CFRN MCQ 2 — Questions and Answers
Question 1: During a rotor-wing transport at 8,000 feet MSL, a patient's endotracheal tube cuff was inflated with air at sea level. What is the most appropriate management?
- Deflate and reinflate the cuff with saline or water to a pressure of 20–30 cmH2O (Correct answer)
- Increase ventilator PEEP to compensate for cuff expansion
- Leave the cuff unchanged because altitude effects are negligible below 10,000 feet
- Deflate the cuff completely and replace the tube
Correct answer: Deflate and reinflate the cuff with saline or water to a pressure of 20–30 cmH2O
Air-filled cuffs expand at altitude due to Boyle's Law, risking tracheal injury; filling with liquid prevents volume changes.
Question 2: A flight nurse is assessing a patient with a suspected tension pneumothorax. Which finding is MOST specific for this diagnosis in the flight environment?
- Tracheal deviation away from the affected side
- Absent breath sounds on the affected side with hypotension and JVD (Correct answer)
- SpO2 of 88% on 15 L/min non-rebreather mask
- Respiratory rate of 30 breaths per minute
Correct answer: Absent breath sounds on the affected side with hypotension and JVD
The triad of absent breath sounds, hypotension, and JVD strongly indicates tension pneumothorax requiring immediate needle decompression.
Question 3: Which IV fluid is MOST appropriate for initial resuscitation of a burn patient during aeromedical transport?
- 0.45% Normal Saline
- Lactated Ringer's solution (Correct answer)
- D5W
- 3% Hypertonic Saline
Correct answer: Lactated Ringer's solution
Lactated Ringer's is the gold-standard resuscitation fluid for burns as recommended by the Parkland formula.
Question 4: A pediatric patient (15 kg) requires succinylcholine for rapid sequence intubation. What is the correct dose?
- 15 mg (1 mg/kg)
- 30 mg (2 mg/kg) (Correct answer)
- 7.5 mg (0.5 mg/kg)
- 45 mg (3 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 5: During scene response to a motor vehicle crash, which mechanism most reliably predicts severe injury requiring trauma center transport?
- Airbag deployment without seatbelt
- Death of an occupant in the same vehicle (Correct answer)
- Damage to the windshield from the patient's head
- Rollover crash regardless of cabin intrusion
Correct answer: Death of an occupant in the same vehicle
Death of another occupant in the same vehicle is a CDC field triage criterion indicating a high-energy mechanism linked to severe injury.
Question 6: 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:
- 2 L of normal saline bolus
- 1 unit of fresh frozen plasma and 1 unit of platelets (Correct answer)
- 1 amp of sodium bicarbonate
- Vasopressin 0.04 units/min drip
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 7: Which altitude-related physiological change MOST significantly affects a patient with a closed pneumocephalus (air in the cranial vault)?
- Hypoxia from decreased FiO2
- Expansion of intracranial air increasing ICP (Correct answer)
- Increased nitrogen narcosis risk
- Cerebral vasoconstriction from hyperoxia
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.
CFRN MCQ 2
During a rotor-wing transport at 8,000 feet MSL, a patient's endotracheal tube cuff was inflated with air at sea level.
What is the most appropriate management?