CFRN MCQ 5 — Questions and Answers
Question 1: When performing a needle decompression for tension pneumothorax in an obese patient, which landmark and technique is MOST appropriate?
- 2nd intercostal space, midclavicular line, 14-gauge angiocath
- 4th–5th intercostal space, anterior axillary line, 14-gauge angiocath using the superior rib border (Correct answer)
- 3rd intercostal space, midaxillary line, 16-gauge angiocath
- 2nd intercostal space, midclavicular line, 10-gauge angiocath at least 8 cm long
Correct answer: 4th–5th intercostal space, anterior axillary line, 14-gauge angiocath using the superior rib border
In obese patients, the 4th–5th ICS anterior axillary line has less chest wall thickness and improves first-attempt success for needle decompression.
Question 2: A patient is receiving a blood transfusion during transport and develops fever, hypotension, back pain, and hemoglobinuria. Which complication should be suspected?
- Transfusion-related acute lung injury (TRALI)
- Febrile non-hemolytic transfusion reaction
- Acute hemolytic transfusion reaction (ABO incompatibility) (Correct answer)
- Transfusion-associated circulatory overload (TACO)
Correct answer: Acute hemolytic transfusion reaction (ABO incompatibility)
The classic triad of hemolysis — fever, flank/back pain, and hemoglobinuria — with hypotension indicates acute hemolytic reaction due to ABO incompatibility.
Question 3: Which ventilator setting change should the flight nurse make when transitioning a ARDS patient from the hospital to transport ventilator?
- Increase tidal volume to 10 mL/kg IBW to offset altitude-related dead space changes
- Maintain lung-protective ventilation: TV 6 mL/kg IBW, plateau pressure < 30 cmH2O (Correct answer)
- Switch to pressure-control mode exclusively to avoid volutrauma
- Increase FiO2 to 1.0 for all ARDS patients during transport
Correct answer: Maintain lung-protective ventilation: TV 6 mL/kg IBW, plateau pressure < 30 cmH2O
Lung-protective ventilation (6 mL/kg IBW, Pplat < 30) reduces VILI and mortality in ARDS and must be maintained during transport.
Question 4: During a critical care transport, a patient's EtCO2 suddenly drops from 38 to 10 mmHg while SPO2 remains unchanged at 99%. What is the MOST likely explanation?
- Inadvertent esophageal intubation during transport
- Right mainstem intubation from tube migration
- Circuit disconnect or esophageal detector failure (Correct answer)
- Pulmonary embolism causing increased dead space
Correct answer: Circuit disconnect or esophageal detector failure
An abrupt EtCO2 drop to near-zero with maintained SpO2 most likely indicates a ventilator circuit disconnect rather than esophageal intubation.
Question 5: A 4-year-old child (18 kg) in status epilepticus unresponsive to two doses of lorazepam requires a second-line agent. What is the MOST appropriate next intervention?
- Phenobarbital 20 mg/kg IV at 1 mg/kg/min
- Levetiracetam 60 mg/kg IV (max 4,500 mg) over 10 minutes (Correct answer)
- Diazepam 0.5 mg/kg PR
- Propofol 1 mg/kg IV bolus
Correct answer: Levetiracetam 60 mg/kg IV (max 4,500 mg) over 10 minutes
Levetiracetam 60 mg/kg IV is a first-line second agent for benzodiazepine-refractory status epilepticus in pediatric patients per current guidelines.
Question 6: Which action is MOST important before initiating a scene flight for a patient with a suspected spinal cord injury?
- Apply a cervical collar and long backboard as the primary spinal immobilization strategy
- Ensure manual inline stabilization and assess the need for selective spinal immobilization based on clinical criteria (Correct answer)
- Defer airway management until spinal imaging is completed
- Administer methylprednisolone 30 mg/kg IV for neuroprotection
Correct answer: Ensure manual inline stabilization and assess the need for selective spinal immobilization based on clinical criteria
Current evidence supports selective spinal immobilization using validated criteria (e.g., NEXUS/Canadian C-spine) over universal backboarding.
Question 7: A CFRN is preparing to transport a patient with an open globe eye injury. Which intervention is MOST critical to prevent worsening?
- Apply a pressure dressing to reduce intraocular bleeding
- Shield the eye without applying pressure and maintain head-of-bed at 30 degrees (Correct answer)
- Irrigate the eye with saline to reduce infection risk
- Patch both eyes to prevent sympathetic ophthalmia during transport
Correct answer: Shield the eye without applying pressure and maintain head-of-bed at 30 degrees
An open globe must be shielded (not patched with pressure) to prevent vitreous extrusion; HOB elevation reduces intraocular pressure.
CFRN MCQ 5
When performing a needle decompression for tension pneumothorax in an obese patient, which landmark and technique is MOST appropriate?