Certified Flight Registered Nurse (CFRN) — Questions and Answers

Question 1: A family of three is rescued from a house fire. All are awake but complain of severe headaches and dizziness. The pulse oximeter reads 99% on room air for all three patients. Which of the following is the most critical initial intervention for suspected carbon monoxide (CO) poisoning?

Prepare for prophylactic endotracheal intubation.
Administer hydroxocobalamin for suspected cyanide toxicity.
Obtain a venous blood gas to confirm acidosis.
Administer 100% high-flow oxygen via a non-rebreather mask. (Correct answer)

Correct answer: Administer 100% high-flow oxygen via a non-rebreather mask.

The definitive initial treatment for carbon monoxide poisoning is the administration of 100% high-flow oxygen. This intervention significantly decreases the half-life of carboxyhemoglobin by competitively displacing CO from hemoglobin. Standard pulse oximetry is unreliable and often falsely elevated in CO poisoning because it cannot differentiate between oxyhemoglobin and carboxyhemoglobin, making clinical suspicion and immediate oxygen administration paramount.

Question 2: A flight nurse is managing a patient with a penetrating brain injury. Which action is most appropriate regarding the impaled object?

Remove the object immediately to assess the wound depth
Cut the object flush with the skull to facilitate transport
Stabilize the object in place and do not remove it (Correct answer)
Apply firm pressure around the object to control hemorrhage

Correct answer: Stabilize the object in place and do not remove it

Impaled objects should be stabilized in place, as removal can cause massive hemorrhage and worsen brain injury; removal occurs in the OR.

Question 3: A 3-year-old weighing 15 kg requires intraosseous (IO) access. After confirming placement, the maximum single fluid bolus volume that should be delivered via IO in this patient is:

50 mL (normal saline)
600 mL (normal saline)
300 mL (normal saline) (Correct answer)
150 mL (normal saline)

Correct answer: 300 mL (normal saline)

IO bolus dose for pediatric resuscitation is 20 mL/kg; for a 15 kg child that equals 300 mL per bolus.

Question 4: A patient in cardiogenic shock is being transported with an intra-aortic balloon pump (IABP). The CFRN understands that the primary physiological goals of IABP counterpulsation are to:

Increase preload and increase systemic vascular resistance.
Decrease heart rate and decrease mean arterial pressure.
Decrease cardiac afterload and augment coronary artery perfusion. (Correct answer)
Increase myocardial oxygen demand and increase contractility.

Correct answer: Decrease cardiac afterload and augment coronary artery perfusion.

The IABP works on the principle of counterpulsation. It inflates during diastole, which displaces blood and increases pressure in the aortic root, augmenting coronary artery perfusion. It deflates just before systole, creating a vacuum effect that reduces the pressure the left ventricle must overcome (afterload), thereby decreasing myocardial oxygen demand and improving cardiac output.

Question 5: During a flight transport, a patient's endotracheal tube cuff pressure should be maintained at what range to prevent tracheal mucosal ischemia?

35-45 cmH2O
10-15 cmH2O
20-30 cmH2O (Correct answer)
50-60 cmH2O

Correct answer: 20-30 cmH2O

ETT cuff pressure should be maintained between 20-30 cmH2O to prevent mucosal ischemia while maintaining an adequate seal.

Question 6: A flight nurse is transporting a patient on a norepinephrine drip at 0.1 mcg/kg/min. The patient weighs 80 kg. At what rate (mL/hr) should the pump be set if norepinephrine is mixed as 4 mg in 250 mL NS?

12 mL/hr (Correct answer)
30 mL/hr
18 mL/hr
24 mL/hr

Correct answer: 12 mL/hr

Concentration = 16 mcg/mL; dose = 0.1 × 80 = 8 mcg/min = 480 mcg/hr; 480 ÷ 16 = 30 mL/hr — wait, 4mg/250mL = 16mcg/mL; 8mcg/min × 60 = 480mcg/hr; 480/16 = 30 mL/hr.

Question 7: A patient with a C5 spinal cord injury is being transported and develops a BP of 170/100 mmHg, bradycardia, and profuse sweating above the level of injury with cool skin below. What condition does this describe?

Hypertensive emergency from pain
Vasovagal syncope
Autonomic dysreflexia (Correct answer)
Neurogenic shock

Correct answer: Autonomic dysreflexia

Autonomic dysreflexia in spinal cord injuries at T6 or above presents with hypertension, bradycardia, and diaphoresis above the lesion level triggered by a noxious stimulus below the level of injury.

Question 8: A patient sustains a traumatic amputation of the right hand at the wrist. The amputated part is recovered at the scene. What is the correct method for preserving the amputated part during transport?

Place the part directly in a bag of ice water to keep it cold
Store the part in a container of normal saline at room temperature
Wrap in a dry sterile dressing, place in a sealed bag, then place that bag on ice (Correct answer)
Wrap in saline-soaked gauze and place directly on ice cubes

Correct answer: Wrap in a dry sterile dressing, place in a sealed bag, then place that bag on ice

The amputated part should be wrapped in a moist sterile dressing, placed in a sealed plastic bag, and then placed on ice — direct contact with ice causes frostbite and tissue damage that may prevent reimplantation.

Question 9: A patient at 32 weeks gestation is being transported with suspected HELLP syndrome. Which lab finding is CHARACTERISTIC of this condition?

Thrombocytopenia and elevated liver enzymes (Correct answer)
Low serum creatinine and normal platelets
Elevated hemoglobin and hematocrit
Leukocytosis with left shift

Correct answer: Thrombocytopenia and elevated liver enzymes

HELLP syndrome is defined by hemolysis, elevated liver enzymes, and low platelets (thrombocytopenia), distinguishing it from isolated preeclampsia.

Question 10: A flight nurse notices significant rotor wash during patient loading. The correct safety approach for ground personnel is to:

Approach only when the rotor fully stops
Crouch low and run under the main rotor from any direction
Wait for the pilot's hand signal and approach from the front in the pilot's line of sight (Correct answer)
Approach from the rear of the aircraft

Correct answer: Wait for the pilot's hand signal and approach from the front in the pilot's line of sight

Personnel should always approach in view of the pilot from the front, never from the rear where the tail rotor poses a lethal hazard.

Question 11: Which preoxygenation technique is MOST effective for extending safe apnea time before RSI in the transport environment?

Bag-valve-mask ventilation at 10 L/min for 60 seconds
Simple face mask at 6 L/min for 3 minutes
Two-person BVM ventilation with PEEP valve
High-flow nasal cannula at 15 L/min combined with non-rebreather mask (Correct answer)

Correct answer: High-flow nasal cannula at 15 L/min combined with non-rebreather mask

Combining high-flow nasal cannula with a non-rebreather mask achieves near-100% denitrogenation of the FRC, maximizing oxygen reserve before apnea.

Question 12: A patient receiving a heparin infusion develops acute HIT (Heparin-Induced Thrombocytopenia). Which action is the priority?

Discontinue all heparin and switch to argatroban or bivalirudin (Correct answer)
Reduce the heparin dose by 50%
Add aspirin to the current regimen
Administer platelets immediately

Correct answer: Discontinue all heparin and switch to argatroban or bivalirudin

All heparin products must be stopped immediately in confirmed or suspected HIT, and a direct thrombin inhibitor such as argatroban should be started.

Question 13: A flight nurse assesses a patient with a permanent pacemaker during transport and notes pacemaker spikes without subsequent P waves or QRS complexes. This finding indicates which malfunction?

Oversensing
Normal inhibited pacing
Failure to sense (undersensing)
Failure to capture (Correct answer)

Correct answer: Failure to capture

Pacemaker spikes not followed by a P wave or QRS complex indicate failure to capture, meaning the electrical stimulus is not producing myocardial depolarization.

Question 14: A flight nurse is treating a patient with a traumatic open femur fracture and Class III hemorrhagic shock. Using Tactical Combat Casualty Care (TCCC) principles, which resuscitation fluid is preferred in the flight environment?

Normal saline 2 L bolus
Packed red blood cells and fresh frozen plasma (Correct answer)
Lactated Ringer's 1 L bolus
Hypertonic saline 250 mL bolus

Correct answer: Packed red blood cells and fresh frozen plasma

TCCC and damage-control resuscitation principles favor blood products (pRBC and FFP) over crystalloids in Class III/IV hemorrhagic shock to restore oxygen-carrying capacity and clotting factors.

Question 15: During high-altitude fixed-wing transport, which physiological change directly causes hypoxia despite normal sea-level oxygen saturation?

Boyle's Law: lung volume expansion compressing alveoli
Henry's Law: decreased oxygen solubility in plasma
Charles' Law: decreased temperature reducing O2 affinity
Dalton's Law: decreased partial pressure of oxygen despite same FiO2 (Correct answer)

Correct answer: Dalton's Law: decreased partial pressure of oxygen despite same FiO2

At altitude, total barometric pressure drops, reducing the partial pressure of oxygen (PO2) even though the fraction of O2 in air (21%) remains constant.

Question 16: Which hemodynamic profile is most characteristic of cardiogenic shock?

High SVR, low CO, high PCWP (Correct answer)
Low SVR, high CO, high PCWP
Low SVR, high CO, low PCWP
High SVR, high CO, low PCWP

Correct answer: High SVR, low CO, high PCWP

Cardiogenic shock features a failing pump (low CO), compensatory vasoconstriction (high SVR), and fluid backup causing elevated PCWP.

Question 17: A spinal cord injury patient develops neurogenic shock during flight. Which hemodynamic profile is expected?

Normal BP with tachycardia and peripheral vasoconstriction
Hypotension with tachycardia and cool clammy skin
Hypertension with bradycardia and diaphoresis
Hypotension with bradycardia and warm skin (Correct answer)

Correct answer: Hypotension with bradycardia and warm skin

Neurogenic shock results from loss of sympathetic tone below the injury, causing vasodilation (warm skin), hypotension, and paradoxical bradycardia.

Question 18: A 28-year-old male with blunt abdominal trauma has a FAST exam showing free fluid in Morrison's pouch. His BP is 70/40 mmHg despite 1L crystalloid. Applying damage-control resuscitation principles, what is the target resuscitation strategy?

Normal saline boluses of 500 mL until HR normalizes
Vasopressors to maintain MAP >65 mmHg
Permissive hypotension targeting SBP 80-90 mmHg with blood products in 1:1:1 ratio (Correct answer)
Aggressive crystalloid until BP reaches 120 mmHg systolic

Correct answer: Permissive hypotension targeting SBP 80-90 mmHg with blood products in 1:1:1 ratio

Damage-control resuscitation uses permissive hypotension (SBP 80-90 for blunt trauma) and balanced blood product resuscitation (1:1:1 ratio of pRBC:FFP:platelets) to minimize coagulopathy.

Question 19: What is the recommended tidal volume for lung-protective ventilation in a patient with ARDS during transport?

4–5 mL/kg IBW
10–12 mL/kg IBW
6–8 mL/kg IBW (Correct answer)
12–15 mL/kg IBW

Correct answer: 6–8 mL/kg IBW

Lung-protective ventilation uses 6–8 mL/kg ideal body weight to minimize volutrauma and barotrauma in ARDS patients.

Question 20: During transport of a patient with a severe traumatic brain injury, the flight nurse notes Cushing's triad. Which set of findings correctly identifies Cushing's triad?

Hypertension, tachycardia, and Cheyne-Stokes breathing
Tachycardia, hypotension, and irregular respirations
Hypertension, bradycardia, and irregular respirations (Correct answer)
Bradycardia, hypotension, and apneustic breathing

Correct answer: Hypertension, bradycardia, and irregular respirations

Cushing's triad (hypertension, bradycardia, and irregular respirations) is a late, ominous sign of severely increased intracranial pressure and impending brainstem herniation.

Question 21: Which statement correctly describes the Fick Principle as it applies to oxygen delivery during aeromedical transport?

Oxygen consumption equals cardiac output multiplied by the arteriovenous oxygen content difference (Correct answer)
Oxygen delivery is primarily determined by dissolved oxygen alone
Tissue oxygen consumption is independent of cardiac output changes
Oxygen delivery equals hemoglobin concentration divided by cardiac output

Correct answer: Oxygen consumption equals cardiac output multiplied by the arteriovenous oxygen content difference

The Fick Principle states VO2 = CO × (CaO2 - CvO2), making cardiac output and hemoglobin critical determinants of tissue oxygen delivery.

Question 22: What is the primary advantage of using a supraglottic airway device (SGA) such as an LMA over endotracheal intubation in certain flight patients?

It can be inserted without direct visualization of the larynx and requires no neuromuscular blockade (Correct answer)
It allows delivery of higher tidal volumes
It is preferred in all trauma patients
It provides complete aspiration protection

Correct answer: It can be inserted without direct visualization of the larynx and requires no neuromuscular blockade

SGAs can be inserted blindly without laryngoscopy or neuromuscular blocking agents, making them valuable rescue airways or when intubation is not feasible.

Question 23: A flight nurse responds to a patient with traumatic arrest after a motor vehicle collision. ACLS guidelines for traumatic cardiac arrest differ from medical arrest primarily in that:

Epinephrine 1 mg IV is given every 3 minutes
Compressions are paused while reversible causes are treated
Reversible causes (Hs and Ts) are addressed simultaneously with CPR (Correct answer)
High-dose epinephrine (5 mg) is first-line therapy

Correct answer: Reversible causes (Hs and Ts) are addressed simultaneously with CPR

In traumatic cardiac arrest, all potentially reversible causes (tension pneumothorax, hypovolemia, cardiac tamponade, hypoxia) must be simultaneously addressed while performing CPR.

Question 24: A 15-year-old male high school sophomore who played football for his school suffered a spinal cord injury (SCI) after unintentionally lowering his head while sprinting and striking the ball carrier's shoulder with the crown of his head during a tackle. The field crew has placed the patient on a backboard, and he is already intubated due to his inability to breathe on his own when the medical transport arrives. The patient was awake, trying to communicate when the ground team arrived, and could turn his head, according to the ground team. According to the initial evaluation by the air transport crew, upper and lower extremity motor, and sensory functions are entirely lost. Based on the information provided in this scenario, which of the following levels of SCI is this patient most likely to have experienced?

C7-C8 SCI
C1-C2 SCI
C3-C4 SCI (Correct answer)
C5-C6 SCI

Correct answer: C3-C4 SCI

Pediatric-aged patients between the ages of 8 to 15 years are at greatest risk of spinal cord injury (SCI) with subaxial vertebral body fractures affecting the C3 to C7 level of the spine as a result of injuries sustained during sports activities, falls, diving accidents, and motor vehicle crashes. An SCI to the C3-C4 level occurs during trauma when the head is bent forward and the spinal cord is compressed at great force when the head is driven into an object in front of it. Fracture of the vertebral body is typically followed by spinal cord edema, resulting in life-threatening disability. A C3-C4 SCI may result in the injured patient being unable to breathe on his own, and with full loss of motor and sensory functions of both his upper and lower extremities, but with the ability to move his head and speak. The C3-C4 spinal cord injured patient will most likely require full care with all activities and functions of daily life for the rest of his life.

Question 25: When performing rapid sequence intubation, succinylcholine is contraindicated in which patient population due to risk of fatal hyperkalemia?

Patients with renal failure on dialysis
Patients with acute traumatic brain injury
Patients with burns older than 24-72 hours or crush injuries (Correct answer)
Patients with coronary artery disease

Correct answer: Patients with burns older than 24-72 hours or crush injuries

Succinylcholine causes hyperkalemia via upregulated acetylcholine receptors in burn injuries older than 24-72 hours, crush injuries, and denervation injuries.

Question 26: When transporting a patient with a nasogastric tube in place, the CFRN should ensure the NG tube is:

Positioned at a 45-degree angle to facilitate drainage
Removed to reduce aspiration risk at altitude
Connected to low intermittent suction or vented to prevent gas expansion (Correct answer)
Clamped tightly during ascent to prevent backflow

Correct answer: Connected to low intermittent suction or vented to prevent gas expansion

Stomach gas expands at altitude; an NG tube vented or on suction decompresses the stomach, preventing vomiting, aspiration, and vagal stimulation from gastric distension.

Question 27: What is the significance of 'density altitude' for helicopter flight nurses?

It calculates the maximum safe dose of medications at altitude
It affects aircraft performance by reducing lift capacity in hot, high, or humid conditions (Correct answer)
It indicates the altitude at which supplemental oxygen is mandatory
It determines the pressurization requirements of the aircraft cabin

Correct answer: It affects aircraft performance by reducing lift capacity in hot, high, or humid conditions

High density altitude (hot, high, humid conditions) reduces rotor efficiency and engine output, limiting payload capacity and increasing risk of crashes.

Question 28: During air transport, a mechanically ventilated patient has decreasing SpO2 and increasing peak airway pressures. What is the first assessment the flight nurse should perform?

Sedate the patient more deeply
Use DOPE mnemonic to troubleshoot (Displacement, Obstruction, Pneumothorax, Equipment) (Correct answer)
Switch to manual bagging immediately
Increase the FiO2 to 100%

Correct answer: Use DOPE mnemonic to troubleshoot (Displacement, Obstruction, Pneumothorax, Equipment)

The DOPE mnemonic (Displacement, Obstruction, Pneumothorax, Equipment failure) guides systematic troubleshooting of acute ventilator deterioration.

Question 29: A patient is being transported via helicopter following a diving accident with suspected decompression sickness. The flight nurse should request the pilot fly at:

The lowest safe altitude, ideally below 1,000 feet AGL (Correct answer)
Altitude does not affect decompression sickness management
Exactly 8,000 feet cabin altitude as per standard protocol
The maximum service ceiling to speed transport

Correct answer: The lowest safe altitude, ideally below 1,000 feet AGL

Flying at the lowest safe altitude minimizes further nitrogen bubble expansion per Boyle's Law, reducing the risk of worsening decompression sickness.

Question 30: During RSI in a patient with a suspected difficult airway, which backup airway device should be immediately available if intubation fails?

Nasopharyngeal airway only
Tracheostomy kit only
Supraglottic airway device (e.g., LMA or King LT) (Correct answer)
Rigid bronchoscope

Correct answer: Supraglottic airway device (e.g., LMA or King LT)

A supraglottic airway device (LMA, King LT) is the primary rescue airway in a failed intubation, providing oxygenation until a definitive airway can be secured.

Question 31: A patient is transported following a high-speed MVC with suspected traumatic aortic injury. During transport, the flight nurse notes increasing left hemothorax and BP drops to 80/50. What is the most appropriate management?

Place a chest tube and autotransfuse drained blood
Aggressive fluid resuscitation to normalize blood pressure
Thoracotomy needle decompression bilaterally
Permissive hypotension, consider MTP activation, expedite transport (Correct answer)

Correct answer: Permissive hypotension, consider MTP activation, expedite transport

Traumatic aortic injury with hemorrhagic shock warrants permissive hypotension to avoid increasing aortic wall stress, massive transfusion protocol activation, and rapid transport to a Level I trauma center.

Question 32: A neonate is born with gastroschisis. During transport, the exposed bowel should be managed by:

Applying petroleum gauze directly and securing with a tight abdominal binder
Covering the bowel with saline-moistened warm gauze and a plastic wrap or bowel bag (Correct answer)
Replacing the bowel into the abdomen manually and applying a pressure dressing
Wrapping the bowel in dry sterile gauze only

Correct answer: Covering the bowel with saline-moistened warm gauze and a plastic wrap or bowel bag

Exposed bowel in gastroschisis must be kept moist and warm with saline-moistened gauze and covered with plastic wrap or a bowel bag to prevent heat and fluid loss.

Question 33: A CFRN is preparing to perform cricothyrotomy. The cricothyroid membrane is located between which two structures?

Cricoid cartilage superiorly and tracheal ring inferiorly
Arytenoid cartilage superiorly and cricoid cartilage inferiorly
Thyroid cartilage superiorly and cricoid cartilage inferiorly (Correct answer)
Hyoid bone superiorly and thyroid cartilage inferiorly

Correct answer: Thyroid cartilage superiorly and cricoid cartilage inferiorly

The cricothyroid membrane lies between the thyroid cartilage superiorly and the cricoid cartilage inferiorly, and is the target for emergency surgical airway.

Question 34: A CFRN is caring for a patient with a suspected C-spine injury who needs emergent intubation. Which technique is MOST appropriate?

Blind nasotracheal intubation without cervical precautions
Video laryngoscopy with manual inline stabilization (MILS) (Correct answer)
Flexion-extension views before any airway intervention
Avoid intubation until CT confirms injury

Correct answer: Video laryngoscopy with manual inline stabilization (MILS)

Video laryngoscopy with manual inline stabilization (MILS) provides improved glottic view with minimal cervical spine movement, balancing airway management with C-spine protection.

Question 35: A flight nurse administers adenosine 6 mg IV push for SVT. The patient does not convert. What is the correct next dose?

24 mg
12 mg (Correct answer)
18 mg
6 mg

Correct answer: 12 mg

If the initial 6 mg dose of adenosine does not convert SVT, the recommended second dose is 12 mg IV push.

Question 36: Rocuronium is selected instead of succinylcholine for RSI. What reversal agent is available for rocuronium?

Physostigmine
Flumazenil
Neostigmine
Sugammadex (Correct answer)

Correct answer: Sugammadex

Sugammadex encapsulates and inactivates rocuronium (and vecuronium), providing rapid reversal of neuromuscular blockade.

Question 37: What is the correct CFRN response if a patient's oxygen tank is damaged during a hard landing and begins to leak inside the aircraft?

Notify the pilot, land immediately, and move the patient away from the tank (Correct answer)
Reduce flow rate to minimize oxygen loss
Tape the valve shut and continue monitoring the patient
Switch to the backup oxygen supply and document the incident

Correct answer: Notify the pilot, land immediately, and move the patient away from the tank

A leaking oxygen tank creates a fire hazard; the priority is immediate landing and removing the patient from proximity to the leaking cylinder.

Question 38: A patient with a traumatic brain injury has a blood pressure of 110/70 mmHg and an intracranial pressure (ICP) of 20 mmHg. What is the patient's Cerebral Perfusion Pressure (CPP), and is it adequate?

CPP is 43 mmHg, which is inadequate.
CPP is 90 mmHg, which is adequate.
CPP is 63 mmHg, which is borderline adequate. (Correct answer)
CPP is 70 mmHg, which is adequate.

Correct answer: CPP is 63 mmHg, which is borderline adequate.

To calculate CPP, first find the Mean Arterial Pressure (MAP). MAP = [(2 x Diastolic) + Systolic] / 3. In this case, MAP = [(2 x 70) + 110] / 3 = (140 + 110) / 3 = 250 / 3 = 83.3 mmHg. Next, use the formula CPP = MAP - ICP. CPP = 83.3 - 20 = 63.3 mmHg. A normal CPP is generally considered to be between 60-80 mmHg. [13, 8] A CPP of 63.3 mmHg is at the low end of the normal range and is considered borderline adequate, requiring close monitoring.

Question 39: A TBI patient in transport develops diabetes insipidus (DI). Which set of findings confirms this diagnosis?

Anuria with elevated BUN and low serum sodium
Polyuria with concentrated urine and hyperkalemia
Polyuria with dilute urine, rising serum sodium, and decreased urine osmolality (Correct answer)
Oliguria with concentrated urine and hyponatremia

Correct answer: Polyuria with dilute urine, rising serum sodium, and decreased urine osmolality

Post-traumatic DI results from hypothalamic/posterior pituitary dysfunction causing ADH deficiency, leading to massive dilute urine output, hypernatremia, and low urine osmolality.

Question 40: During a helicopter emergency landing on water, at what point should flight crew members inflate their personal flotation devices (PFDs)?

Before the aircraft contacts the water
Immediately upon impact with water
Only after exiting the aircraft (Correct answer)
After the rotor blades have stopped and the aircraft is stable

Correct answer: Only after exiting the aircraft

PFDs should be inflated after exiting the aircraft to prevent being trapped inside by the buoyancy during underwater escape.

Question 41: A tornado has injured several people and left a small village with major damage. The nearest medical facility is 150 miles distant. Although there is only one aircraft available for transfer, ambulances are expected to show there in 15 minutes. Which of the following patients needs to be flown after triage?

A 45-year-old man with penetrating trauma in his left leg from shards of wood
A 50-year-old woman with first- and second-degree burns on arms and hands (12% of body surface area)
A 25-year-old woman at 26 weeks’ gestation in active labor (Correct answer)
A 12-year-old boy with a fractured elbow

Correct answer: A 25-year-old woman at 26 weeks’ gestation in active labor

The newborn or infants may still be viable if the mother is in active preterm labor with a singleton or multiple deliveries at 22 weeks or more gestation. Burns that entail an explosion with respiratory difficulty or disorientation, unconsciousness, or burns that cover 18% or more of the body surface area (second or third-degree burns), must be transported by air. A fracture may be rendered immobile for land transportation. Injury to a limb is less urgent unless combined with extensive bleeding or compromised circulation. Penetrating injuries (such as shrapnel, gunshot wounds, or stabbing) to the head or trunk frequently necessitates air transfer, especially with prolonged unconsciousness.

Question 42: In an aircraft ditching scenario, what is the recommended brace position for a rear-facing passenger?

Lean forward with arms crossed over the chest, feet flat on the floor
Curl forward placing forehead on knees with hands over head
Remain upright with seatbelt tightened and hands gripping armrests
Lean back firmly into the seat with arms crossed over the chest (Correct answer)

Correct answer: Lean back firmly into the seat with arms crossed over the chest

Rear-facing passengers should press firmly back into their seat and cross arms over the chest to minimize injury from deceleration forces.

Question 43: A flight nurse monitoring a patient on a ventilator notices end-tidal CO2 (EtCO2) has dropped from 38 to 20 mmHg without changes in ventilator settings. The most likely explanation is:

Improving pulmonary compliance reducing dead space ventilation
Endotracheal tube migration into the right mainstem bronchus
Significant decrease in cardiac output from worsening shock (Correct answer)
Metabolic alkalosis from bicarbonate administration

Correct answer: Significant decrease in cardiac output from worsening shock

A sudden drop in EtCO2 without ventilator changes indicates decreased pulmonary perfusion from reduced cardiac output, making it an early warning of hemodynamic deterioration.

Question 44: During aeromedical transport at altitude, a pregnant patient's oxygen requirements increase due to physiologic changes. Which of the following is a NORMAL respiratory adaptation of pregnancy that affects transport management?

Increased functional residual capacity (FRC)
Chronic compensated respiratory alkalosis (Correct answer)
Decreased tidal volume due to diaphragmatic compression
Decreased minute ventilation

Correct answer: Chronic compensated respiratory alkalosis

Pregnancy causes chronic respiratory alkalosis (decreased PaCO2 ~30 mmHg) due to progesterone-driven hyperventilation, which must be considered during ventilator management.

Question 45: When assessing spinal cord injury level, a patient has intact biceps (C5), absent wrist extensors, and no hand function. At what level is the neurological injury?

T1
C6 (Correct answer)
C7
C5

Correct answer: C6

Wrist extensors are innervated by C6; their absence with intact C5 function localizes the injury to C6 as the most caudal intact motor level.

Question 46: In right ventricular (RV) failure causing obstructive shock, which intervention should the flight nurse avoid?

Rapidly infusing large volumes of IV crystalloid to improve RV preload (Correct answer)
Optimizing oxygenation and ventilation to reduce hypoxic vasoconstriction
Administering inhaled nitric oxide to reduce pulmonary vascular resistance
Using norepinephrine to maintain coronary perfusion pressure

Correct answer: Rapidly infusing large volumes of IV crystalloid to improve RV preload

Aggressive fluid loading in RV failure can overdistend the already stressed right ventricle, worsening septal shift, impairing LV filling, and precipitating cardiovascular collapse.

Question 47: In altitude physiology, what happens to air trapped in a pulmonary bulla as the aircraft ascends?

It remains unchanged
It compresses due to increased atmospheric pressure
It absorbs into surrounding tissue
It expands due to decreased atmospheric pressure, risking rupture (Correct answer)

Correct answer: It expands due to decreased atmospheric pressure, risking rupture

According to Boyle's Law, gas expands as pressure decreases with altitude, making pulmonary bullae at risk for rupture and pneumothorax during ascent.

Question 48: Which of the following situations completely rules out nasotracheal intubation?

Cervical spine injury
Skull fracture
Facial trauma
Apnea (Correct answer)

Correct answer: Apnea

Blind nasotracheal intubation relies on the patient breathing spontaneously to guide the tube through the vocal cords, so apnea (no breathing) absolutely rules out the technique. Cervical spine injury, facial trauma, and skull fracture are relative contraindications or cautions, not absolute bars.

Question 49: A 38-week patient in the transport environment is found to have a category III fetal heart rate tracing. This classification indicates:

Fetal tachycardia only, no intervention needed
Abnormal status associated with fetal acidemia requiring immediate action (Correct answer)
Indeterminate status needing increased surveillance
Normal fetal status requiring routine monitoring

Correct answer: Abnormal status associated with fetal acidemia requiring immediate action

Category III FHR tracings are abnormal, associated with fetal acidemia, and require immediate evaluation and interventions such as repositioning, oxygen, and expedited delivery.

Question 50: Which ventilator setting should be adjusted first when a transport ventilator alarms for high peak airway pressure in a patient with bronchospasm?

Decrease respiratory rate and increase expiratory time (I:E ratio) (Correct answer)
Increase PEEP
Increase tidal volume
Switch to pressure control mode with higher PIP

Correct answer: Decrease respiratory rate and increase expiratory time (I:E ratio)

Decreasing respiratory rate and increasing expiratory time allows complete exhalation and prevents air trapping (auto-PEEP) in obstructive disease.

Question 51: A patient on a fixed-wing transport develops a pneumothorax. At altitude, the pneumothorax will:

Remain the same size due to pressurized cabin compensation
Stabilize within 15 minutes of reaching cruise altitude
Expand and worsen due to Boyle's Law as ambient pressure decreases (Correct answer)
Decrease in size as cabin pressure increases during cruise

Correct answer: Expand and worsen due to Boyle's Law as ambient pressure decreases

Boyle's Law states that gas volume increases as pressure decreases; a pneumothorax will expand at altitude, potentially becoming a tension pneumothorax.

Question 52: During transport, a patient develops third-degree (complete) AV block with a ventricular escape rate of 28 bpm and hypotension. The transcutaneous pacemaker fails to capture. What is the pharmacologic bridge therapy?

Atropine 1 mg IV (repeat up to 3 mg)
Verapamil 2.5 mg IV
Epinephrine infusion 2–10 mcg/min (Correct answer)
Adenosine 6 mg IV push

Correct answer: Epinephrine infusion 2–10 mcg/min

In complete heart block with a slow ventricular escape below the His-Purkinje system, atropine is ineffective; epinephrine (or dopamine) infusion is used as a bridge when transcutaneous pacing fails.

Question 53: During air transport, a TBI patient develops Cushing's triad. Which combination correctly identifies this reflex?

Hypertension, bradycardia, and irregular respirations (Correct answer)
Hypotension, tachycardia, and shallow breathing
Hypotension, bradycardia, and Cheyne-Stokes respirations
Hypertension, tachycardia, and apnea

Correct answer: Hypertension, bradycardia, and irregular respirations

Cushing's triad—hypertension, bradycardia, and irregular respirations—is a late sign of severely elevated ICP and impending herniation.

Question 54: A 3-year-old weighing 14 kg requires a weight-based dopamine infusion at 5 mcg/kg/min. Using the rule of 6, how many mg of dopamine should be added to 100 mL of D5W?

84 mg (Correct answer)
14 mg
70 mg
42 mg

Correct answer: 84 mg

Rule of 6: weight (kg) × 6 = mg added to 100 mL; 14 × 6 = 84 mg, giving 1 mcg/kg/min per 1 mL/hr.

Question 55: A patient with a spinal cord injury at C4 is being transported. What immediate respiratory concern should the flight nurse anticipate?

Paradoxical breathing with preserved SpO2
Hyperventilation due to loss of inhibitory pathways
Intact respiratory drive but impaired intercostal muscles
Loss of diaphragmatic function requiring ventilatory support (Correct answer)

Correct answer: Loss of diaphragmatic function requiring ventilatory support

C4 and above injuries disrupt phrenic nerve function (C3-C5), eliminating diaphragm control and requiring immediate ventilatory support.

Question 56: During rapid ascent to transport altitude, a patient with an air-filled ETT cuff experiences tracheal mucosal ischemia. This is BEST explained by:

Increased respiratory effort forcing the cuff to press harder
Charles' Law warming the cuff air and increasing pressure
Air in the cuff expands at altitude increasing cuff pressure against the tracheal wall (Correct answer)
Tracheal vessels vasoconstrict due to hypoxia at altitude

Correct answer: Air in the cuff expands at altitude increasing cuff pressure against the tracheal wall

Per Boyle's Law, air in the ETT cuff expands as ambient pressure decreases at altitude, increasing lateral tracheal wall pressure and risking ischemic injury.

Question 57: Which of the following readings from an adult's arterial blood gas is consistent with metabolic acidosis?

HCO3-< 22 mEq/L and pH < 7.35 (Correct answer)
PaCO2 > 55 mmHg and PaO2 < 60 mmHg
PaCO2 35-45 mmHg and PaO2 ≥ 80 mmHg
HCO3-> 26 mEq/L and pH > 7.45

Correct answer: HCO3-< 22 mEq/L and pH < 7.35

Bicarbonate (HCO3-) less than 22 mEq/L and a pH less than 7.35 are consistent with metabolic acidosis, which may result from severe diarrhea, starvation, diabetic ketoacidosis, kidney failure, and aspirin toxicity. Symptoms may include headache, altered consciousness, and agitation from lethargy to coma. Cardiac dysrhythmias and Kussmaul respirations are common. The other readings listed in the question indicate the following: <br> <br> ‥ HCO3 of more than 26 mEq/L and a pH of more than 7.45 are consistent with metabolic alkalosis <br> ‥ PaCO2 of 35–45 mmHg and PaO of 80 mmHg or more are normal adult readings <br> ‥ PaCO2 more than 55 mmHg and PaO2 less than 60 mmHg are consistent with acute respiratory failure in a previously healthy adult.

Question 58: A 12-hour-old neonate has a blood glucose of 32 mg/dL and is symptomatic with jitteriness. The appropriate initial IV treatment is:

D5W 5 mL/kg IV bolus
D50W 1 mL/kg IV bolus
Glucagon 0.03 mg/kg IM only
D10W 2 mL/kg IV bolus followed by D10W infusion at GIR 6 mg/kg/min (Correct answer)

Correct answer: D10W 2 mL/kg IV bolus followed by D10W infusion at GIR 6 mg/kg/min

Symptomatic neonatal hypoglycemia is treated with D10W 2 mL/kg IV bolus (200 mg/kg), then a continuous D10W infusion to maintain glucose; D50W is too concentrated for neonates.

Question 59: A CFRN confirms ETT placement with waveform capnography but SpO2 remains at 88% despite FiO2 of 100%. What is the most likely cause?

Right mainstem intubation
Equipment calibration error
Carbon monoxide poisoning causing falsely elevated SpO2 (Correct answer)
Esophageal intubation

Correct answer: Carbon monoxide poisoning causing falsely elevated SpO2

CO poisoning causes carboxyhemoglobin, which pulse oximetry misreads as oxyhemoglobin, giving a falsely elevated SpO2 while tissue hypoxia persists.

Question 60: A flight nurse is transporting a patient with a closed head injury. Which altitude-related concern is MOST critical?

Expansion of intracranial air and worsening ICP (Correct answer)
Hypercapnia from reduced ventilation
Hypothermia risk from cabin cooling
Dehydration from low cabin humidity

Correct answer: Expansion of intracranial air and worsening ICP

Trapped intracranial air expands at altitude per Boyle's Law, increasing intracranial pressure and potentially worsening herniation in head-injured patients.

Question 61: Which of the following is the MOST accurate description of the CFRN certification renewal requirement?

No renewal required once initially certified
Renewal every 3 years by continuing education or re-examination (Correct answer)
Renewal annually through employer verification
Renewal every 5 years by examination only

Correct answer: Renewal every 3 years by continuing education or re-examination

BCEN's CFRN certification is valid for 3 years and can be renewed through continuing education (CE) activities or by retaking the examination.

Question 62: Rocuronium is selected over succinylcholine for RSI in a flight patient. What dose of rocuronium achieves intubating conditions comparable to succinylcholine?

1.0 mg/kg IV
1.6 mg/kg IV
0.6 mg/kg IV
1.2 mg/kg IV (Correct answer)

Correct answer: 1.2 mg/kg IV

A high dose of 1.2 mg/kg rocuronium (approximately twice the standard dose) achieves intubating conditions within 60 seconds, comparable to succinylcholine.

Question 63: Which scoring tool is used specifically to predict outcomes and guide prognosis discussions for moderate-to-severe TBI patients during transport handoff?

CURB-65 score
IMPACT score or Marshall CT Classification (Correct answer)
Revised Trauma Score (RTS) alone
APACHE II score

Correct answer: IMPACT score or Marshall CT Classification

The IMPACT (International Mission for Prognosis and Analysis of Clinical Trials in TBI) score and Marshall CT Classification are validated tools for TBI outcome prediction used in handoff communication.

Question 64: During a rotor-wing transport at 8,000 feet MSL, a patient's endotracheal tube cuff was inflated with air at sea level. What is the most appropriate management?

Deflate and reinflate the cuff with saline or water to a pressure of 20–30 cmH2O (Correct answer)
Deflate the cuff completely and replace the tube
Leave the cuff unchanged because altitude effects are negligible below 10,000 feet
Increase ventilator PEEP to compensate for cuff expansion

Correct answer: Deflate and reinflate the cuff with saline or water to a pressure of 20–30 cmH2O

Air-filled cuffs expand at altitude due to Boyle's Law, risking tracheal injury; filling with liquid prevents volume changes.

Question 65: A CFRN is transporting a patient with a closed bowel obstruction. At altitude, this patient is most at risk for which complication based on gas law principles?

Decreased gastric motility worsening the obstruction
Hyperkalemia from ischemic bowel segments
Bowel distension and perforation due to gas expansion (Correct answer)
Bowel ischemia due to vasoconstriction

Correct answer: Bowel distension and perforation due to gas expansion

Boyle's Law predicts trapped intestinal gas expands as cabin pressure decreases, increasing the risk of bowel distension and potential perforation.

Question 66: In the event of smoke in the helicopter cabin, what is the FIRST priority for the flight nurse?

Don oxygen mask and notify the pilot immediately (Correct answer)
Identify and eliminate the source of smoke
Administer supplemental oxygen to the patient
Open a cabin window to ventilate

Correct answer: Don oxygen mask and notify the pilot immediately

The flight nurse should first don their oxygen mask to maintain their own effectiveness, then immediately alert the pilot to the smoke emergency.

Question 67: A farm worker is found confused and diaphoretic after a pesticide exposure. The patient has pinpoint pupils, is drooling, and has audible wheezing. These findings are consistent with a cholinergic crisis. What is the priority medication to administer to manage the life-threatening respiratory symptoms?

Sodium Bicarbonate
Naloxone
Pralidoxime (2-PAM)
Atropine (Correct answer)

Correct answer: Atropine

The patient is exhibiting signs of a severe cholinergic toxidrome (DUMBELS: Diarrhea, Urination, Miosis, Bronchorrhea/Bronchospasm, Emesis, Lacrimation, Salivation) from organophosphate poisoning. The most immediate life-threatening symptoms are the 'killer Bs' - bronchorrhea and bronchospasm. Atropine is a competitive antagonist at muscarinic receptors and is the first-line treatment to dry secretions and reverse bronchoconstriction, thereby improving oxygenation and ventilation. While Pralidoxime is also an essential antidote that reactivates acetylcholinesterase, atropine must be given first or concurrently to manage the critical respiratory effects.

Question 68: A CFRN is transporting a head-injured patient requiring neuroprotective ventilation. What ETCO2 target is most appropriate?

45-50 mmHg
25-30 mmHg
35-40 mmHg (Correct answer)
50-55 mmHg

Correct answer: 35-40 mmHg

Normocapnia (ETCO2 35-40 mmHg) is the target for neuroprotective ventilation; hypocapnia causes cerebral vasoconstriction and worsens ischemia.

Question 69: When titrating vasopressor therapy in a septic shock patient during air transport, the target MAP should be maintained at a minimum of:

55 mmHg
65 mmHg (Correct answer)
75 mmHg
50 mmHg

Correct answer: 65 mmHg

Surviving Sepsis Campaign guidelines recommend a MAP target of ≥65 mmHg as the minimum threshold to maintain adequate organ perfusion in septic shock.

Question 70: Which medication is used to treat hyperkalemia-induced cardiac arrhythmias as the immediate first step?

Sodium polystyrene sulfonate
Sodium bicarbonate
Insulin and dextrose
Calcium gluconate or calcium chloride (Correct answer)

Correct answer: Calcium gluconate or calcium chloride

Calcium (gluconate or chloride) is given first to stabilize the myocardial membrane and reduce the risk of fatal arrhythmia in hyperkalemia.

Question 71: Which intervention is indicated for a massive hemothorax identified during air transport?

High-dose furosemide IV
Chest tube insertion at the fourth or fifth ICS, anterior axillary line (Correct answer)
Immediate needle decompression at the second ICS
Pericardiocentesis

Correct answer: Chest tube insertion at the fourth or fifth ICS, anterior axillary line

Massive hemothorax is managed with a large-bore chest tube inserted at the fourth or fifth ICS, anterior axillary line to drain blood and re-expand the lung.

Question 72: During helicopter transport at altitude, a trauma patient has a pneumothorax that was treated with a 14-gauge needle at the scene. The patient's respiratory status is deteriorating. What altitude-related physiological principle explains this worsening?

Hyperbaric conditions compress the lung further
Altitude-induced tachycardia increases intrathoracic pressure
Decreased atmospheric pressure causes gas expansion, enlarging the pneumothorax (Correct answer)
Increased nitrogen narcosis at altitude impairs ventilatory drive

Correct answer: Decreased atmospheric pressure causes gas expansion, enlarging the pneumothorax

Boyle's Law dictates that as altitude increases and atmospheric pressure decreases, gas within a pneumothorax expands, potentially converting a simple pneumothorax into a tension pneumothorax.

Question 73: During altitude ascent, a patient with a known subdural hematoma shows acute neurological deterioration. What is the most likely cause?

Hyperventilation-induced cerebral vasodilation
Gas expansion at altitude increasing intracranial volume and ICP (Correct answer)
Hypoxia from reduced ambient oxygen partial pressure
Cold-induced coagulopathy worsening the bleed

Correct answer: Gas expansion at altitude increasing intracranial volume and ICP

Boyle's Law dictates that gas expands at altitude; any intracranial air (pneumocephalus) or gas-containing hematoma can expand and worsen ICP.

Question 74: A patient's blood pressure is 90/60 mmHg. What is the calculated mean arterial pressure (MAP)?

70 mmHg (Correct answer)
63 mmHg
75 mmHg
80 mmHg

Correct answer: 70 mmHg

MAP = DBP + 1/3(PP) = 60 + 1/3(30) = 60 + 10 = 70 mmHg.

Question 75: A patient in the flight environment has a systolic BP of 70 mmHg, HR 120 bpm, and shows signs of right heart failure. Which vasopressor is preferred to avoid increasing pulmonary vascular resistance?

Phenylephrine
Dopamine
Vasopressin
Norepinephrine (Correct answer)

Correct answer: Norepinephrine

Norepinephrine is preferred in right ventricular failure as it improves systemic vascular resistance while having less effect on pulmonary vascular resistance than vasopressin or high-dose dopamine.

Question 76: Which finding during waveform capnography indicates esophageal intubation?

Absence of CO2 waveform after intubation (Correct answer)
Gradually rising ETCO2 over 5 breaths
Continuous plateau waveform at 35-45 mmHg
Shark fin waveform pattern

Correct answer: Absence of CO2 waveform after intubation

Absence of a CO2 waveform after intubation is the most reliable indicator of esophageal placement, as the esophagus does not produce CO2.

Question 77: A flight nurse prepares to administer ketamine for sedation in a TBI patient. What is the current evidence-based stance on this practice?

Ketamine is acceptable when used with controlled ventilation and does not significantly worsen ICP (Correct answer)
Ketamine must be combined with mannitol to offset its ICP effects
Ketamine is absolutely contraindicated in all TBI due to ICP elevation
Ketamine is the preferred first-line sedative for all TBI patients

Correct answer: Ketamine is acceptable when used with controlled ventilation and does not significantly worsen ICP

Current evidence suggests ketamine does not significantly raise ICP in ventilated, normoventilated TBI patients and offers hemodynamic stability, making it a viable option.

Question 78: During air transport, a patient develops a wide-complex tachycardia at 180 bpm with a pulse. The patient is hemodynamically stable. What is the most appropriate initial intervention?

Adenosine 6 mg rapid IV push
Amiodarone 150 mg IV over 10 minutes (Correct answer)
Immediate synchronized cardioversion at 200 J
Defibrillation at 360 J

Correct answer: Amiodarone 150 mg IV over 10 minutes

For stable wide-complex tachycardia of unknown origin, amiodarone 150 mg IV over 10 minutes is the preferred pharmacologic treatment.

Question 79: During flight transport of a postpartum patient with uterine atony unresponsive to oxytocin, which second-line uterotonic is CONTRAINDICATED in a patient with asthma?

Misoprostol
Carboprost (Hemabate) (Correct answer)
Tranexamic acid
Methylergonovine (Methergine)

Correct answer: Carboprost (Hemabate)

Carboprost (15-methyl PGF2α) is contraindicated in patients with asthma because it can cause severe bronchospasm.

Question 80: Which weather condition most commonly contributes to helicopter EMS accidents?

Inadvertent flight into instrument meteorological conditions (IIMC) (Correct answer)
High winds above 40 knots
Thunderstorm proximity within 10 miles
High-density altitude combined with heavy loads

Correct answer: Inadvertent flight into instrument meteorological conditions (IIMC)

IIMC — where a VFR pilot inadvertently enters clouds or fog — is the most lethal weather-related cause of HEMS accidents.

Question 81: A flight nurse is managing a 58-year-old male patient intubated for respiratory failure. Suddenly, the ventilator's high-pressure alarm sounds, and the patient's oxygen saturation begins to drop. Using the DOPE mnemonic, which of the following potential causes corresponds to 'O'?

Mucus plug obstructing the endotracheal tube (Correct answer)
Ventilator circuit disconnection
Tension pneumothorax
Endotracheal tube displaced into the esophagus

Correct answer: Mucus plug obstructing the endotracheal tube

The DOPE mnemonic is a tool for troubleshooting acute desaturation in an intubated patient. It stands for Displacement, Obstruction, Pneumothorax, and Equipment failure. The 'O' specifically refers to Obstruction, which can be caused by factors like a mucus plug, kinking of the tube, or the patient biting the tube. [16, 20]

Question 82: A trauma patient is intubated and mechanically ventilated during transport. Peak airway pressures rise from 28 to 52 cmH2O suddenly. Breath sounds are absent on the left, trachea is midline, and BP drops to 75/45. What is the most likely diagnosis and next intervention?

Left tension pneumothorax — perform needle decompression at left 2nd ICS MCL (Correct answer)
Right mainstem intubation — withdraw ETT 2-3 cm and reassess
ETT displacement into the esophagus — remove and bag-valve-mask ventilate
Mucus plug obstruction — suction the ETT and increase FiO2

Correct answer: Left tension pneumothorax — perform needle decompression at left 2nd ICS MCL

Sudden increase in peak airway pressures with absent unilateral breath sounds, hemodynamic instability, and ventilated patient strongly indicates tension pneumothorax, requiring immediate needle decompression.

Question 83: During transport, a TBI patient's EtCO2 reads 28 mmHg. What is the appropriate action?

Increase ventilation to further reduce ICP
Reduce ventilation rate to target EtCO2 of 35-45 mmHg (Correct answer)
Administer sodium bicarbonate to correct acidosis
Maintain current ventilation as mild hyperventilation is therapeutic

Correct answer: Reduce ventilation rate to target EtCO2 of 35-45 mmHg

EtCO2 of 28 mmHg represents excessive hyperventilation causing cerebral vasoconstriction; target 35-45 mmHg unless herniation is imminent.

Question 84: During helicopter transport, altitude-related gas expansion causes which change in a patient who has an untreated pneumothorax?

Oxygen absorption reduces pneumothorax size
The pneumothorax will shrink due to increased atmospheric pressure
Gas volume remains unchanged due to the pressurized cabin
The pneumothorax will expand, potentially converting to tension pneumothorax (Correct answer)

Correct answer: The pneumothorax will expand, potentially converting to tension pneumothorax

Boyle's Law dictates that as altitude increases and barometric pressure decreases, gas volume expands — a pneumothorax can enlarge and become a tension pneumothorax in flight.

Question 85: When should the flight nurse perform RSI for a head-injured patient with a GCS of 8?

Only if the patient becomes combative or apneic
After arrival at the receiving facility when surgical team is available
Only if SpO2 drops below 85% in flight
Before transport to secure the airway and prevent aspiration (Correct answer)

Correct answer: Before transport to secure the airway and prevent aspiration

GCS ≤ 8 indicates inability to protect the airway; RSI should be performed before transport when possible to prevent secondary injury from hypoxia.

Question 86: What is the correct IV loading dose of amiodarone for a hemodynamically stable patient with ventricular tachycardia?

75 mg over 10 minutes
600 mg over 30 minutes
150 mg over 10 minutes (Correct answer)
300 mg IV push

Correct answer: 150 mg over 10 minutes

The standard amiodarone loading dose for stable VT is 150 mg IV over 10 minutes, followed by a maintenance infusion.

Question 87: During air medical transport, the phenomenon of 'flicker vertigo' is caused by:

Electromagnetic interference from avionics on the visual cortex
Sunlight flickering through rotating rotor blades at 4–20 Hz (Correct answer)
Hypoxia-induced visual disturbances
Sudden changes in cabin pressure affecting the inner ear

Correct answer: Sunlight flickering through rotating rotor blades at 4–20 Hz

Flicker vertigo occurs when sunlight pulses through rotor blades at 4–20 cycles/second, potentially triggering photosensitive seizures or spatial disorientation.

Question 88: During the transport of a patient with a known C5 spinal cord injury, the patient suddenly develops a pounding headache, profuse sweating above the level of the injury, and severe hypertension with a blood pressure of 210/110 mmHg. Which of the following is the MOST appropriate initial action by the flight nurse?

Lay the patient flat to improve cerebral perfusion.
Sit the patient upright and check for bladder distention. (Correct answer)
Administer a fluid bolus to treat potential shock.
Administer an antihypertensive agent immediately.

Correct answer: Sit the patient upright and check for bladder distention.

The patient is exhibiting classic signs of autonomic dysreflexia, a medical emergency common in patients with spinal cord injuries at T6 or above. It is triggered by a noxious stimulus below the level of injury, most commonly a distended bladder or bowel. [3, 6] The initial and most critical action is to sit the patient upright to help lower blood pressure via orthostatic hypotension and then immediately search for and remove the offending stimulus, starting with checking the urinary catheter for kinks or blockage. [12, 33] Administering fluids or laying the patient flat would worsen the hypertension. Antihypertensives are used if initial measures fail.

Question 89: A flight nurse is preparing for the extrication of a patient who has been trapped under a concrete slab for approximately 5 hours. Which life-threatening metabolic derangement should the nurse be most prepared to treat immediately upon the release of the crushing force?

Hypernatremia
Hyperkalemia (Correct answer)
Hypocalcemia
Metabolic alkalosis

Correct answer: Hyperkalemia

Crush syndrome results from prolonged muscle compression, leading to rhabdomyolysis. When the pressure is released, reperfusion washes out toxic byproducts from the damaged muscle cells into the systemic circulation. The most immediate life-threatening substance released is potassium. The resulting acute hyperkalemia can cause fatal cardiac dysrhythmias, including ventricular fibrillation and asystole.

Question 90: During rotor-wing transport, a patient becomes combative. The flight nurse's FIRST priority is:

Ensure crew and aircraft safety before clinical intervention (Correct answer)
Administer sedation immediately
Restrain the patient's arms to the stretcher
Notify the receiving hospital

Correct answer: Ensure crew and aircraft safety before clinical intervention

Scene and crew safety always takes priority in aeromedical transport; a combative patient threatening aircraft control requires safety measures before clinical management.

Question 91: During rotor-wing transport of an 8-year-old burn patient with 40% TBSA burns, fluid resuscitation in the first 24 hours using the Parkland formula should be calculated as:

4 mL × weight (kg) × % TBSA, half given in first 8 hours from burn time
2 mL × weight (kg) × % TBSA, half given in first 8 hours from burn time
3 mL × weight (kg) × % TBSA, all given in first 24 hours
4 mL × weight (kg) × % TBSA plus maintenance, half given in first 8 hours from burn time (Correct answer)

Correct answer: 4 mL × weight (kg) × % TBSA plus maintenance, half given in first 8 hours from burn time

Pediatric burn resuscitation uses the modified Parkland formula: 4 mL × kg × % TBSA plus maintenance fluids, with half delivered in the first 8 hours from time of burn.

Question 92: A CFRN is caring for a ventilated patient at 8,000 feet MSL. How should the endotracheal tube cuff be managed during ascent?

Inflate the cuff more to prevent air leaks at altitude
No adjustment is needed as cuff pressure is unaffected by altitude
Deflate the cuff slightly to prevent pressure buildup during descent
Replace air in the cuff with saline or use a pressure-regulated cuff (Correct answer)

Correct answer: Replace air in the cuff with saline or use a pressure-regulated cuff

Air in the ETT cuff expands at altitude, risking tracheal injury; filling with saline or using a pressure-regulated cuff prevents dangerous over-inflation.

Question 93: A CFRN is managing a patient with Ludwig's angina requiring airway intervention. Why is awake fiberoptic intubation (AFOI) preferred over RSI in this patient?

AFOI is faster than RSI in emergencies
RSI agents are contraindicated in infection
Paralysis from RSI may cause complete airway collapse in a patient whose airway is maintained by muscle tone (Correct answer)
AFOI does not require any sedation or analgesia

Correct answer: Paralysis from RSI may cause complete airway collapse in a patient whose airway is maintained by muscle tone

In Ludwig's angina, muscle tone and patient positioning may be maintaining a partially obstructed airway; paralysis can cause total airway collapse making ventilation and intubation impossible.

Question 94: A 12 kg, 2-year-old child is being transported with suspected septic shock, presenting with tachycardia, delayed capillary refill, and cool extremities. According to Pediatric Advanced Life Support (PALS) guidelines, what is the appropriate initial isotonic crystalloid fluid bolus?

A 480 mL bolus administered over one hour.
A 240 mL bolus administered over 5-20 minutes. (Correct answer)
A 120 mL bolus administered as rapidly as possible.
A 500 mL bolus administered over 30 minutes.

Correct answer: A 240 mL bolus administered over 5-20 minutes.

PALS guidelines for septic shock recommend an initial fluid bolus of 20 mL/kg of an isotonic crystalloid, administered over 5 to 20 minutes. For a 12 kg child, the calculation is 12 kg * 20 mL/kg = 240 mL.

Question 95: A 6-year-old child has ingested approximately 20 adult iron tablets. The child is currently asymptomatic 90 minutes after ingestion. Which statement best guides management?

Activated charcoal is the treatment of choice for iron ingestion
Syrup of ipecac should be administered to induce emesis
Asymptomatic presentation means significant iron toxicity has been ruled out
Early asymptomatic phase can be followed by a severe systemic toxic phase 6–24 hours later (Correct answer)

Correct answer: Early asymptomatic phase can be followed by a severe systemic toxic phase 6–24 hours later

Iron toxicity has a characteristic biphasic course; initial GI symptoms may improve before severe systemic toxicity (shock, metabolic acidosis) develops hours later.

Question 96: To commit suicide, a 17-year-old girl ingested an excessive amount of acetaminophen (thirty 500-mg pills). She informed her parents, who made an emergency call eight hours later. Which of the subsequent initial emergency treatments is appropriate?

Sodium bicarbonate
N-acetylcysteine (Correct answer)
Fomepizole
Gastrointestinal decontamination and instillation of activated charcoal

Correct answer: N-acetylcysteine

N-acetylcysteine best protects the liver if administered within 8 hours of acetaminophen intoxication. Since 8 hours have passed in the scenario outlined in the question, the antidote must be administered immediately because it reduces hepatotoxicity even after 24 hours. Although activated charcoal may have some protective benefits if administered within 4 hours of intake, gastrointestinal decontamination is most successful when done within 1 hour of administration. The Rumack-Matthew nomogram illustrates toxicity, with serum levels greater than 150 mg necessitating an antidote. The initial dosage of the 72-hour N-acetylcysteine regimen is 140 mg/kg (PO), followed by 17 further doses of 70 mg/kg every 4 hours (orally or intravenously).

Question 97: A patient presents with mydriasis, dry flushing skin, urinary retention, tachycardia, and delirium after ingesting an unknown substance. Which toxidrome is present?

Sympathomimetic toxidrome
Anticholinergic toxidrome (Correct answer)
Opioid toxidrome
Cholinergic toxidrome

Correct answer: Anticholinergic toxidrome

The classic anticholinergic toxidrome ('mad as a hatter, red as a beet, dry as a bone, blind as a bat, hot as Hades') includes mydriasis, hyperthermia, dry skin, urinary retention, and delirium.

Question 98: A patient in the aircraft requires RSI. The flight nurse selects succinylcholine. Which contraindication should be assessed first?

Mild renal insufficiency
History of asthma
Recent crush injury or burns (Correct answer)
History of hypertension

Correct answer: Recent crush injury or burns

Succinylcholine is contraindicated in crush injuries or burns because depolarization causes dangerous potassium release, which can trigger cardiac arrest.

Question 99: Serum lactate levels are used in shock assessment primarily because elevated lactate indicates:

Hepatic overproduction during inflammation
Anaerobic metabolism from inadequate tissue perfusion (Correct answer)
Hyperglycemia from stress response
Renal failure with decreased excretion

Correct answer: Anaerobic metabolism from inadequate tissue perfusion

Elevated lactate reflects anaerobic metabolism occurring when tissues are underperfused, making it a key marker of shock severity and resuscitation adequacy.

Question 100: During flight, a multiparous patient at 39 weeks suddenly reports an urge to push. Exam reveals crowning. Which step of emergency delivery management should be performed FIRST?

Administer IV morphine for pain control before delivery
Place the patient in Trendelenburg to delay delivery
Prepare for immediate episiotomy to expedite delivery
Apply gentle steady pressure to the fetal head to control delivery (Correct answer)

Correct answer: Apply gentle steady pressure to the fetal head to control delivery

Controlled delivery of the fetal head with gentle steady pressure prevents rapid expulsion, reduces perineal lacerations, and allows the infant's airway to clear.

Question 101: During scene response to a motor vehicle crash, which mechanism most reliably predicts severe injury requiring trauma center transport?

Rollover crash regardless of cabin intrusion
Airbag deployment without seatbelt
Damage to the windshield from the patient's head
Death of an occupant in the same vehicle (Correct answer)

Correct answer: Death of an occupant in the same vehicle

Death of another occupant in the same vehicle is a CDC field triage criterion indicating a high-energy mechanism linked to severe injury.

Question 102: A flight nurse responds to a scene where a motorcyclist struck a guardrail at high speed. The patient has a deformed left thigh and no palpable distal pulse. Estimated blood loss is 1,500 mL. Which hemorrhage control intervention is highest priority?

Start two large-bore IVs and begin crystalloid resuscitation
Splint the femur and reassess pulses
Apply a tourniquet proximal to the fracture site (Correct answer)
Perform a focused assessment with sonography for trauma (FAST)

Correct answer: Apply a tourniquet proximal to the fracture site

A femur fracture with vascular compromise and major hemorrhage requires immediate tourniquet application proximal to the injury to control life-threatening bleeding.

Question 103: A transport patient on a fentanyl infusion develops rigidity of the chest wall. What is the immediate treatment?

Administer naloxone and/or a neuromuscular blocking agent (Correct answer)
Switch to morphine
Perform needle decompression
Increase the fentanyl rate

Correct answer: Administer naloxone and/or a neuromuscular blocking agent

Opioid-induced chest wall rigidity (wooden chest syndrome) is treated with naloxone to reverse opioid effect or a neuromuscular blocking agent to facilitate ventilation.

Question 104: A flight nurse is transporting a patient with an IABP (intra-aortic balloon pump). Which complication requires IMMEDIATE intervention during transport?

Balloon trigger switching from ECG to arterial pressure mode
Heart rate increase from 70 to 88 bpm
Diastolic augmentation waveform with a slight change in timing
Loss of helium in the drive line with cessation of counterpulsation (Correct answer)

Correct answer: Loss of helium in the drive line with cessation of counterpulsation

Loss of helium gas and IABP cessation means loss of cardiac support, which is immediately life-threatening in cardiogenic shock.

Question 105: When calculating medication dosing for a pediatric transport patient, the flight nurse should use which weight-based standard?

Standard adult dose divided by patient age
Estimated weight by age in years × 4 + 4 (Leffler formula)
Ideal body weight based on height percentile charts
Broselow tape measurement for weight-based dosing (Correct answer)

Correct answer: Broselow tape measurement for weight-based dosing

The Broselow tape correlates patient length to weight and provides pre-calculated drug doses, reducing calculation errors in high-stress pediatric resuscitation situations.

Question 106: A flight crew is dispatched for a 3-year-old in acute respiratory distress. The child is sitting in a tripod position, is drooling, has a muffled voice, and appears toxic with a high fever. Which of the following conditions is most likely, and what is the priority action?

Anaphylaxis; administer intramuscular epinephrine immediately.
Foreign body aspiration; perform abdominal thrusts.
Epiglottitis; minimize stimulation and prepare for definitive airway management. (Correct answer)
Croup; prepare to administer nebulized racemic epinephrine.

Correct answer: Epiglottitis; minimize stimulation and prepare for definitive airway management.

The clinical presentation of drooling, dysphagia (difficulty swallowing), distress, and dysphonia (muffled voice), often with a high fever and toxic appearance, is classic for epiglottitis. This is a life-threatening airway emergency. The priority is to keep the child calm and avoid any procedures (like using a tongue blade) that could provoke laryngospasm and complete airway obstruction. Management should focus on preparing for definitive airway management by a skilled provider in a controlled setting.

Question 107: A patient receiving thrombolytics for massive pulmonary embolism develops an acute intracranial hemorrhage during transport. What is the most critical immediate intervention?

Discontinue thrombolytics and administer fresh frozen plasma and cryoprecipitate (Correct answer)
Increase the thrombolytic dose to resolve the embolism faster
Administer protamine sulfate and continue anticoagulation
Continue thrombolytics and add anticoagulation

Correct answer: Discontinue thrombolytics and administer fresh frozen plasma and cryoprecipitate

Intracranial hemorrhage during thrombolytic therapy requires immediate cessation of the drug and reversal with FFP (replaces clotting factors) and cryoprecipitate (replaces fibrinogen).

Question 108: During flight transport of a patient with suspected carbon monoxide poisoning, the pulse oximeter reads 98%. What is the most accurate interpretation?

The patient is well-oxygenated and CO poisoning is unlikely
The SpO2 of 98% means no supplemental oxygen is needed
The reading confirms adequate tissue oxygenation
Pulse oximetry is unreliable because it cannot differentiate oxyhemoglobin from carboxyhemoglobin (Correct answer)

Correct answer: Pulse oximetry is unreliable because it cannot differentiate oxyhemoglobin from carboxyhemoglobin

Standard pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin, so it may falsely appear normal despite severe CO poisoning.

Question 109: A patient with a diffuse axonal injury (DAI) is being transported. What GCS range and CT finding is most characteristic of DAI?

Variable GCS with obvious cortical laceration on CT
Low GCS (3-8) with normal or subtly abnormal CT scan (Correct answer)
High GCS (13-15) with massive hemorrhage on CT
Moderate GCS (9-12) with large epidural hematoma

Correct answer: Low GCS (3-8) with normal or subtly abnormal CT scan

DAI is caused by rotational shear forces disrupting axons; CT is often normal or shows only small petechial hemorrhages despite severe neurological dysfunction.

Question 110: When performing a pre-flight patient assessment, which condition would most likely require a pressurized fixed-wing aircraft rather than a rotor-wing?

Hemodynamically stable STEMI patient requiring cath lab within 60 miles
Trauma patient in hemorrhagic shock with pneumothorax needing altitude restriction
Pediatric patient with stable respiratory infection
Burn patient requiring transport over 500 miles with altitude-sensitive wounds (Correct answer)

Correct answer: Burn patient requiring transport over 500 miles with altitude-sensitive wounds

Long-distance transports (>150–200 miles) where altitude control is essential favor fixed-wing pressurized aircraft, combining range and the ability to maintain lower cabin altitude.

Question 111: In a patient with increased intracranial pressure requiring intubation, which induction agent is CONTRAINDICATED due to its potential to increase ICP?

Etomidate
Propofol
Midazolam
Ketamine (traditional concern) (Correct answer)

Correct answer: Ketamine (traditional concern)

Ketamine was traditionally avoided in head injury due to concerns of increasing ICP, though current evidence is mixed; it remains a relative contraindication in many transport protocols.

Question 112: Which pupillary finding is most consistent with uncal herniation in a TBI patient?

Bilateral dilated reactive pupils
Unilateral fixed and dilated pupil ipsilateral to the lesion (Correct answer)
Unilateral constricted pupil contralateral to the lesion
Bilateral pinpoint pupils

Correct answer: Unilateral fixed and dilated pupil ipsilateral to the lesion

Uncal herniation compresses CN III on the ipsilateral side, causing a fixed, dilated pupil on the same side as the expanding lesion.

Question 113: When using a Macintosh laryngoscope blade, the tip of the blade is correctly positioned in which anatomical structure to elevate the epiglottis?

Directly under the epiglottis
Vallecula (between base of tongue and epiglottis) (Correct answer)
Right pyriform sinus
Posterior pharynx

Correct answer: Vallecula (between base of tongue and epiglottis)

The Macintosh blade tip is placed in the vallecula; lifting the blade anteriorly creates tension on the hyoepiglottic ligament, indirectly elevating the epiglottis.

Question 114: A premature neonate on a ventilator develops sudden oxygen desaturation, absent breath sounds on the left, and a trachea deviated to the right. The flight nurse should first:

Increase PEEP to recruit alveoli
Needle decompress the left chest at the 2nd ICS MCL (Correct answer)
Order a chest X-ray
Withdraw the ETT 1 cm to reposition

Correct answer: Needle decompress the left chest at the 2nd ICS MCL

Absent unilateral breath sounds with tracheal deviation in a ventilated neonate is a tension pneumothorax requiring immediate needle decompression.

Question 115: A patient was stung by multiple Africanized honeybees and is now showing signs of anaphylaxis. After administering epinephrine, which additional medication is most critical in flight?

Magnesium sulfate
Calcium gluconate
Oral diphenhydramine only
IV corticosteroids and IV antihistamines (Correct answer)

Correct answer: IV corticosteroids and IV antihistamines

IV corticosteroids and antihistamines are used after epinephrine to prevent biphasic anaphylaxis and reduce ongoing inflammatory response.

Question 116: A CFRN is preparing to transport a patient with an open globe eye injury. Which intervention is MOST critical to prevent worsening?

Shield the eye without applying pressure and maintain head-of-bed at 30 degrees (Correct answer)
Apply a pressure dressing to reduce intraocular bleeding
Irrigate the eye with saline to reduce infection risk
Patch both eyes to prevent sympathetic ophthalmia during transport

Correct answer: Shield the eye without applying pressure and maintain head-of-bed at 30 degrees

An open globe must be shielded (not patched with pressure) to prevent vitreous extrusion; HOB elevation reduces intraocular pressure.

Question 117: A patient is found unconscious in a garage with an idling vehicle. En route, the patient has been on 100% oxygen for 15 minutes but remains confused. What intervention should be planned at the receiving facility?

Sodium thiosulfate administration
Hyperbaric oxygen therapy (Correct answer)
Continued normobaric 100% oxygen for 24 hours
Methylene blue infusion

Correct answer: Hyperbaric oxygen therapy

Hyperbaric oxygen therapy is indicated for severe CO poisoning (unconsciousness, neurological deficits) to accelerate CO elimination and reduce delayed neurological sequelae.

Question 118: A burn patient sustained 45% TBSA partial and full thickness burns 2 hours ago. Using the Parkland formula, what is the correct fluid volume for the first 8 hours?

4 mL × 80 kg × 45% TBSA, half over 8 hours from time of burn (Correct answer)
4 mL × 80 kg × 45% TBSA, entire amount over 24 hours
2 mL × 80 kg × 45% TBSA, half over first 16 hours
2 mL × 80 kg × 45% TBSA, entire amount over 8 hours

Correct answer: 4 mL × 80 kg × 45% TBSA, half over 8 hours from time of burn

The Parkland formula calculates 4 mL/kg/% TBSA total over 24 hours, with half given in the first 8 hours from time of burn (not from presentation), and the remainder over the next 16 hours.

Question 119: Following a precipitous home delivery, the flight crew is managing a 26-year-old female with significant postpartum hemorrhage. Her uterus is soft and difficult to palpate. What is the most appropriate initial intervention?

Initiate a blood transfusion with O-negative blood.
Immediately administer tranexamic acid (TXA).
Perform vigorous fundal massage. (Correct answer)
Administer a 1-liter bolus of lactated Ringer's solution.

Correct answer: Perform vigorous fundal massage.

The patient's soft, "boggy" uterus is indicative of uterine atony, the most common cause of postpartum hemorrhage. The first and most critical intervention is vigorous fundal massage to stimulate uterine contraction, which constricts the blood vessels at the placental site and controls bleeding. While fluids, medications, and blood products are important, massage is the immediate action.

Question 120: A 6-year-old with known type 1 diabetes is unresponsive with a blood glucose of 28 mg/dL and no IV access. The most appropriate immediate treatment is:

D50W 1 mL/kg via intraosseous route
Glucagon 1 mg IM (Correct answer)
Normal saline 20 mL/kg IV bolus
Oral glucose gel squeezed into the cheek

Correct answer: Glucagon 1 mg IM

Glucagon 1 mg IM is the appropriate emergency treatment for severe hypoglycemia in a child without IV access.

Question 121: When performing a primary survey on a multi-system trauma patient in the flight environment, which finding during 'Circulation' assessment takes priority over all others?

Heart rate of 110 bpm
Capillary refill of 3 seconds
Systolic BP of 88 mmHg with external arterial bleeding (Correct answer)
Skin pallor and diaphoresis

Correct answer: Systolic BP of 88 mmHg with external arterial bleeding

Active arterial hemorrhage causing hypotension represents an immediately life-threatening circulation problem requiring direct hemorrhage control before other assessments proceed.

Question 122: Which intervention is the HIGHEST priority when managing a patient with a GCS of 6 and suspected herniation syndrome during flight?

Hyperventilate to a PaCO2 of 25 mmHg immediately
Administer mannitol 1 g/kg IV
Initiate hypothermia protocol to 32°C
Elevate head of stretcher to 30 degrees and maintain normocapnia (Correct answer)

Correct answer: Elevate head of stretcher to 30 degrees and maintain normocapnia

HOB elevation and maintaining normocapnia (PaCO2 35–40) is the first-line ICP management; hyperventilation is reserved for impending herniation.

Question 123: What is the recommended initial SpO2 target for adult non-COPD patients during air medical transport?

92–96%
88–92%
94–98% (Correct answer)
100%

Correct answer: 94–98%

For most adult patients, SpO2 of 94–98% is the recommended target to ensure adequate oxygenation without unnecessary hyperoxia.

Question 124: A scuba diver develops joint pain, mottled skin, and neurological symptoms during air transport after a rapid ascent. The flight nurse should:

Administer diuretics to facilitate nitrogen excretion
Perform needle decompression of the chest bilaterally
Fly at the lowest safe altitude and arrange immediate hyperbaric recompression (Correct answer)
Maintain standard cabin altitude to minimize patient discomfort

Correct answer: Fly at the lowest safe altitude and arrange immediate hyperbaric recompression

Decompression sickness requires flying as low as possible (maximizing atmospheric pressure) and urgent transfer to a hyperbaric facility for recompression therapy.

Question 125: A child ingested an unknown mushroom in the woods. The child now has excessive salivation, lacrimation, urination, defecation, and bronchospasm. Which mushroom toxidrome is this consistent with?

Muscarine toxidrome (e.g., Clitocybe or Inocybe species) (Correct answer)
Amanita phalloides (phalloidin toxidrome)
Ibotenic acid toxidrome
Gyromitrin toxidrome

Correct answer: Muscarine toxidrome (e.g., Clitocybe or Inocybe species)

The SLUDGE/DUMBELS constellation of symptoms represents cholinergic excess consistent with muscarine-containing mushrooms.

Question 126: Pulse pressure variation (PPV) greater than 13% in a mechanically ventilated patient in shock suggests:

Fixed cardiac output unresponsive to volume
Fluid overload requiring diuresis
Fluid responsiveness indicating preload dependence (Correct answer)
Ventricular arrhythmia requiring antiarrhythmic therapy

Correct answer: Fluid responsiveness indicating preload dependence

PPV >13% in ventilated patients predicts fluid responsiveness, indicating the patient is preload-dependent and likely to improve cardiac output with fluid bolus.

Question 127: Which pediatric anatomical difference is MOST clinically significant when managing the airway in a 2-year-old patient during aeromedical transport?

The vocal cords are more posterior and horizontal
The trachea is proportionally longer, requiring deeper tube placement
The epiglottis is shorter and less prominent than in adults
The narrowest portion of the airway is at the subglottic level (cricoid cartilage) (Correct answer)

Correct answer: The narrowest portion of the airway is at the subglottic level (cricoid cartilage)

In children under 8 years, the cricoid ring is the narrowest airway point, making cuffed tubes potentially injurious at that level.

Question 128: The oxyhemoglobin dissociation curve shifts LEFT during aeromedical transport primarily as a result of:

Increased body temperature from transport stress
Elevated 2,3-DPG from chronic altitude adaptation
Hyperventilation-induced respiratory alkalosis and hypocapnia (Correct answer)
Metabolic acidosis from tissue hypoperfusion

Correct answer: Hyperventilation-induced respiratory alkalosis and hypocapnia

Altitude-induced hyperventilation causes respiratory alkalosis (increased pH, decreased PaCO2), shifting the curve left and increasing hemoglobin's affinity for oxygen.

Question 129: Henry's Law is most clinically relevant to which aeromedical patient concern?

Oxygen toxicity in COPD patients
Expansion of pneumothorax at altitude
Worsening ear pain during descent
Nitrogen bubble formation in SCUBA divers at altitude (Correct answer)

Correct answer: Nitrogen bubble formation in SCUBA divers at altitude

Henry's Law states that the amount of gas dissolved in liquid is proportional to partial pressure; reduced pressure at altitude causes dissolved nitrogen to come out of solution, risking decompression sickness.

Question 130: What is the correct initial defibrillation dose for a 20 kg child in ventricular fibrillation per current PALS guidelines?

10 J/kg
4 J/kg
1 J/kg
2 J/kg (Correct answer)

Correct answer: 2 J/kg

PALS recommends an initial defibrillation dose of 2 J/kg for pediatric VF/pulseless VT, with subsequent shocks at 4 J/kg.

Question 131: Which of the following is the BEST indicator of proper oxygen cylinder management for a 2-hour fixed-wing transport of a ventilated patient on 10 L/min?

One H-cylinder is always sufficient for any adult transport
Verify at least one full E-cylinder per hour plus a 30-minute reserve
Oxygen will auto-regulate so cylinder size is not critical
Calculate tank duration and confirm sufficient supply before departure (Correct answer)

Correct answer: Calculate tank duration and confirm sufficient supply before departure

The flight nurse must calculate O2 consumption (flow rate × time) and confirm that on-board supply exceeds estimated need plus reserve before departure.

Question 132: A hiker rescued from a high-altitude environment develops pulmonary edema at 14,000 feet. What is the most appropriate initial intervention?

Give nifedipine and continue ascent
Administer IV furosemide and maintain altitude
Initiate positive pressure ventilation only
Descend immediately and administer supplemental oxygen (Correct answer)

Correct answer: Descend immediately and administer supplemental oxygen

Immediate descent combined with supplemental oxygen is the definitive treatment for high-altitude pulmonary edema (HAPE).

Question 133: Which of the following clinical findings is the most reliable differentiating factor between heat stroke and heat exhaustion?

Core body temperature of 39.5°C (103.1°F)
Altered mental status (Correct answer)
Profuse diaphoresis
Tachycardia and weakness

Correct answer: Altered mental status

The hallmark sign that distinguishes heat stroke from heat exhaustion is central nervous system dysfunction, or altered mental status. Patients with heat stroke may present with confusion, delirium, combativeness, seizures, or coma. While patients with heat exhaustion may be dizzy or weak, their sensorium is intact. Tachycardia, weakness, and elevated temperature are present in both conditions, but the neurological compromise defines heat stroke as a true life-threatening emergency.

Question 134: A patient is transported after ingesting methanol. Metabolic acidosis with a high anion gap and elevated osmol gap is present. What is the mechanism of methanol toxicity?

Competitive inhibition of cytochrome P450 enzymes
Conversion to formaldehyde and formic acid by alcohol dehydrogenase (Correct answer)
Direct hepatocellular necrosis from methanol itself
Direct renal tubular toxicity from the parent compound

Correct answer: Conversion to formaldehyde and formic acid by alcohol dehydrogenase

Alcohol dehydrogenase metabolizes methanol to formaldehyde and then formic acid, which causes optic nerve damage and severe metabolic acidosis.

Question 135: As he waits to be airlifted from a tiny rural hospital to a university hospital 200 miles from the scene of the accident for possible limb reattachment, a homeless guy who had recently suffered a horrific below-knee amputation turns violent and disoriented. Which of the following is the most appropriate initial action?

Leave the patient at the rural hospital for treatment
Delay the flight until the patient calms
Provide physical restraints or chemical restraints (Correct answer)
Arrange ground transport for the patient

Correct answer: Provide physical restraints or chemical restraints

In order to protect personal safety as well as the safety of the medical and flight crew, patients who are aggressive or confrontational need be physically confined for transport and may also need chemical restraints. It is not a good idea to leave the patient in the hospital because the majority of rural hospitals lack the expertise and equipment necessary to perform limb reattachments. The likelihood of a successful reattachment may be lowered if ground transportation is delayed by waiting or making other arrangements.

Question 136: During aeromedical transport, lateral uterine displacement in a third-trimester patient is performed to prevent:

Fetal bradycardia from vibration
Placenta previa hemorrhage
Aortocaval compression syndrome (Correct answer)
Aspiration of gastric contents

Correct answer: Aortocaval compression syndrome

Left lateral uterine displacement prevents the gravid uterus from compressing the aorta and inferior vena cava, maintaining maternal cardiac output.

Question 137: A patient is being transported with a suspected organophosphate poisoning. Which medication is the primary antidote?

Naloxone
Atropine (with pralidoxime as adjunct) (Correct answer)
Physostigmine
Pralidoxime alone

Correct answer: Atropine (with pralidoxime as adjunct)

Atropine blocks muscarinic receptor effects of excess acetylcholine and is the primary antidote; pralidoxime reactivates acetylcholinesterase as an adjunct.

Question 138: A patient with a history of COPD has a baseline oxygen saturation of 92% on room air at sea level. During helicopter transport at 8,000 feet, the flight nurse notes the patient's saturation has dropped to 85% despite being on the same FiO2. This physiological change is primarily explained by:

A decrease in the partial pressure of oxygen. (Correct answer)
An expansion of gases in the patient's bullae.
An increase in the partial pressure of carbon dioxide.
A decrease in the percentage of oxygen in the atmosphere.

Correct answer: A decrease in the partial pressure of oxygen.

Dalton's Law states that the total pressure of a gas mixture is the sum of the partial pressures of its individual components. While the percentage of oxygen in the atmosphere remains constant at approximately 21% regardless of altitude, the total atmospheric pressure decreases with ascent. This decrease in total pressure leads to a proportional decrease in the partial pressure of oxygen (PO2), reducing the driving pressure for oxygen to diffuse from the alveoli into the blood and causing hypoxemia.

Question 139: A 7-year-old with anaphylaxis from a bee sting has received epinephrine IM and diphenhydramine. During transport, the child becomes hypotensive again. The next intervention should be:

Repeat epinephrine 0.01 mg/kg IM and start IV fluid bolus 20 mL/kg (Correct answer)
Give methylprednisolone 2 mg/kg IV and observe
Double the diphenhydramine dose IV
Administer glucagon 1 mg IV for refractory anaphylaxis

Correct answer: Repeat epinephrine 0.01 mg/kg IM and start IV fluid bolus 20 mL/kg

Biphasic or refractory anaphylaxis with hypotension requires repeat epinephrine IM plus aggressive IV fluid resuscitation.

Question 140: A flight nurse is managing a ventilated patient at altitude. Tidal volume has NOT been changed, yet peak airway pressures have increased. The most likely gas law explanation is:

Charles' Law causing gas to contract in cold aircraft temperatures
Dalton's Law altering the partial pressure driving ventilation
Gas in the circuit expanded due to lower cabin pressure, increasing effective delivered volume (Correct answer)
Henry's Law causing CO2 to come out of solution in the ventilator circuit

Correct answer: Gas in the circuit expanded due to lower cabin pressure, increasing effective delivered volume

Boyle's Law explains that gas in humidified circuits or bellows can expand at altitude, effectively increasing delivered tidal volume and airway pressures.

Question 141: A patient with known Wolff-Parkinson-White (WPW) syndrome develops atrial fibrillation during transport with a ventricular rate of 240 bpm. Which drug is absolutely contraindicated?

Adenosine (Correct answer)
Amiodarone
Procainamide
Ibutilide

Correct answer: Adenosine

Adenosine (and other AV nodal blockers like verapamil, diltiazem, digoxin) are contraindicated in WPW with AF because blocking the AV node forces conduction entirely through the accessory pathway, risking ventricular fibrillation.

Question 142: The insertion of an endotracheal tube has just been verified by a chest radiograph (x-ray) (ETT). Except for one, every x-ray finding after that indicates a successful ETT placement:

The distal tip of the ETT is located 4 to 5 cm above the carina
Murphy's eye can be visualized where the clavicles meet
Murphy's eye can be seen in the upright position (Correct answer)
The distal tip of the ETT can be seen at the level of the T3 to T4 vertebrae

Correct answer: Murphy's eye can be seen in the upright position

When practical, a chest x-ray should be used to check proper ETT implantation. The third and fourth thoracic vertebrae should be level with the distal tip of the ETT, which should be positioned 4 to 5 cm above the carina. Visualizing Murphy's eye, the vent hole on the side of the ETT near the intersection of the clavicle bones, helps rapidly verify proper installation.

Question 143: A patient with tension pneumothorax is in obstructive shock. Which hemodynamic finding distinguishes obstructive from hypovolemic shock?

Decreased urine output
Cool clammy extremities
Elevated jugular venous distension (JVD) and tracheal deviation (Correct answer)
Tachycardia and hypotension

Correct answer: Elevated jugular venous distension (JVD) and tracheal deviation

Obstructive shock from tension pneumothorax causes elevated venous backpressure leading to JVD and tracheal deviation, absent in pure hypovolemia.

Question 144: When calculating mean arterial pressure (MAP), which formula is correct?

MAP = (SBP + DBP) ÷ 2
MAP = DBP + 1/3(SBP - DBP) (Correct answer)
MAP = SBP - DBP × 2
MAP = SBP × 0.6 + DBP

Correct answer: MAP = DBP + 1/3(SBP - DBP)

MAP = DBP + 1/3(pulse pressure) = DBP + 1/3(SBP - DBP), reflecting that diastole occupies approximately two-thirds of the cardiac cycle.

Question 145: What is the correct management for a patient with status asthmaticus who is not responding to bronchodilators during transport?

Apply CPAP at 15 cmH2O
Consider IV magnesium sulfate and early preparation for intubation if needed (Correct answer)
Increase supplemental oxygen only
Administer IV furosemide

Correct answer: Consider IV magnesium sulfate and early preparation for intubation if needed

IV magnesium sulfate causes bronchial smooth muscle relaxation and is a key adjunct in refractory asthma; intubation preparation is critical if ventilatory failure is imminent.

Question 146: A flight nurse is managing an intubated patient with a severe traumatic brain injury. To mitigate secondary brain injury, which of the following physiological parameters is the MOST critical to maintain?

Normoglycemia (Blood glucose 80-180 mg/dL)
Normocapnia (EtCO2 35-45 mmHg)
Normothermia (Temperature 36.5-37.5°C)
Normotension (Systolic BP > 90-110 mmHg, depending on guidelines) (Correct answer)

Correct answer: Normotension (Systolic BP > 90-110 mmHg, depending on guidelines)

While all listed parameters are important in preventing secondary brain injury, hypotension is the single most critical factor to avoid. A single episode of hypotension (Systolic BP < 90 mmHg) can significantly increase morbidity and mortality in TBI patients by reducing cerebral perfusion pressure and causing ischemia. [2, 35] Therefore, maintaining adequate blood pressure is the highest priority. Hypoxia is equally critical, but not listed as an answer choice. The other parameters (normocapnia, normoglycemia, normothermia) are also goals of care but avoiding hypotension takes precedence.

Question 147: After a car accident, a 50-year-old guy with chest trouble is being transported by the flying crew. On the right side of the midlung field, an air space consolidation may be seen on a chest radiograph. This discovery suggests that

Hemothorax
Pulmonary contusion (Correct answer)
Cardiac tamponade
Pneumothorax

Correct answer: Pulmonary contusion

The chest radiograph revealing airspace consolidation in the midlung field on the right side in a 50-year-old man with chest pain following a motor vehicle collision is indicative of a pulmonary contusion.

Question 148: Which type of transport aircraft provides the most stable platform for performing advanced interventions such as defibrillation or surgical airways?

Unpressurized fixed-wing aircraft
Fixed-wing pressurized aircraft (Correct answer)
Ground critical care transport unit
Helicopter (rotor-wing)

Correct answer: Fixed-wing pressurized aircraft

Pressurized fixed-wing aircraft offer greater cabin space, altitude control, and reduced vibration, making advanced interventions easier to perform.

Question 149: A CFRN is preparing to intubate an obese patient. What positioning modification is most beneficial for preoxygenation and intubation success?

Flat supine position with head ring
Prone position with towel under chest
Left lateral decubitus position
Reverse Trendelenburg or ramped position with ear-to-sternal notch alignment (Correct answer)

Correct answer: Reverse Trendelenburg or ramped position with ear-to-sternal notch alignment

The ramped position (ear-to-sternal notch alignment) improves glottic view, increases FRC, and offsets the weight of abdominal contents from the diaphragm in obese patients.

Question 150: Which finding is most consistent with a right mainstem bronchus intubation?

Bilateral wheezing and low peak pressures
Bilateral equal breath sounds and high ETCO2
No ETCO2 waveform
Absent left-sided breath sounds, high peak pressures, and SpO2 decline (Correct answer)

Correct answer: Absent left-sided breath sounds, high peak pressures, and SpO2 decline

Right mainstem intubation results in the left lung being bypassed, producing absent left-sided breath sounds, elevated peak pressures, and hypoxia.

Question 151: What is the primary cause of hypoxia experienced by flight crew and patients at altitude without supplemental oxygen?

Increased carbon dioxide production
Decreased partial pressure of oxygen (Correct answer)
Reduced nitrogen in inspired air
Hyperventilation-induced alkalosis

Correct answer: Decreased partial pressure of oxygen

As altitude increases, barometric pressure drops, reducing the partial pressure of oxygen (PaO2) in inspired air even though the percentage of oxygen remains 21%.

Question 152: An airplane made a rough landing after experiencing technical issues. Once in secure ground contact, the crew is aware of what to

Exit the aircraft immediately and meet other crew members downwind from the aircraft.
Exit the aircraft after all moving parts have stopped and then meets other crew members at 12 o’clock. (Correct answer)
Exit the aircraft after moving the patient out and secure shelter in the shade of the aircraft.
Stay in the aircraft until the pilot states it is safe to exit.

Correct answer: Exit the aircraft after all moving parts have stopped and then meets other crew members at 12 o’clock.

After a hard landing, crew must wait until all moving parts (rotors/propellers) have fully stopped before exiting, then regroup at the 12 o'clock (nose) position away from the tail rotor and hazards. Exiting immediately risks injury from spinning components, and meeting downwind places the crew near hot exhaust and fumes.

Question 153: A CFRN is transporting a patient with a chest tube connected to a water-seal drainage system. What is the primary concern at altitude?

The water seal will freeze at cruising altitude
The drainage tubing will kink under negative pressure
Increasing altitude may allow air to re-enter the pleural space through the seal (Correct answer)
Decreased cabin humidity will evaporate the water seal

Correct answer: Increasing altitude may allow air to re-enter the pleural space through the seal

As altitude increases, expanding gases in the pleural space can force air backward through the water seal; a Heimlich valve or clamping during climb may be indicated.

Question 154: Which altitude-related physiological change MOST significantly affects a patient with a closed pneumocephalus (air in the cranial vault)?

Hypoxia from decreased FiO2
Cerebral vasoconstriction from hyperoxia
Expansion of intracranial air increasing ICP (Correct answer)
Increased nitrogen narcosis risk

Correct answer: Expansion of intracranial air increasing ICP

Boyle's Law causes trapped gas to expand at altitude, increasing intracranial pressure and worsening neurological status.

Question 155: Lactate clearance of greater than 10% over 2 hours during resuscitation of a shock patient is significant because it indicates:

Adequate tissue reperfusion and response to resuscitative efforts (Correct answer)
Iatrogenic alkalosis from excessive bicarbonate administration
Worsening anaerobic metabolism requiring escalation of vasopressors
Development of hepatic failure impairing lactate metabolism

Correct answer: Adequate tissue reperfusion and response to resuscitative efforts

A lactate clearance rate >10% over 2 hours is a validated resuscitation endpoint showing improved tissue oxygen delivery and response to treatment.

Question 156: Which of the following clinical presentations is most characteristic of an abruptio placentae?

A gradual onset of intermittent, dull lower back pain with cervical effacement.
Painless, bright red vaginal bleeding with a soft, non-tender uterus.
Hypertension, proteinuria, and severe headache with visual disturbances.
Sudden onset of severe abdominal pain, a rigid uterus, and dark red bleeding. (Correct answer)

Correct answer: Sudden onset of severe abdominal pain, a rigid uterus, and dark red bleeding.

Abruptio placentae is the premature separation of the placenta from the uterine wall. The classic presentation includes a sudden onset of intense, constant abdominal or back pain, a firm or rigid (hypertonic) uterus, and vaginal bleeding that is often dark red. This contrasts with placenta previa, which typically presents with painless, bright red bleeding.

Question 157: Which ventilator mode allows the patient to initiate breaths while the ventilator provides a set backup rate if the patient becomes apneic?

Continuous Positive Airway Pressure (CPAP)
Synchronized Intermittent Mandatory Ventilation (SIMV) (Correct answer)
Controlled Mandatory Ventilation (CMV)
Pressure Support Ventilation (PSV)

Correct answer: Synchronized Intermittent Mandatory Ventilation (SIMV)

SIMV delivers mandatory breaths synchronized to the patient's effort while allowing spontaneous breaths between, with a guaranteed backup rate if the patient is apneic.

Question 158: A term neonate is born through thick meconium-stained amniotic fluid and is limp with poor respiratory effort and a heart rate of 70 bpm. According to the most recent Neonatal Resuscitation Program (NRP) guidelines, what is the most appropriate initial action?

Begin positive-pressure ventilation (PPV) with a bag-mask device. (Correct answer)
Provide vigorous tactile stimulation to encourage crying.
Immediately intubate and perform deep tracheal suctioning.
Administer blow-by oxygen and reassess in 30 seconds.

Correct answer: Begin positive-pressure ventilation (PPV) with a bag-mask device.

Current NRP guidelines prioritize establishing effective ventilation. For a non-vigorous neonate (defined by depressed respirations, poor muscle tone, and/or heart rate <100 bpm) born through meconium-stained fluid, the initial steps are to warm, clear the airway (mouth and nose), and stimulate. If the infant remains apneic or has a heart rate less than 100 bpm, positive-pressure ventilation should be initiated immediately. Routine intubation for tracheal suctioning is no longer recommended as the first step, as delaying ventilation can be harmful.

Question 159: A pediatric patient with TBI has a bulging fontanelle and is bradycardic. What does the bulging fontanelle indicate in this context?

Subarachnoid hemorrhage without elevated ICP
Normal physiologic variation in infants during crying
Elevated intracranial pressure transmitted through the open fontanelle (Correct answer)
Dehydration and decreased CSF production

Correct answer: Elevated intracranial pressure transmitted through the open fontanelle

A tense or bulging fontanelle in an infant with altered mental status and bradycardia indicates elevated ICP—the open fontanelle provides a clinical window into intracranial dynamics.

Question 160: During a fixed-wing transport, a patient develops air sickness (motion sickness). The MOST appropriate initial pharmacological intervention is:

Scopolamine 0.3 mg transdermal patch
Dimenhydrinate (Dramamine) 50 mg IM
Promethazine (Phenergan) 25 mg IV
Ondansetron (Zofran) 4 mg IV (Correct answer)

Correct answer: Ondansetron (Zofran) 4 mg IV

Ondansetron is preferred in flight because it lacks the sedative and respiratory-depressant effects associated with promethazine and antihistamines.

Question 161: A patient with a C5 spinal cord injury is being transported on a backboard. What pressure injury concern requires immediate attention?

Occiput and sacrum are highest-risk bony prominences requiring padding (Correct answer)
The thoracic spine is the highest-risk area for pressure necrosis
Pressure injuries are not a concern during short transport windows
Skin breakdown only occurs after 6+ hours on a hard surface

Correct answer: Occiput and sacrum are highest-risk bony prominences requiring padding

SCI patients have impaired sensation and vasomotor control, dramatically accelerating pressure injury formation; pad all bony prominences, especially occiput, sacrum, and heels, even during brief transports.

Question 162: A trauma patient with a femur fracture is receiving a massive transfusion protocol. The flight nurse notices the patient developing prolonged QT interval, peaked T-waves, and muscle twitching. Which electrolyte abnormality is most likely causing these findings?

Hypermagnesemia from massive cellular destruction
Hyponatremia from dilutional effect of blood products
Hypokalemia from insulin-glucose administration
Hypocalcemia from citrate chelation in transfused blood (Correct answer)

Correct answer: Hypocalcemia from citrate chelation in transfused blood

Massive transfusion leads to hypocalcemia because the citrate preservative in blood products chelates ionized calcium, impairing cardiac conduction and muscle function.

Question 163: A 9-year-old with status epilepticus has failed two doses of lorazepam. Per current pediatric guidelines, what is the next appropriate medication?

Phenobarbital 20 mg/kg IV
Ketamine 1–2 mg/kg IV
Fosphenytoin 20 PE/kg IV (Correct answer)
Valproate 40 mg/kg IV

Correct answer: Fosphenytoin 20 PE/kg IV

Fosphenytoin 20 PE/kg IV is the recommended second-line agent for pediatric benzodiazepine-refractory status epilepticus per current guidelines.

Question 164: This person assesses Pulsus paradoxus:

Heart rate (auscultation)
Radial pulse (palpitation)
Systolic blood pressure readings (Correct answer)
Diastolic blood pressure readings

Correct answer: Systolic blood pressure readings

Systolic blood pressure measurements are used to examine pulsus paradoxus. When breathing normally, the blood pressure slightly drops during intake while the heart rate rises and rises slightly during expiration as the heart rate falls. The pulsus paradoxus, assessed by identifying the initial systolic reading during exhale and reducing blood pressure cuff measurements until the systolic pressure can be heard during both cycles, exaggerates this. Positive for pulsus paradoxus is a more than 10 mmHg difference between the systolic reading taken during expiration alone and the reading taken between inhalation and exhalation.

Question 165: A 10 kg toddler in hemorrhagic shock receives an initial fluid bolus of 20 mL/kg NS. After two boluses with minimal improvement, what is the next most appropriate intervention?

Administer 10 mL/kg packed red blood cells (Correct answer)
Administer sodium bicarbonate 1 mEq/kg
Give a third NS bolus at 20 mL/kg
Start dopamine at 10 mcg/kg/min

Correct answer: Administer 10 mL/kg packed red blood cells

After two crystalloid boluses with inadequate response in hemorrhagic shock, early transfusion with pRBC at 10 mL/kg is indicated.

Question 166: A flight nurse is transporting a patient in active preterm labor at 31 weeks gestation. A tocolytic agent, such as terbutaline or nifedipine, is being administered. What is the primary goal of this therapy during transport?

To increase the strength of uterine contractions to facilitate delivery.
To provide sedation and pain relief for the mother during transport.
To suppress uterine contractions long enough to allow for antenatal corticosteroid administration. (Correct answer)
To permanently stop labor until the pregnancy reaches full term.

Correct answer: To suppress uterine contractions long enough to allow for antenatal corticosteroid administration.

The primary goal of tocolytic therapy is not to stop labor indefinitely but to delay delivery for a short period, typically 48 hours. This delay allows time for the administration of antenatal corticosteroids (e.g., betamethasone) to enhance fetal lung maturity and for safe transport to a facility with a neonatal intensive care unit.

Question 167: During a critical care transport, a patient's EtCO2 suddenly drops from 38 to 10 mmHg while SPO2 remains unchanged at 99%. What is the MOST likely explanation?

Circuit disconnect or esophageal detector failure (Correct answer)
Pulmonary embolism causing increased dead space
Inadvertent esophageal intubation during transport
Right mainstem intubation from tube migration

Correct answer: Circuit disconnect or esophageal detector failure

An abrupt EtCO2 drop to near-zero with maintained SpO2 most likely indicates a ventilator circuit disconnect rather than esophageal intubation.

Question 168: When managing a patient with suspected increased ICP, what is the recommended head-of-bed position during transport?

Lateral decubitus to prevent aspiration
30-degree elevation with midline head position (Correct answer)
Flat supine to maximize cerebral perfusion
Trendelenburg position to improve venous return

Correct answer: 30-degree elevation with midline head position

Elevating the head 30 degrees in the midline optimizes cerebral venous drainage without significantly compromising MAP or CPP.

Question 169: A 34-week pregnant patient is transported by air with a BP of 160/110 mmHg, 3+ proteinuria, and severe headache. Which medication is the FIRST-LINE treatment for severe-range hypertension in this setting?

Nifedipine PO
Magnesium sulfate IV
Labetalol IV (Correct answer)
Hydralazine IV

Correct answer: Labetalol IV

Labetalol IV is the first-line agent for acute severe hypertension in pregnancy due to its rapid onset, predictable response, and safety profile.

Question 170: During a neonatal transport, the flight nurse notes the neonate's oxygen saturation is 72% in the first 3 minutes of life. What is the MOST appropriate response?

Begin supplemental oxygen via blow-by and titrate to SpO2 targets for age in minutes (Correct answer)
Administer epinephrine 0.1 mg/kg IV
Begin chest compressions at 3:1 ratio
Immediately intubate and begin PPV at 100% FiO2

Correct answer: Begin supplemental oxygen via blow-by and titrate to SpO2 targets for age in minutes

NRP guidelines specify SpO2 targets that gradually rise from 60–65% at 1 min to 85–95% at 10 min; titrating supplemental O2 is appropriate.

Question 171: Night vision goggles (NVGs) used in air medical operations amplify which part of the electromagnetic spectrum?

Visible blue-green spectrum (400–550 nm)
Ultraviolet light (200–400 nm)
Near-infrared light (700–900 nm) (Correct answer)
Mid-wave infrared thermal emissions (3–5 μm)

Correct answer: Near-infrared light (700–900 nm)

NVGs amplify near-infrared light (700–900 nm) that is invisible to the naked eye, enabling low-light navigation without overt white light sources.

Question 172: A CFRN is responding to a scene where the landing zone has a 5% slope. Which direction should the helicopter land relative to the slope?

Facing downhill so the tail is lower than the nose
Facing uphill so the nose points toward the high side (Correct answer)
Direction is irrelevant as long as the slope is under 8%
Perpendicular to the slope with the left skid on the high side

Correct answer: Facing uphill so the nose points toward the high side

Helicopters should land facing uphill (nose upslope) to prevent dynamic rollover and maintain rotor clearance from rising terrain.

Question 173: During flight transport of a hemorrhagic shock patient, which resuscitation strategy is recommended over large-volume crystalloid administration?

Permissive hypotension with balanced blood product resuscitation (1:1:1 ratio) (Correct answer)
Colloid-only resuscitation with 5% albumin
Hypertonic saline 3% at 250 mL boluses
Normal saline at 30 mL/kg over 30 minutes

Correct answer: Permissive hypotension with balanced blood product resuscitation (1:1:1 ratio)

Damage control resuscitation using balanced blood products (RBC:FFP:platelets 1:1:1) with permissive hypotension reduces coagulopathy and improves survival in hemorrhagic shock.

Question 174: You are using medical air transport to deliver a really ill patient, however due to storm activity, there is substantial turbulence throughout the flight, therefore you must leave your patient lying down. Which of the following issues could be brought on by carrying the patient supine?

Increase in after load
Decrease in functional reserve capacity (Correct answer)
Increase in preload
Decrease in central circulation

Correct answer: Decrease in functional reserve capacity

When at all practicable, the head and/or upper body of the patient should be elevated via ramping (a folded blanket stack) or by raising the head of the transport bed, ideally to a 30-degree angle. This increases the period of safe apnea (the amount of time until a patient reaches an oxygen saturation level of 88% to 90%), lowers the burden of the patient's breathing, and improves patency of the upper airway. Confounding factors, such as severe weather, may call for the patient to be transported in a supine position to ensure patient safety, but doing so puts them at risk for a decline in functional reserve capacity, a drop in tidal volume, an elevation of the gastric bubble above the cardiac sphincter, and a drop in preload, all of which could worsen their overall condition. In a supine position, the lung capacity is reduced by around 50%.

Question 175: During transport of a pediatric trauma patient (8 years old, 25 kg) with a suspected pelvic fracture, the flight nurse needs to estimate the systolic blood pressure lower limit of normal. What is the correct calculation?

70 + (age in years × 2) (Correct answer)
80 + (age in years × 2)
60 + (weight in kg / 2)
90 + age in years

Correct answer: 70 + (age in years × 2)

The formula for the lower limit of normal systolic blood pressure in pediatric patients is 70 + (age in years × 2), giving approximately 86 mmHg for this 8-year-old.

Question 176: During transport of a septic patient, the flight nurse notes a central venous pressure (CVP) of 2 mmHg. This finding is most consistent with:

Pulmonary hypertension
Right ventricular failure
Hypovolemia requiring fluid resuscitation (Correct answer)
Cardiac tamponade

Correct answer: Hypovolemia requiring fluid resuscitation

A CVP below 5 mmHg indicates low right-sided filling pressure, suggesting hypovolemia and the need for fluid resuscitation.

Question 177: A patient with Brugada syndrome is being transported after an episode of syncope. Which environmental factor during flight can precipitate a life-threatening arrhythmia in this patient?

High-altitude-induced hypocapnia
Increased ambient light exposure
Fever from an untreated infection (Correct answer)
Noise-induced sympathetic activation

Correct answer: Fever from an untreated infection

Fever is a well-known trigger for unmasking Brugada syndrome and can precipitate ventricular fibrillation — temperature management is critical in these patients.

Certified Flight Registered Nurse (CFRN)

The CFRN certification, administered by BCEN, validates advanced nursing competency for registered nurses who provide patient care in air medical transport environments, covering flight physiology, trauma, medical emergencies, resuscitation principles, and special populations.

175

Questions

180 min

Time Limit

72%

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