Technology-dependent Patients: Home Ventilators, Tracheostomies, Vascular Access, LVADs, Pumps, Dialysis, and Feeding Tubes Practice Questions

25 multiple-choice questions on Technology-dependent patients: home ventilators, tracheostomies, vascular access, LVADs, pumps, dialysis, and feeding tubes for paramedic and EMT students, from Chapter 46 (Patients With Special Challenges). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A man had a tracheostomy placed 4 days ago. At home the tube comes out, and he is in distress. His mouth and upper airway are clear. You should first:

   1. A. Force a new tube into the fresh stoma
   2. B. Pack the stoma and start chest compressions
   3. C. Cover the stoma and oxygenate from above
   4. D. Wait for the surgeon to replace the tube
   Show answer

   Answer: C. Cover the stoma and oxygenate from above

   A tracheostomy tract younger than about a week has not matured, and blind reinsertion can create a false passage into the neck tissues, with subcutaneous emphysema and failed ventilation. With a patent upper airway, cover the stoma and give oxygen or bag-mask ventilation through the face, with oral intubation as the backup; only experienced providers should attempt reinsertion, per protocol. Packing the stoma is reasonable only while ventilating from above, and compressions are not indicated in a patient with a pulse. Waiting for a surgeon delays oxygenation. (NTSP emergency algorithm.)

2. A ventilated patient's high-pressure alarm is sounding. A likely cause is:

   1. A. A disconnected ventilator circuit
   2. B. A leak around a deflated cuff
   3. C. A loose humidifier connection
   4. D. Secretions blocking the tracheostomy
   Show answer

   Answer: D. Secretions blocking the tracheostomy

   High-pressure alarms signal resistance to flow: mucus plugs, kinked tubing, coughing, bronchospasm, or pneumothorax. Disconnections and leaks trigger the low-pressure alarm instead.

3. A home ventilator's low-pressure alarm most often indicates:

   1. A. A leak or disconnection in the circuit
   2. B. A mucus plug in the tracheostomy tube
   3. C. Bronchospasm in the lower airways
   4. D. A tension pneumothorax developing
   Show answer

   Answer: A. A leak or disconnection in the circuit

   When the circuit leaks or comes apart, the ventilator cannot build its usual pressure. Mucus plugs, bronchospasm, and pneumothorax raise airway pressure and set off the high-pressure alarm.

4. A man with a tracheostomy has a small filter-like cap (a heat and moisture exchanger) on his tube. Its main purpose is to:

   1. A. Keep the tube from slipping out of the stoma
   2. B. Let him speak by sealing the tube on exhale
   3. C. Warm and humidify the air he breathes
   4. D. Deliver a set amount of extra oxygen to him
   Show answer

   Answer: C. Warm and humidify the air he breathes

   A tracheostomy bypasses the nose and mouth, which normally warm, humidify, and filter inhaled air. A heat and moisture exchanger traps the warmth and moisture of exhaled air and returns it on the next breath, keeping secretions thin. If it becomes clogged with mucus and he is in distress, remove it. A speaking valve, not an HME, allows speech.

5. A patient has a cuffed tracheostomy tube. The main purpose of the inflated cuff is to:

   1. A. Hold the tube in place so ties are not needed
   2. B. Let the patient speak around the tube more easily
   3. C. Warm and humidify the air entering the lungs
   4. D. Seal the airway for positive-pressure breaths
   Show answer

   Answer: D. Seal the airway for positive-pressure breaths

   An inflated cuff seals the trachea so positive-pressure breaths go to the lungs, and it reduces (but does not eliminate) aspiration. Speaking requires air to pass around the tube, so the cuff must be deflated when a speaking valve is used.

6. A woman who had a tracheostomy 3 weeks ago coughs up a small amount of bright red blood, then has brisk, pulsing bleeding from around the tube. You should suspect:

   1. A. Erosion into the innominate artery
   2. B. Minor irritation from suctioning
   3. C. Bleeding from a stomach ulcer
   4. D. A nosebleed draining down her throat
   Show answer

   Answer: A. Erosion into the innominate artery

   A tracheoinnominate fistula most often appears 1 to 4 weeks after tracheostomy, and a small 'sentinel' bleed often comes before a massive one. Overinflate the cuff (or place a cuffed tube below the bleeding), press a finger through the stoma against the back of the sternum if trained, and transport rapidly. Suction irritation produces small streaks, not pulsing bleeding. Bleeding from an ulcer is vomited, not coughed up around the tube. A nosebleed comes from the nose. (Grant 2006; NTSP.)

7. When inserting a replacement tracheostomy tube, the obturator is:

   1. A. Left in place to keep the airway open
   2. B. Placed in the tube for insertion, then removed
   3. C. Used to inflate the cuff after insertion
   4. D. Inserted after the inner cannula is fully seated
   Show answer

   Answer: B. Placed in the tube for insertion, then removed

   The obturator's rounded tip guides insertion and must be removed right away because it occludes the tube; then the inner cannula is inserted. Leaving it in blocks all airflow.

8. A man with a total laryngectomy is in respiratory distress, and a mucus plug is visible in his neck stoma. You should first:

   1. A. Suction the stoma and remove the plug
   2. B. Ventilate by mask over his mouth
   3. C. Perform an oral endotracheal intubation
   4. D. Give a nebulized bronchodilator
   Show answer

   Answer: A. Suction the stoma and remove the plug

   The stoma is his only airway, so clearing it with suction and removing crusted secretions comes first. Mouth ventilation and oral intubation cannot reach the lungs after total laryngectomy.

9. A tracheostomy patient with a one-way speaking valve needs assisted ventilation. Before bagging, you should:

   1. A. Inflate the valve's balloon
   2. B. Tape the valve firmly in place
   3. C. Cover the valve with gauze
   4. D. Remove the speaking valve
   Show answer

   Answer: D. Remove the speaking valve

   A speaking valve lets air in through the trach but not back out, so bagging through it causes air trapping and barotrauma. Remove it and, if the tube has a cuff, inflate it before ventilating.

10. A man who breathes through a tracheostomy needs transport. Before leaving, you should make sure his emergency bag includes:

    1. A. A tube two sizes larger for a tighter seal
    2. B. A spare tube in his size and a smaller one
    3. C. His oxygen concentrator for use in the unit
    4. D. A nasal airway to place into the stoma
    Show answer

    Answer: B. A spare tube in his size and a smaller one

    A tracheostomy emergency kit holds a spare tube of the same size and one size smaller (for a stoma that has narrowed), the obturator, suction catheters, a syringe for the cuff, and ties. A larger tube may not pass and can tear the stoma. The ambulance has its own oxygen, and a concentrator needs household power. A nasal airway can slip into the stoma and is no substitute for a trach or endotracheal tube. (NTSP; AAO-HNS consensus.)

11. A patient with obstructive sleep apnea uses CPAP at night. CPAP works mainly by:

    1. A. Delivering a set number of breaths per minute
    2. B. Removing carbon dioxide from the blood
    3. C. Splinting the upper airway open with pressure
    4. D. Increasing the patient's respiratory drive
    Show answer

    Answer: C. Splinting the upper airway open with pressure

    Continuous positive pressure holds the pharynx open so it does not collapse during sleep. Unlike a ventilator or BiPAP with a backup rate, CPAP delivers no breaths; the patient must breathe spontaneously.

12. An implanted vascular port is accessed by:

    1. A. Unscrewing a cap on the external catheter
    2. B. A standard IV catheter inserted into the port
    3. C. A noncoring (Huber) needle through the skin
    4. D. Pulling the port's tubing out of the chest
    Show answer

    Answer: C. A noncoring (Huber) needle through the skin

    A port sits entirely under the skin and is accessed with a special noncoring needle that does not damage its septum. Accessing ports in the field is limited to trained personnel per local protocol.

13. A woman with a portable home chemotherapy infusion pump has a disconnected line, and the drug is leaking onto her shirt and the floor. You should:

    1. A. Reconnect the tubing and restart the pump
    2. B. Wipe it up with bare hands and paper towels
    3. C. Remove the needle from her port right away
    4. D. Clamp the line; glove up for the spill
    Show answer

    Answer: D. Clamp the line; glove up for the spill

    Many chemotherapy drugs are hazardous on contact. Stop the flow (clamp the line and stop the pump), wear chemotherapy-rated gloves, contain the spill with absorbent pads, bag contaminated items, wash her skin with soap and water, and notify her oncology or home infusion team. Reconnecting contaminated tubing risks infection and an unknown dose. Bare hands expose you to the drug. Removing the port needle is the infusion team's job and is not needed to stop the leak. (NIOSH hazardous drugs; ONS safe handling.)

14. A patient has a PICC line in his right upper arm. When you take his blood pressure, you should:

    1. A. Place the cuff directly over the PICC site
    2. B. Use the left arm instead of the PICC arm
    3. C. Clamp the PICC before inflating the cuff
    4. D. Inflate the cuff to 250 mmHg on either arm
    Show answer

    Answer: B. Use the left arm instead of the PICC arm

    A blood pressure cuff on the arm with a PICC can compress and damage the catheter or cause clotting in the vein, so the other arm or a leg is used. If no other site is possible, place the cuff below the insertion point per protocol. Clamping the line is not needed for a blood pressure check.

15. A 61-year-old man with an LVAD is alert and talking, but the monitor shows ventricular tachycardia at 170/min. The pump is humming. This is possible because:

    1. A. The pump keeps moving blood despite the VT
    2. B. The monitor is misreading the pump's motor
    3. C. VT is harmless in patients with an LVAD
    4. D. The LVAD is pacing his heart at that rate
    Show answer

    Answer: A. The pump keeps moving blood despite the VT

    An LVAD pumps blood from the left ventricle to the aorta regardless of the native rhythm, so many patients stay awake in VT or even VF for a time; right ventricular failure follows, so treat per ACLS (cardioversion and defibrillation are safe) and contact the VAD coordinator. The monitor reads the heart's own electrical activity, not the motor. VT is not harmless, since it can cause right heart failure and reduce pump filling. An LVAD does not pace the heart. (AHA 2017 scientific statement.)

16. An LVAD patient has a fever and redness with drainage where the driveline exits his abdomen. You should suspect:

    1. A. Driveline infection, a sepsis risk
    2. B. Normal healing that needs no follow-up
    3. C. An allergy to the dressing tape
    4. D. A pump motor that is overheating
    Show answer

    Answer: A. Driveline infection, a sepsis risk

    Driveline infections are among the most common LVAD complications and can spread to the pump pocket and bloodstream. Keep the driveline secured and connected, cover the site with a sterile dressing, treat for sepsis per protocol, and contact the VAD team. Fever and drainage are not normal healing. Tape allergy causes local itching or rash without fever. Pump overheating does not cause a skin infection, and the controller would alarm. (ISHLT 2023; ISHLT infection consensus 2017.)

17. In an LVAD patient with little or no pulse, the pressure at which you first hear flow with a Doppler as a manual cuff deflates mainly reflects the:

    1. A. Diastolic blood pressure
    2. B. Central venous pressure
    3. C. Pump speed in RPM
    4. D. Mean arterial pressure
    Show answer

    Answer: D. Mean arterial pressure

    With continuous flow and little pulsatility, the Doppler opening pressure approximates the mean arterial pressure; when the native heart adds pulsatility, the reading moves toward the systolic pressure. VAD programs usually aim for roughly 75 to 90 mmHg, and a low value with poor perfusion suggests hypovolemia, bleeding, or pump trouble. It is not the diastolic pressure. Central venous pressure is a venous value that a cuff cannot measure. Pump speed is shown on the controller, not by a cuff. (Bennett 2010; ISHLT 2023; AHA 2017.)

18. During home hemodialysis, the needle in a patient's arm fistula pulls out and blood is spurting from the site. Your first action is to:

    1. A. Apply a tourniquet above the fistula
    2. B. Stop the pump and press firmly on the site
    3. C. Reinsert the needle into the fistula
    4. D. Elevate the arm and wait for a clot to form
    Show answer

    Answer: B. Stop the pump and press firmly on the site

    A fistula carries high arterial flow, so a dislodged needle can cause rapid, life-threatening blood loss. Stop the blood pump to halt further loss and hold firm direct pressure with gauze. Avoid a tourniquet unless direct pressure fails, because it can clot and destroy the access. Never reinsert a dislodged needle in the field.

19. A 44-year-old woman with pulmonary arterial hypertension receives continuous IV epoprostenol through a central line from a portable pump. The pump has stopped. You should:

    1. A. Flush the line to clear a clot first
    2. B. Leave it off and recheck in an hour
    3. C. Get the infusion restarted with no delay
    4. D. Give a fluid bolus through the same line
    Show answer

    Answer: C. Get the infusion restarted with no delay

    Epoprostenol has a half-life of only a few minutes, and stopping it can cause rebound pulmonary hypertension, right heart failure, and death within minutes; help her or her caregiver switch to the backup pump or cassette she carries, and call her PAH center. Never flush the line or push fluid through it, because a bolus of this potent vasodilator can cause severe hypotension; use a separate IV for other fluids and drugs. Leaving it off for an hour is life-threatening. (Flolan prescribing information; ESC/ERS 2022.)

20. A patient has a negative-pressure wound therapy (wound vac) dressing on his leg, and the canister is quickly filling with bright red blood. You should:

    1. A. Turn the suction higher to clear the clot
    2. B. Change the canister and keep it running
    3. C. Elevate the leg and keep therapy running
    4. D. Stop the device and apply direct pressure
    Show answer

    Answer: D. Stop the device and apply direct pressure

    Negative-pressure wound therapy can pull blood from an injured vessel, and the FDA has reported deaths from bleeding. Stop the device, apply firm direct pressure (removing the dressing if needed to reach the source), use a tourniquet for life-threatening limb bleeding, and transport. More suction pulls out more blood. A fresh canister lets the bleeding continue. Elevation alone does not stop arterial bleeding while suction keeps drawing it out. (FDA safety communication.)

21. A dialysis patient with hypotension has a tunneled dialysis catheter in his upper chest and no other IV. Regarding that catheter, you should:

    1. A. Avoid using it unless protocol allows
    2. B. Flush it with saline before each drug
    3. C. Use it like a peripheral IV line
    4. D. Remove it, since it is not in use right now
    Show answer

    Answer: A. Avoid using it unless protocol allows

    Tunneled dialysis catheters are locked with concentrated heparin (often 1,000 to 5,000 units/mL) or citrate and are reserved for dialysis; using them risks pushing the lock into the circulation and causing bleeding, and adds infection risk. In an emergency, use one only if your protocol allows, after withdrawing the lock. Start a peripheral IV or IO instead. Flushing before each drug pushes the heparin in. It is not a peripheral line. Removing a tunneled catheter is a procedure, not a field task. (KDOQI 2019.)

22. A woman's continuous glucose monitor reads 52 mg/dL, but she is alert, talking normally, and not sweaty. Before treating, you should:

    1. A. Recalibrate the sensor to a normal value
    2. B. Confirm it with a fingerstick glucose
    3. C. Give IV dextrose based on the reading
    4. D. Remove the sensor and discard it
    Show answer

    Answer: B. Confirm it with a fingerstick glucose

    A CGM measures interstitial glucose, which lags blood glucose by several minutes, and readings can be falsely low (for example, when she lies on the sensor); when the reading does not match the patient, confirm with a capillary or blood glucose, but treat a symptomatic patient right away. Recalibrating to an assumed value hides a real low. Giving IV dextrose for a number alone may be unnecessary. Removing the sensor is not needed and loses her data. (ADA Standards of Care 2025, diabetes technology.)

23. A hospice patient with a home opioid infusion pump is hard to wake, with a respiratory rate of 6 and pinpoint pupils. Along with supporting ventilation, you should:

    1. A. Keep it running and give naloxone
    2. B. Lower the rate by half and keep it on
    3. C. Pause the pump and keep it for review
    4. D. Disconnect it and discard the bag and tubing
    Show answer

    Answer: C. Pause the pump and keep it for review

    Stop the source first: pause the pump (or clamp the line) and keep the pump, bag, and settings so the dose can be checked, then give titrated naloxone per protocol while you ventilate, aiming to restore breathing without stripping away all pain control. Leaving the infusion running, even at a lower rate, keeps adding opioid while naloxone wears off. Discarding the bag and tubing loses the evidence needed to find a programming or concentration error. (ISMP; Caroline, Emergency Care in the Streets, 9th ed., Patients With Special Challenges chapter.)

24. A nursing home resident on continuous gastrostomy feeds vomited and now has coughing, crackles, and an SpO2 of 88%. Along with suctioning and oxygen, you should:

    1. A. Keep the feeds running to prevent low blood sugar
    2. B. Lay her flat on her back to drain her secretions
    3. C. Stop the feeding pump and keep her head raised
    4. D. Flush the tube with water to clear the formula
    Show answer

    Answer: C. Stop the feeding pump and keep her head raised

    Vomiting during tube feeding suggests aspiration of formula. Stop the feeding pump, keep the head of the bed raised at least 30 to 45 degrees, suction, give oxygen, and transport for evaluation of aspiration pneumonia. Lying flat and adding more fluid into the stomach both raise the risk of further aspiration.

25. A 30-year-old man with a VP shunt has fever, abdominal pain, and redness along the shunt tubing behind his ear and down his neck. You should suspect:

    1. A. Mastoiditis
    2. B. Appendicitis
    3. C. Cellulitis from a bite
    4. D. Shunt infection
    Show answer

    Answer: D. Shunt infection

    Redness along the shunt tract with fever, sometimes with abdominal pain from the peritoneal end, suggests shunt infection, which can lead to meningitis or ventriculitis. Mastoiditis causes swelling over the mastoid bone, not a red streak following the tubing.