22 Airway, Respiration & Ventilation Practice Questions & Answers

1. 1. A 60-year-old with severe shortness of breath was sitting upright, anxious, and speaking in short phrases. Ten minutes later he is quiet, hard to rouse, his respiratory effort has decreased, and his skin is mottled. What does this change most likely indicate?

   • A.He has a new upper airway obstruction limiting his air movement.
   • B.He is calmer, and his breathing pattern is settling toward normal.
   • C.He is responding to oxygen, and his work of breathing has normalized.
   • D.He is tiring, and ventilation is now failing rather than improving.✓ Answer

   Distress becomes failure when compensation is exhausted, and the bedside marker is a falling level of response together with decreasing effort: a brain that is hypoxic and loaded with carbon dioxide can no longer drive the respiratory muscles. Quiet in a previously frantic patient signals impending arrest and calls for assisted ventilation.

   Source: National EMS Education Standards / AEMT Instructional Guidelines AM2 (Respiration) — adequacy of breathing and recognition of respiratory failureReport a problem with this question

2. 2. An adult is breathing 36 times a minute with barely visible chest movement and can speak only single words. Which action is most appropriate, and for what reason?

   • A.Apply a mask with a reservoir, because the fast rate moves enough volume.
   • B.Assist his ventilations, because shallow breaths mostly move dead-space air.✓ Answer
   • C.Place a nasal cannula, because it is better tolerated at a rapid rate.
   • D.Coach him to slow down, because the rapid rate itself is causing the distress.

   Minute volume is tidal volume multiplied by rate, and a fixed portion of every breath only fills the conducting airways, so very shallow breaths deliver almost nothing to the alveoli no matter how fast they come. Inadequate tidal volume is corrected by assisting ventilation, not by a higher oxygen concentration on a mask.

   Source: AEMT Instructional Guidelines AM2/AM3 — minute volume, anatomic dead space, and indications for assisted ventilationReport a problem with this question

3. 3. An unresponsive patient with pinpoint pupils breathes slowly and shallowly. On a mask with a reservoir his oxygen saturation reads 97 percent, yet his exhaled carbon dioxide value keeps climbing. What does this combination indicate?

   • A.Gas exchange has improved, and the rise is an expected response.
   • B.Oxygenation is supported, but ventilation remains inadequate.✓ Answer
   • C.Perfusion is falling, and carbon dioxide is trapped in the tissues.
   • D.Ventilation is adequate, and the rising value is an artifact.

   Oxygenation and ventilation are different processes: a high inspired oxygen concentration can keep hemoglobin saturated while air movement is far too small to clear carbon dioxide, which is why the exhaled value rises. The saturation reading is reassuring and misleading at once, and the treatment is to ventilate the patient.

   Source: AEMT Instructional Guidelines AM2 — ventilation versus oxygenation versus respiration; capnography interpretationReport a problem with this question

4. 4. A woman in a restaurant is coughing forcefully, can force out a few words between coughs, and has normal skin color. What is the most appropriate action?

   • A.Lay her down and start compressions to raise the airway pressure.
   • B.Sweep a gloved finger through her throat to locate the object.
   • C.Deliver abdominal thrusts from behind until the object comes out.
   • D.Encourage her coughing, offer oxygen, and watch for deterioration.✓ Answer

   Forceful coughing and audible speech mean air is still moving past the obstruction, and a spontaneous cough generates higher airway pressure than any maneuver the provider can apply. Intervening on a mild obstruction risks driving the object deeper or converting it into a complete obstruction.

   Source: AEMT Instructional Guidelines AM1 (Airway Management) — mild versus severe foreign body airway obstructionReport a problem with this question

5. 5. Firefighters carry a man out of a smoke-filled basement. He has a pounding headache, nausea and confusion, and his oxygen saturation reads 99 percent on room air. How should that reading be interpreted?

   • A.It is unreliable, because carbon monoxide is read as bound oxygen.✓ Answer
   • B.It is accurate, so oxygen can be withheld while he is transported.
   • C.It is falsely low, because soot on the skin blocks the light sensor.
   • D.It shows ventilation is adequate, so only his exhaled value matters.

   Pulse oximetry reports the percentage of hemoglobin that is saturated but cannot identify what is bound to it, so carboxyhemoglobin is counted as though it were oxyhemoglobin and the number stays high while tissue oxygen delivery collapses. The exposure history and the symptoms, not the number, drive the decision to give high-concentration oxygen.

   Source: AEMT Instructional Guidelines AM2 — pulse oximetry limitations; toxic inhalation (carbon monoxide) assessmentReport a problem with this question

6. 6. A patient with a history of asthma has a prolonged expiratory phase. The capnography waveform has lost its square plateau and shows a sloping, fin-shaped upstroke. What does this indicate, and what does it call for?

   • A.Lower airway narrowing, which calls for an inhaled bronchodilator.✓ Answer
   • B.Moisture in the sampling line, which calls for the line to be changed.
   • C.Falling blood flow, which calls for a fluid challenge to be started.
   • D.A leak around the mask, which calls for the seal to be redone.

   The square plateau depends on alveoli emptying together; when bronchioles are constricted the gas leaves at uneven rates and the expiratory phase slopes upward into the fin shape. Because the cause is bronchoconstriction, a bronchodilator is the treatment, and the plateau squaring off again is objective evidence it worked.

   Source: AEMT Instructional Guidelines AM2 — waveform capnography interpretation in obstructive lower airway diseaseReport a problem with this question

7. 7. A patient has sudden shortness of breath and sharp chest pain, clear lung sounds in all fields, a fast pulse, and a low exhaled carbon dioxide value despite an adequate rate and depth. What does the low value most likely reflect?

   • A.Rapid breathing blowing off carbon dioxide faster than it is produced.
   • B.A partly disconnected sampling line diluting the exhaled sample.
   • C.Air trapped in the lower airways holding gas back inside the chest.
   • D.Reduced blood flow through the lungs, so less gas reaches the alveoli.✓ Answer

   Exhaled carbon dioxide depends on blood carrying it to the alveoli, so when pulmonary blood flow is obstructed the lung is ventilated but not perfused and the measured value falls even though breathing looks adequate. Clear lungs with hypoxia and a low reading is the classic dead-space pattern.

   Source: AEMT Instructional Guidelines AM2 — ventilation/perfusion mismatch; capnography as a perfusion indicatorReport a problem with this question

8. 8. You are ventilating an unresponsive patient through a supraglottic airway. While the stretcher is being loaded, the waveform drops abruptly to zero and stays flat. What should you do first?

   • A.Keep ventilating and recheck the waveform after arrival.
   • B.Change to another monitor, since movement corrupts the signal.
   • C.Increase the rate of ventilation to bring the value back up.
   • D.Check the device and the circuit for displacement or disconnection.✓ Answer

   A sudden flat trace means no carbon dioxide is returning through the sensor, and during patient movement the overwhelmingly likely cause is a displaced device or an open circuit rather than a change in the patient's physiology. Placement must be reconfirmed after every move, and the device is checked before anything else is adjusted.

   Source: AEMT Instructional Guidelines AM1 — supraglottic airway monitoring and reconfirmation of placement after patient movementReport a problem with this question

9. 9. Assuming it is authorized under the service's protocols and medical direction, for which patient is a supraglottic airway most appropriate?

   • A.A drowsy overdose patient who gags when an oral airway is attempted.
   • B.An apneic adult with no gag reflex whose bag-mask ventilation fails.✓ Answer
   • C.An exhausted asthmatic who is still moving air and answering questions.
   • D.A bleeding facial trauma patient who is speaking in short phrases.

   A blindly inserted supraglottic device is intended for the deeply unresponsive, apneic patient with no protective reflexes in whom mask ventilation cannot be made effective or sustained. Any patient who still gags, still speaks, or is still moving air will not tolerate the device and does not need it, and the AEMT places it only when authorized and indicated.

   Source: National EMS Scope of Practice Model 2019 (Change Notices 1–2, 2021), Skill I Airway/Ventilation/Oxygenation — supraglottic airway indicationsReport a problem with this question

10. 10. You are preparing to place a supraglottic airway in an unresponsive patient. Which finding should stop you from proceeding?

    • A.He gags and clenches his jaw as the device enters his mouth.✓ Answer
    • B.His dentures were taken out before ventilation was started.
    • C.He has chronic lung disease and uses oxygen at home every night.
    • D.His abdomen is distended from the earlier bag-mask ventilation.

    An intact gag reflex means the patient retains protective airway reflexes, and forcing a supraglottic device past them provokes laryngospasm, vomiting and aspiration. The device is withdrawn and mask ventilation with a basic adjunct is continued instead.

    Source: AEMT Instructional Guidelines AM1 — supraglottic (blind insertion) airway contraindicationsReport a problem with this question

11. 11. A supraglottic airway has just been inserted. Which approach best confirms placement and continues to monitor it during transport?

    • A.Repeated saturation readings taken from two different fingers.
    • B.Watching for tube condensation, rechecked every few minutes.
    • C.Continuous waveform capnography, with chest rise and breath sounds.✓ Answer
    • D.Listening over the stomach alone, repeated after every few breaths.

    A persistent square waveform proves that carbon dioxide from the lungs is passing the sensor with every breath, which no intermittent physical sign can demonstrate continuously. Chest rise, bilateral sounds and an absence of epigastric sounds support the finding, and saturation lags too far behind to detect a displacement quickly.

    Source: AEMT Instructional Guidelines AM1/AM3 — confirmation and continuous monitoring of advanced airway placementReport a problem with this question

12. 12. Your partner is squeezing the bag fast and hard through a supraglottic airway in a patient whose blood pressure is already low. What is the most likely result?

    • A.Chest pressure rises, venous return drops, and the pressure falls.✓ Answer
    • B.Chest pressure rises, cardiac filling improves, and the pressure recovers.
    • C.The extra volume loads more oxygen, and the low pressure corrects itself.
    • D.Carbon dioxide falls, the vessels dilate, and tissue blood flow improves.

    Positive pressure reverses the normal negative intrathoracic pressure that pulls blood back to the heart, so excessive rate or volume reduces preload and worsens an already low blood pressure, while also risking gastric insufflation and barotrauma. Breaths are given slowly and only to the volume that produces visible chest rise.

    Source: AEMT Instructional Guidelines AM3 (Artificial Ventilation) — hemodynamic consequences of positive pressure and over-ventilationReport a problem with this question

13. 13. An unresponsive patient has vomit pooling in his mouth and gurgling respirations. What comes first, and how is it done?

    • A.Insert an oral airway first, then suction around it once it is seated.
    • B.Roll him onto his side and let the airway drain during transport.
    • C.Suction the mouth with a rigid catheter, applying it while withdrawing.✓ Answer
    • D.Apply a mask with a reservoir first, then suction once he pinks up.

    Oxygen and adjuncts cannot help through a column of fluid, and any positive pressure applied over pooled vomit drives it into the lungs, so clearing the airway precedes everything else. Suction is applied only on withdrawal and kept brief, because prolonged suctioning removes oxygen and can provoke a vagal slowing of the heart.

    Source: AEMT Instructional Guidelines AM1 — suctioning technique and the airway management sequenceReport a problem with this question

14. 14. A patient with pneumonia is alert, breathing at an adequate rate and depth, and hypoxic. He pulls a tight-fitting mask off his face each time it is applied. What is the most reasonable step?

    • A.Fit a nasal cannula and titrate the flow to his saturation.✓ Answer
    • B.Hold the mask on his face and have a relative steady it.
    • C.Begin assisted ventilations with a bag-mask because he is hypoxic.
    • D.Withhold oxygen until he calms, then reapply the same mask.

    The delivery device is chosen from what the patient needs and will actually keep on, not from a fixed rule, and a patient who is ventilating adequately needs supplemental oxygen rather than assisted breaths. Oxygen that is worn continuously at a lower concentration delivers more than a high-concentration mask that is repeatedly removed.

    Source: AEMT Instructional Guidelines AM3 — selection of oxygen delivery devices based on patient need and toleranceReport a problem with this question

15. 15. An asthmatic who was wheezing loudly on arrival now has a quiet chest, is drowsy, and his saturation is drifting down. What does this change indicate?

    • A.The stethoscope is misplaced and the breath sounds are being missed.
    • B.The spasm has broken and the wheezing has settled with treatment.
    • C.Fluid has filled the alveoli and replaced the earlier bronchospasm.
    • D.Air movement has fallen so far that respiratory arrest is near.✓ Answer

    Wheezing is produced by air forced through narrowed bronchioles, so it requires enough airflow to make the sound; when the patient tires and flow collapses the chest goes silent. A silent chest with drowsiness and falling saturation is deterioration, and the response is assisted ventilation with oxygen and rapid transport.

    Source: AEMT Instructional Guidelines AM2 — asthma pathophysiology and recognition of impending respiratory arrestReport a problem with this question

16. 16. Under standing orders an AEMT gives a nebulized beta-2 agonist to a wheezing patient. Which statement best describes the expected effect and the reassessment that follows?

    • A.Alveolar fluid is reabsorbed; recheck blood pressure and neck veins.
    • B.Respiratory drive is stimulated; recheck the rate and responsiveness.
    • C.Airway secretions dry up; recheck skin temperature and pupil size.
    • D.Bronchial muscle relaxes; recheck breath sounds, effort and heart rate.✓ Answer

    Bronchiolar smooth muscle carries beta-2 receptors, and stimulating them relaxes the muscle and widens the lower airways, which is why the drug is indicated for wheezing and bronchospasm rather than for fluid or sedation. Reassessment looks for improved air movement and reduced effort, and for the expected side effects of tachycardia, tremor and anxiety.

    Source: National EMS Scope of Practice Model 2019, AEMT medications — inhaled beta-2 agonist bronchodilator for dyspnea and wheezingReport a problem with this question

17. 17. A patient with long-standing chronic obstructive pulmonary disease is confused, cyanotic and severely hypoxic. A crew member warns that oxygen will take away his drive to breathe. What is the correct course?

    • A.Give oxygen to correct the hypoxia, then titrate and watch him closely.✓ Answer
    • B.Cap the flow at a low nasal setting whatever his saturation does.
    • C.Delay oxygen until his level of response improves during transport.
    • D.Withhold oxygen and transport quickly, watching for a slowing rate.

    Hypoxia kills within minutes while the theoretical loss of respiratory drive develops slowly and is managed by monitoring and assisting ventilation if it appears, so oxygen is never withheld from a hypoxic patient. The oxygen is titrated to the patient's response and his breathing is watched, which addresses the concern without accepting the harm.

    Source: AEMT Instructional Guidelines AM2 — chronic obstructive pulmonary disease and oxygen administration in hypoxiaReport a problem with this question

18. 18. A heart failure patient sits upright, awake and following commands, with crackles throughout and heavy work of breathing; his blood pressure is adequate. Why does continuous positive airway pressure help him?

    • A.It replaces oxygen therapy by raising the flow he receives.
    • B.It delivers the breaths for him and takes over his effort.
    • C.It holds the alveoli open and lowers his work of breathing.✓ Answer
    • D.It pushes secretions upward so they can be suctioned away.

    Continuous pressure through the whole respiratory cycle splints alveoli open, increases the volume left in the lung at end expiration and drives fluid back across the alveolar membrane, improving matching of air and blood flow. It improves oxygenation and unloads the breathing muscles, but it does not breathe for the patient, which is why he must be awake and breathing adequately on his own.

    Source: AEMT Instructional Guidelines AM3 — continuous positive airway pressure indications and mechanism in acute cardiogenic pulmonary edemaReport a problem with this question

19. 19. Ten minutes into continuous positive airway pressure the patient stops answering, becomes unresponsive, and his breathing turns slow and irregular. What should you do?

    • A.Leave the mask on and add a nasal cannula underneath it.
    • B.Keep the therapy running and reassess him in a few minutes.
    • C.Remove the mask and begin ventilating him with a bag-mask.✓ Answer
    • D.Raise the pressure setting to support his failing effort.

    Continuous positive airway pressure only supports a patient who is breathing spontaneously and protecting his own airway; once he is unresponsive with inadequate breathing those conditions are gone and the mask now blocks access while gastric distention and aspiration risk climb. The therapy is stopped and positive pressure ventilation is started.

    Source: AEMT Instructional Guidelines AM3 — continuous positive airway pressure contraindications and management of deteriorationReport a problem with this question

20. 20. Minutes after a wasp sting a patient has hives, swollen lips and tongue, stridor at rest, and a blood pressure of 82/50 that was 130/78 on arrival. Which action is the priority?

    • A.Give intramuscular epinephrine while airway support is prepared.✓ Answer
    • B.Give a nebulized bronchodilator and recheck her breath sounds.
    • C.Apply a mask with a reservoir and monitor the airway closely.
    • D.Insert a nasal airway to bypass the swelling above the cords.

    Stridor at rest with facial swelling and a falling blood pressure is anaphylaxis, and only epinephrine reverses the underlying process by constricting vessels and relaxing bronchial muscle, so it is given without delay by the intramuscular route. Oxygen, adjuncts and bronchodilators treat symptoms and cannot stop swelling that is closing the upper airway.

    Source: National EMS Scope of Practice Model 2019, AEMT medications — intramuscular epinephrine for anaphylaxis; AEMT Instructional Guidelines AM1 upper airway swellingReport a problem with this question

21. 21. A 4-year-old with a high fever that began a few hours ago sits leaning forward, drooling, with a muffled voice and noisy breathing. What is the most appropriate management?

    • A.Suction the mouth repeatedly to clear the saliva he is drooling.
    • B.Keep him with his caregiver, give blowby oxygen, and transport.✓ Answer
    • C.Use a tongue blade to view the throat before deciding on transport.
    • D.Lay him flat and place an oral airway to quiet the noisy breathing.

    Rapid onset with high fever, drooling, a muffled voice and a tripod posture points to swelling of the supraglottic structures, where any stimulation of the throat or forcing the child to lie down can trigger complete obstruction. Keeping the child calm, upright and with the caregiver preserves the airway the child has already found for himself.

    Source: AEMT Instructional Guidelines AM1 — pediatric upper airway infections; epiglottitis versus croup managementReport a problem with this question

22. 22. You are managing the airway of an unresponsive 8-month-old. Why is padding placed under the shoulders rather than under the head?

    • A.The small tongue rarely obstructs, so head padding adds nothing.
    • B.The trachea is rigid, so padding under the head would compress it.
    • C.The large occiput flexes the neck, and padding restores neutral.✓ Answer
    • D.The larynx sits low, so the head must be tipped far backward.

    An infant's occiput is proportionally large, so lying supine on a flat surface already pushes the head forward and folds the soft airway shut, and adding padding under the head worsens that flexion. Padding under the shoulders lifts the torso to meet the head and produces the neutral alignment that opens the airway.

    Source: AEMT Instructional Guidelines AM1 — pediatric airway anatomy and positioning differencesReport a problem with this question

Practice questions based on the National Registry Advanced EMT Examination Specifications and the National EMS Education Standards. This site is not affiliated with or endorsed by the National Registry of Emergency Medical Technicians, and nothing here is medical advice. AEMT scope of practice is set by your state and by your medical director, and drug doses, concentrations, infusion rates and clinical thresholds come from your protocols — never from a practice test. Resuscitation guidance is revised on a cycle; always follow the guidelines and protocols currently in effect where you practice. Confirm eligibility and current exam requirements with the National Registry before you test. About AEMT certification →