SAN PEDRO COLLEGE COMPETENCY APPRAISAL - OXYGENATION

Name: __________________________ Date: _____________

1. During a “code blue” or other medical emergency, a physician is having trouble starting an
intravenous line. Which of the following drugs can be placed down an endotracheal tube
during emergency life support?

I. naloxone
II. lidocaine
III. atropine
IV. epinephrine
A) II and IV only

B) I, II, and III only

C) III and IV only

D) I, II, III, and IV

Ans: D

Response:
Naloxone, lidocaine, atropine, and epinephrine all can be administered via the endotracheal
tube during emergency life support.

2. Which of the following techniques can be used to determine effectiveness of ventilation?

I. looking for the rise and fall of the victim’s chest

II. feeling for air exchange near the victim’s mouth and nose
III. listening for audible breathing efforts from the victim
A) I and II only

B) II and III only

C) I and III only

D) I, II, and III

Ans: D

Response:
Once an airway has been opened and ventilation started, you should assess its effectiveness by
looking for the rise and fall of the victim's chest and listening for breathing efforts, which
should be audible. You can also feel for air exchange by placing a check near the victim's
mouth and nose.

3. At the onset of adult mouth-to-mouth or mouth-to-mask ventilation, you should:

A) provide two normal breaths, then assess the pulse

B) provide four fast, shallow breaths, then assess the pulse

C) provide four slow, deep breaths, then immediately start compressions

D) provide one very slow breath, then immediately start compressions

Ans: A

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Response:
According to the American Heart Association guidelines, at the onset of adult mouth-to-
mouth or mouth-to-mask ventilation, once the airway is open, you should give two normal
breaths, each lasting about 1 second, then assess the pulse for up to 10 seconds.

4. After two attempts of ventilating an infant in respiratory arrest, you still cannot deliver
breaths. At this point you should:
A) apply back blows, followed by chest thrusts

B) try to ventilate again with smaller puffs

C) apply six to ten strong abdominal thrusts

D) go on to provide external cardiac compressions

Ans: A

Response:
After two failed attempts to ventilate an infant in respiratory arrest, there is most likely an
obstruction. For older patients, an obstructed airway is addressed via abdominal thrusts (the
Heimlich maneuver). However, for infants back blows are combined with chest thrusts. Chest
thrusts may also be used for pregnant women and in markedly obese persons. Both procedures
are normally followed by checking the airway and removal of any obstruction.

5. The ideal ratio of chest compressions to rescue breaths that should be given by a single
rescuer during a cardiopulmonary resuscitation (CPR) attempt on an adult is:
A) 5:1

B) 15:2

C) 2:15

D) 30:2

Ans: D

Response:
In accordance with AHA guidelines, in one- and two-rescuer CPR for adults, the ratio for
chest compressions to breaths is 30 compressions to every two breaths, with a reassessment
after five cycles.

6. When transporting critically ill patients who are receiving supplemental oxygen in
unpressurized aircraft, it is often necessary to make which adjustment in FIO2 in order to
maintain adequate oxygenation?
A) increase the FIO2

B) decrease the FIO2

C) increase ventilation

D) no change to ventilation or FIO2 is needed

Ans: A

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Response:
In accordance with Dalton's law, the partial pressure of oxygen at sea level is 160 torr, versus
only 134 torr at the increased altitude. As a result, in order to maintain acceptable
oxygenation, it is often necessary to increase the FIO2 during air transport. For example, a
patient on room air would need an FIO2 of approximately 31% to maintain the same PaO2 at
an altitude of 10,000 feet.

7. The proper rate and depth of external chest compressions for an adult is:
A) rate of 80–100/min with a depth of one inch

B) rate of 70–80/min with a depth of 1 to 1½ inches

C) rate of 100/min with a depth of 1½ to 2 inches

D) rate of 60–80/min with a depth of 1½ to 2 inches

Ans: C

Response:
For adult resuscitation, a chest compression rate of approximately 100/min with a depth of 1½
to 2 inches should be achieved.

8. The initial energy level for defibrillation for ventricular fibrillation is:
A) 100 joules

B) 200 joules

C) 300 joules

D) 360 joules

Ans: D

Response:
The initial energy level for defibrillation (via typical monophasic device) is 360 joules, not
200 joules per the old AHA ACLS guidelines. Individual subsequent shocks are given after
each five cycles, also at 360 joules.

9. All of the following monitoring equipment is mandatory when transporting a critically ill
patient within or outside of the hospital except:
A) end-tidal CO2 monitor

B) an oxygen source/delivery device

C) blood pressure monitor/cuff

D) cardiac monitor/defibrillator

Ans: A

Response:
A blood pressure monitor (or standard blood pressure cuff), an oxygen source and delivery
device, as well as a cardiac monitor/defibrillator should accompany every critically ill patient
on transport.

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10. If the number of ventilators needed to support patients in respiratory failure after a chemical
disaster is insufficient to meet the need, your initial response should be to:
A) contact other local facilities and arrange for patient transfers

B) call and order additional backup ventilators from the vendor

C) enlist non–respiratory personnel to perform manual ventilation

D) assign patients without needed equipment to triage priority Black

Ans: C

Response:
Preparedness planning for the respiratory care department includes estimating the number of
patients who may need ventilatory support, determining number of staff members required to
meet patient needs, and having in place a staff emergency call-back procedure. Should the
available equipment and personnel not be able to meet patient needs, the first step would be to
enlist non–respiratory personnel to perform manual ventilation using disposable BVMs. Once
adequate immediate patient support is ensured, you can attempt to get additional backup
equipment and/or make arrangements to transfer patients to other facilities.

11. One of the best ways to determine whether mouth-to-mouth breathing is effective during a
CPR attempt is to watch the patient's:
A) Chest rise when a breath is given

B) Skin color for cyanosis

C) Heart rate for a return to normal

D) Pupils for reaction to light

Ans: A

Response:
According to AHA guidelines, the best way to determine whether mouth-to-mouth breathing
is effective during CPR is to watch the patient's chest rise as the breath is administered.

12. To open an obstructed airway of a patient who has a possible cervical fracture, you should
A) perform a cricothyroid puncture with a 13 gauge needle

B) flex the patient's head after a cervical collar is in place

C) hyperextend the patient's head after a cervical collar is in place

D) perform the jaw thrust maneuver

Ans: D

Response:
To open an obstructed airway of a patient who has a possible cervical fracture, you should
perform the jaw thrust maneuver WITHOUT the head tilt.

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13. Which of the following arrhythmias are considered potentially lethal?

I. ventricular fibrillation
II. ventricular tachycardia
III. 3rd degree heart block
IV. supraventricular tachycardia
A) I, II and III only

B) I and II only

C) II, III and IV only

D) I, II, III and IV

Ans: A

Response:
3rd degree heart block (atrial-venticular conduction disassociation), ventricular tachycardia,
and ventricular fibrillation are all potentially lethal arrhythmias.

14. After attaching the automatic external defibrillator (AED) sensor/electrodes on an arrest
victim in a sub-acute facility, you press the analyze button, and the AED gives you a "shock
indicated" message, and charges to the preset energy level. What do you do next?
A) press the SHOCK button

B) check for signs of circulation

C) shout "clear!" and make sure no one is touching the victim

D) begin chest compressions immediately

Ans: C

Response:
Before administering the shock via any defibrillator, rescuers must make sure that you and
any other caregivers or bystanders are clear of the patient.

15. A 70-year-old patient was found unresponsive by EMS. Upon arrival in the emergency
department, the patient is cyanotic, apneic, and pulseless. Manual ventilation is initiated by
the respiratory therapist. The cardiac rhythm below is noted in the monitor. Which of the
following should the respiratory therapist recommend next?

A) administer chest compressions

B) perform cardioversion

C) perform defibrillation

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D) administer epinephrine

Ans: C

Response:
The patient has ventricular fibrillation and should be defibrillated without delay.

16. When assisting a physician with needle thoracostomy for a patient with a confirmed
pneumothorax, you should advise the physician that the needle should be inserted in what
anatomic location?
A) over the fourth rib, mid-sternal line

B) over the fourth rib, mid-clavicular line

C) over the second rib, mid-clavicular line

D) under the fourth rib, laterally

Ans: C

Response:
When assisting a physician with an emergency needle decompression of a tension
pneumothorax, you should recommend that it be inserted over the second rib, in the mid-
clavicular line.

17. For single-rescuer resuscitation of a child (1-8 years old), the proper rate, depth of external
chest compressions and compression to breath ratio is:
A) Rate of 100/min, depth of one inch and ratio of 30:2

B) Rate of 80/min, depth of 1 to 1½ inches and ratio of 15:2.

C) Rate of 100/min, depth of 1 to 1½ inches and ratio of 30:2

D) Rate of 80/min, a depth of 1½ to 2 inches and ratio of 30:2.

Ans: C

Response:
For resuscitation a child (1-8 years old), a chest compression rate of approximately 100/min,
depth of 1 to 1½ and compression to breath ratio of 30:2 should be achieved.

18. A patient in ventricular fibrillation should receive IV epinephrine at what dose and frequency?
A) 10 mg every 1-2 min

B) 1 mg every 3-5 min

C) 1 mg every 6-8 min

D) 0.10mg every 9-10 min

Ans: B

Response:
A patient in ventricular fibrillation should receive 1 mg epinephrine by IV push every 3-5
min.

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19. During an in-hospital transport of an orally intubated patient, the respiratory therapist notes a
drop in SpO2 to 85%, gurgling sounds coming out of the patient's mouth and mild respiratory
distress is observed. Which of the following actions would be appropriate at this time?

I. stop the transport immediately

II. call the attending physician
III. ask the nurse to sedate the patient
IV. assess the chest for bilateral breath sounds
A) I and III only

B) I and II

C) II and IV only

D) I and IV only

Ans: D

Response:
Respiratory compromise and gurgling sounds are signs of a potential endotracheal tube cuff
leak or dislodgment. The transport should be immediately stopped and bilateral breath sounds
and epigastric sounds assessed for proper tube position. The tube cuff should be re-inflated if
needed. In cases of unplanned extubations, the patient should be immediately ventilated with a
manually resuscitator bag.

20. One of the best ways to ensure that hospital healthcare workers are prepared to deal with
disaster emergencies is to:
A) educate the community on disaster management

B) conduct regular emergency response training and disaster drills

C) run in-service classes on disaster management

D) provide self-teaching materials on dealing with disasters

Ans: B

Response:
In accordance with several authoritative sources, regular training and disaster response drills
is the best way to prepare hospital healthcare workers to deal with disaster emergencies.

21. During cardiopulmonary resuscitation, manual ventilation of a patient with a self-inflating

bag-valve-mask device fails to adequately inflate the patient's chest. You should do which of
the following?
A) intubate and mechanically ventilate the patient

B) switch to gas-powered resuscitator with mask

C) reposition the patient's head, neck and mask

D) insert a laryngeal mask airway (LMA)

Ans: C

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Response:
The most common difficulty with bag-valve-mask is upper airway obstruction due to
improper positioning of the head/neck or a mask leak. To improve ventilation, you should first
reposition the patient's head, neck (both the head tilt-chin lift and jaw thrust can should
improve airway patency and optimize BVM ventilation). If an inadequate mask seal is causing
leakage, first try to reposition it. If that fails, you should have someone else tightly apply the
mask for you.

22. During a short pause from resuscitation of a child in the emergency department, you cannot
palpate a carotid pulse but observe the following rhythm on the ECG monitor:

Which of the following actions should you take at this time?

A) resume cardiac compressions and ventilation

B) discontinue compressions and monitor the patient

C) recommend cardioversion at 100 Joules

D) recommend epinephrine administration

Ans: A

Response:
The ECG indicates a normal sinus rhythm. However, one often can be fooled by a monitor
display. In this case the presence of normal electrical activity in combination with a lack of a
palpable pulse indicates pulseless electrical activity (PEA). Because PEA is associated with
minimal cardiac output, you must continue cardiac compressions (and ventilation). Always
treat the patient, not the monitor!

23. The ideal ratio of chest compressions to breaths that should be given when two health care
professionals provide cardiopulmonary resuscitation (CPR) to a child (1-8 years old) is:
A) 5:1

B) 15:2

C) 3:1

D) 30:2

Ans: B

Response:
In accordance with AHA guidelines, in two-person CPR for children 1-8 years old, the ratio
for chest compressions to breaths is 15 compressions to every two breaths.

24. The ideal ratio of chest compressions to breaths that should be given when two health care
professionals provide resuscitation to a newborn infant/neonate is:
A) 5:1

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B) 15:2

C) 3:1

D) 30:2

Ans: C

Response:
In accordance with AHA guidelines, for neonatal resuscitation there should be a 3:1 ratio of
compressions to ventilations, with 90 compressions and 30 breaths to achieve approximately
120 events per minute. Respirations, heart rate, and color should be reassessed about every 30
seconds, and coordinated chest compressions and ventilations should continue until the
spontaneous heart rate is  60/min and improving.

25. When two health professionals are resuscitating an infant (< 1 year old), the proper rate, depth
of external chest compressions and compression to breath ratio is:
A) Rate of 100/min, depth of ½ to 1 inch, ratio of 15:2

B) Rate of 120/min, depth of 1 to 1½ inches, ratio of 15:2

C) Rate of 100/min, depth of 1 to 1½ inches, ratio of 30:2

D) Rate of 120/min, depth of ½ to 1 inches, ratio of 30:2

Ans: A

Response:
When two health professionals are resuscitating an infant (< 1 year old), a chest compression
rate of approximately 100/min should be maintained at a depth of 1/3 to 1/2 the depth of chest
or about 1/2 to 1 inch, with a compression to breath ratio of 15:2.

26. Which of the following ACLS drugs is used to treat most bradycardias, PEA or asystole?
A) vasopressin

B) atropine

C) amiodarone

D) lidocaine

Ans: B

Response:
During ACLS, atropine is the most commonly used drug to treat bradycardias, PEA or
asystole. Epinephrine is a cardiac stimulant and vasoconstrictor. Vasopressin (ADH) is also a
vasoconstrictor. Lidocaine is an anti-arrhythmic commonly used to treat ventricular
fibrillation and ventricular tachycardia.

27. You are transporting a patient in an unpressurized airplane at a cruising altitude of 10000 ft
(PB = 523 mm Hg). The patient was receiving 40% oxygen at sea level. What FIO2 should be
provided to this patient at this cruising altitude?
A) 0.30

B) 0.50

C) 0.60

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D) 0.70

Ans: B

Response:
To compute the FIO2 needs of a patient at altitude compared to sea level, multiply the FIO2 at
sea level times [760/PB altitude]. In this case, FIO2 needed at altitude = 0.40 x [760/523] = .58
or about 60% O2.

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