventing the tongue and soft
tissues from obstructing the posterior oropharynx.
7. A patient with a stoma is in respiratory arrest. How should you ventilate this
patient?
A. Use a pediatric mask over the stoma.
B. Perform a head-tilt, chin-lift and use a BVM over the mouth.
C. Ventilate directly over the stoma with a pediatric or tracheostomy mask.
D. Intubate the stoma with an endotracheal tube.
Correct Answer: C
Rationale: The most direct and effective way to ventilate a patient with a
stoma is to create a seal directly over the stoma. A pediatric mask often fits well.
Ventilating the mouth or nose would be ineffective as the air would not reach the
lungs.
8. What is the correct compression-to-ventilation ratio for a 6-month-old infant
with two rescuers?
A. 30:2
B. 15:2
C. 3:1
D. 5:1
, Correct Answer: B
Rationale: For pediatric patients (infants and children) with two or more
rescuers, the compression-to-ventilation ratio is 15:2. For a single rescuer, it is
30:2. This higher ratio provides more frequent ventilations, which is critical for
pediatric patients who often suffer from primary respiratory arrest.
9. Which of the following is a contraindication for the use of an oropharyngeal
airway (OPA)?
A. The patient is in respiratory arrest.
B. The patient is deeply unresponsive.
C. The patient has an intact gag reflex.
D. The patient has facial trauma.
Correct Answer: C
Rationale: An OPA is contraindicated in a patient with an intact gag reflex, as
it can stimulate the gag reflex, leading to vomiting and aspiration. An NPA is a
better choice for these patients.
10. A patient is exhibiting signs of inadequate breathing. Which of the following
is a sign of inadequate breathing?
A. Respiratory rate of 16
B. Clear and equal breath sounds
C. Shallow chest rise and fall
D. Pink, warm, and dry skin
Correct Answer: C
Rationale: Shallow chest rise and fall indicates that the tidal volume is
inadequate. Even if the respiratory rate is normal, if the volume of air moved is
insufficient, the patient is not breathing adequately.
11. What is the maximum flow rate for a standard nasal cannula?
A. 2 Lpm
B. 6 Lpm
C. 10 Lpm
D. 15 Lpm
