Field Internship Student Data Acquisition Project. (FISDAP) Airway Practice Exam

Which of the following is a contraindication for using a nasopharyngeal airway (NPA)?

1. Unconscious patient with intact gag reflex

2. Patient who otherwise cannot tolerate an oropharyngeal airway

3. History of fractured nasal bone

4. Alert patient able to follow commands

The correct answer is: History of fractured nasal bone

A contraindication for using a nasopharyngeal airway (NPA) is indeed a history of fractured nasal bone. This is due to the risk of further injury to the nasal passages and potential complications such as bleeding, creating a direct pathway for infection, or displacing fractured bone fragments. Utilizing an NPA in such cases could exacerbate existing injuries and lead to significant patient harm. In contrast, if a patient is unconscious yet has an intact gag reflex, this would generally suggest that an oropharyngeal airway may be more appropriate, as NPAs can stimulate the gag reflex. For patients who cannot tolerate an oropharyngeal airway, an NPA could still be a viable option if there are no contraindicating injuries like a fractured nasal bone. An alert patient able to follow commands may not require airway adjuncts at all, as they would be able to protect their own airway effectively. Thus, while other options raise caution regarding the use of an NPA, the presence of a history of fractured nasal bone stands out as a clear contraindication.