Basic Airway Maneuvers and Adjuncts Practice Questions

30 multiple-choice questions on Basic airway maneuvers and adjuncts for paramedic and EMT students, from Chapter 16 (Airway Management). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. While performing a head-tilt chin-lift, your fingertips press into the soft tissue under the chin and the snoring gets worse. Why?

   1. A. The head is tilted back much too far
   2. B. It pushes the tongue up into the airway
   3. C. Your fingers are pinching the nostrils closed
   4. D. The jaw has slipped out of joint
   Show answer

   Answer: B. It pushes the tongue up into the airway

   The fingers should lift the bony chin. Pressing the soft tissue under the jaw pushes the tongue base up into the airway. Moderate head tilt is part of the maneuver and is not the cause. Fingers under the chin do not pinch the nostrils closed. The jaw does not slip out of joint from this hand position.

2. After an NPA is placed, the patient begins to gag, and his abdomen swells during bag-mask ventilation. What is the most likely problem?

   1. A. The nasal airway is too short
   2. B. The bevel faces the septum
   3. C. The nasal airway is too long
   4. D. The airway was lubricated
   Show answer

   Answer: C. The nasal airway is too long

   An NPA that is too long can pass into the esophagus or touch the epiglottis and larynx, causing gagging and sending air to the stomach. Remeasure from nose tip to earlobe and replace it. A short NPA does not reach far enough to cause gagging or gastric inflation. The bevel should face the septum. Being lubricated with a water-soluble gel is correct.

3. An intubated patient begins clenching his teeth on the endotracheal tube and the waveform shrinks. What should you add?

   1. A. A bite block or an OPA beside the tube
   2. B. A tighter strap on the commercial tube holder
   3. C. A cervical collar to limit jaw motion
   4. D. More air into the tube's cuff
   Show answer

   Answer: A. A bite block or an OPA beside the tube

   A biting patient can flatten the tube and block ventilation. A bite block or an OPA placed beside the tube keeps the teeth apart, and the patient's sedation should be reassessed. The cuff seals the trachea and has nothing to do with biting. A tighter holder strap does not keep the teeth apart, and a cervical collar does not stop the jaw from clenching.

4. You are performing a jaw thrust on a trauma patient but cannot open the airway or achieve chest rise. What should you do?

   1. A. Keep the jaw thrust only
   2. B. Go straight to cricothyrotomy
   3. C. Stop and check a pulse
   4. D. Add a head tilt
   Show answer

   Answer: D. Add a head tilt

   An open airway takes priority over possible spinal injury. AHA guidance is to use a head-tilt chin-lift if the jaw thrust does not open the airway.

5. How is an oropharyngeal airway correctly sized?

   1. A. Mouth corner to earlobe
   2. B. Tip of nose to earlobe
   3. C. Lips to thyroid cartilage
   4. D. Chin to the sternal notch
   Show answer

   Answer: A. Mouth corner to earlobe

   Measure from the corner of the mouth to the earlobe (or angle of the jaw). Nose to earlobe is used for a nasopharyngeal airway.

6. How is the length of a nasopharyngeal airway correctly measured?

   1. A. Mouth corner to earlobe
   2. B. Nose tip to the chin
   3. C. Nose tip to earlobe
   4. D. Nostril to the jaw midpoint
   Show answer

   Answer: C. Nose tip to earlobe

   Measure from the tip of the nose to the earlobe. Diameter should fit the nostril without blanching it.

7. Which patient finding contraindicates insertion of an oropharyngeal airway?

   1. A. A suspected spinal injury
   2. B. An intact gag reflex
   3. C. Snoring respirations
   4. D. Absence of teeth
   Show answer

   Answer: B. An intact gag reflex

   An OPA in a patient with a gag reflex can cause gagging, vomiting, and aspiration. A nasopharyngeal airway is better tolerated.

8. A 28-year-old who was struck in the head is unresponsive, with bruising around both eyes and clear fluid from the nose. Which adjunct should you avoid?

   1. A. Bag-mask device
   2. B. Rigid suction catheter
   3. C. Oropharyngeal airway
   4. D. Nasopharyngeal airway
   Show answer

   Answer: D. Nasopharyngeal airway

   Raccoon eyes and CSF rhinorrhea suggest a basilar skull fracture. Many protocols avoid an NPA because of the risk of passing it into the cranial vault.

9. When inserting a nasopharyngeal airway, the bevel should face:

   1. A. Toward the nasal septum
   2. B. Toward the floor of the mouth
   3. C. Straight up toward the eye
   4. D. Toward the outer nostril
   Show answer

   Answer: A. Toward the nasal septum

   The bevel faces the septum to reduce trauma. Lubricate with a water-soluble lubricant and advance along the nasal floor.

10. What type of lubricant should be used on a nasopharyngeal airway?

    1. A. Water-soluble
    2. B. Petroleum-based
    3. C. Lidocaine-free oil
    4. D. Silicone spray
    Show answer

    Answer: A. Water-soluble

    Water-soluble lubricant is safe for mucosa. Petroleum products can damage tissue and may be aspirated.

11. Which technique is commonly used to insert an OPA in an adult?

    1. A. Along the floor of the nose
    2. B. Sideways, then rotated 45°
    3. C. Upside down, rotated 180°
    4. D. Right side up, with no blade
    Show answer

    Answer: C. Upside down, rotated 180°

    In adults the OPA is inserted with the tip toward the hard palate and rotated 180° as it nears the posterior pharynx, so it does not push the tongue back.

12. How should an OPA be inserted in a young child?

    1. A. Tip toward the hard palate
    2. B. Upside down, then rotated 180°
    3. C. Sideways, then rotated 90°
    4. D. Right side up, tongue blade
    Show answer

    Answer: D. Right side up, tongue blade

    In children, depress the tongue with a tongue blade and insert the OPA in its anatomic position to avoid injuring the soft palate.

13. What is the risk of an oropharyngeal airway that is too long?

    1. A. It can fold the epiglottis
    2. B. It will fall out on its own
    3. C. It pushes the tongue back
    4. D. It bruises the nasal septum
    Show answer

    Answer: A. It can fold the epiglottis

    An oversized OPA can press the epiglottis against the glottis and worsen obstruction. One that is too short can push the tongue into the pharynx.

14. You insert an OPA in a patient who then begins to gag and retch. What should you do?

    1. A. Remove it and use an NPA
    2. B. Leave it and suction
    3. C. Tape it securely in place
    4. D. Push it in further
    Show answer

    Answer: A. Remove it and use an NPA

    Gagging means the patient still has a gag reflex. Remove the OPA and consider a better-tolerated NPA, with suction ready.

15. A 25-year-old is postictal after a seizure, has clenched teeth, and snoring respirations. Which adjunct is most appropriate?

    1. A. Oropharyngeal airway
    2. B. Nasopharyngeal airway
    3. C. Endotracheal tube
    4. D. Supraglottic airway
    Show answer

    Answer: B. Nasopharyngeal airway

    An NPA can be placed despite clenched teeth and is tolerated by patients who retain a gag reflex.

16. Which statement about oropharyngeal and nasopharyngeal airways is correct?

    1. A. Both prevent vomiting
    2. B. An NPA prevents aspiration
    3. C. An OPA seals off the trachea
    4. D. Neither prevents aspiration
    Show answer

    Answer: D. Neither prevents aspiration

    Basic adjuncts only keep the tongue off the posterior pharynx. They do not seal or protect the lower airway.

17. Which nostril is generally preferred for NPA insertion when both are equally patent?

    1. A. The right nostril
    2. B. The left nostril
    3. C. The one with bleeding
    4. D. The nostril nearest you
    Show answer

    Answer: A. The right nostril

    When both nostrils are equally patent, use the right nostril: most NPAs are beveled so that, in the right nostril, the bevel faces the septum and slides past it without catching. In the left nostril the device must be inserted upside down and rotated 180 degrees, a bleeding nostril should be avoided, and which side is nearest you is not a selection criterion. If the right side is blocked, choose the larger, more open nostril.

18. What is a common complication of nasopharyngeal airway insertion?

    1. A. Gastric distension
    2. B. Broken teeth
    3. C. Laryngospasm
    4. D. Nosebleed
    Show answer

    Answer: D. Nosebleed

    Epistaxis is common, especially with forced insertion. If resistance is met, try the other nostril rather than forcing it.

19. Which patient finding should make you hesitate before inserting a nasopharyngeal airway?

    1. A. Anticoagulation with a very high INR
    2. B. Clenched teeth after a generalized seizure
    3. C. An intact gag reflex
    4. D. A history of snoring
    Show answer

    Answer: A. Anticoagulation with a very high INR

    Nasal airways often cause some bleeding, and with anticoagulation a patient with a very high INR can bleed into the airway, so weigh the risk and use an OPA or positioning if possible. Clenched teeth and an intact gag are reasons an NPA is chosen over an OPA. A history of snoring is not a contraindication.

20. To achieve the sniffing position in an adult, where is padding usually placed?

    1. A. Under the occiput
    2. B. Under the lower back
    3. C. Under the chin
    4. D. Under the shoulders
    Show answer

    Answer: A. Under the occiput

    Raising the occiput flexes the lower neck and extends the head, aligning the airway axes in adults.

21. You are managing the airway of a 160-kg patient. Which positioning best improves BVM ventilation and laryngoscopy?

    1. A. Flat supine, head neutral
    2. B. Trendelenburg position
    3. C. Ear level with sternal notch
    4. D. Pad under the shoulders only
    Show answer

    Answer: C. Ear level with sternal notch

    Ramping the obese patient until the external ear canal is level with the sternal notch improves the view and slows desaturation.

22. An unresponsive 55-year-old overdose patient is breathing adequately with no trauma. You need both hands to prepare equipment. How should you position him?

    1. A. Trendelenburg
    2. B. Prone, head turned
    3. C. Recovery position
    4. D. Supine, head flat
    Show answer

    Answer: C. Recovery position

    The lateral recovery position helps keep the airway open and lets secretions or vomit drain from the mouth.

23. How is a jaw thrust performed?

    1. A. Pull the tongue forward with gauze
    2. B. Push down firmly on the forehead
    3. C. Lift the jaw forward at its angles
    4. D. Press the chin down to open the mouth
    Show answer

    Answer: C. Lift the jaw forward at its angles

    Place the fingers behind the angles of the mandible and lift it forward, which pulls the tongue off the pharynx.

24. What is the primary purpose of an oropharyngeal airway?

    1. A. Seal the trachea from vomitus
    2. B. Deliver oxygen to the alveoli
    3. C. Prevent vagal stimulation
    4. D. Keep the tongue off the pharynx
    Show answer

    Answer: D. Keep the tongue off the pharynx

    Basic adjuncts hold the tongue away from the posterior pharynx to maintain an open airway, especially during BVM ventilation.

25. You meet resistance while inserting an NPA in the right nostril. What is the best next step?

    1. A. Try the other nostril
    2. B. Rotate it 180 degrees
    3. C. Force it gently past
    4. D. Switch to a larger size
    Show answer

    Answer: A. Try the other nostril

    Forcing an NPA risks bleeding and mucosal injury. Withdraw and try the other nostril, perhaps with a smaller size.

26. While ventilating an unresponsive patient with a BVM, chest rise is poor despite a good mask seal. What is the best first step?

    1. A. Move to cricothyrotomy
    2. B. Reposition and add an OPA
    3. C. Increase the oxygen flow
    4. D. Squeeze the bag harder
    Show answer

    Answer: B. Reposition and add an OPA

    Poor chest rise is usually an airway problem. Reposition the head and jaw and insert an airway adjunct before escalating.

27. Which maneuver is used to open the mouth of an unresponsive patient so you can look for a foreign body or insert an adjunct?

    1. A. Sellick maneuver
    2. B. Cross-finger technique
    3. C. Jaw thrust without tilt
    4. D. Head-tilt chin-lift
    Show answer

    Answer: B. Cross-finger technique

    Crossing the thumb and index finger and pushing the teeth apart opens the mouth for inspection, suction, or insertion.

28. An unresponsive motorcyclist in a full-face helmet is breathing poorly. The face shield is up. What should you do to manage his airway?

    1. A. Remove the helmet with two rescuers
    2. B. Ventilate through the open face shield
    3. C. Leave it on and insert a nasal airway
    4. D. Cut the chin strap and tilt the head back
    Show answer

    Answer: A. Remove the helmet with two rescuers

    A full-face helmet blocks a mask seal, suction, and airway adjuncts, so it must come off when the airway needs management. One rescuer holds in-line stabilization while the other removes the helmet. You cannot ventilate well through the open face shield. A nasal airway placed with the helmet on does not fix poor breathing and still leaves no way to bag. Tilting the head back risks spinal injury; use a jaw thrust.

29. A properly sized and placed oropharyngeal airway's flange should rest:

    1. A. Inside the cheek
    2. B. At the gum line
    3. C. Against the lips
    4. D. Behind the teeth
    Show answer

    Answer: C. Against the lips

    When fully inserted, the flange sits against the patient's lips with the curve following the tongue.

30. A 1-year-old with a nasal airway in place develops more retractions and a gurgling sound at the device. What should you do?

    1. A. Suction the nasal airway
    2. B. Push it further into the nose
    3. C. Remove it and place an OPA
    4. D. Increase the oxygen flow
    Show answer

    Answer: A. Suction the nasal airway

    The small lumen of a pediatric NPA plugs easily with secretions. Suction through it, and replace it if it stays blocked. Pushing it deeper makes it too long. Replacing it with an OPA is not indicated unless the gag is absent and the NPA has failed. More oxygen does not clear a plugged airway.