Certified Flight Registered Nurse (CFRN) — Questions and Answers

Question 1: A flight nurse is managing a patient with Type A aortic dissection during transport. Which medication class is the priority to initiate first for blood pressure and heart rate control?

Beta-blockers (Correct answer)
Nitrates alone
ACE inhibitors
Calcium channel blockers

Correct answer: Beta-blockers

Beta-blockers are initiated first in aortic dissection to reduce heart rate and dp/dt (rate of pressure rise) before adding vasodilators to avoid reflex tachycardia.

Question 2: 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 preload
Increase in after load
Decrease in functional reserve capacity (Correct answer)
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 3: 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?

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

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 4: 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 5: The maximum safe time for a patient to remain in a cold helicopter cabin without active warming during winter transport is best determined by:

A fixed 30-minute limit established by aviation regulations
The referring physician's transport order
The patient's core temperature, risk factors for hypothermia, and cabin temperature (Correct answer)
SpO2 and heart rate trends alone

Correct answer: The patient's core temperature, risk factors for hypothermia, and cabin temperature

There is no fixed time limit; the decision must account for patient baseline temperature, trauma, age, medications, and actual cabin environmental conditions.

Question 6: A CFRN is caring for a patient with an IABP (intra-aortic balloon pump) during transport. The balloon should inflate and deflate in relation to the cardiac cycle in which way?

Inflate during diastole, deflate during mid-systole
Inflate during systole, deflate during diastole
Inflate continuously at a fixed rate
Inflate during diastole, deflate just before systole (Correct answer)

Correct answer: Inflate during diastole, deflate just before systole

The IABP inflates during diastole to augment coronary perfusion and deflates just before systole to reduce afterload.

Question 7: 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)
Pressure injuries are not a concern during short transport windows
The thoracic spine is the highest-risk area for pressure necrosis
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 8: A patient receiving thrombolytics for massive pulmonary embolism develops an acute intracranial hemorrhage during transport. What is the most critical immediate intervention?

Increase the thrombolytic dose to resolve the embolism faster
Continue thrombolytics and add anticoagulation
Discontinue thrombolytics and administer fresh frozen plasma and cryoprecipitate (Correct answer)
Administer protamine sulfate and continue 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 9: A patient is in SVT with a heart rate of 190 bpm and is hemodynamically stable. After vagal maneuvers fail, which pharmacological intervention should be administered FIRST?

Metoprolol 5 mg IV
Amiodarone 150 mg IV over 10 minutes
Diltiazem 0.25 mg/kg IV over 2 minutes
Adenosine 6 mg rapid IV push followed by saline flush (Correct answer)

Correct answer: Adenosine 6 mg rapid IV push followed by saline flush

Adenosine 6 mg rapid IV push is first-line pharmacological treatment for stable SVT per ACLS guidelines.

Question 10: 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?

Vasovagal syncope
Autonomic dysreflexia (Correct answer)
Hypertensive emergency from pain
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 11: Which type of transport aircraft provides the most stable platform for performing advanced interventions such as defibrillation or surgical airways?

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

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

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

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 13: Which standardized communication technique is recommended in HEMS to reduce read-back errors during critical phases of flight?

NATO phonetic alphabet exclusively for all transmissions
SBAR (Situation, Background, Assessment, Recommendation)
One-way radio silence during approach and landing
Closed-loop communication with mandatory read-back confirmation (Correct answer)

Correct answer: Closed-loop communication with mandatory read-back confirmation

Closed-loop communication requires the receiver to read back instructions, confirming accurate receipt — the aviation-standard method to prevent miscommunication errors.

Question 14: A patient with a high-velocity gunshot wound to the abdomen is hemodynamically unstable with a distended, rigid abdomen. In the context of damage-control surgery principles, what is the flight nurse's primary goal during transport?

Administer broad-spectrum antibiotics and prepare for definitive repair
Perform peritoneal lavage to assess for hollow viscus injury
Minimize transport time and maintain the patient viable for damage-control surgery (Correct answer)
Achieve full physiologic normalization before surgical intervention

Correct answer: Minimize transport time and maintain the patient viable for damage-control surgery

Damage-control resuscitation aims to minimize the lethal triad (hypothermia, acidosis, coagulopathy) while expediting transport so surgeons can perform abbreviated hemorrhage control rather than awaiting full physiologic optimization.

Question 15: The emergency locator transmitter (ELT) of an airplane transmits distress signals on the frequency of 121.5 MHz, which are picked up by

Emergency position indicating radio beacons
Ground-based receivers only (Correct answer)
Digital duplex radios
Search and rescue satellite systems

Correct answer: Ground-based receivers only

Distress signals transmitted by an aircraft's Emergency Locator Transmitter (ELT) on the 121.5 MHz frequency are received by ground-based receivers only.

Question 16: Night vision goggles (NVGs) used in air medical operations amplify which part of the electromagnetic spectrum?

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

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

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

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

Elevated intracranial pressure transmitted through the open fontanelle (Correct answer)
Subarachnoid hemorrhage without elevated ICP
Normal physiologic variation in infants during crying
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 19: A patient injured in a vehicle accident is being evacuated through hilly terrain at a height of more than 5000 feet. Due to a broken pump, the patient gets intravenous (IV) fluids by gravity. What impact will the IV infusion have when the altitude is raised to more than 5000 feet?

There will be no effect
The IV flow will increase (Correct answer)
The IV flow will stop
The IV flow will decrease

Correct answer: The IV flow will increase

With this rise in altitude, the intravenous (IV) flow will increase, necessitating modifications to the flow rate. When feasible, a pump that adjusts to maintain a specific flow rate should be employed since barometric pressure impacts the flow rate. The barometric pressure drops as the altitude rises, and the increased flow in the IV tubing is made possible by the lower pressure. This may impact the dosage of IV drugs given. Cabins for fixed-wing aircraft traveling at high altitudes are pressurized, but only to a height of 6000–8000 feet, not sea level.

Question 20: A gunshot wound victim has a bullet entry wound at the right chest and exit at the upper back. Breath sounds are decreased on the right with SpO2 84%. The flight nurse applies an occlusive dressing. Shortly after, the patient's BP drops to 70/40 and trachea deviates left. What is the most likely cause?

Tension pneumothorax developing under the sealed dressing (Correct answer)
Pericardial tamponade from mediastinal injury
Massive hemothorax filling the right pleural space
Pulmonary contusion causing V/Q mismatch

Correct answer: Tension pneumothorax developing under the sealed dressing

Sealing all four sides of a chest wound can convert an open pneumothorax into a tension pneumothorax by preventing air escape; the occlusive dressing should be vented or a chest seal with flutter valve used.

Question 21: 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?

Start dopamine at 10 mcg/kg/min
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

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 22: A flight patient with severe TBI has a GCS of 6 and a BP of 90/60 mmHg. What is the primary hemodynamic goal during transport?

Allow permissive hypotension to limit hemorrhage
Maintain SBP ≥ 90 mmHg to prevent secondary brain injury (Correct answer)
Target SBP 70-80 mmHg to reduce cerebral edema
Prioritize MAP > 110 mmHg at all times

Correct answer: Maintain SBP ≥ 90 mmHg to prevent secondary brain injury

Hypotension (SBP < 90 mmHg) in TBI significantly worsens outcomes by reducing cerebral perfusion pressure and causing secondary brain injury.

Question 23: 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 24: During air medical transport, the phenomenon of 'flicker vertigo' is caused by:

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

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 25: A patient is brought in after ingesting a large quantity of acetaminophen 4 hours ago. Which laboratory value is most important to guide treatment decisions?

Serum acetaminophen level plotted on the Rumack-Matthew nomogram (Correct answer)
Prothrombin time/INR
AST and ALT levels
Serum creatinine

Correct answer: Serum acetaminophen level plotted on the Rumack-Matthew nomogram

The Rumack-Matthew nomogram uses a timed serum acetaminophen level (4–24 hours post-ingestion) to determine whether N-acetylcysteine is indicated.

Question 26: A 4-month-old presents with inspiratory stridor, a 'seal-bark' cough, and a Westley croup score of 8. The flight nurse should prioritize:

Heliox 70/30 nebulization as first-line therapy
Immediate RSI and intubation with a tube one size smaller
High-flow oxygen via non-rebreather mask only
Racemic epinephrine nebulization and dexamethasone (Correct answer)

Correct answer: Racemic epinephrine nebulization and dexamethasone

Severe croup (Westley ≥6) is managed with racemic epinephrine for rapid airway dilation and dexamethasone for sustained anti-inflammatory effect before considering intubation.

Question 27: 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?

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

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

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

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

10–12 mL/kg IBW
6–8 mL/kg IBW (Correct answer)
4–5 mL/kg IBW
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 30: During a winter transport in a rotor-wing aircraft, the flight nurse notices that the pressure reading on a portable oxygen cylinder has decreased significantly since the pre-flight check, even though no oxygen has been administered. Which of the following gas laws provides the best explanation for this observation?

Boyle's Law
Dalton's Law
Charles's Law (Correct answer)
Henry's Law

Correct answer: Charles's Law

Charles's Law states that for a fixed mass of gas at a constant volume, the pressure is directly proportional to the absolute temperature. As the aircraft ascends into colder temperatures, the temperature of the gas inside the oxygen cylinder decreases. This reduction in temperature causes the gas molecules to move more slowly, resulting in a decrease in the pressure exerted on the cylinder walls.

Question 31: A term neonate requires PPV during resuscitation. After 30 seconds of PPV with no improvement in heart rate, what is the NEXT step per NRP guidelines?

Increase oxygen concentration to 100% and continue PPV
Perform MR. SOPA corrective steps (mask adjustment, reposition, suction, open mouth, pressure increase, alternative airway) (Correct answer)
Initiate chest compressions immediately
Administer epinephrine 0.1 mg/kg IV

Correct answer: Perform MR. SOPA corrective steps (mask adjustment, reposition, suction, open mouth, pressure increase, alternative airway)

If PPV is not producing chest rise or improving heart rate, NRP directs the provider through corrective ventilation steps (MR. SOPA) before escalating to compressions.

Question 32: During transport of a hypothermic patient (core temp 30°C) with a stable cardiac rhythm, which intervention should be avoided?

Passive external rewarming with blankets
Rough handling or jostling of the patient (Correct answer)
Active core rewarming with warmed humidified oxygen
Monitoring continuous cardiac rhythm

Correct answer: Rough handling or jostling of the patient

Rough handling of a hypothermic patient can precipitate ventricular fibrillation due to myocardial irritability at low core temperatures.

Question 33: During a rotor-wing transport at 8,000 feet MSL, an unventilated pneumothorax is most likely to worsen because of which gas law?

Dalton's Law
Charles's Law
Henry's Law
Boyle's Law (Correct answer)

Correct answer: Boyle's Law

Boyle's Law states that as pressure decreases with altitude, gas volume expands, causing a pneumothorax to enlarge.

Question 34: A 7-year-old with a closed head injury has a GCS of 8 and ICP suspected to be elevated. During transport, head positioning should be:

Flat supine to maximize cerebral perfusion pressure
Trendelenburg to increase venous return to the brain
Left lateral decubitus to prevent aspiration
30-degree head elevation with the head in midline (Correct answer)

Correct answer: 30-degree head elevation with the head in midline

Elevating the head of bed 30 degrees with the head in a neutral midline position promotes venous drainage and reduces ICP without compromising CPP.

Question 35: According to Boyle's Law, what happens to a gas-filled space (e.g., pneumothorax) as aircraft altitude increases?

Volume decreases proportionally
Volume expands as pressure decreases (Correct answer)
Volume remains unchanged
Volume doubles every 1,000 feet

Correct answer: Volume expands as pressure decreases

Boyle's Law states that at constant temperature, gas volume is inversely proportional to pressure, so trapped gas expands as altitude increases and atmospheric pressure falls.

Question 36: A flight nurse is assessing a patient with a crush injury to both lower extremities who was extricated after 4 hours of entrapment. What metabolic complication is most critical to monitor for during transport?

Hyponatremia from third-space fluid shifts
Metabolic alkalosis from lactic acid clearance
Hypoglycemia from muscle glycogen depletion
Hyperkalemia and myoglobinuria leading to renal failure (Correct answer)

Correct answer: Hyperkalemia and myoglobinuria leading to renal failure

Crush syndrome causes massive release of intracellular potassium and myoglobin, leading to potentially fatal hyperkalemia and myoglobinuria-induced acute kidney injury (rhabdomyolysis).

Question 37: What does an increasing plateau pressure with unchanged peak pressure suggest in a ventilated patient during transport?

Decreased lung or chest wall compliance (Correct answer)
Worsening bronchospasm
Auto-PEEP development
Endotracheal tube obstruction

Correct answer: Decreased lung or chest wall compliance

Plateau pressure reflects lung and chest wall compliance; a rising plateau with stable peak pressure suggests decreased pulmonary compliance (e.g., worsening ARDS, pneumothorax, or fluid overload).

Question 38: Which of the following BEST describes the concept of 'sterile cockpit' during aeromedical transport?

Requiring pilots to wear sterile gloves during patient loading
Disinfecting the cockpit between patients for infection control
Prohibiting any medical equipment in the forward cabin
Restricting all non-essential communication during critical flight phases (Correct answer)

Correct answer: Restricting all non-essential communication during critical flight phases

Borrowed from commercial aviation, 'sterile cockpit' means no non-essential conversation or communication during critical phases (takeoff, landing, emergencies) to prevent crew distraction.

Question 39: A CFRN confirms ETT placement with waveform capnography but SpO2 remains at 88% despite FiO2 of 100%. What is the most likely cause?

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

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

Insulin and dextrose
Sodium polystyrene sulfonate
Sodium bicarbonate
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 41: 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
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
Store the part in a container of normal saline at room temperature

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 42: A CFRN crew is completing a post-crash survival checklist in a remote wilderness area. After ensuring personal safety, what is the next priority?

Establish radio contact with the communications center (Correct answer)
Treat all injuries including minor lacerations
Retrieve the flight manifest from the wreckage
Signal for rescue using any available means

Correct answer: Establish radio contact with the communications center

After immediate safety, establishing radio contact with the communications center activates search and rescue and provides rescuers with location and status information.

Question 43: 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?

Hyperkalemia (Correct answer)
Hypocalcemia
Metabolic alkalosis
Hypernatremia

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 44: A diabetic patient transported by air has a blood glucose of 38 mg/dL and is unconscious. There is no IV access. What is the best immediate treatment?

D50W via IO access
Insulin drip
Glucagon 1 mg IM (Correct answer)
Oral glucose gel

Correct answer: Glucagon 1 mg IM

When IV access is unavailable and the patient is unconscious, glucagon 1 mg IM stimulates hepatic glycogenolysis to raise blood glucose.

Question 45: Battle's sign, a clinical indicator of basilar skull fracture, refers to ecchymosis over which anatomical area?

Mastoid process posterior to the ear (Correct answer)
Periorbital region (raccoon eyes)
The bridge of the nose
The temporal fossa

Correct answer: Mastoid process posterior to the ear

Battle's sign is ecchymosis over the mastoid process, resulting from blood tracking along the skull base fracture, typically appearing 12-24 hours post-injury.

Question 46: A patient with TBI has a serum sodium of 118 mEq/L and cerebral edema. What syndrome does this suggest?

Cerebral Salt Wasting (CSW)
Hyperaldosteronism
Diabetes Insipidus (DI)
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) (Correct answer)

Correct answer: Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

SIADH after TBI causes dilutional hyponatremia with euvolemia or mild hypervolemia due to excess ADH release from hypothalamic/pituitary dysfunction.

Question 47: Which condition defines 'crew incapacitation' in the context of HEMS operations, and what is the flight nurse's role?

Fatigue that exceeds FAA duty hour limits requiring a mandatory rest stop
Any illness requiring the nurse to take over clinical duties from the paramedic
Any medication taken by a crew member within 8 hours of flight duty
Any physical or mental impairment of a crew member that compromises their ability to perform duties; the CFRN must notify the remaining crew and assume appropriate tasks (Correct answer)

Correct answer: Any physical or mental impairment of a crew member that compromises their ability to perform duties; the CFRN must notify the remaining crew and assume appropriate tasks

Crew incapacitation is any impairment affecting duty performance; the CFRN plays an active CRM role in identifying it and redistributing tasks to maintain safety.

Question 48: 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?

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

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

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

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

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

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

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

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 52: Which lead configuration is most sensitive for detecting ST changes associated with left anterior descending (LAD) artery occlusion during continuous cardiac monitoring in flight?

Lead V5 or MCL5 (Correct answer)
Lead V1
Lead II
Lead aVR

Correct answer: Lead V5 or MCL5

Lead V5 (or its modified equivalent MCL5) overlies the lateral precordium and is most sensitive for detecting anterior and lateral wall ischemia from LAD territory involvement.

Question 53: A trauma patient is found unresponsive with decorticate posturing. Which brain region is most likely affected?

Cerebellar involvement bilaterally
Isolated frontal lobe contusion
Pontine or medullary level
Cortical or subcortical white matter pathways above the midbrain (Correct answer)

Correct answer: Cortical or subcortical white matter pathways above the midbrain

Decorticate posturing (flexion of arms, extension of legs) indicates disruption of cortical or subcortical pathways above the level of the red nucleus in the midbrain.

Question 54: Which sign is the MOST reliable bedside indicator that a King LT or Combitube supraglottic airway is seated in the esophagus (correct position)?

Bilateral equal breath sounds
Absence of abdominal distension
Positive waveform capnography with each breath (Correct answer)
Chest rise with ventilation

Correct answer: Positive waveform capnography with each breath

Positive waveform capnography confirming CO2 with each breath is the most reliable indicator of ventilation through a correctly positioned supraglottic airway.

Question 55: When should the flight nurse perform RSI for a head-injured patient with a GCS of 8?

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

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 56: A patient receiving IV heparin infusion for ACS develops a platelet count drop from 280,000 to 60,000 over 8 days with new arterial thrombus. What condition should the flight nurse suspect?

Dilutional thrombocytopenia from fluid resuscitation
Immune thrombocytopenic purpura (ITP)
Heparin-induced thrombocytopenia (HIT) (Correct answer)
Disseminated intravascular coagulation (DIC)

Correct answer: Heparin-induced thrombocytopenia (HIT)

A 50%+ platelet drop 5–10 days after heparin initiation with new thrombosis is the hallmark presentation of heparin-induced thrombocytopenia (HIT).

Question 57: A patient with a bowel obstruction is being transported by a fixed-wing aircraft pressurized to a cabin altitude of 8,000 feet. The flight nurse should anticipate and monitor for which potential complication related to gas expansion?

Decreased nasogastric tube output
Increased pain and abdominal distention (Correct answer)
Development of a fever
Sudden onset of hypotension

Correct answer: Increased pain and abdominal distention

According to Boyle's Law, as the aircraft ascends and cabin pressure decreases, the volume of trapped gas within the patient's bowel will expand. In a patient with a bowel obstruction, this expansion can lead to increased abdominal distention, worsening pain, and potentially compromise of the bowel wall or respiratory function due to pressure on the diaphragm.

Question 58: From the intensive care unit to another institution, a patient is being moved. In-flight assessment suggests a postoperatively abrupt shift in mental state, and the patient is now having trouble responding to questions and reports seeing visual hallucinations. The nurse gets ready to provide medicine.

Clonidine (Duraclon), .0.1 mg PO.
haloperidol (Haldol), 0.5 to 2 mg IV. (Correct answer)
Midazolam (Versed) 0.5 to 1 mg IV.
lorazepam (Ativan), 1 to 2 mg IV.

Correct answer: haloperidol (Haldol), 0.5 to 2 mg IV.

In the given scenario, where a patient being transported from the ICU to another facility experiences an acute change in mental status postoperatively, difficulty answering questions, and visual hallucinations, the nurse prepares to administer haloperidol (Haldol) intravenously (IV) at a dose of 0.5 to 2 mg.

Question 59: Which vasopressor is considered first-line therapy for septic shock according to current Surviving Sepsis Campaign guidelines?

Vasopressin
Epinephrine
Dopamine
Norepinephrine (Correct answer)

Correct answer: Norepinephrine

Norepinephrine is the first-line vasopressor for septic shock due to its potent alpha-adrenergic effect restoring vascular tone with minimal tachycardia.

Question 60: In a patient with increased intracranial pressure requiring intubation, which induction agent is CONTRAINDICATED due to its potential to increase ICP?

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

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 61: While transporting a patient after a brown recluse spider bite, which systemic complication is most concerning in the first 24–72 hours?

Compartment syndrome of the bite extremity
Hemolysis, DIC, and acute renal failure (Correct answer)
Neurotoxic respiratory failure
Immediate anaphylactic shock

Correct answer: Hemolysis, DIC, and acute renal failure

Loxoscelism (systemic brown recluse envenomation) can cause intravascular hemolysis, disseminated intravascular coagulation, and subsequent renal failure.

Question 62: When calculating medication dosing for a pediatric transport patient, the flight nurse should use which weight-based standard?

Ideal body weight based on height percentile charts
Estimated weight by age in years × 4 + 4 (Leffler formula)
Standard adult dose divided by patient age
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 63: During air transport, a patient's endotracheal tube cuff is inflated with air. What is the recommended management?

Deflate the cuff completely during flight
Add extra air to compensate for altitude changes
Leave cuff pressure unchanged; air fluctuation is negligible
Inflate with normal saline or use a pressure-regulated cuff (Correct answer)

Correct answer: Inflate with normal saline or use a pressure-regulated cuff

ETT cuffs inflated with air expand at altitude, potentially causing tracheal ischemia; filling with saline or using a pressure regulator maintains consistent cuff pressure.

Question 64: Which of the following is the MOST critical initial intervention for a patient experiencing hypoxic hypoxia due to an unexpected loss of cabin pressure at high altitude?

Applying 100% supplemental oxygen (Correct answer)
Administering a bronchodilator
Initiating a rapid intravenous fluid bolus
Placing the patient in a Trendelenburg position

Correct answer: Applying 100% supplemental oxygen

Hypoxic hypoxia at altitude is caused by a decreased partial pressure of inspired oxygen (Dalton's Law). The most critical and immediate intervention is to increase the fraction of inspired oxygen (FiO2) to the maximum possible level, which is 100%. This helps to maximize the alveolar oxygen partial pressure, improving the pressure gradient for oxygen diffusion into the blood and correcting the hypoxemia. Descent to a lower altitude is also a primary goal.

Question 65: Which hemodynamic profile is most characteristic of cardiogenic shock?

High SVR, low CO, high PCWP (Correct answer)
High SVR, high CO, low PCWP
Low SVR, high CO, high PCWP
Low 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 66: 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)
Worsening anaerobic metabolism requiring escalation of vasopressors
Iatrogenic alkalosis from excessive bicarbonate administration
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 67: Third-spacing of fluids at altitude most commonly occurs because of:

Charles' Law decreasing plasma volume in cold aircraft cabins
Boyle's Law expanding extracellular fluid compartments
Reduced oncotic pressure relative to increased hydrostatic pressure from hypoxia-induced pulmonary vasoconstriction (Correct answer)
Henry's Law causing plasma gas release into interstitial space

Correct answer: Reduced oncotic pressure relative to increased hydrostatic pressure from hypoxia-induced pulmonary vasoconstriction

Altitude-induced hypoxia causes pulmonary vasoconstriction and increased hydrostatic pressure, promoting fluid movement from capillaries to interstitial spaces.

Question 68: A patient involved in a severe deceleration injury has a widened mediastinum on a pre-hospital chest x-ray. The patient's blood pressure is 165/95 mmHg and heart rate is 115 bpm. For the suspected traumatic aortic injury, what is the primary management goal during air transport?

Maintaining permissive hypotension with a target systolic BP of 90 mmHg without heart rate control.
Titrating anti-impulse therapy to reduce heart rate and blood pressure. (Correct answer)
Administering tranexamic acid (TXA) to prevent further bleeding.
Aggressive fluid resuscitation to maintain a MAP greater than 85 mmHg.

Correct answer: Titrating anti-impulse therapy to reduce heart rate and blood pressure.

The primary goal in managing a suspected or confirmed traumatic aortic injury is to reduce aortic wall shear stress to prevent propagation or rupture of the dissection. This is achieved through 'anti-impulse therapy,' which involves carefully titrating medications (typically a beta-blocker first, followed by a vasodilator) to lower both the heart rate (to < 100 bpm) and blood pressure (SBP < 120 mmHg). Aggressive fluid resuscitation would increase pressure and shear stress, worsening the injury.

Question 69: During flight transport of a hemorrhagic shock patient, which resuscitation strategy is recommended over large-volume crystalloid administration?

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

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 70: 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
Pralidoxime (2-PAM)
Atropine (Correct answer)
Naloxone

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 71: 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:

Administer glucagon 1 mg IV for refractory anaphylaxis
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

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 72: Which vasopressor is considered first-line for septic shock in the flight transport environment?

Vasopressin
Norepinephrine (Correct answer)
Dopamine
Epinephrine

Correct answer: Norepinephrine

Norepinephrine is the first-line vasopressor for septic shock due to its potent alpha-adrenergic vasoconstriction with less tachycardia than dopamine.

Question 73: During a prolonged transport of a mechanically ventilated patient with ARDS, the flight nurse notes a sudden decrease in the end-tidal CO2 (EtCO2) value from 35 mmHg to 15 mmHg, accompanied by hypotension and tachycardia. Which of the following is the most likely cause?

Auto-PEEP or air trapping
Development of a significant pulmonary embolism (Correct answer)
Hypoventilation due to a low respiratory rate setting
Exhaustion of the ventilator's oxygen supply

Correct answer: Development of a significant pulmonary embolism

A sudden, significant drop in EtCO2 without a loss of the waveform, coupled with signs of shock (hypotension, tachycardia), is highly suggestive of a massive pulmonary embolism (PE). [2] The PE obstructs pulmonary blood flow, leading to a large area of dead-space ventilation where gas exchange does not occur, thus reducing the amount of CO2 returned to the lungs to be exhaled. Hypoventilation would cause EtCO2 to rise, not fall. [2]

Question 74: A mountaineer is being evacuated with acute mountain sickness and is unable to descend. Which pharmacological agent is most effective for preventing progression to HACE?

Furosemide
Dexamethasone
Nifedipine
Acetazolamide (Correct answer)

Correct answer: Acetazolamide

Acetazolamide accelerates acclimatization by stimulating increased ventilation and is the primary pharmacological prophylaxis and treatment for AMS/HACE.

Question 75: A flight nurse is caring for a patient with a suspected tension pneumothorax during transport. Which finding most urgently requires needle decompression before definitive chest tube placement?

Absent breath sounds with tracheal deviation and hypotension (Correct answer)
SpO2 of 94% with mild tachycardia
Mild respiratory distress with equal chest rise
Decreased breath sounds with rib tenderness on palpation

Correct answer: Absent breath sounds with tracheal deviation and hypotension

Tension pneumothorax is identified by absent breath sounds, tracheal deviation away from the affected side, and hemodynamic compromise requiring immediate needle decompression.

Question 76: A patient's pulse oximeter reads 92% SpO2 during flight at cabin altitude equivalent to 8,000 feet. The flight nurse knows that the actual PaO2 is approximately:

60 mmHg (Correct answer)
80 mmHg
100 mmHg
40 mmHg

Correct answer: 60 mmHg

An SpO2 of 92% corresponds to approximately 60 mmHg PaO2 on the oxyhemoglobin dissociation curve, which is the critical inflection point.

Question 77: When an asthmatic patient is transported by air, noninvasive ventilation is started. The patient experiences considerable hypotension shortly after takeoff, although the oxygen saturation level stays at 95%. This deterioration's most likely source is

Hypovolemia
Pneumothorax
Hyperinflation (Correct answer)
Hypercapnia

Correct answer: Hyperinflation

In the given scenario, where noninvasive ventilation is initiated during the air transport of a patient with asthma, and the patient becomes significantly hypotensive while maintaining an oxygen saturation of 95%, the most likely cause of this deterioration is hyperinflation.

Question 78: An individual suffers from barotitis media while flying in a fixed-wing aircraft. Pain is not lessened by descending more slowly. Another therapy option is

Advising the patient to maintain ahead-down position
Providing hearing protection
Applying supplemental oxygen.
Instructing the patient to perform the Valsalva maneuver. (Correct answer)

Correct answer: Instructing the patient to perform the Valsalva maneuver.

Another option for treating barotitis media in a patient during descent in a fixed-wing aircraft is instructing the patient to perform the Valsalva maneuver.

Question 79: During a mass casualty event involving nerve agent exposure, patients are being triaged. Which finding indicates the patient is in immediate life threat and requires antidotal therapy without delay?

Localized sweating at the exposure site
Seizures, loss of consciousness, and severe bronchospasm (Correct answer)
Nausea and abdominal cramping
Mild miosis and rhinorrhea only

Correct answer: Seizures, loss of consciousness, and severe bronchospasm

Severe nerve agent toxicity with seizures, unconsciousness, and bronchospasm indicates crisis-level acetylcholinesterase inhibition requiring immediate atropine and pralidoxime.

Question 80: 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
Reversible causes (Hs and Ts) are addressed simultaneously with CPR (Correct answer)
Compressions are paused while reversible causes are treated
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 81: Which ventilator setting change should the flight nurse make when transitioning a ARDS patient from the hospital to transport ventilator?

Maintain lung-protective ventilation: TV 6 mL/kg IBW, plateau pressure < 30 cmH2O (Correct answer)
Increase FiO2 to 1.0 for all ARDS patients during transport
Increase tidal volume to 10 mL/kg IBW to offset altitude-related dead space changes
Switch to pressure-control mode exclusively to avoid volutrauma

Correct answer: Maintain lung-protective ventilation: TV 6 mL/kg IBW, plateau pressure < 30 cmH2O

Lung-protective ventilation (6 mL/kg IBW, Pplat < 30) reduces VILI and mortality in ARDS and must be maintained during transport.

Question 82: A patient with tension pneumothorax is in obstructive shock. Which hemodynamic finding distinguishes obstructive from hypovolemic shock?

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

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 83: When preparing a patient with a PASG (pneumatic anti-shock garment) for air transport, the flight nurse should:

Monitor and adjust pressure during altitude changes (Correct answer)
Deflate it fully before departure
Leave it as inflated on the ground
Replace air with saline to prevent volume shifts

Correct answer: Monitor and adjust pressure during altitude changes

PASG compartments expand at altitude so pressure must be monitored and released incrementally to prevent over-inflation.

Question 84: 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
Continued normobaric 100% oxygen for 24 hours
Methylene blue infusion
Hyperbaric oxygen therapy (Correct answer)

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 85: A patient with COPD relying on hypoxic drive is being transported at altitude. The flight nurse should be MOST concerned about administering high-flow oxygen because:

High-flow oxygen increases CO2 production via the Haldane effect
High FiO2 worsens V/Q mismatch through pulmonary vasoconstriction
Oxygen toxicity will occur within the transport window
Eliminating the hypoxic drive may cause apnea or severe hypoventilation (Correct answer)

Correct answer: Eliminating the hypoxic drive may cause apnea or severe hypoventilation

In COPD patients dependent on hypoxic drive, high-flow oxygen can remove the primary stimulus to breathe, causing dangerous hypoventilation or apnea.

Question 86: 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)
Right mainstem intubation from tube migration
Inadvertent esophageal intubation during transport
Pulmonary embolism causing increased dead space

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 87: 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?

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

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 88: While transporting a patient with suspected cyanide poisoning from an industrial fire, which finding most specifically suggests cyanide toxicity over simple CO poisoning?

Bradycardia and miosis
Cherry-red skin discoloration
Elevated venous oxygen saturation with profound metabolic acidosis (Correct answer)
Bilateral crackles on auscultation

Correct answer: Elevated venous oxygen saturation with profound metabolic acidosis

Cyanide inhibits cellular respiration causing elevated venous pO2 (cells cannot use oxygen) along with severe lactic acidosis.

Question 89: Rocuronium is selected over succinylcholine for RSI in a flight patient. What dose of rocuronium achieves intubating conditions comparable to succinylcholine?

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

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 90: 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?

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

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

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

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 92: 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'?

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

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 93: Which drug class is used to treat alcohol withdrawal seizures and delirium tremens during transport?

Benzodiazepines (Correct answer)
Opioids
Antipsychotics
Beta-blockers

Correct answer: Benzodiazepines

Benzodiazepines (e.g., diazepam, lorazepam) are first-line for alcohol withdrawal because they enhance GABA-A inhibition and suppress autonomic hyperactivity.

Question 94: 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?

2 mL × 80 kg × 45% TBSA, half over first 16 hours
4 mL × 80 kg × 45% TBSA, entire amount over 24 hours
4 mL × 80 kg × 45% TBSA, half over 8 hours from time of burn (Correct answer)
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 95: 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?

Epiglottitis; minimize stimulation and prepare for definitive airway management. (Correct answer)
Foreign body aspiration; perform abdominal thrusts.
Anaphylaxis; administer intramuscular epinephrine immediately.
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 96: A flight nurse is transporting a neonate with suspected critical congenital heart disease who is cyanotic and not improving with oxygen. Which intervention is most appropriate to maintain ductal patency?

High-dose furosemide to reduce pulmonary edema
Prostaglandin E1 (alprostadil) infusion (Correct answer)
Indomethacin IV to close the ductus
Phenylephrine to increase systemic vascular resistance

Correct answer: Prostaglandin E1 (alprostadil) infusion

Prostaglandin E1 infusion maintains or reopens the ductus arteriosus in ductal-dependent congenital heart lesions, providing the only source of pulmonary or systemic blood flow.

Question 97: During nasotracheal intubation in a spontaneously breathing patient, the CFRN hears peak airflow through the tube. What should be done at this moment?

Pause and wait for the next breath
Inflate the cuff immediately
Advance the tube rapidly during peak inspiratory airflow (Correct answer)
Rotate the tube 90 degrees

Correct answer: Advance the tube rapidly during peak inspiratory airflow

Advancing the tube during peak inspiratory flow maximizes the chance of passing the vocal cords as they are most widely abducted during inspiration.

Question 98: When managing a patient with suspected increased ICP, what is the recommended head-of-bed position during transport?

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

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 99: Which personal protective equipment (PPE) item is considered MOST critical for flight crew to wear at all times during operations?

Noise-attenuating helmet with visor
Steel-toed boots
Anti-vibration gloves
Flame-resistant flight suit (Correct answer)

Correct answer: Flame-resistant flight suit

A flame-resistant flight suit is the most critical PPE because post-crash fires are a major cause of crew fatalities in helicopter accidents.

Question 100: 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)
Ibotenic acid toxidrome
Amanita phalloides (phalloidin 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 101: A patient presents with a rattlesnake bite to the right lower leg. The area is markedly swollen and ecchymotic, and the patient is tachycardic and hypotensive. Which of the following interventions is the definitive treatment for this envenomation?

Application of a tourniquet proximal to the bite.
Application of an ice pack directly to the bite site.
Incision of the wound with mechanical suction.
Administration of Crotalidae polyvalent immune Fab (antivenom). (Correct answer)

Correct answer: Administration of Crotalidae polyvalent immune Fab (antivenom).

The definitive treatment for a significant North American pit viper (Crotalidae family, including rattlesnakes) envenomation with systemic signs (hypotension, tachycardia) and progressive local tissue damage is the administration of antivenom, such as Crotalidae polyvalent immune Fab (CroFab). Interventions like tourniquets, incision and suction, and the application of ice are contraindicated, as they are ineffective and can worsen tissue damage.

Question 102: Mixed venous oxygen saturation (SvO2) of 55% in a critically ill patient most likely indicates:

Left-to-right shunting increasing venous oxygenation
Inadequate oxygen delivery with increased tissue extraction (Correct answer)
Adequate oxygen delivery with normal tissue extraction
Increased oxygen delivery exceeding tissue demand

Correct answer: Inadequate oxygen delivery with increased tissue extraction

Normal SvO2 is 65–75%; a value of 55% reflects tissues extracting more oxygen due to inadequate delivery, signaling low cardiac output or severe hypoxia.

Question 103: 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)
6 mg
18 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 104: During air transport, a 28-week gestation patient develops umbilical cord prolapse confirmed on exam. What is the PRIORITY nursing intervention?

Apply oxygen and elevate head of bed
Administer tocolytics immediately
Manually elevate the presenting part off the cord (Correct answer)
Position the patient supine and increase IV fluids

Correct answer: Manually elevate the presenting part off the cord

Manual elevation of the presenting fetal part off the prolapsed cord relieves compression and preserves umbilical blood flow until emergency delivery.

Question 105: A pediatric patient ingested an unknown quantity of calcium channel blockers. Despite fluid resuscitation and vasopressors, hypotension persists. Which adjunct therapy has shown benefit in refractory CCB toxicity?

High-dose magnesium sulfate
Sodium bicarbonate bolus
Activated charcoal via nasogastric tube
High-dose insulin euglycemic therapy (HIET) (Correct answer)

Correct answer: High-dose insulin euglycemic therapy (HIET)

High-dose insulin euglycemic therapy improves cardiac contractility in CCB toxicity by providing alternative energy substrate to myocardial cells impaired by calcium channel blockade.

Question 106: A patient is transported at 38 weeks with a history of previous cesarean section and is now in active labor. She suddenly develops acute onset of severe tearing abdominal pain, cessation of contractions, and the previously engaged fetal head is now unengaged. This presentation is MOST consistent with:

Complete uterine rupture (Correct answer)
Placenta previa with hemorrhage
Rapid cervical dilation causing round ligament pain
Placental abruption with fetal distress

Correct answer: Complete uterine rupture

Sudden severe abdominal pain, loss of previously palpable uterine contractions, and retraction of the fetal presenting part are the hallmark signs of complete uterine rupture.

Question 107: At altitude, nitrogen-filled ETT cuffs may over-inflate due to gas expansion. What is the preferred filling agent during flight?

Carbon dioxide
Normal saline or sterile water (Correct answer)
Room air
Nitrogen

Correct answer: Normal saline or sterile water

Normal saline or sterile water is preferred to fill ETT cuffs during flight because liquids are incompressible and do not expand with altitude changes.

Question 108: 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?

Apply a tourniquet proximal to the fracture site (Correct answer)
Splint the femur and reassess pulses
Start two large-bore IVs and begin crystalloid resuscitation
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 109: When performing a pre-flight patient assessment, which condition would most likely require a pressurized fixed-wing aircraft rather than a rotor-wing?

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

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 110: A flight nurse is caring for a patient at 8,000 feet cabin altitude. Compared to sea level, which physiological change is expected in a healthy individual?

Increased respiratory rate to compensate for lower PaO2 (Correct answer)
Decreased 2,3-DPG levels shifting the oxyhemoglobin curve left
Decreased heart rate due to reduced metabolic demand
Increased arterial CO2 due to hypoventilation

Correct answer: Increased respiratory rate to compensate for lower PaO2

At altitude, lower PaO2 stimulates peripheral chemoreceptors causing compensatory hyperventilation and increased respiratory rate.

Question 111: A patient involved in a high-speed MVC presents with hypotension, bradycardia, and warm flushed skin below the level of injury. Which type of shock should the flight nurse suspect?

Septic shock
Hypovolemic shock
Neurogenic shock (Correct answer)
Anaphylactic shock

Correct answer: Neurogenic shock

Neurogenic shock from spinal cord injury causes loss of sympathetic tone, resulting in vasodilation (warm skin), hypotension, and paradoxical bradycardia.

Question 112: When managing a patient with eclampsia in a transport environment, magnesium sulfate toxicity is BEST assessed by monitoring which parameter?

Deep tendon reflexes (DTR) (Correct answer)
Urine output via Foley catheter
Blood pressure every 5 minutes
Fetal heart rate pattern

Correct answer: Deep tendon reflexes (DTR)

Loss of deep tendon reflexes is the earliest clinical sign of magnesium toxicity, preceding respiratory depression and cardiac arrest.

Question 113: A CFRN is transporting a patient post-CABG who develops ST elevation in leads II, III, and aVF with reciprocal changes in I and aVL. Which coronary artery is most likely occluded?

Right coronary artery (RCA) (Correct answer)
Left circumflex artery (LCx)
Left anterior descending artery (LAD)
Left main coronary artery

Correct answer: Right coronary artery (RCA)

ST elevation in the inferior leads (II, III, aVF) with reciprocal depression in I and aVL represents an inferior STEMI, most commonly caused by RCA occlusion.

Question 114: Which antidysrhythmic drug is preferred for stable wide-complex tachycardia of uncertain origin during air transport?

Procainamide (Correct answer)
Lidocaine
Verapamil
Digoxin

Correct answer: Procainamide

Procainamide is preferred for stable wide-complex tachycardia of uncertain origin because it can treat both ventricular and supraventricular rhythms.

Question 115: A patient is being transported after a rattlesnake bite to the lower leg. The leg is markedly edematous and the patient's coagulation studies are severely deranged. What is the treatment priority in flight?

Immobilize and elevate the extremity above heart level
Initiate antivenom (CroFab) as early as possible and supportive care (Correct answer)
Apply a tourniquet proximal to the bite to limit venom spread
Incise and suction the wound

Correct answer: Initiate antivenom (CroFab) as early as possible and supportive care

CroFab antivenom is the definitive treatment for Crotalid (rattlesnake) envenomation and should be administered as soon as possible to halt venom-induced coagulopathy.

Question 116: 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 dilute urine, rising serum sodium, and decreased urine osmolality (Correct answer)
Polyuria with concentrated urine and hyperkalemia
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 117: During a scene flight, the pilot announces an emergency landing is required. The flight nurse should:

Continue patient care procedures uninterrupted
Administer sedation to prevent patient injury on landing
Immediately brace, secure equipment, and prepare for impact (Correct answer)
Radio dispatch for a new aircraft to meet them

Correct answer: Immediately brace, secure equipment, and prepare for impact

On emergency landing notification, all crew must immediately brace, secure unsecured equipment, and prepare for impact per emergency protocols — patient care is secondary to survival.

Question 118: 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)
Pressure Support Ventilation (PSV)
Controlled Mandatory Ventilation (CMV)

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 119: 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)
Using norepinephrine to maintain coronary perfusion pressure
Optimizing oxygenation and ventilation to reduce hypoxic vasoconstriction
Administering inhaled nitric oxide to reduce pulmonary vascular resistance

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 120: 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 121: When performing rapid sequence intubation, succinylcholine is contraindicated in which patient population due to risk of fatal hyperkalemia?

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

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

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

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 123: Which patient condition poses the GREATEST risk of expanding gas complications during aeromedical transport?

Stable chronic obstructive pulmonary disease
Recent pneumocephalus following neurosurgical procedure (Correct answer)
Treated urinary tract infection
Controlled diabetes mellitus

Correct answer: Recent pneumocephalus following neurosurgical procedure

Pneumocephalus contains intracranial air that expands at altitude per Boyle's Law, potentially causing increased intracranial pressure and brain herniation.

Question 124: During fixed-wing transport, a TBI patient is on a ventilator. Which EtCO2 parameter should the flight nurse target to avoid secondary brain injury?

50-55 mmHg (permissive hypercapnia)
35-45 mmHg (normocapnia) (Correct answer)
20-25 mmHg (aggressive hyperventilation)
25-30 mmHg (mild hyperventilation)

Correct answer: 35-45 mmHg (normocapnia)

Normocapnia (EtCO2 35-45 mmHg) is the standard goal in TBI; hypocapnia causes cerebral vasoconstriction and ischemia, while hypercapnia causes vasodilation and worsens ICP.

Question 125: During a long fixed-wing transport at FL250 (25,000 feet), the aircraft loses pressurization. The flight nurse's FIRST priority is:

Don supplemental oxygen for crew and patient immediately (Correct answer)
Reassess the patient's SpO2 every 2 minutes
Notify medical direction of the emergency
Request diversion to the nearest Level I trauma center

Correct answer: Don supplemental oxygen for crew and patient immediately

At 25,000 feet the time of useful consciousness is approximately 3–5 minutes; immediate oxygen use is the first and critical survival action.

Question 126: A patient at 34 weeks is receiving magnesium sulfate for seizure prophylaxis. The flight nurse notes absent deep tendon reflexes and a respiratory rate of 10/min. The CORRECT immediate action is:

Administer naloxone to reverse respiratory depression
Reduce the magnesium infusion rate by half
Increase supplemental oxygen and continue monitoring
Stop magnesium and administer calcium gluconate IV (Correct answer)

Correct answer: Stop magnesium and administer calcium gluconate IV

Absent DTRs with respiratory depression indicates magnesium toxicity; the antidote is calcium gluconate 1 gram IV given slowly to reverse neuromuscular blockade.

Question 127: A CFRN is transporting a pediatric patient who was submerged in cold water. The patient is unconscious with no gag reflex. What is the FIRST priority?

Establish definitive airway control with RSI and orotracheal intubation (Correct answer)
Place a nasogastric tube to decompress the stomach
Administer epinephrine IV
Place bilateral chest tubes prophylactically

Correct answer: Establish definitive airway control with RSI and orotracheal intubation

An unconscious drowning victim with no protective reflexes requires immediate definitive airway management to protect against aspiration and ensure adequate oxygenation.

Question 128: A patient is receiving a blood transfusion during transport and develops fever, hypotension, back pain, and hemoglobinuria. Which complication should be suspected?

Transfusion-related acute lung injury (TRALI)
Transfusion-associated circulatory overload (TACO)
Acute hemolytic transfusion reaction (ABO incompatibility) (Correct answer)
Febrile non-hemolytic transfusion reaction

Correct answer: Acute hemolytic transfusion reaction (ABO incompatibility)

The classic triad of hemolysis — fever, flank/back pain, and hemoglobinuria — with hypotension indicates acute hemolytic reaction due to ABO incompatibility.

Question 129: A patient on a fixed-wing transport develops a pneumothorax. At altitude, the pneumothorax will:

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

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 130: During a scene response to a construction accident, a worker is found with a steel rod impaled through the left flank. The patient is awake and anxious with BP 100/70 mmHg. What is the correct management of the impaled object?

Stabilize the object in place and do not remove it (Correct answer)
Remove the object immediately to assess the wound
Apply direct pressure around the object and attempt removal
Shorten the object with bolt cutters to facilitate transport

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

Impaled objects must be stabilized in place because removal can cause massive hemorrhage by releasing the tamponade effect the object provides on injured vessels.

Question 131: A patient receiving a blood transfusion develops sudden hypotension, urticaria, bronchospasm, and angioedema. The flight nurse's priority intervention is:

Increase the IV fluid rate and notify the receiving facility
Administer epinephrine 0.3 mg IM to the lateral thigh (Correct answer)
Stop the transfusion and administer methylprednisolone
Administer diphenhydramine 50 mg IV

Correct answer: Administer epinephrine 0.3 mg IM to the lateral thigh

Epinephrine IM is the first-line treatment for anaphylactic shock, reversing bronchospasm, vasodilation, and angioedema rapidly.

Question 132: A 29-week pregnant patient involved in a motor vehicle collision is immobilized on a backboard. She is hypotensive at 85/48 mmHg and tachycardic at 125 bpm. In addition to securing IV access and initiating fluid resuscitation, which intervention is a priority for managing her hypotension?

Apply a pneumatic anti-shock garment (PASG).
Place the patient in a steep Trendelenburg position.
Manually displace the uterus to the left. (Correct answer)
Administer a vasopressor agent like norepinephrine.

Correct answer: Manually displace the uterus to the left.

In a pregnant patient beyond 20 weeks gestation, the gravid uterus can compress the inferior vena cava when the patient is supine, leading to supine hypotensive syndrome. This reduces venous return to the heart and decreases cardiac output. Manually displacing the uterus to the left (or tilting the backboard) relieves this compression and can significantly improve maternal hemodynamics.

Question 133: A pediatric patient (15 kg) requires succinylcholine for rapid sequence intubation. What is the correct dose?

15 mg (1 mg/kg)
7.5 mg (0.5 mg/kg)
45 mg (3 mg/kg)
30 mg (2 mg/kg) (Correct answer)

Correct answer: 30 mg (2 mg/kg)

Pediatric RSI dosing for succinylcholine is 2 mg/kg IV due to children's larger volume of distribution.

Question 134: Which medication is the antidote for acetaminophen overdose and should be initiated during long-distance transport?

N-acetylcysteine (NAC) (Correct answer)
Deferoxamine
Fomepizole
Pyridoxine

Correct answer: N-acetylcysteine (NAC)

N-acetylcysteine replenishes glutathione stores, preventing hepatic damage from the toxic acetaminophen metabolite NAPQI.

Question 135: 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?

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

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 136: 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?

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

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 137: A patient involved in a high-speed motor vehicle collision is found to be hypotensive and tachycardic, with a grossly unstable pelvis on examination. After addressing the airway and breathing, which of the following is the most critical initial intervention?

Application of a commercial pelvic binder or improvised sheet. (Correct answer)
Immediate log roll to assess for spinal injuries.
Bilateral needle decompression for suspected tension pneumothorax.
Rapid infusion of two liters of isotonic crystalloid.

Correct answer: Application of a commercial pelvic binder or improvised sheet.

In a hemodynamically unstable patient with a suspected open-book pelvic fracture, the immediate priority after ABCs is to control the hemorrhage. Applying a pelvic binder reduces the volume of the pelvic ring, which provides stability and tamponades the significant venous and cancellous bone bleeding that is the primary source of blood loss. While fluid resuscitation is necessary, it is secondary to hemorrhage control; adding volume without controlling the bleeding is ineffective.

Question 138: 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:

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

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 139: 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?

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

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 140: A patient with a spinal cord injury above T6 develops sudden hypertension (BP 210/115), bradycardia, and pounding headache during a Foley catheter change. What condition is occurring?

Sympathetic storming from diffuse axonal injury
Autonomic dysreflexia triggered by a noxious stimulus below the level of injury (Correct answer)
Cushing's reflex from acute intracranial hypertension
Malignant hypertension from pre-existing renal disease

Correct answer: Autonomic dysreflexia triggered by a noxious stimulus below the level of injury

Autonomic dysreflexia is a life-threatening exaggerated sympathetic reflex in SCI above T6, triggered by a noxious stimulus (e.g., bladder distension) causing severe hypertension.

Question 141: A patient has a large abdominal stab wound with a significant portion of the small bowel eviscerated. Which of the following describes the most appropriate field management for the exposed organs?

Apply a bulky dressing to exert direct pressure on the organs to control bleeding.
Cover the bowel with a dry sterile dressing to absorb any contaminants.
Cover the organs with a moist, sterile saline dressing and then an occlusive layer. (Correct answer)
Gently attempt to reduce the bowel back into the abdominal cavity.

Correct answer: Cover the organs with a moist, sterile saline dressing and then an occlusive layer.

The proper management of an abdominal evisceration is to protect the exposed organs from further injury, contamination, and dehydration. This is best accomplished by covering the organs with a sterile dressing moistened with saline, and then applying an occlusive layer (like plastic wrap or a sterile bag) over the top to prevent heat and moisture loss. The bowel should never be pushed back into the abdomen in the field, and dry dressings can adhere to and damage the serosa.

Question 142: 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
4 mL × weight (kg) × % TBSA plus maintenance, half given in first 8 hours from burn time (Correct answer)
3 mL × weight (kg) × % TBSA, all given in first 24 hours
2 mL × weight (kg) × % TBSA, half given in first 8 hours from burn time

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 143: A CFRN is transporting a patient with a known difficult airway. The video laryngoscope fails. Which device is the most appropriate next step for a 'can't intubate, can't oxygenate' scenario?

Blind nasotracheal intubation
Nasopharyngeal airway
Surgical cricothyrotomy (Correct answer)
King LT airway

Correct answer: Surgical cricothyrotomy

Surgical cricothyrotomy is the definitive rescue airway in a true 'can't intubate, can't oxygenate' situation when all other methods have failed.

Question 144: The oxyhemoglobin dissociation curve shifts LEFT during aeromedical transport primarily as a result of:

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

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

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

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 146: Graham's Law states that the rate of diffusion of a gas is inversely proportional to the square root of its molecular weight. This explains why:

Helium accumulates in body cavities faster than oxygen at altitude
Carbon dioxide diffuses 20 times more readily across the alveolar membrane than oxygen (Correct answer)
Nitrogen causes decompression sickness faster than carbon dioxide
Oxygen crosses the alveolar membrane faster than nitrogen at altitude

Correct answer: Carbon dioxide diffuses 20 times more readily across the alveolar membrane than oxygen

CO2 has greater solubility (approximately 20× more soluble than O2) and diffuses across the alveolar-capillary membrane much more readily than oxygen.

Question 147: Which finding during waveform capnography indicates esophageal intubation?

Gradually rising ETCO2 over 5 breaths
Absence of CO2 waveform after intubation (Correct answer)
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 148: A patient in the aircraft requires RSI. The flight nurse selects succinylcholine. Which contraindication should be assessed first?

Recent crush injury or burns (Correct answer)
Mild renal insufficiency
History of asthma
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 149: While transporting a pediatric patient with suspected SVT, the flight nurse performs vagal maneuvers without success. What is the correct first-line pharmacologic treatment?

Adenosine 0.1 mg/kg rapid IV push (max 6 mg) (Correct answer)
Verapamil 0.1 mg/kg IV
Digoxin 10 mcg/kg IV
Amiodarone 5 mg/kg IV

Correct answer: Adenosine 0.1 mg/kg rapid IV push (max 6 mg)

Adenosine 0.1 mg/kg (max 6 mg first dose) given as a rapid IV push is the first-line drug for pediatric SVT after failed vagal maneuvers.

Question 150: A 5-month-old in respiratory distress has nasal flaring, subcostal retractions, and diffuse wheezing. RSV bronchiolitis is suspected. Which intervention has the BEST evidence for flight transport?

High-flow nasal cannula oxygen therapy (Correct answer)
Nebulized epinephrine 5 mg
Nebulized albuterol every 20 minutes
Systemic corticosteroids IV

Correct answer: High-flow nasal cannula oxygen therapy

High-flow nasal cannula therapy is the best-supported intervention for moderate-to-severe bronchiolitis, reducing work of breathing without the inconsistent response seen with bronchodilators.

Question 151: A flight nurse is preparing to intubate a patient with facial trauma, blood in the airway, and a GCS of 7. Rapid sequence intubation is planned. Which pre-oxygenation technique is most appropriate for this scenario?

Passive apneic oxygenation via nasal cannula at 15 L/min only
Bag-valve-mask ventilation with 100% FiO2 for 3-5 minutes with suction available (Correct answer)
Non-rebreather mask at 15 L/min for 8 breaths
Delayed sequence intubation using ketamine followed by 3 minutes of BVM

Correct answer: Bag-valve-mask ventilation with 100% FiO2 for 3-5 minutes with suction available

BVM pre-oxygenation with 100% FiO2 for 3-5 minutes with suction immediately available is optimal for maximizing nitrogen washout and oxygen reserve in a patient with a compromised, bloody airway.

Question 152: A scuba diver develops joint pain, mottled skin, and neurological symptoms during air transport after a rapid ascent. The flight nurse should:

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

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 153: A flight nurse is assessing a patient from a high-speed MVC who complains of mid-sternal chest pain and has a new right bundle branch block on ECG. What injury should be strongly suspected?

Pericardial tamponade
Myocardial contusion (Correct answer)
Traumatic aortic dissection
Tension pneumothorax

Correct answer: Myocardial contusion

Myocardial contusion from blunt chest trauma can cause dysrhythmias, conduction abnormalities such as RBBB, ST changes, and reduced cardiac output, and must be monitored closely during transport.

Question 154: The CFRN is assessing a 36-week pregnant patient who was the restrained driver in a frontal-impact collision. Her vital signs are stable (BP 118/76, HR 98, RR 20). The nurse understands that due to the physiological changes of pregnancy:

Signs of hypovolemia, such as hypotension, will appear much earlier than in a non-pregnant patient.
The patient can lose 30-35% of her blood volume before exhibiting hypotension. (Correct answer)
The patient has decreased plasma volume, making her more susceptible to shock.
The resting heart rate is typically lower, so a rate of 98 bpm is a definitive sign of shock.

Correct answer: The patient can lose 30-35% of her blood volume before exhibiting hypotension.

Pregnant patients experience a significant increase in blood volume, up to 45-50%, primarily due to plasma expansion. This hypervolemia creates a physiological reserve, allowing the mother to lose a substantial amount of blood (up to 30-35% or 1500-2000 mL) before classic signs of shock, like hypotension, become apparent. This can mask the true severity of hemorrhage.

Question 155: A patient with blunt chest trauma is noted to have paradoxical chest wall motion, tachypnea, and significant hypoxemia. While the mechanics of the flail segment are dramatic, what is the primary cause of the patient's hypoxemia?

Rebreathing of dead-space gas between the lungs (Pendelluft effect).
Inability to generate sufficient negative intrathoracic pressure.
Pain from the fractures causing splinting and atelectasis.
The underlying pulmonary contusion beneath the fractured segment. (Correct answer)

Correct answer: The underlying pulmonary contusion beneath the fractured segment.

While pain, splinting, and altered chest wall mechanics contribute to respiratory insufficiency, the most significant cause of hypoxemia in a patient with a flail chest is the underlying pulmonary contusion. The contusion involves bleeding and edema in the lung parenchyma, leading to a severe ventilation/perfusion (V/Q) mismatch and shunting, which is the primary driver of hypoxemia. The Pendelluft theory is now considered to be of minimal clinical significance.

Question 156: A CFRN is transporting a patient requiring continuous cardiac monitoring. A potentially fatal dysrhythmia is identified en route. After initiating treatment, the nurse should:

Contact medical control and await orders before any treatment changes
Continue to destination while documenting the event
Land immediately regardless of proximity to the destination
Notify the pilot and reassess whether diversion to the nearest appropriate facility is warranted (Correct answer)

Correct answer: Notify the pilot and reassess whether diversion to the nearest appropriate facility is warranted

The flight nurse must communicate critical changes to the pilot so they can jointly decide whether diversion is safer than continuing to the planned destination — this is a shared CRM decision.

Question 157: During high-altitude fixed-wing transport, which physiological change directly causes hypoxia despite normal sea-level oxygen saturation?

Henry's Law: decreased oxygen solubility in plasma
Boyle's Law: lung volume expansion compressing alveoli
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 158: 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?

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

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 159: A patient with frostbite to both hands has been in a warm transport environment for 30 minutes. The thawed tissue now appears blistered and edematous. What is the most important management principle?

Avoid refreezing the thawed tissue at all costs (Correct answer)
Debride all blisters immediately
Rewarm with direct dry heat such as a heat lamp
Massage the affected tissue vigorously to restore circulation

Correct answer: Avoid refreezing the thawed tissue at all costs

Refreezing previously thawed tissue causes far greater cellular damage than the original frostbite, making prevention of refreezing the top priority.

Question 160: A CFRN is transporting a head-injured patient requiring neuroprotective ventilation. What ETCO2 target is most appropriate?

50-55 mmHg
35-40 mmHg (Correct answer)
45-50 mmHg
25-30 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 161: Which IV fluid is MOST appropriate for initial resuscitation of a burn patient during aeromedical transport?

0.45% Normal Saline
D5W
Lactated Ringer's solution (Correct answer)
3% Hypertonic Saline

Correct answer: Lactated Ringer's solution

Lactated Ringer's is the gold-standard resuscitation fluid for burns as recommended by the Parkland formula.

Question 162: A patient at 26 weeks gestation develops sudden dyspnea, hypoxia, and cardiovascular collapse during transport. Amniotic fluid embolism (AFE) is suspected. What is the PRIORITY intervention?

Immediate intubation and high-flow oxygen (Correct answer)
Administer epinephrine and prepare for ECMO
Administer magnesium sulfate to prevent seizures
Perform emergency cesarean section in the aircraft

Correct answer: Immediate intubation and high-flow oxygen

In AFE, immediate airway management with intubation and high-flow oxygen is the priority to address the severe hypoxia and cardiovascular collapse.

Question 163: A trauma patient in Class IV hemorrhagic shock (>40% blood volume loss) will most likely present with:

Tachycardia with systolic BP 90–100 mmHg and mild confusion
Heart rate >140 bpm, negligible urine output, and loss of consciousness (Correct answer)
Normal heart rate with profound hypotension and diaphoresis
Mildly elevated heart rate with normal blood pressure and anxiety

Correct answer: Heart rate >140 bpm, negligible urine output, and loss of consciousness

Class IV hemorrhage is immediately life-threatening, presenting with profound tachycardia, negligible urine output, and altered or lost consciousness from critical hypoperfusion.

Question 164: A patient with a history of depression is transported after an intentional overdose. The ECG reveals a sinus tachycardia at 120 bpm, a QRS duration of 140 ms, and a prominent R wave in lead aVR. This presentation is highly suggestive of toxicity from which drug class, and what is the indicated treatment?

Beta-blocker toxicity, requiring glucagon.
Tricyclic antidepressant (TCA) toxicity, requiring sodium bicarbonate. (Correct answer)
Opioid toxicity, requiring naloxone.
Calcium channel blocker toxicity, requiring calcium chloride.

Correct answer: Tricyclic antidepressant (TCA) toxicity, requiring sodium bicarbonate.

The ECG findings of sinus tachycardia, a widened QRS complex (>100 ms), and a terminal R wave in aVR are classic signs of cardiotoxicity from a tricyclic antidepressant (TCA) overdose. TCAs block fast sodium channels in the myocardium, leading to these conduction delays. The first-line treatment is intravenous sodium bicarbonate, which helps overcome the sodium channel blockade and increases serum pH, reducing the amount of active drug.

Question 165: A hiker is found unconscious in a cold environment with a core body temperature of 29°C (84.2°F). The patient has a weak, slow pulse and shallow respirations. Which rewarming strategy is most appropriate for this patient during transport?

Vigorous rubbing of the torso and limbs with blankets.
Administration of warmed, humidified oxygen and warmed IV fluids. (Correct answer)
Aggressive application of heating packs to the extremities.
Submersion in a warm water bath.

Correct answer: Administration of warmed, humidified oxygen and warmed IV fluids.

In moderate to severe hypothermia (core temp <32°C), the priority is active core rewarming. Administering warmed, humidified oxygen and warmed intravenous fluids provides heat directly to the patient's core. This method helps prevent 'rewarming shock' or 'afterdrop,' a dangerous phenomenon where cold, acidotic blood from the periphery returns to the central circulation, potentially causing a further drop in core temperature and precipitating ventricular fibrillation. Active external rewarming of the extremities should be avoided until the core temperature begins to rise.

Question 166: Which action is MOST important before initiating a scene flight for a patient with a suspected spinal cord injury?

Apply a cervical collar and long backboard as the primary spinal immobilization strategy
Ensure manual inline stabilization and assess the need for selective spinal immobilization based on clinical criteria (Correct answer)
Administer methylprednisolone 30 mg/kg IV for neuroprotection
Defer airway management until spinal imaging is completed

Correct answer: Ensure manual inline stabilization and assess the need for selective spinal immobilization based on clinical criteria

Current evidence supports selective spinal immobilization using validated criteria (e.g., NEXUS/Canadian C-spine) over universal backboarding.

Question 167: A flight patient post-RSI develops a 'shark fin' or upsloping waveform on capnography. This pattern is MOST consistent with:

Esophageal intubation
Correct ETT placement with normal physiology
Apnea with inadequate ventilator rate
Obstructive disease (bronchospasm or COPD exacerbation) causing incomplete exhalation (Correct answer)

Correct answer: Obstructive disease (bronchospasm or COPD exacerbation) causing incomplete exhalation

A 'shark fin' or upsloping capnography waveform reflects incomplete exhalation due to airflow obstruction, as seen in bronchospasm or COPD.

Question 168: Which pupillary finding is most consistent with uncal herniation in a TBI patient?

Bilateral pinpoint pupils
Unilateral fixed and dilated pupil ipsilateral to the lesion (Correct answer)
Unilateral constricted pupil contralateral to the lesion
Bilateral dilated reactive 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 169: During transport, a TBI patient's EtCO2 reads 28 mmHg. What is the appropriate action?

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

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 170: A patient with a suspected tension pneumothorax develops severe hypotension and tracheal deviation during flight. The CFRN should:

Increase oxygen flow and wait for vital signs to stabilize
Perform immediate needle thoracostomy without waiting for physician order (Correct answer)
Radio medical control and await orders before any intervention
Position patient in Trendelenburg and administer fluid bolus

Correct answer: Perform immediate needle thoracostomy without waiting for physician order

Tension pneumothorax is immediately life-threatening; CFRN scope of practice includes needle thoracostomy as an emergency intervention, and delay risks cardiac arrest.

Question 171: During a rotor-wing transport of a patient with a traumatic brain injury, the flight nurse notes a GCS drop from 11 to 7 and unilateral pupil dilation. What is the most appropriate immediate intervention?

Administer 20% mannitol 1 g/kg IV (Correct answer)
Administer lorazepam for suspected seizure activity
Hyperventilate to a target EtCO2 of 25-30 mmHg
Increase IV fluid rate to 150 mL/hr

Correct answer: Administer 20% mannitol 1 g/kg IV

Mannitol 1 g/kg IV is the standard osmotic therapy for herniation signs in TBI, while hyperventilation is reserved only as a bridge therapy when herniation is imminent and other measures fail.

Question 172: Rocuronium is selected instead of succinylcholine for RSI. What reversal agent is available for rocuronium?

Neostigmine
Physostigmine
Flumazenil
Sugammadex (Correct answer)

Correct answer: Sugammadex

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

Question 173: A 3-kg neonate with ductal-dependent congenital heart disease becomes cyanotic after birth. The most critical pharmacologic intervention to maintain ductal patency is:

Sildenafil 1 mg/kg PO
Indomethacin 0.2 mg/kg IV
Prostaglandin E1 (alprostadil) 0.05–0.1 mcg/kg/min IV infusion (Correct answer)
Nitroglycerin 1 mcg/kg/min IV

Correct answer: Prostaglandin E1 (alprostadil) 0.05–0.1 mcg/kg/min IV infusion

Prostaglandin E1 infusion keeps the ductus arteriosus open in ductal-dependent congenital heart lesions, providing critical pulmonary or systemic blood flow.

Question 174: A CFRN is managing a patient with a tracheostomy whose tube has become dislodged during transport. The stoma is mature (>7 days old). The first intervention should be:

Attempt to replace the tracheostomy tube through the stoma (Correct answer)
Cover the stoma and apply BVM to the mouth
Orotracheal intubation immediately
Insert a nasopharyngeal airway into the stoma

Correct answer: Attempt to replace the tracheostomy tube through the stoma

In a mature stoma (>7 days), the tract is established and the tracheostomy tube should be replaced directly through the stoma as the first intervention.

Question 175: When using a Macintosh laryngoscope blade, the tip of the blade is correctly positioned in which anatomical structure to elevate the epiglottis?

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

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

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

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

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

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.

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%

To Pass

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