Free NREMT Practice Questions
Airway Management
Open, suction, position, and ventilate. Recognize obstruction and failure early, then escalate correctly.
What you'll master
- ✓Airway positioning and suction sequencing
- ✓OPA vs NPA indications and contraindications
- ✓BVM technique decisions and escalation triggers
- ✓Oxygen delivery selection and reassessment
Common misses
- –Delaying ventilation support
- –Choosing adjuncts without checking contraindications
- –Failing to reassess oxygenation and work of breathing
Sample questions.
25 free airway management questions with answers and explanations. MedRelay's full question bank covers every NREMT domain, plus live scenarios that grade the decision, not just the answer.
Question 1
You respond to a 19-year-old male from a diving accident hitting the pool bottom head-first. He is pulseless and apneic. You must open the airway for CPR. What is the correct technique?
Why:Correct. Jaw thrust with in-line cervical spine stabilization is correct when spinal injury is suspected. Head-tilt chin-lift extends the cervical spine and is contraindicated. Resuscitation does not wait for spinal clearance — airway management and CPR proceed with spinal precautions.
Question 2
At a manufacturing floor, a 58-year-old male is unresponsive with wet snoring respirations and vomit at the lips. What should you do first?
Why:Correct. Visible fluid and vomit threaten airway patency. Suction first, then reassess breathing and ventilation.
Question 3
You respond to a 58-year-old male with GCS 6 who needs airway management. When you test his gag reflex by touching the posterior pharynx, he gags briefly. You opt for an NPA. As you insert the NPA into the right nostril, you encounter resistance and cannot advance it. What is the correct next step?
Why:Correct. NPA insertion resistance: never force an NPA — significant resistance indicates anatomical obstruction. Try the other nostril. The NPA should advance with gentle steady pressure along the floor of the nasal passage. If resistance continues in both nostrils, reassess whether an OPA is appropriate given the current gag reflex status. Document the difficulty and the approach used.
Question 4
When is continuous compression CPR with asynchronous ventilations at 10 per minute appropriate for EMT-Bs?
Why:Correct. Continuous compressions with asynchronous ventilation is appropriate only when a supraglottic or advanced airway device protects the airway. Without an airway device, asynchronous BVM ventilation during compressions inflates the stomach, risking regurgitation and aspiration. Without an advanced airway, EMT-Bs use 30:2.
Question 5
You respond to a 78-year-old male who was found on his kitchen floor. GCS is 6. He has no gag reflex. You are preparing to insert an OPA. You measure from the corner of his mouth to the earlobe — 90 mm. You have 80 mm, 90 mm, and 100 mm OPAs available. Which do you select and what is the correct insertion technique for an adult?
Why:Correct. OPA sizing and adult insertion technique: match the measurement (corner of mouth to earlobe). Adult insertion technique: tip pointing toward the palate (curved end up), advance while rotating 180 degrees so the tip curves posteriorly into the pharynx. This rotation technique avoids pushing the tongue backward. Alternative: insert with tongue blade holding tongue forward and direct the OPA posteriorly without rotation.
Question 6
A patient vomits during BVM ventilation. What should you do first?
Why:Correct. Vomit must be cleared quickly. Roll if safe, suction, then resume airway support and reassess ventilation.
Question 7
A semiconscious trauma patient needs an airway adjunct. Blood is seen behind both ears. What should you avoid?
Why:Correct. Signs of basilar skull fracture make NPA insertion contraindicated. Use positioning, suction, and ventilation as needed.
Question 8
You respond to a 55-year-old male who is unconscious from alcohol intoxication. GCS is 7. He has a partial gag reflex. You are preparing to place an NPA. While inserting the NPA into his right nostril you feel it pass easily to the level of the flange. He coughs slightly but does not gag. SpO2 is 94%. You begin positioning him for transport. Your partner suggests placing him in the left lateral recumbent position. Why is this position preferred?
Why:Correct. Left lateral recumbent (recovery position): positions the airway so that vomit and secretions drain by gravity away from the trachea. In supine position, vomit pools posteriorly in the pharynx and flows into the trachea. Lateral recumbent allows gravity drainage of the oral cavity and pharynx. Critical for any obtunded patient with possible vomiting risk. Maintain airway access while transporting.
Question 9
You measure an OPA for an adult patient without a gag reflex. Which sizing method is correct?
Why:Correct. An adult OPA is sized from the corner of the mouth to the earlobe or angle of the jaw.
Question 10
A 57-year-old female is unresponsive after a seizure. Respirations are shallow at 8/min and a pulse is present. What is the priority?
Why:Correct. A pulse with inadequate breathing requires BVM ventilations with oxygen.
Question 11
At a church basement, a 65-year-old male is breathing 30/min but has shallow chest movement and altered mental status. Which problem should you suspect?
Why:Correct. Fast shallow breathing with altered mental status can still be inadequate ventilation.
Question 12
A 19-year-old female vomits after an OPA is inserted. What should you do immediately?
Why:Correct. Vomiting requires removal of the adjunct, positioning if safe, suctioning, and reassessment.
Question 13
A patient with facial trauma has noisy respirations and secretions. What airway action is safest within EMT-B scope?
Why:Correct. EMT-B airway care includes positioning, suctioning, adjuncts when safe, and BVM support. Advanced airways listed are not EMT-B care.
Question 14
You respond to a 3-year-old male in respiratory failure. He is unconscious with GCS 5 and no gag reflex. You need to insert an NPA. How do you size an NPA for a pediatric patient and what is the correct insertion technique?
Why:Correct. Pediatric NPA sizing: nostril tip to the earlobe (tragus). This approximates the distance from the nostril to the posterior nasopharynx. Lubricate well. Insert with bevel toward septum, directed along the floor of the nasal passage horizontally — not angled upward toward the cribriform plate. Advance until flange rests at the nostril. Contraindicated in suspected basal skull fracture.
Question 15
A 29-year-old female has no gag reflex and needs an OPA. Which finding would make the OPA inappropriate?
Why:Correct. An intact gag reflex makes an OPA inappropriate because it can trigger vomiting or airway trauma.
Question 16
A 52-year-old female vomits after an OPA is inserted. What should you do immediately?
Why:Correct. Vomiting requires removal of the adjunct, positioning if safe, suctioning, and reassessment.
Question 17
You respond to a 3-year-old male who is choking. His mother says he was eating grapes and suddenly became silent and blue. He is limp and unresponsive. You take him from his mother. He is pulseless. What is the complete FBAO management sequence for an unresponsive infant or child in cardiac arrest?
Why:Correct. Pulseless FBAO in a child: begin CPR immediately. The modified sequence — before each ventilation, open mouth, look for visible object, remove if visible (never blind finger sweeps), then ventilate. Chest compressions generate intrathoracic pressure that can dislodge the object. Do not delay CPR to perform Heimlich maneuvers in a pulseless child. Continue until object expelled or ALS arrives.
Question 18
You respond to a 77-year-old female in respiratory arrest secondary to a large stroke. She is unconscious with GCS 4. ALS is 12 minutes away. You have placed an OPA and are performing BVM ventilation. Your partner has been squeezing the bag at what appears to be one breath every 2 seconds. SpO2 is 94%. Why is the current rate harmful even though SpO2 appears adequate?
Why:Correct. Over-ventilation at 30 breaths/min causes hypocapnia and cerebral vasoconstriction — dangerous in stroke. Target 10-12 breaths/min. SpO2 improvement does not validate rate — oxygenation and ventilation are separate parameters. CO2 levels are not measured by SpO2. Slow the rate to 10-12/min regardless of SpO2.
Question 19
You respond to a 52-year-old male who is unconscious from a drug overdose. GCS is 5. He has no gag reflex. You have placed an OPA and are performing 2-person BVM ventilation. After 3 ventilations you notice large amounts of gastric fluid appearing in the oral cavity. What is the immediate action and what is the risk if you do not act immediately?
Why:Correct. Active vomiting with OPA in place: gastric fluid around the OPA in an unconscious patient without a gag reflex poses immediate aspiration risk. The fluid can passively enter the trachea during ventilation. Turn lateral or tilt to drain, suction immediately with rigid Yankauer, then resume ventilation. Keep suction immediately accessible during all BVM ventilation of unconscious patients. Aspiration of gastric acid causes severe pneumonitis.
Question 20
A 66-year-old male achieves ROSC after cardiac arrest. RR is 14 with adequate depth, SpO2 96% on NRB, no gag reflex. Which airway management is most appropriate?
Why:Correct. Post-ROSC NPA: breathing spontaneously with adequate SpO2 but no gag reflex. NPA provides airway support without aspiration risk if the gag reflex recovers during neurological improvement. Target SpO2 94-99% post-ROSC. ALS for definitive airway management.
Question 21
You respond to a 55-year-old male in respiratory failure from a drug overdose. He is unconscious with GCS 5 and no gag reflex. You and your partner are performing 2-person BVM ventilation. What ventilation rate is appropriate for an adult patient who is NOT in cardiac arrest?
Why:Correct. Adult BVM ventilation rate: 10-12 per minute for non-arrest respiratory failure. Over-ventilation causes hypocapnia and cerebral vasoconstriction (harmful in brain injury) and raises intrathoracic pressure reducing venous return. Under-ventilation causes hypoxia and CO2 retention. One breath every 5-6 seconds with visible chest rise is the target.
Question 22
At a fitness center, after opening the airway, an unresponsive patient begins breathing normally. What should you do next?
Why:Correct. Maintain airway position, monitor breathing and mental status, and prepare for transport.
Question 23
You respond to a 6-year-old female who choked on a grape at school. She was coughing forcefully when the teacher called 911 but has now gone silent and her face is turning blue. She is still standing. What change in your intervention does her transition from forceful coughing to silence with cyanosis require?
Why:Correct. Partial vs complete FBAO management: partial obstruction with effective coughing = do not interfere, encourage coughing. Complete obstruction (silence, cyanosis, ineffective breathing) = immediate intervention. For children over 1 year: 5 back blows between the shoulder blades alternating with 5 abdominal thrusts (Heimlich). If she loses consciousness, begin CPR and look for visible object before each ventilation.
Question 24
You respond to a 44-year-old male who was found in his home with GCS 6 and no gag reflex. You place an OPA and begin BVM ventilation. En route to the hospital you notice that after each ventilation the patient vomits a small amount of gastric content that pools around the OPA. SpO2 is 94%. Your partner asks if you should stop and place an NPA instead. What is the correct management?
Why:Correct. Active vomiting around an OPA in a patient with no gag reflex: suction immediately with rigid Yankauer catheter. The OPA is appropriate here — the patient has no gag reflex. An NPA would not prevent aspiration as effectively in this setting. Consider lateral tilt between ventilations. Keep suction immediately accessible at all times.
Question 25
You respond to an 82-year-old female who is obtunded from a large ischemic stroke. GCS is 6. She has no gag reflex. You place a 90 mm OPA. During BVM ventilation, after your first two breaths, you notice the patient coughs weakly and the OPA appears to be causing an upper airway stimulation despite the absent gag reflex. SpO2 is improving. What does a weak cough response with an OPA in a patient with absent gag suggest?
Why:Correct. Gag reflex vs cough reflex: these are neurologically distinct reflexes. Absent gag (cranial nerves IX/X at the soft palate and posterior pharynx) does not mean absent cough (tracheal/lower airway). An oversized OPA can stimulate lower pharyngeal receptors triggering a cough. Try a smaller OPA or switch to NPA which avoids posterior pharynx contact. Continue effective BVM ventilation.
Keep going
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