CFRN ANSWERS & RATIONALES (2025)
RESUSCITATION PRINCIPLES
QUESTION ONE: The correct answer is B: Cardiac dysrhythmias
Rationale: Suctioning can stimulate the vagus nerve, leading to bradycardia or other arrhythmias, particularly in patients who are hypoxic or have underlying cardiac conditions. While vocal cord damage can occur during certain airway procedures, such as intubation, it is not a common complication of suctioning because the suction catheter does not typically interact directly with the vocal cords. Increased intrathoracic pressure is associated with excessive positive pressure ventilation, not suctioning. Suctioning, if anything, may temporarily decrease intrathoracic pressure due to interruption of normal breathing patterns. Incorrect placement of the suction catheter into the esophagus is not a negative effect and is not a recognized complication of suctioning.
QUESTION TWO: The correct answer is D: known to reduce the incidence of aspiration because of the presence of a gastric channel.
Rationale: The I-gel is designed with a gastric channel that can allow gastric contents to escape into the mouth rather than be aspirated. It also allows for the placement of an orogastric or nasogastric tube, which can help reduce the risk of aspiration by providing a route to drain gastric contents. I-gel devices come in different sizes to accommodate a range of weights, including pediatric sizes for patients weighing less than 50 pounds (22.5 kg). Although an i-Gel is an option for securing the airway of a patient with maxillofacial trauma, it is not considered a form of intubation. The I-gel is not ideal for patients with an intact gag reflex, as its insertion may trigger gagging or vomiting.
QUESTION THREE: The correct answer is C: Respiratory acidosis
Rationale: A myasthenic crisis is a life-threatening condition in which the weakness associated with myasthenia gravis becomes severe enough to impair respiratory function, often leading to respiratory failure. This can result in hypoventilation, where the patient is unable to effectively expel CO₂ from the body, causing a respiratory acidosis. A respiratory alkalosis would be associated with excessive respirations causing a decrease in CO₂. This is the opposite of what occurs due to the respiratory insufficiency of a myasthenia crisis. A myasthenia crisis causes respiratory insufficiency resulting in respiratory blood gas abnormalities rather than metabolic abnormalities.
QUESTION FOUR: The correct answer is B: Hypocalcemia
Rationale: Alkalosis causes hypocalcemia because it increases the binding of calcium to albumin, reducing ionized (active) calcium levels. Hypocalcemia leads to symptoms such as muscle cramps, tetany, paresthesias, and in severe cases, seizures. These are the same symptoms that a patient with alkalosis is expected to exhibit. The symptoms of hypothermia (low body temperature, shivering, confusion, slow metabolism) are not the same as alkalosis. The symptoms of myasthenia gravis (Muscle weakness, fatigue, difficulty swallowing or breathing) are not the same as alkalosis. The symptoms of Cushing’s syndrome (Weight gain, hypertension, hyperglycemia, muscle weakness, and skin changes due to cortisol excess) are not the same as alkalosis.
QUESTION FIVE: The correct answer is B: In hypovolemic shock
Rationale: High levels of positive end expiratory pressure may decrease left ventricular preload leading to hypotension. It must be used in caution with patients who may already by hypotensive, such as with hypovolemic shock as the loss of left ventricular afterload can have devastating effects on the patient’s blood pressure. Positive end expiratory pressure is less likely to have a negative impact on a patient who is pregnant and would not have a negative impact on a patient with a hypertensive emergency. Positive end expiratory pressure is the treatment of choice for acute respiratory distress syndrome as a way to improve oxygenation.
QUESTION SIX: The correct answer is B: The workload of the patient increases
Rationale: A low trigger sensitivity means the patient may need to generate more effort to initiate the breath, increasing their workload. Auto-PEEP (air remaining in the alveoli at the beginning of a new breath) is not associated with low trigger sensitivity. Since the patient has to work harder to get a breath, low trigger sensitivity may actually decrease the risk of auto-PEEP. Although the patient has to work harder to take a breath with low trigger sensitivity, they will still be able to trigger a breath and if they don’t trigger a breath, the time trigger backup will deliver a breath therefore, elongation of the time between breaths is not associated with low trigger sensitivity. High trigger sensitivity is more likely to provide the patient additional breaths as opposed to low trigger sensitivity.
QUESTION SEVEN: The correct answer is C: Barotrauma
Rationale: With volume-controlled ventilation (VCV), a set amount of air is delivered with each breath. If the patient’s lung becomes stiff and non-compliant or if the patient develops a space-occupying lesion in the lung such as a pleural effusion or pneumothorax, that set volume can overstretch the alveoli (known as barotrauma). Auto-PEEP is not directly associated with VCV itself. Auto-PEEP is more often seen in patients with obstructive lung disease, where exhalation is incomplete before the next mechanical breath begins. Hypotension is more likely to be seen with high levels of PEEP but is not associated with VCV. Alkalosis is associated with hyperventilation but not VCV.
QUESTION EIGHT: The correct answer is B: Additional intravenous fluids should be provided
Rationale: To calculate a patient’s shock index, the heart rate is divided by the systolic pressure. Anything above 0.9 indicates inadequate resuscitation and additional resuscitation, including intravenous fluids, should be provided. The shock index does not give an indication of the need for more or less FiO2. This is better measured using oxygen saturation or arterial blood gases. The shock index is not related to the patient’s pulse pressure.
QUESTION NINE: The correct answer is B: Diltiazem (Cardiazem).
Rationale: Milrinone, dobutamine and norepinephrine are all positive inotropes whereas diltiazem is a calcium channel blockers known to have negative inotropic effects.
QUESTION TEN: The correct answer is C: 150 mL
Rationale: When administering packed red blood cells to a pediatric patient, 10 - 15 mL per kilogram of body weight is considered a unit of blood, Therefore, a 15 kg child should receive 150 -225 mL of packed red blood cells.
QUESTION ELEVEN: The correct answer is A: Administer intravenous glucagon
Rationale: Beta-blockers block the effects of epinephrine and other catecholamines, making epinephrine less effective in treating anaphylaxis. Glucagon bypasses the beta-adrenergic receptors because it acts via different pathways to increase intracellular cyclic AMP (cAMP), which helps stimulate cardiac output, relax smooth muscles (bronchodilation and vasodilation reversal) and increase blood pressure. Glucagon should be used for anaphylaxis refractory to epinephrine. Although surgical airways are sometimes needed in the management of anaphylaxis, this will resolve the issue of epinephrine not working and they are independent of one another. If intramuscular epinephrine is not working, intravenous epinephrine may not work either, so glucagon should be used first. Norepinephrine primarily targets alpha-adrenergic receptors to cause vasoconstriction, which may help hypotension but does not address the beta-blockade issue.
QUESTION TWELVE: The correct answer is C: Ensuring the temperature of the transport vehicle is comfortable for the patient.
Rationale: Numerous non-pharmacological interventions can be considered to augment analgesia in relieving a patient’s pain. These can include:
Distraction
Patient comfort (e.g., ensuring a comfortable temperature in the transport vehicle)
Reducing patient fear and anxiety
Allowing the family to accompany the patient.
Therapeutic touch
Although flying at lower altitudes may relieve pain associated with expanding air, this is unlikely to be the case in patients with pelvic pain related to vaginal bleeding, therefore this is not an appropriate non-pharmacological intervention for this patient. Warm packs should not be applied to the abdomen of patients with abdominal pain. The vasodilation associated with this intervention can worsen blood loss and if the patient were to require surgical intervention at the destination, the vasodilation would increase the risk of intra-operative bleeding. Neuromuscular agents do not reduce pain but they make it more difficult for a patient to communicate that pain. Therefore, this is not an effective pain relief technique.
MEDICAL EMERGENCIES
QUESTION THIRTEEN: The correct answer is A: The airway
Rationale: A myasthenia crisis is marked by severe muscular weakness, especially in the central regions of the body. That weakness can lead to an inability of the patient to maintain their own airway and increases the risk of aspiration. The patient may require interventions such as suctioning and intubation to protect the airway. The patient will likely need support with breathing as well due to weakness of the respiratory muscles, but airway is always a higher priority. Similarly, these patients sometimes have circulation disturbances including myocardial infarctions and dysrhythmias, but these are a lower priority than protecting the airway. Neurological function does not tend to be altered with this condition.
QUESTION FOURTEEN: The correct answer is C: On the same horizontal plane as V6
Rationale V8 describes placement of a posterior lead. It should be placed at the same horizontal plane as V6 (and V6 is placed in the fifth, not the fourth intercostal space). It is placed right below the scapula (not just to the left of the vertebral column) and is placed on the posterior left chest wall, not the right midaxillary line.
QUESTION FIFTEEN: The correct answer is D: Cardioversion
Rationale: One complication of Wolfe-Parkinson-White (WPW) syndrome is tachyarrhythmias. The fact that the patient had a syncopal episode along with palpitations further validates this. Tachyarrhythmias associated with WPW syndrome often do not respond well to pharmacological treatment and cardioversion is often required if they are unstable. Atropine is used to treat bradycardia rather than tachycardia. Fluid boluses are not therapeutic in the treatment of tachyarrhythmias associated with WPW. Magnesium is more likely to be used in the treatment of torsade de pointes.
QUESTION SIXTEEN: The correct answer is A: Fluid boluses
Rationale: Chattering (visible and often rhythmic movement or vibration in the venous line) is a sign of impaired venous flow. One of the interventions that may be used for this complication is to provide fluid boluses to increase venous flow. Intravenous anxiolytics and tightening of the tubing connections will not improve “chattering”. ECMO tubing should not be milked and this will not improve impaired venous flow causing “chattering”.
QUESTION SEVENTEEN: The correct answer is D: Acute respiratory distress syndrome
Rationale: Epoprostenol is a pulmonary vasodilator that is used in the treatment of conditions such as acute respiratory distress syndrome and pulmonary hypertension. Because Epoprostenol is a vasodilator, it would exacerbate cardiogenic shock and would not improve pre-renal acute kidney injury (although the effects of this medication are generally limited to the pulmonary vasculature and would not affect systemic blood pressure significantly). The use of Epoprostenol has not therapeutic value in the management of vaginal bleeding.
QUESTION EIGHTEEN: The correct answer is A: Balloon tamponade
Rationale: Hematemesis, the presence of bright red blood in emesis, causing hypotension and tachycardia indicates significant blood loss and treatment is identical to treatment for any form of hypovolemic shock including supplemental oxygen to maintain oxygen saturation above 94% and volume resuscitation preferably with blood products when available. A balloon tamponade may be appropriate if the hematemesis is caused by variceal bleeding, but hematemesis could be caused by other things other than variceal bleeding therefore, a balloon tamponade would not be a higher priority compared to volume resuscitation. Similarly, gastric tubes may be indicated for some causes of gastrointestinal bleeding but do not constitute a higher priority than volume administration. There is nothing in this scenario to indicate that the patient cannot maintain their own airway or breathing therefore intubation with mechanical ventilation is not a higher priority compared to volume resuscitation. If the scenario indicated that the patient was unable to maintain their own airway or breathing, then intubation with mechanical ventilation would have been a higher priority.
QUESTION NINETEEN: The correct answer is A: Palpation
Rationale: Murphy’s sign is used to confirm gall bladder disease. To perform this test, the practitioner should palpate deeply in the right upper quadrant and ask the patient to inhale deeply. If the patient’ experiences right upper quadrant pain during inhalation, Murphys’ sign is considered positive. Positive Murphy’s sign is associated with gall bladder disease. Percussion, auscultation and visualization will not assist in testing for Murphy’s sign.
QUESTION TWENTY: The correct answer is D: Generalized weakness
Rationale: The changes associated with this electrocardiogram include ST depression and the presence of U waves. These are both consistent with hypokalemia. Hypokalemia causes shortness of breath. Headaches, visual disturbances and shortness of breath are not as common as generalized weakness in patients with hypokalemia.
QUESTION TWENTY-ONE: The correct answer is D: Potassium
Rationale: Addison’s crisis causes excessive urinary losses leading to hyponatremia (therefore treatment should increase serum sodium) and hyperkalemia (therefore treatment should decrease serum potassium). Platelets are relatively unaffected by Addison’s crisis, therefore a goal of treatment does not result in a decreased platelet count. Addison’s crisis causes hypoglycemia so a goal of treatment is to increase serum glucose.
QUESTION TWEENTY TWO: The correct answer is D: reddened, painful, purulent lesion on the skin with a yellow center
Rationale: Methicillin-resistant Staphylococcus Aureus lives on the skin of individuals and if it enters through a break in the skin, especially in the immunocompromised individual, it can cause lesions on the skin. The lesions tend to be reddened, painful and purulent with a yellow or white center. Infections by this bacteria does not cause foul-smelling, hazy colored urine, bloody diarrhea or septic arthritis (which causes a swollen, painful, reddened joint).
QUESTION TWENTY-THREE: The correct answer is A: Defibrillation
Rationale: In the profoundly hypothermic pulseless patient, it is appropriate to provide both defibrillation and one dose of intravenous epinephrine. If the patient does not respond and the temperature is found to be less than 84 F (28 C), aggressive warming measures should be undertaken and the patient should be transported. Further defibrillation and intravenous medications such as epinephrine should be withheld until the temperature exceeds 84 F (28 C). As per ACLS protocols, defibrillation is generally attempted prior to intravenous medications such as epinephrine.
QUESTION TWENTY-FOUR: The correct answer is C: Methamphetamines
Rationale: Methamphetamines are sympathomimetic and may cause dangerous elevations in core body temperature requiring aggressive cooling measures. Heroin (a narcotic), insecticides and poison mushrooms (which are cholinergic substances) do not cause elevations in core body temperature and would not require aggressive cooling measures.
QUESTION TWENTY-FIVE: The correct answer is C: Prolonged QT interval
Rationale: Electrocardiogram changes associated with tricyclic antidepressants include prolonged PR intervals, widened QRS complexes, prolonged QT intervals, depressed ST segments and atrioventricular blocks. Atrial flutter is not associated with tricyclic antidepressant overdoses. ST segment elevation is associated with myocardial ischemia and injury. The appearance of a U wave is associated with hypokalemia.
TRAUMA
QUESTION TWENTY-SIX: The correct answer is A: Crush injuries
Rationale: As a projectile, such as a bullet, moves through tissue, it displaces the tissue through which it moves. This displacement is known as the temporary cavity. It is temporary because the tissue is displaced for as little as 0.5 seconds before returning to its original position. However, the displacement of the tissue crushes it, leading to injuries such as contusions and bleeding. A thermal injury occurs when tissue is exposed to abnormally high or low temperatures. Crush injuries are more closely associated with tissue displacement than with thermal injury. Shearing injuries occur when tissues of different densities move against each other, damaging the area between them (e.g., diffuse axonal injury). Although a projectile causes penetrating trauma, this is more closely aligned with the “permanent cavity” created by the projectile rather than the temporary cavity.
QUESTION TWENTY-SEVEN: The correct answer is C: Hemotympanum
Rationale: Hemotympanum, a collection of blood behind the ear drum, will tend to appear shortly after a basilar skull fracture if there is bleeding from the fracture site into the ear canal. Battle’s sign (bruising behind the ear) or raccoon’s eyes (bruising around the eyes) will tend to be delayed 12 hours or more after the injury because blood under the skin must discolor before it becomes apparent and this can take 12 hours or longer. Flexion posturing is not commonly associated with a basilar skull fracture. It is more commonly associated with increased intracranial pressure, diffuse axonal injuries and intracerebral bleeding.
QUESTION TWENTY-EIGHT: The correct answer is A: Post-injury seizures
Rationale: Seizures can increase oxygen and glucose metabolism in the brain. A secondary brain injury occurs from lack of oxygen and glucose to the brain after head injury. Therefore, seizures should be aggressively managed if they occur in the head-injured patient and anti-epileptic medication may be administered if there is a high risk for seizures. Higher pCO2 levels are more worrisome than lower pCO2 levels. Ideally, pCO2 levels should be maintained between 35- and 40-mm Hg is the patient with a brain injury. Although a complete cord injury may exacerbate care of the patient with a brain injury, it is not directly related to secondary brain injury. Depressed skull fractures can also exacerbate the care of the patient with a traumatic brain injury but this diagnosis is not specifically associated with secondary brain injury.
QUESTION TWENTY-NINE: The correct answer is C: Cerebrospinal fluid in the nose
Rationale: LeFort fractures are fractures of the maxillary bone. LeFort II and LeFort III fractures involve the bridge of the nose and frequently involve fractures of the cribriform plate allowing leakage of cerebrospinal fluid from the nose. Ocular entrapment is associated with orbital blowout fractures and zygomatic fractures. Tear-drop shaped pupils are associated with ruptures of the globe. Numbness to the chin and lower lip are associated with mandibular fractures
QUESTION THIRTY: The correct answer is A: Control of bleeding
Rationale: Supraglottic airway devices have large ballons on the distal end that when inflated, may tamponade bleeding in the neck while simultaneously protecting the airway. They can also block blood from above the device from running into the trachea and larynx. These devices play no role in immobilizing fractures or improving cerebral blood flow. Although these devices may facilitate protection of the spine because they can be inserted without moving the neck, they do not assist with spinal motion restriction.
QUESTION THIRTY-ONE: The correct answer is D: “The water in the water seal chamber of the chest drainage set will elevate during exhalation".
Rationale: Mechanical ventilation is a form of positive-pressure ventilation, therefore, water in the water seal chamber should elevate during exhalation when the patient is mechanically ventilated. This is the opposite of spontaneous respirations which are negative pressure. With spontaneous respirations, water in the water seal chamber will elevate during inhalation but fall during exhalation.
QUESTION THIRTY-TWO: The correct answer is B: Between the scapulae
Rationale: Bruits associated with aortic injuries are often heard in the intrascapular region. Injuries to the aorta will not cause bruits of the carotids. The third intercostal space (midclavicular line) and fifth intercostal space (right of the sternum) are too far from the injury and bruits associated with aortic injuries are less likely to be heard here.
QUESTION THIRTY-THREE: The correct answer is A: Scrotum
Rationale: Because the rectum is located in the pelvis, bleeding from the rectum may collect in the scrotum in the form of scrotal swelling and/or bruising. Bruising in the lower back or umbilicus is more likely associated with injuries to retroperitoneal organs (pancreas, duodenum, kidney). Rectal trauma does not cause changes to the contents of the urine collection bag.
QUESTION THIRTY-FOUR: The correct answer is A: Serum pH
Rationale: Hypotension and diminished oxygen delivery cause acidosis in patients with abdominal compartment syndrome. Acidosis is marked by a reduction in serum pH. Compartment syndrome causes the abdomen to enlarge against the diaphragm which causes a decrease in tidal volume. This will cause end-tidal CO2 to climb rather than fall. The body’s response to hypotension is vasoconstriction which will cause central venous pressure and systemic vascular resistance to climb.
QUESTION THIRTY-FIVE: The correct answer is A: With the fingers slightly flexed over a roll of gauze
Rationale: If the injury allows, hands should be splinted in anatomical position, which is slightly flexing the fingers over something which will hold them in that position (e.g., a small towel, gauze roll, etc.). Applying a rigid split from the tips of the fingers to the middle of the forearm does not maintain the hand in anatomical position and is not preferred. There is no therapeutic value in placing gauze between abducted fingers for hand injuries. Although the fingers should be slightly flexed in anatomical position, the patient’s hand should not be splinted with the fingers fully flexed in a fist.
QUESTION THIRTY-SIX: The correct answer is C: The patient’s voice sounds hoarse.
Rationale: Burns to the upper airway can cause a rapid onset of airway edema and should be prophylactically intubated. Symptoms associated with upper airway burns include a hoarse voice, carbonaceous sputum, burns around the mouth and nares and stridor. An oxygen saturation of 94% is not an indication for immediate intubation although the patient should be carefully monitored for a decline in oxygen saturation. A harsh cough may indicate an inhalation injury but this is not an indication of the need for intubation. In fact, in the absence of upper airway burns, coughing with an inhalation injury should be encouraged to clear the airway to the greatest extent possible. The patient with partial thickness burns to the legs and perineum should be carefully assessed for potential airway burns but in the absence of signs of upper airway burns, partial thickness burns to the legs are not an indication of the need for intubation.
QUESTION THIRTY-SEVEN: The correct answer is D: The presence of an inhalation injury.
Rationale: The American Burn Association has developed the following recommendations for transfer to a burn center:
Second-degree burns >10% total body surface area (TBSA)
Third-degree burns
Burns that involve the face, hands, feet, genitalia, perineum, and major joints
Chemical burns
Electrical burns including lightning injuries
Any burn with concomitant trauma in which the burn injuries pose the greatest risk to the patient
Inhalation injury
Patients with pre-existing medical disorders that could complicate management, prolong recovery, or affect mortality
Hospitals without qualified personnel or equipment for care of critically burned children
Burn injury in patients who will require special social, emotional, or long-term rehabilitative interventions
Because this patient has an inhalation injury, he should be transferred to a burn center. The depth of the burn (partial thickness less than 10% of the body) does not require transfer to a burn center. The age of the patient is non-contributory in this scenario. The fact that the anterior thighs are burned does not influence the decision to transfer the patient to a burn center.
SPECIAL PATIENT POPULATIONS
QUESTION THIRTY-EIGHT: The correct answer is D: Pain in the right upper quadrant.
Rationale: Right upper quadrant (RUQ) pain is the hallmark symptom, associated with liver involvement, including hepatic swelling, distension of the liver capsule, or subcapsular hematoma may occur with HELLP syndrome. Pain-free presentations of HELLP syndrome are rare. Neither anginal-like pain nor burning pain in the extremities is associated with HELLP syndrome.
QUESTION THIRTY-NINE: The correct answer is C: Placing the palm of the hand on the abdomen during contractions.
Rationale: Palpating the abdomen during a contraction is a practical and commonly used clinical approach to assess contraction intensity. The palmar surface should be placed directly on the abdomen with the fingertips on the fundal area of the uterus. Cardiotocographic (CTG) monitoring records the frequency and duration of uterine contractions. However, it does not accurately measure their intensity. Placing fingers against the cervix is primarily done to assess cervical dilation and effacement, not contraction intensity. Asking the mother for a subjective score on contraction intensity reflects perceived pain, not the true physiological strength of uterine contractions. While this provides insight into the mother’s experience, it is not a reliable measure of contraction intensity.
QUESTION FORTY: The correct answer is A: The umbilical vein has far thinner walls than the umbilical arterieis
Rationale: The umbilical vein has thinner and more distensible walls compared to the thicker, muscular walls of the umbilical arteries. The arteries have thicker, more muscular walls to handle higher pressure as they carry deoxygenated blood from the fetus to the placenta. The umbilical vein is usually found at the 12 o’clock, not the 6 o’clock position. The umbilical vein is not in the exact center but rather positioned slightly off-center. Both the umbilical vein and arteries can contain clotted blood post-delivery. The presence of clotting is not a reliable way to differentiate them.
QUESTION FORTY-ONE: The correct answer is D: 200 mL.
Rationale: One unit of fresh frozen platelets in the pediatric patient is 10 mL/kg. In a 20 kg child, this equates to 200 mL.
QUESTION FORTY-TWO: The correct answer is A: Utilizing open-ended questions
Rationale: While the use of open-ended questions is appropriate for most age groups, it is even more important in the elderly patient. Because they are slower in their responses, open-ended questions gives the elderly patient more time to express themselves. If the patient is hard of hearing, it is more difficult to give incorrect responses to an open-ended questions compared to a “yes” or “no” question. Making eye contact is a good communication practice as it establishes rapport and trust. However, while it can enhance the interaction, it does not directly ensure the accuracy of the history. Starting with recent events can help orient the patient and focus their memory. However, this technique is secondary to open-ended questioning when it comes to eliciting detailed and accurate information. Waiting until the patient is in the transport vehicle will not increase the accuracy when obtaining a history.
GENERAL PRINCIPLES OF TRANSPORT
QUESTION FORTY-THREE: The correct answer is C: Blood.
Rationale: Hypemic hypoxia is a reduction in the oxygen carrying capacity of the blood. It is an inability of the blood to carry oxygen to the tissues. Hypoxic hypoxia is a problem within the lungs, a decrease in oxygen exchange. Stagnant hypoxia is frequently a problem with delivery and often arises from poor cardiac output. Histotoxic hypoxia occurs at the tissue and cellular level where the cells and tissues cannot adequately accept or utilize oxygen.
QUESTION FORTY-FOUR: The correct answer is D: Looking at bright lights
Rationale: Bright lights is associated with altered depth perception which can increase the incidence of spatial disorientation. Avoiding bright lights may decease the incidence of spatial disorientation. Spatial disorientation is not associated with hyperventilation or sinus congestion. Scanning the horizon with the eyes may actually reduce rather than cause spatial disorientation.
QUESTION FORTY-FIVE: The correct answer is D: Emergencies requiring an emergency landing
Rationale: The term “Mayday” is a unique term reserved for serious emergencies on a transport vehicle and should be used to ensure that the severity of the situation is clear to the receiving party. It indicates the need for help to respond to an emergency landing. Although it can be used for fires in an aircraft, it is not reserved for fires in the aircraft. It can also be used for other emergencies such as emergency decompression. “Mayday” should not be used for any emergency in flight but should be reserved for serious emergencies requiring emergency landing. Although “Mayday” could be used to summon help after a crash, it is not reserved for this situation and may be used prior to a crash.
QUESTION FORTY-SIX: The correct answer is B: Grass
Rationale: If a fire is being lit as the sun is beginning to set, a fire that emits white smoke is more likely to be seen from a distance, both during sunset as well as after dark. Burning green leaves, grass or adding a little fire to water is known to create white smoke. Adding oil, rubber, plastic or pitchy wood to a fire creates black smoke. This is more appropriate during daylight or in lighter colored environments but is not ideal for sunset and after dark.
QUESTION FORTY-SEVEN: The correct answer is D: Has serious injuries that are not immediately life-threatening.
Rationale: The “yellow” designation in mass casualty triage indicates that the patient has serious injuries but not immediately life threatening. The “yellow” designation is also known as “delayed”. Patients designated as “walking wounded” are given a green tag and placed in the triage area that is identified by the color green. The color-coded system of mass casualty triage is not used to identify what patients will require decontamination and which patients will not require decontamination. Patients identified as “immediate” (red colored designation) will be given the highest priority for transport from the scene. Those with a “yellow” designation can be transported after those with a “red” or immediate designation.
QUESTION FORTY-EIGHT: The correct answer is C: Excessive consumption of caffeine
Rationale: Caffeine has diuretic effects. While the consumption of moderate amounts of caffeine may improve alertness, excessive caffeine can cause diuresis, exacerbating the dehydration caused by flight. Although crew fatigue is a major contributor to safety incidents, crew fatigue does not contribute to dehydration in flight. The use of oxygen within an aircraft does not increase the risk of dehydration nor does taking NSAIDs within two hours of a flight.
QUESTION FORTY-NINE: The correct answer is D: Improves the distance radio messages can be carried.
Rationale: A radio repeater is a combination of a radio receiver and a radio transmitter that receives a signal and retransmits it, so that two-way signals can cover longer distances. They are often placed on higher elevations and increase the distance radio transmissions can be carried, especially in mountainous regions. A satellite phone requires a satellite not a repeater. Repeaters do not influence the accuracy of a patient report nor have any impact on the incidence of medication errors.
QUESTION FIFTY: The correct answer is B: How protected health information is encrypted and transmitted.
Rationale: The Health Insurance Portability and Privacy Act (HIPAA) clearly lays out how protected health information is protected. This includes how it is encrypted and transmitted. Since flight agencies frequently transmit protected health information, it is incumbent on them to ensure that all protected health information that is transmitted is done so in a way that meets the standards of HIPAA and protects the patient’s right to privacy. There are no provisions in HIPAA about what may be included in a patient bill. HIPAA does allow for protected health information to be shared between members of the health care team involved in the patient’s care but it does not specify how information is shared between healthcare providers. There are no provisions in HIPAA about what information may be recorded in the patient record. HIPAA only lays out how that information is protected and the patient’s right to access that information.