Free FP-C practice questions

Answer: B

• A. Standing up seems to help visibility, but it gives up the rotor clearance that crouching provides, and the grit still blinds the eyes at any height near the aircraft.
• B. Correct. Moving blind near turning rotors is the danger. Stopping low keeps the head below the rotor disc, and the pilot or a crew member who can see guides the team in.
• C. Retreating feels like moving away from danger, but backing up blind with a loaded stretcher can bring the team around toward the tail rotor and risks a fall with the patient.
• D. Tempting because the door was visible a moment ago, but a few steps off line in a brownout can take the team toward the tail rotor or an upslope blade tip.

Aviation safety guidance says that anyone blinded by swirling dust or grit near a helicopter should stop, crouch lower or sit down, and wait for help, because a person who keeps moving blind can walk into the tail rotor or under a low part of the rotor disc. Eye protection against blowing dust reduces the problem, and loose articles should be secured before the load. CAMTS requires each program to have a written policy and training for rapid (hot) loading and unloading, and requires hearing protection for everyone who helps with it.

Sources: CAA NZ: Safety Around Helicopters (2022); CAMTS Accreditation Standards, 12th ed.; ASTNA Patient Transport, 6th ed.

Answer: B

• A. Vibration increases metabolic demand and discomfort but is not the main cause of heat loss.
• B. Correct. Temperature falls about 2 °C per 1,000 feet and the cabin is drafty, so critically ill patients lose heat quickly. Active warming devices, reflective and insulating layers, warmed fluids and cabin heating are used, with temperature monitoring throughout.
• C. Dry cabin air worsens dehydration and secretion thickness but is not the primary thermal stressor.
• D. Fatigue is a crew stressor, and transport time is dictated by the mission.

The stressors of flight: decreased partial pressure of oxygen, barometric pressure changes, thermal changes, decreased humidity, noise, vibration, fatigue, gravitational forces, spatial disorientation, and flicker. Each affects the patient and the crew, and the crew mitigates them: oxygen, altitude requests, warming, humidification, hearing protection, padding, and rest.

Sources: ASTNA Patient Transport, 6th ed.; Critical Care Transport, 3rd ed.

Answer: A

• A. Correct. Gastric distention from mask ventilation raises the diaphragm, impairs ventilation and increases aspiration risk; decompression, head elevation and an adequate cuff seal reduce these risks during transport.
• B. Abdominal pressure causes regurgitation and aspiration.
• C. It persists and worsens with continued positive pressure if a leak exists.
• D. Larger volumes raise pressures and do not treat the distention.

Post-intubation checklist for transport: tube depth and security, cuff pressure, capnography, ventilator settings and alarms, gastric decompression, head elevation, sedation and analgesia, suction available, a backup airway plan, and documentation. Nasogastric tubes are avoided with basilar skull or midface fractures.

Sources: Critical Care Transport, 3rd ed.; Walls Manual of Emergency Airway, 6th ed.

Answer: B

• A. Misting occurs with esophageal placement as well.
• B. Correct. Continuous waveform capnography is the accepted standard for confirming and monitoring tube placement; a sustained waveform with an appropriate value confirms tracheal position, whereas esophageal placement produces no waveform after a few breaths.
• C. Colorimetric devices give a single qualitative reading, can be fooled by gastric contents and low-flow states, and do not provide continuous monitoring.
• D. Auscultation is unreliable in a helicopter and can be misleading even in a quiet room.

Tube confirmation and monitoring: waveform capnography, direct visualization during placement, chest rise, saturation, and tube depth at the teeth (about three times the internal diameter in centimeters, typically 21 to 23 cm in adults), reconfirmed after every move. The tube is secured with a commercial holder, and the depth is recorded and reported at handoff.

Sources: Walls Manual of Emergency Airway, 6th ed.; Critical Care Transport, 3rd ed.; AHA 2025 Part 9: Adult ALS

Answer: D

• A. Disconnecting and bagging is reasonable for a sudden rise in airway pressure, but the suction catheter passes freely, which argues against obstruction, and bagging does not treat the hypotension or the cause.
• B. Rising airway pressure with hypotension suggests tension pneumothorax, but breath sounds are equal and there are bilateral wheezes and new flushing, which point to bronchospasm and a systemic reaction rather than a collapsed lung.
• C. The patient does have sepsis, but the abrupt onset within minutes of a new drug, with bronchospasm and skin changes, points to anaphylaxis. A pressor alone does not treat the mast-cell reaction.
• D. Correct. A new drug followed within minutes by bronchospasm, hypotension and flushing is anaphylaxis until proved otherwise. The trigger is stopped and epinephrine is given at once, IM or as a titrated IV dose by a clinician experienced in its use.

Antibiotics are among the commonest drug triggers of anaphylaxis, and in a sedated, ventilated patient the usual complaints are missing, so the crew has to read the monitor. Bronchospasm raises airway pressure and slows exhalation, while vasodilation and capillary leak drop the blood pressure and cardiac output, which is why the EtCO2 falls. The first steps are to stop the suspected drug, give epinephrine, give a rapid crystalloid bolus and start an epinephrine infusion if the reaction persists. Chest compressions begin early if the systolic pressure stays below 50 mm Hg.

Sources: AHA 2025 Part 10: Special Circumstances; ASTNA Patient Transport: Medical Crit Care; Critical Care Transport, 3rd ed.

Answer: A

• A. Correct. He is confused and actively vomiting blood, and guidance calls for endotracheal intubation in patients with ongoing bleeding before balloon tamponade or an esophageal stent is placed, so the airway is secured before the tube goes in.
• B. Emptying the stomach sounds like it lowers aspiration risk, but routine nasogastric tubes before intubation or endoscopy are discouraged in variceal bleeding, and it leaves a confused, vomiting patient with an unprotected airway.
• C. Erythromycin given 30 to 120 minutes before endoscopy improves the view for the endoscopist, but it does not protect the airway and has no role in preparing for balloon tamponade.
• D. Speed matters with this much bleeding, but waiting for aspiration reverses the sequence; patients with ongoing variceal bleeding are intubated before tamponade, and aspiration pneumonia is the most common infection after variceal bleeding.

When endoscopic therapy fails to stop variceal bleeding, AASLD guidance is endotracheal intubation followed by balloon tamponade or a covered esophageal stent as a temporizing bridge to TIPS. Balloon tamponade is limited to 24 hours, whereas a stent can stay up to 1 week with similar efficacy and better safety where one is available, and emergent TIPS may be considered before the balloon is removed. Securing the airway first matters because aspiration pneumonia is the most common infection in variceal bleeding.

Sources: AASLD Portal Hypertension Guidance (2024)

Answer: D

• A. Steroids for spinal cord injury are no longer recommended because of harm without proven benefit.
• B. Excess fluid causes pulmonary edema because the problem is loss of vascular tone, not volume.
• C. Pure alpha agonism worsens reflex bradycardia and does not reach the recommended MAP target.
• D. Correct. Neurogenic shock is treated with judicious fluids and an agent with alpha and beta activity to support both vascular tone and heart rate; a MAP of 85 to 90 for the first week is recommended to protect cord perfusion (AANS/CNS 2013), and the 2024 AO Spine/Praxis guideline suggests at least 75 to 80 and no higher than 90 to 95 for 3 to 7 days.

High cervical injuries also threaten ventilation (loss of diaphragm function at C3 to C5 and of intercostals below), temperature regulation (poikilothermia), and airway management (bradycardia and hypotension with laryngoscopy, succinylcholine contraindicated after the first 48 to 72 hours). Spinal motion restriction continues, and pressure injuries are prevented with padding during long transports.

Sources: Critical Care Transport, 3rd ed.; NAEMT PHTLS, 10th ed.; McQuillan, Trauma Nursing, 5th ed.

Answer: A

• A. Correct. Until the aneurysm is clipped or coiled, a systolic pressure below 160 (some centers use 140) is the usual target to lower rebleeding risk, though no target is proven; nimodipine reduces vasospasm-related injury. Hypotension is avoided because it worsens ischemia.
• B. Before the aneurysm is secured, hypertension increases the risk of rebleeding, which is often fatal.
• C. Nitroprusside raises intracranial pressure and a target of 100 causes ischemia.
• D. Antiplatelet agents worsen bleeding.

Subarachnoid hemorrhage transport: airway protection for a declining level of consciousness, blood pressure control, nimodipine, seizure precautions, analgesia for headache, reversal of anticoagulants, avoidance of hypotonic fluids, and monitoring for hydrocephalus (worsening consciousness) and rebleeding (sudden headache, decline, or arrest). Cardiac complications including stunned myocardium and arrhythmias are common in the first days.

Sources: Critical Care Transport, 3rd ed.; AHA/ASA Aneurysmal SAH Guideline (2023)

Answer: C

• A. Heparin does not lyse the clot; a hypotensive patient needs reperfusion now.
• B. Overloading a failing right ventricle reduces left ventricular filling and worsens shock.
• C. Correct. High-risk pulmonary embolism with shock is an indication for systemic thrombolysis. The failing right ventricle is supported with norepinephrine, avoiding large fluid volumes that further dilate it and shift the septum, and intubation is avoided when possible because positive pressure worsens right ventricular failure.
• D. Positive pressure raises pulmonary vascular resistance and can precipitate arrest in massive PE; intubation is reserved for failure of other measures.

Pulmonary embolism risk stratification (ESC): high risk (hypotension), intermediate risk (right ventricular strain or elevated troponin without hypotension), low risk. The 2026 AHA/ACC guideline uses clinical categories A to E in place of the older US terms massive and submassive; persistent hypotension with cardiogenic shock is category E1. Transport considerations include avoiding hypotension and hypoxia, pulmonary vasodilators such as inhaled nitric oxide when available, inotropes for right ventricular failure, and careful induction if intubation cannot be avoided. Catheter-directed therapy and ECMO are options at the destination.

Sources: Critical Care Transport, 3rd ed.; AHA/ACC Acute Pulmonary Embolism (2026); ASTNA Patient Transport: Medical Crit Care

Answer: C

• A. The pump does sustain output for a time, which makes observation tempting, but sustained VT can lead to right ventricular failure and loss of LVAD filling.
• B. Unsynchronized shocks are for pulseless or unresponsive patients; an awake patient with adequate perfusion is managed as stable VT.
• C. Correct. The LVAD keeps forward flow, so the VT is tolerated for now, but it still needs treatment because the unsupported right ventricle can fail; cardioversion is used if mental status or perfusion worsens.
• D. The missing pulse looks like pulseless VT, but continuous-flow LVADs rarely produce a palpable pulse; this patient is awake and perfusing, so compressions are not indicated.

LVAD flow does not depend on the ECG, so ventricular arrhythmias that would kill an unsupported patient may be tolerated, sometimes even VF with preserved consciousness. They are still treated: the right ventricle receives the venous return the LVAD pumps around but cannot eject it well, so it distends and fails, LVAD filling falls, and the patient decompensates. Correct triggers such as electrolytes or suction events, use standard antiarrhythmics (amiodarone, lidocaine), which often fail in LVAD patients, and cardiovert or defibrillate if mental status or perfusion deteriorates.

Sources: LVAD Management in the ED, JACEP Open (2020); Ambulance LVAD Algorithms, Emerg Med J (2017); AHA 2025 Part 10: Special Circumstances; Critical Care Transport, 3rd ed.

Answer: A

• A. Correct. When brain injury coexists with hemorrhage, cerebral perfusion takes priority; a systolic of at least 110 (or 100 to 110 depending on age) is maintained with blood rather than crystalloid, and surgery is expedited.
• B. Even a single episode of hypotension doubles mortality in brain injury.
• C. Vasopressors do not replace volume in hemorrhage, and a target that high increases bleeding without added benefit.
• D. A target guides the resuscitation.

Brain injury guidelines recommend avoiding a systolic pressure below 110 mm Hg in adults 15 to 49 and over 70, and below 100 in those 50 to 69, along with avoidance of hypoxia (saturation below 90%), normocapnia, and tranexamic acid within 3 hours for moderate injury. Hemorrhage control remains urgent because blood pressure cannot be sustained without it.

Sources: Critical Care Transport, 3rd ed.; BTF Severe TBI Guidelines, 4th ed. (2016); BTF Prehospital TBI, 3rd ed. (2023)

Answer: C

• A. Once induction and paralytic drugs are given, the eye, verbal and motor responses are pharmacologically abolished, so a post-intubation score is not interpretable and the pre-drug baseline is lost.
• B. Tempting because it is the earliest possible score, but a GCS taken while the patient is hypoxic and hypotensive reflects those secondary insults, not the injury itself, and it delays correcting the hypoxemia.
• C. Correct. Hypoxia and hypotension both depress consciousness, so a score taken before they are corrected understates the brain injury; a score taken after sedatives and paralytics cannot be obtained at all. The window between resuscitation and induction gives the most accurate baseline, as long as it does not delay securing the airway.
• D. The guideline accepts a score taken after the drugs have been metabolized only when a pre-drug score is not possible. Here there is a window before induction, and waiting leaves the receiving team without the baseline and trend it needs in every report.

The Brain Trauma Foundation prehospital guidelines (3rd edition) recommend measuring the GCS after airway, breathing and circulation are assessed and any needed ventilatory or circulatory resuscitation is done, and before sedative or paralytic agents when this does not delay airway stabilization. The score is obtained by interacting with the patient (verbal commands, then a painful stimulus such as nail bed pressure or an axillary pinch), repeated every 30 minutes and with any change, and reported with confounders such as seizures, intoxication and drugs given. Pupils are examined after resuscitation for the same reason.

Sources: BTF Prehospital TBI, 3rd ed. (2023); Critical Care Transport, 3rd ed.

Answer: B

• A. A rate that low is inadequate for a neonate.
• B. Correct. Preterm infants are ventilated with low volumes (4 to 6 mL/kg) or modest pressures, adequate PEEP to prevent atelectasis, and saturation targets that avoid hyperoxia, with close attention to temperature and glucose.
• C. Hyperoxia causes retinopathy and lung injury in preterm infants; oxygen is titrated.
• D. High volumes and high saturations injure the preterm lung and eyes.

Neonatal transport priorities: thermoregulation (36.5 to 37.5 °C with an incubator or warming devices, hat and plastic wrap for very preterm infants), glucose above 45 to 50 mg/dL, gentle ventilation, saturation targets by gestational age, umbilical or peripheral access, and the S.T.A.B.L.E. approach (sugar, temperature, airway, blood pressure, laboratory work, emotional support). Cuffless tubes are traditional in small neonates.

Sources: AAP Field Guide: Neonatal/Peds Transport; Textbook of Neonatal Resuscitation, 9th ed.; ASTNA Patient Transport, 6th ed.

Answer: A

• A. Correct. Flexing the knees to the chest raises systemic vascular resistance, which reduces right-to-left flow across the ventricular septal defect and pushes more blood into the pulmonary artery; it is immediate and needs no equipment.
• B. Tempting because he looks shocked, but beta stimulation raises heart rate and contractility, which tightens the dynamic outflow obstruction; spells are treated with drugs that slow the heart or raise systemic resistance.
• C. Intubation is a later step if the spell does not break; fast bag ventilation raises intrathoracic pressure and agitation, and positioning and oxygen come first.
• D. The hyperpnea reflects hypoxemia, not pulmonary edema, and a diuretic lowers preload, which reduces right ventricular filling and pulmonary blood flow.

A hypercyanotic (tet) spell is a sudden increase in right-to-left shunting when systemic resistance falls or pulmonary outflow resistance rises, triggered by agitation, pain, fever or hypovolemia. The murmur softens because less blood crosses the narrowed outflow tract. Treatment escalates from knee-chest positioning and oxygen to morphine for agitation, a fluid bolus to fill the right ventricle, an IV beta-blocker to slow the heart, and phenylephrine to raise systemic afterload. An untreated spell can cause syncope and death, so the child needs prompt surgical referral.

Sources: StatPearls (NCBI Bookshelf); AHA PALS Provider Manual (2025); Wong's Care of Infants & Children, 12th ed.; Critical Care Transport, 3rd ed.

Answer: D

• A. Written records alone omit the reasoning and the trends.
• B. The receiving team needs the whole picture to continue care safely.
• C. The en-route report prepares the unit but does not replace the bedside handoff.
• D. Correct. Structured, face-to-face handoff with the receiving team, covering situation, background, assessment and recommendations, with time for questions, reduces the information loss that causes errors at transitions of care.

Transitions of care are high-risk moments. Structured tools, read-back of critical values, a checklist of lines, tubes, infusions and belongings, and documentation of the time and the receiving clinician complete the transfer of responsibility. The crew stays until the receiving team accepts care.

Sources: ASTNA Patient Transport, 6th ed.; Critical Care Transport, 3rd ed.; ASTNA Standards for CC Transport, 2nd ed.