The correct answers are D. Place the device in the larger nostril and E. Lubricate the distal tip.

Proper insertion of a nasopharyngeal airway (NPA) follows specific steps outlined in NREMT-aligned airway management guidelines.

Correct Steps:

1. Choose the larger nostril (D):

The NPA should be inserted into the nostril with better airflow (larger nostril) to reduce resistance and trauma.

This improves ease of insertion and patient comfort.

2. Lubricate the distal tip (E):

The airway must be lubricated with a water-soluble lubricant before insertion.

This minimizes friction and reduces the risk of nasal mucosal injury or bleeding.

NREMT-aligned references state:

“Insert the NPA into the larger nostril when possible.”

“Lubricate the airway prior to insertion.”

Why the other options are incorrect:

A. Measure from the corner of the mouth to the tip of the ear → Incorrect

This measurement is used for an oropharyngeal airway (OPA), not an NPA.

NPA is measured from nose to earlobe.

B. Follow the base of the tongue during insertion → Incorrect

This applies to OPA insertion, not NPA.

NPA is inserted along the floor of the nasal passage.

C. Insert the bevel away from the septum → Incorrect

The bevel should face toward the septum (medially), not away.

Exact Extracts (NREMT-aligned EMT educational references):

“Measure NPA from the nostril to the earlobe.”

“Lubricate the airway before insertion.”

“Insert into the larger nostril if possible.”

“Advance gently along the nasal floor.”

Clinical Priority Summary:

Correct NPA insertion requires proper nostril selection and lubrication, making D and E the correct answers.