CFRN General 3 — Questions and Answers
Question 1: During rotor-wing transport, a patient becomes combative. The flight nurse's FIRST priority is:
- Administer sedation immediately
- Notify the receiving hospital
- Ensure crew and aircraft safety before clinical intervention (Correct answer)
- Restrain the patient's arms to the stretcher
Correct answer: Ensure crew and aircraft safety before clinical intervention
Scene and crew safety always takes priority in aeromedical transport; a combative patient threatening aircraft control requires safety measures before clinical management.
Question 2: When performing a pre-flight patient assessment, which condition would most likely require a pressurized fixed-wing aircraft rather than a rotor-wing?
- Hemodynamically stable STEMI patient requiring cath lab within 60 miles
- Trauma patient in hemorrhagic shock with pneumothorax needing altitude restriction
- Burn patient requiring transport over 500 miles with altitude-sensitive wounds (Correct answer)
- Pediatric patient with stable respiratory infection
Correct answer: Burn patient requiring transport over 500 miles with altitude-sensitive wounds
Long-distance transports (>150–200 miles) where altitude control is essential favor fixed-wing pressurized aircraft, combining range and the ability to maintain lower cabin altitude.
Question 3: A CFRN is preparing to transport a neonate. Which physiologic characteristic makes neonates especially vulnerable to hypothermia during flight?
- High body fat percentage insulating core
- Large surface-area-to-body-mass ratio (Correct answer)
- Mature thermoregulatory shivering mechanism
- Elevated baseline metabolic rate
Correct answer: Large surface-area-to-body-mass ratio
Neonates have a large surface-area-to-body-mass ratio, thin skin, minimal subcutaneous fat, and an immature shivering mechanism, making them highly susceptible to heat loss.
Question 4: Which communication technique is MOST recommended for flight nurses using crew resource management (CRM)?
- Deferring all decisions to the pilot in command
- Closed-loop communication with read-back confirmation (Correct answer)
- Using medical jargon to maintain crew professionalism
- Minimizing radio communication to reduce distractions
Correct answer: Closed-loop communication with read-back confirmation
Closed-loop communication — where the receiver repeats back the message for confirmation — is a cornerstone of CRM and reduces critical errors in high-noise aviation environments.
Question 5: A CFRN is transporting a patient with a chest tube connected to a water-seal drainage system. What is the primary concern at altitude?
- The water seal will freeze at cruising altitude
- Increasing altitude may allow air to re-enter the pleural space through the seal (Correct answer)
- The drainage tubing will kink under negative pressure
- Decreased cabin humidity will evaporate the water seal
Correct answer: Increasing altitude may allow air to re-enter the pleural space through the seal
As altitude increases, expanding gases in the pleural space can force air backward through the water seal; a Heimlich valve or clamping during climb may be indicated.
Question 6: Which IV fluid consideration is MOST important when preparing for aeromedical transport?
- Use colloids exclusively due to lower expansion at altitude
- Glass bottles are preferred over plastic bags at altitude
- Air-vented IV tubing sets should be used over all liquid bags
- Plastic IV bags perform better than glass bottles as altitude increases (Correct answer)
Correct answer: Plastic IV bags perform better than glass bottles as altitude increases
Glass IV bottles contain a fixed air space that expands at altitude, potentially altering drip rates or causing air embolism; plastic bags, being collapsible, are preferred for air transport.
Question 7: During a scene flight, the pilot announces an emergency landing is required. The flight nurse should:
- Continue patient care procedures uninterrupted
- Immediately brace, secure equipment, and prepare for impact (Correct answer)
- Radio dispatch for a new aircraft to meet them
- Administer sedation to prevent patient injury on landing
Correct answer: Immediately brace, secure equipment, and prepare for impact
On emergency landing notification, all crew must immediately brace, secure unsecured equipment, and prepare for impact per emergency protocols — patient care is secondary to survival.
CFRN General 3
During rotor-wing transport, a patient becomes combative.
The flight nurse's FIRST priority is: