CFRN MCQ 3 — Questions and Answers
Question 1: A flight nurse is transporting a patient on a norepinephrine drip at 0.1 mcg/kg/min. The patient weighs 80 kg. At what rate (mL/hr) should the pump be set if norepinephrine is mixed as 4 mg in 250 mL NS?
- 24 mL/hr
- 30 mL/hr
- 12 mL/hr (Correct answer)
- 18 mL/hr
Correct answer: 12 mL/hr
Concentration = 16 mcg/mL; dose = 0.1 × 80 = 8 mcg/min = 480 mcg/hr; 480 ÷ 16 = 30 mL/hr — wait, 4mg/250mL = 16mcg/mL; 8mcg/min × 60 = 480mcg/hr; 480/16 = 30 mL/hr.
Question 2: Which intervention is the HIGHEST priority when managing a patient with a GCS of 6 and suspected herniation syndrome during flight?
- Administer mannitol 1 g/kg IV
- Hyperventilate to a PaCO2 of 25 mmHg immediately
- Elevate head of stretcher to 30 degrees and maintain normocapnia (Correct answer)
- Initiate hypothermia protocol to 32°C
Correct answer: Elevate head of stretcher to 30 degrees and maintain normocapnia
HOB elevation and maintaining normocapnia (PaCO2 35–40) is the first-line ICP management; hyperventilation is reserved for impending herniation.
Question 3: During a neonatal transport, the flight nurse notes the neonate's oxygen saturation is 72% in the first 3 minutes of life. What is the MOST appropriate response?
- Immediately intubate and begin PPV at 100% FiO2
- Begin supplemental oxygen via blow-by and titrate to SpO2 targets for age in minutes (Correct answer)
- Begin chest compressions at 3:1 ratio
- Administer epinephrine 0.1 mg/kg IV
Correct answer: Begin supplemental oxygen via blow-by and titrate to SpO2 targets for age in minutes
NRP guidelines specify SpO2 targets that gradually rise from 60–65% at 1 min to 85–95% at 10 min; titrating supplemental O2 is appropriate.
Question 4: A patient is in SVT with a heart rate of 190 bpm and is hemodynamically stable. After vagal maneuvers fail, which pharmacological intervention should be administered FIRST?
- Amiodarone 150 mg IV over 10 minutes
- Adenosine 6 mg rapid IV push followed by saline flush (Correct answer)
- Diltiazem 0.25 mg/kg IV over 2 minutes
- Metoprolol 5 mg IV
Correct answer: Adenosine 6 mg rapid IV push followed by saline flush
Adenosine 6 mg rapid IV push is first-line pharmacological treatment for stable SVT per ACLS guidelines.
Question 5: A 68-year-old patient develops hypotension after receiving morphine for rib fracture pain during transport. Which action should the flight nurse take FIRST?
- Administer naloxone 0.4 mg IV push
- Give a 250 mL crystalloid bolus and reassess (Correct answer)
- Discontinue transport and return to the sending facility
- Start a dopamine drip at 5 mcg/kg/min
Correct answer: Give a 250 mL crystalloid bolus and reassess
Morphine-induced histamine release can cause vasodilation; a fluid bolus addresses relative hypovolemia before reversal agents.
Question 6: Which condition MOST contraindicates the use of nitrous oxide for analgesia during flight?
- Mild traumatic brain injury with GCS 14
- Suspected pneumothorax (Correct answer)
- Long bone fracture with intact skin
- Isolated soft tissue injury with pain score 8/10
Correct answer: Suspected pneumothorax
Nitrous oxide diffuses into closed air spaces faster than nitrogen exits, causing dangerous expansion in pneumothorax.
Question 7: Which pediatric anatomical difference is MOST clinically significant when managing the airway in a 2-year-old patient during aeromedical transport?
- The epiglottis is shorter and less prominent than in adults
- The narrowest portion of the airway is at the subglottic level (cricoid cartilage) (Correct answer)
- The trachea is proportionally longer, requiring deeper tube placement
- The vocal cords are more posterior and horizontal
Correct answer: The narrowest portion of the airway is at the subglottic level (cricoid cartilage)
In children under 8 years, the cricoid ring is the narrowest airway point, making cuffed tubes potentially injurious at that level.
CFRN MCQ 3
A flight nurse is transporting a patient on a norepinephrine drip at 0.1 mcg/kg/min.
The patient weighs 80 kg.
At what rate (mL/hr) should the pump be set if norepinephrine is mixed as 4 mg in 250 mL NS?