Certified Flight Registered Nurse (CFRN) — Questions and Answers

Question 1: What is the correct initial defibrillation dose for a 20 kg child in ventricular fibrillation per current PALS guidelines?

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

Correct answer: 2 J/kg

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

Question 2: Which of the following situations completely rules out nasotracheal intubation?

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

Correct answer: Apnea

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

Question 3: What is the primary purpose of a helicopter Emergency Locator Transmitter (ELT)?

To automatically broadcast distress signals on 406 MHz to satellites after a crash (Correct answer)
To alert ground crews of an imminent landing
To communicate with ATC during flight emergencies
To track fuel consumption in real time

Correct answer: To automatically broadcast distress signals on 406 MHz to satellites after a crash

The ELT automatically activates on impact and broadcasts on 406 MHz to COSPAS-SARSAT satellites to initiate search and rescue.

Question 4: 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?

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

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

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

Correct answer: Hypotension with bradycardia and warm skin

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

Question 6: A patient presents with altered mental status, tachycardia, diaphoresis, and hyperthermia after exposure to an organophosphate insecticide. Which antidote should be administered first?

Pralidoxime (2-PAM)
Flumazenil
N-acetylcysteine
Atropine (Correct answer)

Correct answer: Atropine

Atropine is the first-line antidote for organophosphate poisoning as it blocks muscarinic effects; pralidoxime should follow but atropine takes priority.

Question 7: 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?

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

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

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

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

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

Question 9: A flight nurse is transporting a patient with a closed head injury. Which altitude-related concern is MOST critical?

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

Correct answer: Expansion of intracranial air and worsening ICP

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

Question 10: A tornado has injured several people and left a small village with major damage. The nearest medical facility is 150 miles distant. Although there is only one aircraft available for transfer, ambulances are expected to show there in 15 minutes. Which of the following patients needs to be flown after triage?

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

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

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

Question 11: A 3-year-old weighing 15 kg requires intraosseous (IO) access. After confirming placement, the maximum single fluid bolus volume that should be delivered via IO in this patient is:

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

Correct answer: 300 mL (normal saline)

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

Question 12: A 34-week pregnant patient with severe pre-eclampsia is being transported while receiving a magnesium sulfate infusion. The patient becomes lethargic, her respiratory rate drops to 10 breaths/min, and deep tendon reflexes are absent. What is the flight nurse's most appropriate immediate action?

Prepare the patient for emergent intubation.
Increase the rate of the magnesium sulfate infusion.
Administer a 500 mL bolus of normal saline.
Stop the infusion and administer calcium gluconate. (Correct answer)

Correct answer: Stop the infusion and administer calcium gluconate.

The patient's clinical presentation, including respiratory depression, lethargy, and loss of deep tendon reflexes, are classic signs of magnesium sulfate toxicity. The immediate priority is to stop the infusion and administer the antidote, calcium gluconate, to reverse the life-threatening effects.

Question 13: During air transport, a patient develops a wide-complex tachycardia at 180 bpm with a pulse. The patient is hemodynamically stable. What is the most appropriate initial intervention?

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

Correct answer: Amiodarone 150 mg IV over 10 minutes

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

Question 14: Which of the following readings from an adult's arterial blood gas is consistent with metabolic acidosis?

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

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

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

Question 15: 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

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

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

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

Correct answer: C3-C4 SCI

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

Question 17: 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?

Administering a bronchodilator
Applying 100% supplemental oxygen (Correct answer)
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 18: A 5-year-old with suspected meningitis develops a petechial/purpuric rash en route. The MOST critical immediate intervention is:

Administer IV ceftriaxone immediately (Correct answer)
Perform lumbar puncture to confirm diagnosis
Obtain blood cultures before any antibiotics
Give IV dexamethasone 0.6 mg/kg before antibiotics

Correct answer: Administer IV ceftriaxone immediately

Purpuric rash with meningitis signs suggests meningococcal septicemia; immediate ceftriaxone administration takes priority over cultures or LP in the flight environment.

Question 19: During air transport of a 29-week gestation patient, the flight nurse administers betamethasone. This corticosteroid is given to:

Accelerate fetal lung maturity and reduce RDS risk (Correct answer)
Reduce uterine contractions in preterm labor
Treat fetal anemia detected on Doppler ultrasound
Prevent maternal sepsis from chorioamnionitis

Correct answer: Accelerate fetal lung maturity and reduce RDS risk

Antenatal betamethasone at 24–34 weeks gestation accelerates fetal lung surfactant production, significantly reducing the risk of neonatal respiratory distress syndrome.

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

Administer 10 mL/kg packed red blood cells (Correct answer)
Administer sodium bicarbonate 1 mEq/kg
Start dopamine at 10 mcg/kg/min
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 21: 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)
Nitrogen
Room air

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

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

Correct answer: N-acetylcysteine (NAC)

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

Question 23: 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?

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

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 24: Henry's Law is most clinically relevant for the flight nurse when managing a patient with:

Pulmonary edema
Tension pneumothorax
Decompression sickness after SCUBA diving (Correct answer)
Carbon monoxide poisoning

Correct answer: Decompression sickness after SCUBA diving

Henry's Law states that the amount of gas dissolved in liquid is proportional to its partial pressure; decompression sickness results from nitrogen bubbling out of solution as pressure decreases.

Question 25: Which antidysrhythmic drug is preferred for stable wide-complex tachycardia of uncertain origin during air transport?

Lidocaine
Verapamil
Digoxin
Procainamide (Correct answer)

Correct answer: Procainamide

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

Question 26: During a fixed-wing transport, a patient develops air sickness (motion sickness). The MOST appropriate initial pharmacological intervention is:

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

Correct answer: Ondansetron (Zofran) 4 mg IV

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

Question 27: Which hemodynamic profile is most characteristic of cardiogenic shock?

High SVR, high CO, low PCWP
Low SVR, high CO, low PCWP
High SVR, low CO, high PCWP (Correct answer)
Low SVR, high CO, high 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 28: What is the purpose of applying cricoid pressure (Sellick's maneuver) during RSI?

To facilitate jaw thrust in trauma patients
To improve visualization of the glottis
To stabilize the larynx for intubation
To occlude the esophagus and reduce the risk of passive regurgitation (Correct answer)

Correct answer: To occlude the esophagus and reduce the risk of passive regurgitation

Cricoid pressure compresses the esophagus between the cricoid ring and vertebral body, theoretically reducing the risk of passive regurgitation and aspiration.

Question 29: A pediatric patient (15 kg) requires succinylcholine for rapid sequence intubation. What is the correct dose?

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

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 30: A patient with a TBI is receiving mannitol. What lab value must be monitored to avoid toxicity?

Blood glucose must stay above 200 mg/dL
Serum sodium should be kept below 130 mEq/L
Serum osmolality should remain below 320 mOsm/kg (Correct answer)
Serum potassium must stay above 5.0 mEq/L

Correct answer: Serum osmolality should remain below 320 mOsm/kg

Serum osmolality above 320 mOsm/kg increases risk of mannitol-induced renal failure and paradoxical ICP elevation from mannitol accumulation in brain tissue.

Question 31: 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?

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

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 32: A flight nurse responds to a scene where a patient fell 30 feet from scaffolding and is found supine with paradoxical chest wall movement of the right chest. What injury pattern does this represent and what is the immediate treatment?

Simple rib fractures — apply circumferential chest wrap for stabilization
Open pneumothorax — apply a three-sided occlusive dressing
Hemothorax — needle decompression at the second intercostal space
Flail chest — provide positive pressure ventilation and consider intubation (Correct answer)

Correct answer: Flail chest — provide positive pressure ventilation and consider intubation

Paradoxical chest wall movement indicates flail chest (≥3 consecutive ribs fractured in ≥2 places); treatment focuses on positive pressure ventilation to restore normal chest mechanics and intubation for severe respiratory compromise.

Question 33: A patient in the flight environment has a systolic BP of 70 mmHg, HR 120 bpm, and shows signs of right heart failure. Which vasopressor is preferred to avoid increasing pulmonary vascular resistance?

Norepinephrine (Correct answer)
Dopamine
Phenylephrine
Vasopressin

Correct answer: Norepinephrine

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

Question 34: What is the recommended initial SpO2 target for adult non-COPD patients during air medical transport?

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

Correct answer: 94–98%

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

Question 35: A CFRN is managing a pediatric patient requiring intubation. Which formula correctly estimates uncuffed ETT size for a child?

Age / 2 + 3
(Age + 16) / 4
(Weight in kg / 10) + 3
(Age / 4) + 4 (Correct answer)

Correct answer: (Age / 4) + 4

The formula (Age/4) + 4 estimates uncuffed ETT internal diameter in millimeters for pediatric patients.

Question 36: 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)
Controlled Mandatory Ventilation (CMV)
Pressure Support Ventilation (PSV)
Synchronized Intermittent Mandatory Ventilation (SIMV) (Correct answer)

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 37: A patient in hemorrhagic shock has received 2 units of packed RBCs. The MOST appropriate next step following a balanced resuscitation strategy is to administer:

1 unit of fresh frozen plasma and 1 unit of platelets (Correct answer)
1 amp of sodium bicarbonate
Vasopressin 0.04 units/min drip
2 L of normal saline bolus

Correct answer: 1 unit of fresh frozen plasma and 1 unit of platelets

Balanced (1:1:1) resuscitation with pRBC:FFP:platelets reduces coagulopathy and improves survival in hemorrhagic shock.

Question 38: A patient with a stab wound to zone II of the neck is intubated and hemodynamically stable. During flight, the pilot reports significant turbulence ahead. What is the most important nursing action regarding the airway?

Administer a paralytic to prevent patient movement
Switch to a supraglottic airway device for stability
Request the pilot avoid turbulence at all costs
Confirm ETT position with waveform capnography and secure the tube thoroughly (Correct answer)

Correct answer: Confirm ETT position with waveform capnography and secure the tube thoroughly

Confirming ETT position with waveform capnography and ensuring the tube is well-secured is critical before turbulence to prevent inadvertent extubation in a difficult airway patient.

Question 39: Which breath sound finding is associated with pulmonary edema during auscultation in-flight?

Expiratory wheezing only
Bilateral basilar crackles (rales) (Correct answer)
Stridor
Unilateral absent breath sounds

Correct answer: Bilateral basilar crackles (rales)

Pulmonary edema causes fluid accumulation in the alveoli, producing bilateral fine crackles (rales) heard predominantly at the lung bases.

Question 40: A patient with tricyclic antidepressant (TCA) overdose develops a wide QRS complex and hypotension. What is the treatment of choice?

Sodium bicarbonate IV bolus (Correct answer)
Magnesium sulfate IV bolus
Calcium chloride IV bolus
Amiodarone IV bolus

Correct answer: Sodium bicarbonate IV bolus

Sodium bicarbonate alkalinizes the serum and reverses TCA-induced sodium channel blockade, narrowing the QRS and improving hemodynamics.

Question 41: 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?

Dexamethasone
Nifedipine
Furosemide
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 42: What is the primary mechanism of action of ketamine when used for induction in the flight setting?

Mu-opioid receptor agonism
NMDA receptor antagonism (Correct answer)
Alpha-2 adrenergic agonism
GABA-A receptor agonism

Correct answer: NMDA receptor antagonism

Ketamine produces dissociative anesthesia by blocking NMDA receptors, while preserving airway reflexes and hemodynamic stability.

Question 43: During transport of a septic patient, the flight nurse notes a central venous pressure (CVP) of 2 mmHg. This finding is most consistent with:

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

Correct answer: Hypovolemia requiring fluid resuscitation

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

Question 44: A flight nurse is managing a patient with a penetrating brain injury. Which action is most appropriate regarding the impaled object?

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

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

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

Question 45: A flight nurse prepares to administer ketamine for sedation in a TBI patient. What is the current evidence-based stance on this practice?

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

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

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

Question 46: A patient exposed to chlorine gas at an industrial accident arrives with coughing, wheezing, and conjunctival irritation. What is the priority airway management concern specific to chlorine inhalation?

Expect the symptoms to resolve without intervention within 1 hour
Administer sodium bicarbonate nebulization as primary treatment
Anticipate delayed pulmonary edema up to 24 hours after exposure (Correct answer)
Immediate orotracheal intubation regardless of current status

Correct answer: Anticipate delayed pulmonary edema up to 24 hours after exposure

Chlorine gas exposure can cause delayed-onset pulmonary edema hours after initial exposure, requiring prolonged monitoring even in initially stable patients.

Question 47: Which medication is the first-line osmotic agent for managing elevated ICP during aeromedical transport?

Dexamethasone
Mannitol 20% or hypertonic saline (3% NaCl) (Correct answer)
Albumin 5%
Furosemide alone

Correct answer: Mannitol 20% or hypertonic saline (3% NaCl)

Mannitol and hypertonic saline are the primary osmotic agents used to reduce ICP by drawing fluid from brain tissue into the vasculature.

Question 48: 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

Pneumothorax
Hypovolemia
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 49: A flight nurse is transporting a patient with suspected cardiac tamponade. Which hemodynamic triad (Beck's Triad) is classically associated with this condition?

Pulsus paradoxus, fever, and pleural friction rub
Tachycardia, hypertension, and pulmonary edema
Hypotension, muffled heart sounds, and jugular venous distension (Correct answer)
Hypertension, bradycardia, and widened pulse pressure

Correct answer: Hypotension, muffled heart sounds, and jugular venous distension

Beck's Triad for cardiac tamponade consists of hypotension, muffled heart sounds, and jugular venous distension (JVD).

Question 50: During altitude ascent, a patient with a known subdural hematoma shows acute neurological deterioration. What is the most likely cause?

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

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

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

Question 51: Which of the following represents the MOST significant physiological danger to a patient with a pneumothorax being transported by air medical services, especially during ascent?

Hypoxia due to the lower partial pressure of oxygen at altitude.
Increased pain from vibration and movement of the aircraft.
Development of a tension pneumothorax due to gas expansion. (Correct answer)
Hypothermia from the colder temperatures at higher altitudes.

Correct answer: Development of a tension pneumothorax due to gas expansion.

According to Boyle's Law, as an aircraft ascends and atmospheric pressure decreases, the volume of gas in an enclosed space will expand. For a patient with a pneumothorax, this means the trapped air in the pleural space will expand, potentially converting a simple pneumothorax into a life-threatening tension pneumothorax by compressing the heart and great vessels.

Question 52: 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:

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

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 53: During intubation of a patient in anaphylaxis, which finding of the airway is MOST concerning and warrants immediate surgical airway consideration?

Cherry-red epiglottis with complete supraglottic edema obliterating the glottis (Correct answer)
Mild tongue edema
Uvular edema only
Mild secretions pooling in the oropharynx

Correct answer: Cherry-red epiglottis with complete supraglottic edema obliterating the glottis

Complete supraglottic edema obliterating the glottic opening may make conventional laryngoscopy impossible, requiring immediate surgical cricothyrotomy.

Question 54: A flight nurse is transporting a patient in active preterm labor at 31 weeks gestation. A tocolytic agent, such as terbutaline or nifedipine, is being administered. What is the primary goal of this therapy during transport?

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

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

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

Question 55: Auto-PEEP (intrinsic PEEP) is most likely to develop in which type of transport patient?

Mechanically ventilated COPD or asthma patient with air trapping (Correct answer)
Patient with cardiogenic shock on low respiratory rates
Patient with normal lung compliance on assist-control ventilation
Patient with ARDS on high PEEP settings

Correct answer: Mechanically ventilated COPD or asthma patient with air trapping

Patients with obstructive lung disease (COPD, asthma) develop auto-PEEP due to incomplete exhalation, causing progressive air trapping and hemodynamic compromise.

Question 56: A flight crew is transporting a patient with a pneumothorax from a rural facility at sea level to a trauma center. As the aircraft ascends to cruising altitude, the patient develops increasing respiratory distress, hypotension, and tachycardia. Which gas law best explains this clinical deterioration?

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

Correct answer: Boyle's Law

Boyle's Law states that the volume of a gas is inversely proportional to the pressure exerted upon it, assuming a constant temperature. As the aircraft ascends, the atmospheric pressure decreases, causing the trapped air within the patient's pleural space (pneumothorax) to expand in volume. This expansion can convert a simple pneumothorax into a tension pneumothorax, leading to the observed signs of cardiorespiratory compromise.

Question 57: Which medication is used to rapidly reduce intracranial pressure during air transport of a TBI patient?

Furosemide IV
Hypertonic saline (3% NaCl) or mannitol (Correct answer)
Dexamethasone
Nimodipine

Correct answer: Hypertonic saline (3% NaCl) or mannitol

Hypertonic saline or mannitol creates an osmotic gradient that draws water out of brain tissue, acutely reducing intracranial pressure.

Question 58: Which flight physiology principle explains why sinusitis or ear pain may worsen during aircraft descent?

Gay-Lussac's Law — pressure-temperature relationship
Dalton's Law — partial pressure changes
Henry's Law — gas dissolving into blood
Boyle's Law — gas compression in blocked cavities (Correct answer)

Correct answer: Boyle's Law — gas compression in blocked cavities

During descent, atmospheric pressure rises and gas in blocked sinuses or middle ear cannot equalize, compressing trapped air and causing pain or barotrauma.

Question 59: Rocuronium is selected over succinylcholine for RSI in a flight patient. What dose of rocuronium achieves intubating conditions comparable to succinylcholine?

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

Correct answer: 1.2 mg/kg IV

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

Question 60: During air transport at altitude, a neonate with a congenital diaphragmatic hernia (CDH) deteriorates. The priority intervention is:

Perform needle decompression of the left chest
Increase FiO2 to 1.0 and bag-mask ventilate
Insert an orogastric tube to decompress the stomach (Correct answer)
Administer surfactant intratracheally

Correct answer: Insert an orogastric tube to decompress the stomach

Gas in the herniated bowel expands at altitude, worsening lung compression; OG tube decompression reduces bowel distension and improves ventilation.

Question 61: What is the correct management for a patient with status asthmaticus who is not responding to bronchodilators during transport?

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

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

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

Question 62: 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?

Amanita phalloides (phalloidin toxidrome)
Muscarine toxidrome (e.g., Clitocybe or Inocybe species) (Correct answer)
Gyromitrin toxidrome
Ibotenic acid 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 63: A patient with TBI is being transported and has a seizure lasting 3 minutes. What is the first-line pharmacological treatment?

Lorazepam or diazepam IV (Correct answer)
Phenytoin IV loading dose
Propofol infusion only
Levetiracetam oral route

Correct answer: Lorazepam or diazepam IV

Benzodiazepines (lorazepam or diazepam) are the first-line treatment for acute seizures, including post-traumatic seizures, due to rapid onset and efficacy.

Question 64: A flight patient post-RSI develops a 'shark fin' or upsloping waveform on capnography. This pattern is MOST consistent with:

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

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 65: 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:

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

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 66: A 45-year-old trauma patient with severe maxillofacial injuries cannot be intubated or ventilated effectively with a bag-valve-mask. The flight crew determines a surgical airway is necessary. Which of the following is the most appropriate definitive emergency procedure in this 'can't intubate, can't oxygenate' scenario for an adult?

Needle cricothyrotomy with transtracheal jet ventilation
Emergency tracheostomy
Surgical cricothyrotomy (Correct answer)
Retrograde intubation

Correct answer: Surgical cricothyrotomy

In a "can't intubate, can't oxygenate" (CICO) situation, a surgical cricothyrotomy is the preferred emergency procedure for establishing a definitive airway in an adult. [27, 29] It is faster and requires less surgical expertise than an emergency tracheostomy. [5] Needle cricothyrotomy is considered a temporizing measure and may not provide adequate ventilation, while retrograde intubation is a complex technique not suitable for this emergent scenario. [29]

Question 67: During the transport of a patient who was intubated via Rapid Sequence Intubation (RSI), you observe a capnography waveform that has lost its rectangular shape and now appears rounded, like a 'shark fin'. This waveform is most indicative of what condition?

Esophageal intubation
Bronchospasm (Correct answer)
Return of spontaneous circulation (ROSC)
Hyperventilation

Correct answer: Bronchospasm

A 'shark fin' or sloped appearance of the Phase III alveolar plateau on a capnogram is a classic sign of bronchoconstriction or airway obstruction, such as in asthma or COPD exacerbation. [7] This shape indicates a delay and uneven emptying of the alveoli. Hyperventilation would show a low EtCO2 value, esophageal intubation would show little to no waveform, and ROSC would cause a sudden spike in EtCO2. [7, 13]

Question 68: 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?

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

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

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

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 70: 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?

Labetalol IV (Correct answer)
Nifedipine PO
Hydralazine IV
Magnesium sulfate 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 71: While transporting a patient with suspected cyanide poisoning from an industrial fire, which finding most specifically suggests cyanide toxicity over simple CO poisoning?

Elevated venous oxygen saturation with profound metabolic acidosis (Correct answer)
Bradycardia and miosis
Cherry-red skin discoloration
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 72: A patient with a spinal cord injury at C4 is being transported. What immediate respiratory concern should the flight nurse anticipate?

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

Correct answer: Loss of diaphragmatic function requiring ventilatory support

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

Question 73: A patient with a C5 spinal cord injury is being transported on a backboard. What pressure injury concern requires immediate attention?

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

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 74: A construction worker collapsed after working in a confined space. Bystanders report the smell of rotten eggs. Which immediate action is most important for the flight crew's safety?

Enter immediately and begin CPR
Administer oxygen to the patient from a distance
Don self-contained breathing apparatus before approaching the patient (Correct answer)
Call for hazmat support and wait indefinitely

Correct answer: Don self-contained breathing apparatus before approaching the patient

Hydrogen sulfide is immediately dangerous to life; crew must use SCBA before entering the space to avoid becoming secondary victims.

Question 75: During pediatric transport at altitude, a child with a pneumothorax has a chest tube in place draining to a water-seal device. The flight nurse should:

Increase suction to -30 cmH2O during flight
Clamp the chest tube to prevent air entry
Convert to a one-way Heimlich valve before ascent
Keep the device unclamped and below chest level (Correct answer)

Correct answer: Keep the device unclamped and below chest level

The chest tube should remain unclamped and the drainage device kept below chest level to allow continuous drainage as gas expands at altitude.

Question 76: According to the American College of Surgeons, Class III hemorrhagic shock is characterized by blood loss of approximately:

Up to 750 mL (up to 15% blood volume)
750–1500 mL (15–30% blood volume)
Greater than 2000 mL (>40% blood volume)
1500–2000 mL (30–40% blood volume) (Correct answer)

Correct answer: 1500–2000 mL (30–40% blood volume)

Class III hemorrhage (30–40% blood volume loss) manifests with marked tachycardia, tachypnea, altered mental status, and hypotension.

Question 77: A burn patient sustained 45% TBSA partial and full thickness burns 2 hours ago. Using the Parkland formula, what is the correct fluid volume for the first 8 hours?

4 mL × 80 kg × 45% TBSA, half over 8 hours from time of burn (Correct answer)
2 mL × 80 kg × 45% TBSA, half over first 16 hours
2 mL × 80 kg × 45% TBSA, entire amount over 8 hours
4 mL × 80 kg × 45% TBSA, entire amount over 24 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 78: As he waits to be airlifted from a tiny rural hospital to a university hospital 200 miles from the scene of the accident for possible limb reattachment, a homeless guy who had recently suffered a horrific below-knee amputation turns violent and disoriented. Which of the following is the most appropriate initial action?

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

Correct answer: Provide physical restraints or chemical restraints

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

Question 79: During a rotor-wing transport at 8,000 feet MSL, an unventilated pneumothorax is most likely to worsen because of which gas law?

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

Correct answer: Boyle's Law

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

Question 80: 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 just before systole (Correct answer)
Inflate during systole, deflate during diastole
Inflate during diastole, deflate during mid-systole
Inflate continuously at a fixed rate

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 81: When transporting a patient with a closed head injury at altitude, a CFRN should be most concerned about which secondary effect of altitude?

Tachycardia induced by altitude-related stress response
Increased intracranial pressure secondary to hypoxia and gas expansion (Correct answer)
Worsening coagulopathy from cold temperature in the cabin
Decreased medication absorption due to low pressure

Correct answer: Increased intracranial pressure secondary to hypoxia and gas expansion

Altitude-related hypoxia can increase cerebral vasodilation and ICP, while any trapped intracranial gas expands per Boyle's Law, worsening head injury outcomes.

Question 82: What is the recommended tidal volume for lung-protective ventilation in a patient with ARDS during transport?

6–8 mL/kg IBW (Correct answer)
12–15 mL/kg IBW
4–5 mL/kg IBW
10–12 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 83: 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?

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

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 84: A flight nurse is transporting a patient with an endotracheal tube inflated with air at sea level. At altitude, the cuff pressure will most likely:

Increase due to expansion of trapped air (Correct answer)
Remain unchanged because the cuff is sealed
Decrease due to tracheal dilation
Decrease due to lower atmospheric pressure

Correct answer: Increase due to expansion of trapped air

Air in the ETT cuff expands at altitude per Boyle's Law, increasing cuff pressure and risking tracheal mucosal ischemia.

Question 85: A patient receiving a heparin infusion develops acute HIT (Heparin-Induced Thrombocytopenia). Which action is the priority?

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

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

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

Question 86: Which ECG finding is most consistent with hyperkalemia in a patient being transported after a crushing injury?

Shortened PR interval and tall P waves
ST segment depression and U waves
Peaked T waves and widened QRS complex (Correct answer)
Prolonged QT interval and delta waves

Correct answer: Peaked T waves and widened QRS complex

Hyperkalemia classically causes peaked (tall, narrow) T waves and progressive QRS widening, which can degrade into a sine-wave pattern.

Question 87: During high-altitude transport, a mechanically ventilated patient's tidal volume delivered by a flow-triggered transport ventilator increases unexpectedly. What is the most likely cause?

Increased airway resistance from bronchospasm
Increased lung compliance
Decreased ambient pressure causing the ventilator to deliver more volume to achieve set pressure (Correct answer)
Right mainstem intubation

Correct answer: Decreased ambient pressure causing the ventilator to deliver more volume to achieve set pressure

In pressure-controlled modes, lower ambient pressure at altitude means the ventilator delivers more volume to achieve the set driving pressure, potentially causing volutrauma.

Question 88: Which intervention is indicated for a massive hemothorax identified during air transport?

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

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

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

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

Metabolic alkalosis
Hypocalcemia
Hyperkalemia (Correct answer)
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 90: During a rotor transport at high altitude, a patient with STEMI receives fibrinolytic therapy. Which finding represents a sign of successful reperfusion?

Persistent ST elevation and absence of chest pain
Increase in serum troponin levels
New-onset complete heart block
Development of accelerated idioventricular rhythm (AIVR) and decreasing ST elevation (Correct answer)

Correct answer: Development of accelerated idioventricular rhythm (AIVR) and decreasing ST elevation

Reperfusion after fibrinolysis is suggested by accelerated idioventricular rhythm, resolution of ST elevation, and relief of chest pain.

Question 91: When transporting a patient with suspected ectopic pregnancy at 8 weeks who is hemodynamically unstable, which assessment finding BEST confirms rupture?

Unilateral adnexal tenderness on palpation
Positive urine beta-hCG with no visible IUP
Absence of intrauterine pregnancy on portable ultrasound
Referred shoulder pain (Kehr's sign) and peritoneal signs (Correct answer)

Correct answer: Referred shoulder pain (Kehr's sign) and peritoneal signs

Kehr's sign (referred shoulder pain from diaphragmatic irritation by hemoperitoneum) combined with peritoneal signs indicates ruptured ectopic with free abdominal bleeding.

Question 92: A hiker rescued from a high-altitude environment develops pulmonary edema at 14,000 feet. What is the most appropriate initial intervention?

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

Correct answer: Descend immediately and administer supplemental oxygen

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

Question 93: To commit suicide, a 17-year-old girl ingested an excessive amount of acetaminophen (thirty 500-mg pills). She informed her parents, who made an emergency call eight hours later. Which of the subsequent initial emergency treatments is appropriate?

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

Correct answer: N-acetylcysteine

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

Question 94: A patient with a traumatic brain injury has a blood pressure of 110/70 mmHg and an intracranial pressure (ICP) of 20 mmHg. What is the patient's Cerebral Perfusion Pressure (CPP), and is it adequate?

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

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

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

Question 95: Which IV fluid is MOST appropriate for initial resuscitation of a burn patient during aeromedical transport?

Lactated Ringer's solution (Correct answer)
3% Hypertonic Saline
D5W
0.45% Normal 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 96: An airplane made a rough landing after experiencing technical issues. Once in secure ground contact, the crew is aware of what to

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

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

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

Question 97: A CFRN is assessing a patient for potential time of useful consciousness (TUC) after cabin decompression. At 25,000 feet, TUC is approximately:

2–3 hours
10–15 minutes
30–60 seconds (Correct answer)
3–5 minutes

Correct answer: 30–60 seconds

At 25,000 feet the TUC is approximately 3–5 minutes; at 35,000+ feet it drops to 30–60 seconds, requiring immediate oxygen supplementation.

Question 98: Which weather condition most commonly contributes to helicopter EMS accidents?

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

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

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

Question 99: After a car accident, a 50-year-old guy with chest trouble is being transported by the flying crew. On the right side of the midlung field, an air space consolidation may be seen on a chest radiograph. This discovery suggests that

Pneumothorax
Hemothorax
Cardiac tamponade
Pulmonary contusion (Correct answer)

Correct answer: Pulmonary contusion

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

Question 100: A trauma patient is found unresponsive with decorticate posturing. Which brain region is most likely affected?

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

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 101: Which electrolyte imbalance is most commonly associated with torsades de pointes?

Hypernatremia
Hypomagnesemia (Correct answer)
Hypercalcemia
Hyperkalemia

Correct answer: Hypomagnesemia

Hypomagnesemia prolongs the QT interval and is the most common electrolyte trigger for torsades de pointes; magnesium sulfate is the treatment.

Question 102: A CFRN is transporting a combative, intoxicated patient who requires restraints. During a period of turbulence, the patient becomes increasingly agitated. Which concept of crew resource management (CRM) is most important for the nurse to utilize first?

Situational Awareness, by focusing solely on the patient's medical needs.
Communication, by clearly stating the situation and need for assistance to the other crew members. (Correct answer)
Workload Management, by asking the pilot to assist with the patient.
Decision Making, by immediately administering a sedative without consultation.

Correct answer: Communication, by clearly stating the situation and need for assistance to the other crew members.

Effective crew resource management hinges on clear, direct communication. In this scenario, the nurse's first action should be to communicate the problem to the entire team (pilot and other medical crew). This ensures everyone is aware of the safety threat, can anticipate needs, and can contribute to a solution, such as having the other medical crew member assist or preparing for a potential diversion.

Question 103: 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:

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.
Signs of hypovolemia, such as hypotension, will appear much earlier than in a non-pregnant patient.

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 104: A 2-week-old term neonate presents with poor feeding, hypotonia, and a serum sodium of 118 mEq/L. The SAFEST rate of sodium correction is:

Bolus 2 mL/kg of 3% NaCl and repeat every 15 minutes until 125 mEq/L
Give isotonic NS at 20 mL/kg boluses until symptoms resolve
Correct sodium to normal within 4 hours using 3% NaCl
Increase serum sodium no faster than 0.5 mEq/L/hr (max 10–12 mEq/L/24 hr) (Correct answer)

Correct answer: Increase serum sodium no faster than 0.5 mEq/L/hr (max 10–12 mEq/L/24 hr)

Overcorrection of hyponatremia risks osmotic demyelination; the safe rate is no faster than 0.5 mEq/L/hr or 10–12 mEq/L per 24 hours.

Question 105: A flight nurse has just intubated a patient and is confirming tube placement. Which method is considered the gold standard for confirming endotracheal tube placement in a patient with a perfusing rhythm?

Auscultation of bilateral breath sounds and absence of epigastric sounds
Visualization of the tube passing through the vocal cords
Continuous waveform capnography showing a consistent waveform (Correct answer)
Persistent color change on a colorimetric CO2 detector

Correct answer: Continuous waveform capnography showing a consistent waveform

Continuous waveform capnography is the most reliable method and considered the gold standard for confirming and continuously monitoring endotracheal tube placement. [7] It provides a real-time physiological measurement of CO2 in exhaled air. While the other methods are important parts of the assessment process, they are not as definitive. Auscultation can be misleading, visualization confirms initial placement but not its continued position, and colorimetric devices can have false positives. [2, 7]

Question 106: According to Boyle's Law, what happens to a gas-filled space (e.g., pneumothorax) as aircraft altitude increases?

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

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

Hypertension, proteinuria, and severe headache with visual disturbances.
A gradual onset of intermittent, dull lower back pain with cervical effacement.
Sudden onset of severe abdominal pain, a rigid uterus, and dark red bleeding. (Correct answer)
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 108: The emergency locator transmitter (ELT) of an airplane transmits distress signals on the frequency of 121.5 MHz, which are picked up by

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

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

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

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

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

Question 110: During RSI in a patient with a suspected difficult airway, which backup airway device should be immediately available if intubation fails?

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

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

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

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

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

Correct answer: Ketamine (traditional concern)

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

Question 112: A patient was stung by multiple Africanized honeybees and is now showing signs of anaphylaxis. After administering epinephrine, which additional medication is most critical in flight?

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

Correct answer: IV corticosteroids and IV antihistamines

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

Question 113: 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
Immediate anaphylactic shock
Hemolysis, DIC, and acute renal failure (Correct answer)
Neurotoxic respiratory failure

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 114: 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?

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

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

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

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

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

Question 116: 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?

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

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 117: Long-distance, high-altitude fixed-wing transport is being used to move a patient with pulmonary edema. Because of the patient's worsening respiratory condition, bi-level positive airway pressure (BiPAP) treatment is started. How many centimeters of water (cm H2O) should be set as the initial pressure setting for inhalational positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP)?

25/15
6/3
10/5 (Correct answer)
40/20

Correct answer: 10/5

In the case of a patient with pulmonary edema being transported via long-distance, high-altitude, fixed-wing transport and experiencing a deteriorating respiratory status, initiating bi-level positive airway pressure (BiPAP) therapy can be beneficial. The initial pressure settings for inspiratory positive airway pressure/expiratory positive airway pressure (IPAP/EPAP) typically depend on the individual patient's condition and the recommendations of the medical professionals involved. However, a common starting point for IPAP/EPAP settings in this scenario is 10/5 centimeters of water (cm H2O).

Question 118: 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
Initiate chest compressions immediately
Perform MR. SOPA corrective steps (mask adjustment, reposition, suction, open mouth, pressure increase, alternative airway) (Correct answer)
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 119: Which type of transport aircraft provides the most stable platform for performing advanced interventions such as defibrillation or surgical airways?

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

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 120: A 45-year-old male involved in a blast injury from an improvised explosive device presents with tympanic membrane rupture, respiratory distress with hemoptysis, and abdominal pain. These findings are consistent with which phase of blast injury?

Tertiary blast injury from patient displacement
Secondary blast injury from fragmentation projectiles
Primary blast injury from overpressure wave damage to air-filled structures (Correct answer)
Quaternary blast injury from structural collapse

Correct answer: Primary blast injury from overpressure wave damage to air-filled structures

Primary blast injury is caused by the overpressure wave directly affecting air-filled organs such as the tympanic membranes, lungs (blast lung), and gastrointestinal tract.

Question 121: A flight nurse administers adenosine 6 mg IV push for SVT. The patient does not convert. What is the correct next dose?

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

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

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

Correct answer: 150 mg over 10 minutes

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

Question 123: 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
Place bilateral chest tubes prophylactically
Administer epinephrine IV

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 124: When utilizing the Broselow Pediatric Emergency Tape on a critically ill child, the flight nurse places the red end at the child's head. The measurement corresponding to the child's heels falls within the purple color zone. This information primarily provides the user with:

The child's exact age and allergy information.
Estimated weight, pre-calculated drug doses, and equipment sizes. (Correct answer)
A definitive diagnosis based on the color zone.
The percentage of body surface area burned.

Correct answer: Estimated weight, pre-calculated drug doses, and equipment sizes.

The Broselow Tape is a length-based resuscitation tool. By measuring the child from head ('red to head') to heel, the corresponding color zone provides a rapid estimation of the child's weight. Within that color zone, the tape provides pre-calculated medication dosages and sizes for critical equipment such as endotracheal tubes, catheters, and chest tubes, reducing the cognitive load and potential for error during a pediatric emergency.

Question 125: A trauma patient with a suspected high thoracic spinal cord injury presents with a blood pressure of 80/40 mmHg, a heart rate of 52 bpm, and warm, dry skin. This clinical picture is most consistent with which type of shock?

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

Correct answer: Neurogenic shock

Neurogenic shock, a form of distributive shock, results from the loss of sympathetic tone following a spinal cord injury (typically above T6). This leads to massive vasodilation and a decreased heart rate (bradycardia) due to unopposed vagal stimulation. The combination of hypotension and bradycardia, along with warm, dry skin from peripheral vasodilation, is the classic presentation. [5, 29, 18] Other forms of shock are typically associated with tachycardia as a compensatory mechanism.

Question 126: Which of the following patients poses the GREATEST risk for decompression sickness during air transport?

A patient who completed SCUBA diving 4 hours ago (Correct answer)
A patient with a simple closed femur fracture
A patient who underwent laparoscopic surgery 48 hours ago
A patient recovering from uncomplicated appendectomy

Correct answer: A patient who completed SCUBA diving 4 hours ago

Nitrogen bubbles from recent SCUBA diving can expand and cause decompression sickness when cabin altitude increases; standard guidance is to wait 12–24 hours before flying after diving.

Question 127: 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
Hypertonic saline 250 mL bolus
Packed red blood cells and fresh frozen plasma (Correct answer)
Lactated Ringer's 1 L 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 128: During flight transport of a patient with suspected carbon monoxide poisoning, the pulse oximeter reads 98%. What is the most accurate interpretation?

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

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

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

Question 129: During air transport, a patient with severe hypothermia (core temp 28°C) develops ventricular fibrillation. After the first defibrillation attempt fails, what is the most appropriate next action?

Administer amiodarone and continue CPR while actively rewarming
Increase defibrillation energy to maximum immediately
Withhold further defibrillation until core temperature exceeds 30°C (Correct answer)
Continue repeated defibrillation attempts every 2 minutes

Correct answer: Withhold further defibrillation until core temperature exceeds 30°C

Below 30°C, the hypothermic heart is refractory to defibrillation; current guidelines recommend withholding additional shocks until rewarming achieves at least 30°C.

Question 130: A 10-year-old girl who lived in a gated neighborhood was driving a golf cart when she lost control of it, was ran over by the automobile, and had a serious open tibia/fibula fracture. The youngster had many "road rash" wounds and contusions to her face and torso when emergency medical services (EMS) arrived. She also seemed to be in shock and was bleeding from her damaged leg. Which of the following assertions about compressible limb hemorrhage treatment is accurate?

Commercial tourniquet application should take place early in management of limb hemorrhage
A commercial tourniquet should be applied to the injured extremity distal to the site of the bleeding
Direct pressure should be applied on the site of the wound hemorrhage
Bulky dressings applied to treat hemorrhage may be ineffective at controlling bleeding (Correct answer)

Correct answer: Bulky dressings applied to treat hemorrhage may be ineffective at controlling bleeding

The initial step in treating patients who have suffered serious limb injuries that have resulted in bleeding should be the rapid application of strong direct pressure in the management of compressible extremities hemorrhage. If continuous direct pressure can be administered and sustained by the transport provider, bleeding can typically be stopped in parts of the body that can be easily compressed—the extremities and scalp. The transport provider should make sure they are exerting pressure properly if this intervention doesn't help to quickly reduce or stop the bleeding. applied direct pressure

Question 131: When performing rapid sequence intubation, succinylcholine is contraindicated in which patient population due to risk of fatal hyperkalemia?

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

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 132: Which clinical finding differentiates central cord syndrome from anterior cord syndrome?

Central cord has greater motor weakness in arms than legs; anterior cord has complete motor loss but preserves posterior column function (Correct answer)
Central cord has complete motor and sensory loss; anterior cord has only sensory deficits
Central cord and anterior cord have identical presentations
Central cord preserves all motor function; anterior cord eliminates all sensation

Correct answer: Central cord has greater motor weakness in arms than legs; anterior cord has complete motor loss but preserves posterior column function

Central cord syndrome disproportionately affects the upper extremities and bladder function; anterior cord syndrome causes loss of motor function and pain/temperature but spares proprioception and vibration.

Question 133: Which drug class is used to treat alcohol withdrawal seizures and delirium tremens during transport?

Opioids
Benzodiazepines (Correct answer)
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 134: During a flight transport, a patient's endotracheal tube cuff pressure should be maintained at what range to prevent tracheal mucosal ischemia?

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

Correct answer: 20-30 cmH2O

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

Question 135: A transport patient with COPD has a PaCO2 of 78 mmHg and pH of 7.22. What ventilator adjustment addresses the respiratory acidosis?

Add bronchodilators only
Decrease FiO2
Increase respiratory rate or tidal volume to increase minute ventilation (Correct answer)
Increase PEEP

Correct answer: Increase respiratory rate or tidal volume to increase minute ventilation

Increasing minute ventilation (via rate or tidal volume) enhances CO2 elimination, raising pH and correcting respiratory acidosis.

Question 136: A TBI patient in transport develops diabetes insipidus (DI). Which set of findings confirms this diagnosis?

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

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 137: 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?

Autonomic dysreflexia triggered by a noxious stimulus below the level of injury (Correct answer)
Sympathetic storming from diffuse axonal injury
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 138: A patient arrives with suspected iron overdose. After stabilization, which antidote is used for significant iron toxicity?

Calcium EDTA
Succimer (DMSA)
Dimercaprol (BAL)
Deferoxamine (Correct answer)

Correct answer: Deferoxamine

Deferoxamine is a chelating agent that binds free iron to form ferrioxamine, which is then renally excreted, and is the specific antidote for iron toxicity.

Question 139: 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)
Start two large-bore IVs and begin crystalloid resuscitation
Perform a focused assessment with sonography for trauma (FAST)
Splint the femur and reassess pulses

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 140: 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?

Tricyclic antidepressant (TCA) toxicity, requiring sodium bicarbonate. (Correct answer)
Beta-blocker toxicity, requiring glucagon.
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 141: During a rotor-wing transport, a mechanically ventilated patient develops sudden loss of breath sounds on the left with tracheal deviation to the right. The CFRN should first suspect:

Right mainstem intubation
Left tension pneumothorax (Correct answer)
ETT cuff herniation
Mucus plug obstruction

Correct answer: Left tension pneumothorax

Absent left breath sounds with tracheal deviation to the right in a ventilated patient is classic for left tension pneumothorax requiring immediate needle decompression.

Question 142: Which medication should be given prophylactically during RSI for TBI to blunt the ICP spike from laryngoscopy?

Atropine 0.5 mg IV immediately before succinylcholine
Fentanyl 3 mcg/kg as the paralytic agent
Lidocaine 1.5 mg/kg IV given 3 minutes before intubation (Correct answer)
Midazolam 0.1 mg/kg as the sole premedication

Correct answer: Lidocaine 1.5 mg/kg IV given 3 minutes before intubation

Lidocaine IV given 3 minutes before laryngoscopy may blunt the catecholamine surge and ICP increase associated with airway manipulation in TBI patients.

Question 143: 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 144: Which altitude-related physiological change MOST significantly affects a patient with a closed pneumocephalus (air in the cranial vault)?

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

Correct answer: Expansion of intracranial air increasing ICP

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

Question 145: A patient is being transported with an ECG showing an acute inferior wall ST-elevation myocardial infarction (STEMI). The patient suddenly develops a heart rate of 38, becomes hypotensive, and complains of dizziness. Which of the following interventions is MOST appropriate?

Immediate synchronized cardioversion at 100 joules.
Administering a 2-liter bolus of normal saline.
Administering atropine 0.5 mg IV and preparing for transcutaneous pacing. (Correct answer)
Administering lidocaine 1 mg/kg IV push.

Correct answer: Administering atropine 0.5 mg IV and preparing for transcutaneous pacing.

Symptomatic bradycardia is a common complication of inferior wall MI due to ischemia of the SA or AV nodes, which are often supplied by the right coronary artery. The first-line treatment for symptomatic bradycardia according to ACLS guidelines is atropine. If atropine is ineffective, transcutaneous pacing is the next step.

Question 146: During transport of a patient with a severe traumatic brain injury, the flight nurse notes Cushing's triad. Which set of findings correctly identifies Cushing's triad?

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

Correct answer: Hypertension, bradycardia, and irregular respirations

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

Question 147: 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).
Administer a vasopressor agent like norepinephrine.
Place the patient in a steep Trendelenburg position.
Manually displace the uterus to the left. (Correct answer)

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

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

Correct answer: Thrombocytopenia and elevated liver enzymes

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

Question 149: 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
Hypertensive emergency from pain
Neurogenic shock
Autonomic dysreflexia (Correct answer)

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

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

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 151: A flight nurse is assessing a trauma patient with an obvious open book pelvic fracture. The patient has a Foley catheter in place and 50 mL of gross blood is seen in the drainage bag. What does this finding most likely indicate?

Urethral or bladder injury requiring urologic evaluation (Correct answer)
Bladder contusion from blunt impact
Renal laceration with hematuria draining through the ureter
Normal finding in pelvic fracture patients due to retroperitoneal hematoma pressure

Correct answer: Urethral or bladder injury requiring urologic evaluation

Gross hematuria in a patient with a pelvic fracture strongly suggests associated urethral or bladder injury, which must be evaluated urologically; a Foley catheter should not have been placed if urethral injury was suspected.

Question 152: A flight nurse is transporting a patient at 36 weeks gestation who suddenly develops severe abdominal pain, rigid uterus, and fetal bradycardia. These findings are MOST consistent with:

Preterm labor
Uterine rupture
Placenta previa
Placental abruption (Correct answer)

Correct answer: Placental abruption

Sudden severe abdominal pain, board-like uterine rigidity, and acute fetal distress are classic signs of placental abruption.

Question 153: Which pupillary finding is most consistent with uncal herniation in a TBI patient?

Unilateral fixed and dilated pupil ipsilateral to the lesion (Correct answer)
Bilateral pinpoint pupils
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 154: During air transport, a patient's endotracheal tube cuff is inflated with air. What is the recommended management?

Add extra air to compensate for altitude changes
Leave cuff pressure unchanged; air fluctuation is negligible
Deflate the cuff completely during flight
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 155: A flight nurse is assessing a patient with suspected cardiac tamponade after a stab wound to the chest. Which classic triad of findings supports this diagnosis?

Hypertension, tachycardia, and distended neck veins
Tachycardia, fever, and pulsus paradoxus >20 mmHg
Hypotension, muffled heart sounds, and distended neck veins (Beck's triad) (Correct answer)
Hypotension, bradycardia, and absent breath sounds

Correct answer: Hypotension, muffled heart sounds, and distended neck veins (Beck's triad)

Beck's triad of cardiac tamponade consists of hypotension, muffled heart sounds, and distended neck veins due to impaired cardiac filling from pericardial fluid accumulation.

Question 156: A family of three is rescued from a house fire. All are awake but complain of severe headaches and dizziness. The pulse oximeter reads 99% on room air for all three patients. Which of the following is the most critical initial intervention for suspected carbon monoxide (CO) poisoning?

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

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

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

Question 157: A 4-year-old presents with sudden onset drooling, a muffled 'hot potato' voice, trismus, and unilateral tonsillar bulging with uvular deviation. The most likely diagnosis requiring surgical consultation is:

Epiglottitis
Peritonsillar abscess (Correct answer)
Severe croup (subglottic stenosis)
Retropharyngeal abscess

Correct answer: Peritonsillar abscess

Unilateral peritonsillar bulging with uvular deviation away from the affected side and trismus are classic signs of peritonsillar abscess requiring drainage.

Question 158: When performing a primary survey on a multi-system trauma patient in the flight environment, which finding during 'Circulation' assessment takes priority over all others?

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

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

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

Question 159: A 2-year-old ingested a button battery 2 hours ago. X-ray confirms the battery is lodged in the esophagus. The flight nurse should anticipate the need for:

Observation and serial X-rays only
Emergent endoscopic removal within 2 hours of ingestion (Correct answer)
High-dose steroids to reduce inflammation
Gastric lavage en route

Correct answer: Emergent endoscopic removal within 2 hours of ingestion

Esophageal button battery ingestion causes rapid liquefactive necrosis and requires emergent endoscopic removal, ideally within 2 hours.

Question 160: Which finding during waveform capnography indicates esophageal intubation?

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

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

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 equals hemoglobin concentration divided by cardiac output
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 162: A transport patient on a fentanyl infusion develops rigidity of the chest wall. What is the immediate treatment?

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

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

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

Question 163: When should the flight nurse perform RSI for a head-injured patient with a GCS of 8?

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

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

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

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

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

Question 165: A 16-month-old presents with multiple bruises in various stages of healing, a posterior rib fracture on X-ray, and a history inconsistent with the injury pattern. The flight nurse's priority is:

Defer reporting to the receiving physician only
Document and notify receiving facility of suspected non-accidental trauma (Correct answer)
Confront the caregivers directly before transport
Discharge after pain management and advise the family to follow up

Correct answer: Document and notify receiving facility of suspected non-accidental trauma

Posterior rib fractures and inconsistent history are hallmarks of non-accidental trauma; the flight nurse must document findings and notify the receiving team per mandatory reporting obligations.

Question 166: 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?

Hyperventilate to a target EtCO2 of 25-30 mmHg
Administer lorazepam for suspected seizure activity
Administer 20% mannitol 1 g/kg IV (Correct answer)
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 167: A 6-year-old with known type 1 diabetes is unresponsive with a blood glucose of 28 mg/dL and no IV access. The most appropriate immediate treatment is:

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

Correct answer: Glucagon 1 mg IM

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

Question 168: A patient with a basilar skull fracture is exhibiting CSF rhinorrhea. What intervention is contraindicated?

Cervical spine immobilization
Continuous SpO2 monitoring
IV fluid resuscitation
Nasogastric tube insertion (Correct answer)

Correct answer: Nasogastric tube insertion

Nasogastric tube insertion is contraindicated in basilar skull fracture due to risk of the tube entering the cranial vault through the fractured cribriform plate.

Question 169: In an aircraft ditching scenario, what is the recommended brace position for a rear-facing passenger?

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

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

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

Question 170: Which scoring tool is used specifically to predict outcomes and guide prognosis discussions for moderate-to-severe TBI patients during transport handoff?

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

Correct answer: IMPACT score or Marshall CT Classification

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

Question 171: What is the primary risk of administering 100% FiO2 for extended periods during flight transport?

Hypercapnia
Pulmonary hypertension
Hypoglycemia
Absorption atelectasis and oxygen toxicity (Correct answer)

Correct answer: Absorption atelectasis and oxygen toxicity

Prolonged 100% FiO2 causes nitrogen washout, absorption atelectasis, and oxygen-induced lung injury (oxygen toxicity) over time.

Question 172: A patient with a diffuse axonal injury (DAI) is being transported. What GCS range and CT finding is most characteristic of DAI?

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

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

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

Question 173: A patient who achieved Return of Spontaneous Circulation (ROSC) after a witnessed out-of-hospital cardiac arrest remains comatose. The flight crew initiates Targeted Temperature Management (TTM) during transport. What is the recommended target temperature range to be maintained for at least 24 hours?

28°C to 30°C
37.5°C to 38.5°C
30°C to 32°C
32°C to 36°C (Correct answer)

Correct answer: 32°C to 36°C

Current AHA and ILCOR guidelines recommend Targeted Temperature Management for comatose adult patients after cardiac arrest. The goal is to select and maintain a constant temperature between 32°C and 36°C for at least 24 hours to improve neurological outcomes. Actively preventing fever is a key component of this strategy.

Question 174: 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.

lorazepam (Ativan), 1 to 2 mg IV.
haloperidol (Haldol), 0.5 to 2 mg IV. (Correct answer)
Clonidine (Duraclon), .0.1 mg PO.
Midazolam (Versed) 0.5 to 1 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 175: During aeromedical transport, lateral uterine displacement in a third-trimester patient is performed to prevent:

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

Correct answer: Aortocaval compression syndrome

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

Question 176: A CFRN is preparing to intubate an obese patient. What positioning modification is most beneficial for preoxygenation and intubation success?

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

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

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

Question 177: A CFRN confirms ETT placement with waveform capnography but SpO2 remains at 88% despite FiO2 of 100%. What is the most likely cause?

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

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.

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.

Questions

35 min

Time Limit

72%

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