Endotracheal Intubation Practice Questions

31 multiple-choice questions on Endotracheal intubation 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.

31 practice questions

1. Which is an indication for endotracheal intubation?

   1. A. Mild asthma with good air entry
   2. B. A GCS of 13 with an intact gag
   3. C. SpO2 of 90% in a CO2 retainer
   4. D. Inability to protect the airway
   Show answer

   Answer: D. Inability to protect the airway

   Indications include failure to protect the airway, failure to oxygenate or ventilate, and an anticipated clinical course that will threaten the airway. A patient with a GCS of 13 and an intact gag is protecting his airway, an SpO2 of 90% is within the 88% to 92% target for a CO2 retainer, and mild asthma with good air entry needs bronchodilators, not a tube.

2. What is the most reliable method to confirm and continuously monitor endotracheal tube placement?

   1. A. Pulse oximetry
   2. B. Waveform capnography
   3. C. Auscultating the lungs
   4. D. Tube fogging
   Show answer

   Answer: B. Waveform capnography

   Continuous waveform capnography is the gold standard. Breath sounds and tube condensation can be misleading.

3. In which hand is the laryngoscope held?

   1. A. Dominant hand
   2. B. Left hand
   3. C. Right hand
   4. D. Either hand
   Show answer

   Answer: B. Left hand

   Laryngoscope blades are designed for the left hand, inserted on the right side of the mouth to sweep the tongue to the left.

4. After inserting the laryngoscope blade, how should you lift to expose the glottis?

   1. A. Up and away along the handle
   2. B. Pivot the blade like a lever
   3. C. Straight down toward the chest
   4. D. Rock back on the upper teeth
   Show answer

   Answer: A. Up and away along the handle

   Lift along the axis of the handle, roughly 45 degrees, toward the ceiling and away from you. Levering on the teeth risks dental injury.

5. How does a straight (Miller) blade expose the glottis?

   1. A. Sits in the vallecula only
   2. B. Pushes the tongue to the right
   3. C. Lifts the epiglottis directly
   4. D. Compresses the cricoid ring
   Show answer

   Answer: C. Lifts the epiglottis directly

   The straight blade tip passes under the epiglottis and lifts it directly. It is often preferred in infants, whose epiglottis is floppy.

6. Using the 3 x tube size rule, what is the approximate depth at the teeth for a 7.5-mm endotracheal tube?

   1. A. 30 cm
   2. B. 22.5 cm
   3. C. 15 cm
   4. D. 25.5 cm
   Show answer

   Answer: B. 22.5 cm

   Depth at the teeth is roughly 3 x the tube's internal diameter: 3 x 7.5 = 22.5 cm.

7. Using the formula for a cuffed tube, what size endotracheal tube is estimated for a 6-year-old?

   1. A. 5.5 mm
   2. B. 4.0 mm
   3. C. 5.0 mm
   4. D. 6.0 mm
   Show answer

   Answer: C. 5.0 mm

   Cuffed tube size = (age / 4) + 3.5 = (6 / 4) + 3.5 = 5.0 mm. For an uncuffed tube, add 4 instead of 3.5.

8. Where should the tip of a stylet be positioned in the endotracheal tube?

   1. A. Flush with the tip
   2. B. Short of the tube tip
   3. C. Past the tube tip
   4. D. At the Murphy eye
   Show answer

   Answer: B. Short of the tube tip

   The stylet should end proximal to the Murphy eye and tube tip to avoid injuring the trachea or vocal cords.

9. Once the tube passes the cords, how far should you advance it?

   1. A. Until resistance is felt
   2. B. Cuff resting at the carina
   3. C. Cuff just past the cords
   4. D. Until the tube reads 30 cm
   Show answer

   Answer: C. Cuff just past the cords

   Watch the cuff pass through the cords and advance it about 1 to 2 cm beyond them, then note depth at the teeth.

10. What is the typical target cuff pressure for an adult endotracheal tube?

    1. A. 40 to 50 cmH2O
    2. B. 5 to 10 cmH2O
    3. C. 20 to 30 cmH2O
    4. D. 60 to 80 cmH2O
    Show answer

    Answer: C. 20 to 30 cmH2O

    Pressures of 20 to 30 cmH2O seal the airway while limiting mucosal ischemia. Many services inflate with 5 to 10 mL and check with a manometer.

11. What is the purpose of the Murphy eye on an endotracheal tube?

    1. A. Alternate airflow path
    2. B. Inflates the cuff
    3. C. Marks the cord level
    4. D. Holds the stylet in place
    Show answer

    Answer: A. Alternate airflow path

    If the tube tip is occluded by the tracheal wall or secretions, air can still pass through the side hole (Murphy eye).

12. During laryngoscopy you can see only the posterior arytenoids. Applying backward, upward, and rightward pressure on the thyroid cartilage is called:

    1. A. Bimanual tilt
    2. B. BURP
    3. C. Jaw thrust
    4. D. Sellick maneuver
    Show answer

    Answer: B. BURP

    The BURP maneuver moves the larynx into better view. Sellick (cricoid pressure) is a different maneuver aimed at the esophagus.

13. As you pass a bougie, you feel clicking and then the bougie stops advancing. What does this indicate?

    1. A. Bronchial rupture
    2. B. Vocal cord injury
    3. C. Tracheal placement
    4. D. Esophageal placement
    Show answer

    Answer: C. Tracheal placement

    Clicks from the tracheal rings and hold-up in a small bronchus suggest tracheal placement. In the esophagus the bougie usually advances without resistance.

14. After moving an intubated patient, you hear air escaping from his mouth with each breath, and the depth mark has changed from 23 to 19 cm at the teeth. What is most likely?

    1. A. The cuff has burst from overinflation
    2. B. The tube has advanced into the right mainstem
    3. C. The cuff has pulled up to the vocal cords
    4. D. The patient has a tension pneumothorax
    Show answer

    Answer: C. The cuff has pulled up to the vocal cords

    The tube has come out 4 cm, so the cuff now sits at or above the cords and air leaks around it. Deflate, advance to the original depth under direct or video view if possible, reinflate, and reconfirm. A burst cuff would leave the depth unchanged. A right mainstem tube follows a deeper, not shallower, tube. A pneumothorax does not cause an air leak from the mouth.

15. An intubated patient suddenly needs high pressure to bag, the waveform is small, and a suction catheter will not pass beyond 10 cm into the tube. What is most likely?

    1. A. A tube that is in the esophagus
    2. B. A mucus plug blocking the tube
    3. C. A right mainstem intubation
    4. D. A tension pneumothorax
    Show answer

    Answer: B. A mucus plug blocking the tube

    A catheter that stops partway down the tube means something is inside the tube: a mucus plug, blood clot, or kink. Suction it, check for biting or kinking, and replace the tube if it cannot be cleared. An esophageal tube shows no waveform and passes a catheter easily. Right mainstem placement and tension pneumothorax do not stop a catheter inside the tube.

16. An intubated patient's SpO2 slowly falls during transport. The waveform, chest rise, and equal breath sounds are unchanged, and a suction catheter passes easily. What should you check next?

    1. A. The oxygen source and tubing to the bag
    2. B. The tube's cuff pressure with a manometer
    3. C. The depth, by withdrawing the tube 2 cm
    4. D. For a tension pneumothorax on the left
    Show answer

    Answer: A. The oxygen source and tubing to the bag

    With displacement, obstruction, and pneumothorax made unlikely by a good waveform, equal breath sounds, and a clear tube, check the 'E' in DOPE: equipment, such as an empty cylinder or oxygen tubing that has come off the regulator. Cuff pressure does not explain falling oxygenation with no leak. Withdrawing a well-placed tube risks dislodging it. Equal breath sounds make a tension pneumothorax on the left unlikely.

17. You ventilate after intubation and hear gurgling over the epigastrium, see no chest rise, and have no capnography waveform. What should you do?

    1. A. Remove the tube, ventilate by BVM
    2. B. Advance the tube 2 cm
    3. C. Bag faster and reassess
    4. D. Inflate the cuff more and recheck
    Show answer

    Answer: A. Remove the tube, ventilate by BVM

    These findings mean esophageal intubation. Remove the tube immediately, suction as needed, reoxygenate, and then reattempt or use an SGA.

18. A colorimetric CO2 detector changes from purple to yellow with ventilation. What does this indicate?

    1. A. CO2 is being detected
    2. B. The device is expired
    3. C. The cuff is overinflated
    4. D. The tube is in the esophagus
    Show answer

    Answer: A. CO2 is being detected

    Yellow ("gold is good") indicates exhaled CO2. In cardiac arrest, low CO2 levels may not change the color even with correct placement.

19. Why can a colorimetric CO2 detector be misleading in cardiac arrest?

    1. A. Epinephrine inactivates it
    2. B. It detects only oxygen
    3. C. CPR raises CO2 levels
    4. D. Low perfusion lowers CO2
    Show answer

    Answer: D. Low perfusion lowers CO2

    Poor pulmonary blood flow during arrest delivers little CO2 to the lungs, so a correctly placed tube may show little color change.

20. An esophageal detector device bulb is squeezed and attached to the ET tube. It reinflates quickly. What does this suggest?

    1. A. Right mainstem tube
    2. B. A cuff leak
    3. C. Esophageal placement
    4. D. Tracheal placement
    Show answer

    Answer: D. Tracheal placement

    The rigid trachea stays open, so the bulb refills rapidly. The soft esophagus collapses and the bulb reinflates slowly or not at all.

21. When using a hyperangulated video laryngoscope blade, why is a rigid, sharply curved stylet usually needed?

    1. A. To seal the trachea
    2. B. To lift the epiglottis
    3. C. To steer around the curve
    4. D. To guard the teeth
    Show answer

    Answer: C. To steer around the curve

    Hyperangulated blades give a view around the curve, but a straight tube will not follow that path. A rigid stylet shaped to match the blade guides the tube.

22. During video laryngoscopy you have an excellent view of the cords but cannot pass the tube. What is the most likely explanation?

    1. A. The patient has laryngospasm
    2. B. The blade is too short for him
    3. C. The camera lens has fogged
    4. D. View does not ensure delivery
    Show answer

    Answer: D. View does not ensure delivery

    With hyperangulated blades, seeing the glottis and delivering the tube are separate problems. Adjust the stylet shape or back the blade out slightly. A short blade or a fogged lens would spoil the view, but this view is excellent, and laryngospasm closes the cords rather than explaining a delivery problem with a hyperangulated blade.

23. Which patient is a candidate for blind nasotracheal intubation?

    1. A. Infant in respiratory arrest
    2. B. Patient with raccoon eyes
    3. C. Apneic, pulseless patient
    4. D. Breathing patient with a gag
    Show answer

    Answer: D. Breathing patient with a gag

    Blind nasotracheal intubation requires spontaneous breathing to guide the tube. It is contraindicated in apnea and suspected basilar skull fracture.

24. During nasotracheal intubation, when should the tube be advanced through the cords?

    1. A. During a breath-hold
    2. B. During inhalation
    3. C. During exhalation
    4. D. During a cough
    Show answer

    Answer: B. During inhalation

    The vocal cords open widest on inspiration, so advance the tube as the patient inhales.

25. After an intubated patient's head is flexed forward, what happens to the tube tip?

    1. A. It rotates to the left
    2. B. It moves toward the cords
    3. C. It does not move
    4. D. It moves deeper
    Show answer

    Answer: D. It moves deeper

    Flexion pushes the tube deeper and extension pulls it toward the cords. Reconfirm placement after any head or patient movement.

26. While you slide an ET tube over a bougie, the tube catches at the glottis and will not advance. What usually helps?

    1. A. Pull out the bougie and then push the tube in
    2. B. Rotate the tube 90 degrees counterclockwise
    3. C. Push harder until it pops through
    4. D. Inflate the cuff to widen the opening
    Show answer

    Answer: B. Rotate the tube 90 degrees counterclockwise

    The bevel commonly catches on the right arytenoid. Rotating the tube about 90 degrees counterclockwise turns the bevel and lets it pass, while the laryngoscope stays in to lift the tongue. Removing the bougie loses the guide. Pushing harder until it pops through injures the larynx. An inflated cuff makes the tube larger and will not pass.

27. How long should a single intubation attempt last, per many protocols?

    1. A. About 2 minutes
    2. B. Until it succeeds
    3. C. About 60 seconds
    4. D. About 30 seconds
    Show answer

    Answer: D. About 30 seconds

    Many protocols limit attempts to about 30 seconds, or less if SpO2 falls. Reoxygenate between attempts.

28. During CPR, how should intubation be timed relative to chest compressions?

    1. A. Minimize any pause
    2. B. Only after ROSC
    3. C. Stop CPR for 30 s
    4. D. Stop CPR for 1 min
    Show answer

    Answer: A. Minimize any pause

    Intubation should be done with minimal or no interruption of compressions. Many providers intubate during ongoing CPR.

29. Five minutes after intubation, BP falls from 128/80 to 82/50. The waveform is normal, breath sounds are equal, and bagging is easy. What is the most likely cause?

    1. A. A tube migrating into the esophagus
    2. B. A tube advanced into the right mainstem
    3. C. Induction drugs and positive pressure
    4. D. A sudden rise in intracranial pressure
    Show answer

    Answer: C. Induction drugs and positive pressure

    Post-intubation hypotension is common: induction agents lower sympathetic tone and positive-pressure ventilation reduces venous return, especially in volume-depleted patients. Give fluids or a pressor and avoid fast bagging. A normal waveform rules out esophageal placement. Equal breath sounds argue against a mainstem tube. Rising ICP causes hypertension and bradycardia, not this pattern.

30. After confirming tube placement, what is the best way to secure it?

    1. A. Tie it to the cervical collar
    2. B. Tape it to the forehead
    3. C. Hold it by hand only
    4. D. A commercial tube holder
    Show answer

    Answer: D. A commercial tube holder

    Commercial holders resist movement better than tape alone. Note depth at the teeth and reconfirm after every move.

31. After intubating a patient who had a full stomach and gastric distension from BVM ventilation, which step helps decompress the stomach?

    1. A. Place an orogastric tube
    2. B. Deflate the ET tube cuff
    3. C. Hyperventilate the lungs
    4. D. Push on the epigastrium
    Show answer

    Answer: A. Place an orogastric tube

    An orogastric tube decompresses the stomach, improving ventilation and reducing aspiration risk.