Free FP-C practice test, weighted by the 2026 outline

A newly hired flight paramedic sees the senior flight nurse draw up norepinephrine at the wrong concentration but hesitates to speak up because of the nurse's experience and seniority. Which CRM concept best explains the hesitation?

1. Loss of situational awareness

   The new paramedic saw the error clearly, so situational awareness is intact; the failure is in speaking up.
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2. Confirmation bias

   Confirmation bias is favoring information that fits an existing belief; here the error is recognized but not voiced.
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3. Task saturation

   Nothing suggests the paramedic is overloaded with tasks; the hesitation comes from rank and experience.
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4. A steep authority gradient

   Deference to a senior colleague that silences a junior one is the classic steep authority gradient that crew resource management aims to flatten.
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Select an answer to record it. The card then marks the key and opens the reasoning under every choice.

A HEMS pilot turns down a scene request because of low ceilings. Twenty minutes later, the same agency calls a second air medical operator for the same patient. What should the communication center do?

1. Relay the turndown only if asked directly

   Relaying it only when asked fails: the second crew may not know there is anything to ask about.
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2. Let the second operator's dispatcher handle it

   The other dispatcher cannot pass on a turndown it has never heard of; the center that knows about it has to share it.
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3. Tell the second operator of the prior turndown

   Passing a weather turndown to every operator called for the same patient prevents 'helicopter shopping', in which a second crew accepts a flight without knowing another pilot refused it.
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4. Withhold it from the second operator

   Withholding it leaves the second pilot deciding without knowing another pilot already declined; an independent decision still needs the same information.
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In an unpressurized aircraft at 18,000 ft (about 380 mmHg), what FiO2 would restore an inspired PO2 equal to breathing room air at sea level (760 mmHg), ignoring water vapor?

1. About 0.42

   Inspired PO2 at sea level is 0.21 × 760 ≈ 160 mmHg; at 380 mmHg, 160 ÷ 380 gives an FiO2 of about 0.42.
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2. 0.21

   0.21 is the oxygen fraction at every altitude; at 380 mmHg it supplies only about 80 mmHg, half the sea-level value.
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3. About 0.32

   An FiO2 of 0.32 gives about 122 mmHg at 380 mmHg, still well short of the 160 mmHg target.
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4. 1.00

   An FiO2 of 1.00 gives 380 mmHg, more than double sea-level room air; it overshoots the stated target.
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An unconscious 130-kg man is being ventilated by one rescuer with a bag-mask. Chest rise is minimal and SpO2 is 86%. HR 110, BP 150/90. What is the most appropriate next step?

1. Squeeze the bag harder and faster

   Squeezing harder and faster inflates the stomach and raises aspiration risk without fixing the leak or obstruction.
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2. Proceed directly to cricothyrotomy

   Cricothyrotomy is for a cannot-intubate, cannot-oxygenate situation, and basic airway maneuvers have not yet been optimized.
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3. Apply cricoid pressure during ventilation

   Cricoid pressure can compress the airway and make mask ventilation harder; it is no longer routinely recommended.
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4. Two-person bag-mask with OPA and NPAs

   Poor chest rise in a large patient is usually a seal and patency problem; a two-person technique (one rescuer holding a two-handed seal, the other bagging) with an OPA and NPAs fixes both before anything invasive.
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A 45-year-old with pneumonia is confused and agitated, repeatedly pulling off his non-rebreather. SpO2 82%, HR 124, BP 136/82, RR 36. He needs intubation before transport. Which approach is most appropriate?

1. Midazolam 5 mg IV, then reapply the non-rebreather

   Midazolam depresses breathing and airway tone without reliably producing cooperation, a dangerous mix at SpO2 82%.
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2. Physical restraint and a tighter-fitting mask

   Restraint raises oxygen demand and agitation, and a tighter mask he keeps pulling off does not solve the problem.
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3. Immediate RSI without further preoxygenation

   Inducing at 82% leaves no safe apnea time; saturation would fall to critical levels within seconds.
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4. Ketamine 1 mg/kg, preoxygenate, then paralyze

   This is delayed sequence intubation: a dissociative ketamine dose preserves breathing and airway reflexes while allowing effective preoxygenation, and the paralytic follows.
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During RSI, laryngoscopy shows only the tip of the epiglottis (Cormack-Lehane grade 3) despite repositioning. SpO2 is 98% with apneic oxygenation running; HR 92, BP 132/80. What is the most appropriate next step?

1. Apply firm cricoid pressure

   Cricoid pressure often worsens the laryngeal view; external laryngeal manipulation is the maneuver that can improve it.
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2. Pass a bougie beneath the epiglottis

   With a grade 3 view and good saturation, a bougie slid under the epiglottis can find the trachea by feel (tracheal clicks, hold-up) and then guide the tube.
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3. Advance the ETT blindly under the epiglottis

   A tube passed blind under the epiglottis often goes into the esophagus and can injure the airway; the bougie is designed for exactly this view.
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4. Abandon laryngoscopy for an extraglottic airway

   An extraglottic device is the rescue when oxygenation fails or attempts run out; saturation is 98% and a good option remains.
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Immediately after a rapid IV push of fentanyl 250 mcg before intubation, a patient cannot be ventilated by bag-mask. The jaw is clenched, the chest and abdominal walls are board-like, and SpO2 falls to 85%. What is the most likely cause?

1. Tension pneumothorax

   A tension pneumothorax brings one-sided findings and shock during positive-pressure ventilation, not a board-like abdomen and clenched jaw right after a fentanyl push.
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2. Laryngospasm

   Laryngospasm closes the cords after airway stimulation; it does not make the chest and abdominal walls rigid.
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3. Truncal rigidity

   Truncal rigidity from a rapid, large fentanyl push can stiffen the chest wall, abdomen and jaw, sometimes with vocal cord closure, so the bag cannot move air; a paralytic, or naloxone if intubation is not planned, relieves it.
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4. Acute bronchospasm

   Acute bronchospasm gives wheeze, a prolonged expiration and a shark-fin capnogram; it does not stiffen the chest and abdomen.
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A malnourished 50-year-old with chronic alcohol use is found confused and ataxic with nystagmus. Glucose 42 mg/dL, HR 104, BP 118/74. Which medication is most important to give along with the IV dextrose?

1. Thiamine IV

   Confusion, ataxia and nystagmus in a malnourished drinker point to Wernicke encephalopathy; thiamine goes in with the dextrose, without delaying the glucose, because glucose metabolism uses up what thiamine is left.
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2. Folic acid IV

   Folic acid is often replaced in heavy drinkers, but a lack of folate does not cause Wernicke encephalopathy, so it is not the urgent replacement.
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3. Flumazenil IV

   Flumazenil reverses benzodiazepines and can provoke seizures in chronic users; nothing points to a benzodiazepine here.
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4. Naloxone IV

   Naloxone reverses opioids; the findings and the low glucose point to nutrition and alcohol rather than opioid toxicity.
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Which finding in a patient with acute salicylate toxicity is an indication for emergent hemodialysis?

1. New altered mental status

   New altered mental status means salicylate has reached the brain in quantity, a marker of severe toxicity and an indication for hemodialysis whatever the measured level.
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2. Tinnitus at a level of 45 mg/dL

   Tinnitus is an early, common sign, and 45 mg/dL is far below the levels (around 90–100 mg/dL) that call for dialysis on their own.
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3. Nausea and vomiting

   Nausea and vomiting are expected early effects and not a reason to dialyze.
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4. Respiratory alkalosis on the ABG

   Respiratory alkalosis is the usual early acid-base response to salicylate; acidemia with a pH of 7.20 or lower is the worrying change.
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A 28-year-old with T5 paraplegia and an indwelling Foley catheter develops severe hypertension (210/120 mmHg), bradycardia (50 bpm), and flushing above the level of injury during transport. What is the most likely diagnosis?

1. Septic shock

   Septic shock produces hypotension and tachycardia, the opposite of this picture.
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2. Pulmonary embolism

   Pulmonary embolism brings tachycardia, hypoxia and often hypotension, not severe hypertension with a slow pulse.
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3. Autonomic dysreflexia

   This is autonomic dysreflexia: with injury above T6, a stimulus below the lesion such as a blocked catheter triggers unopposed sympathetic hypertension, with reflex bradycardia and flushing above the level; the Foley is checked first.
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4. Malignant hypertension

   Malignant hypertension is end-organ injury from severe chronic hypertension; it does not explain bradycardia, flushing above a cord lesion or a trigger from the catheter.
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A 62-year-old male is being aeromedically transported directly to a comprehensive stroke center for a suspected large vessel occlusion. Flight time is 25 minutes. Which combination of pre-arrival information is most critical to transmit to the receiving neurological team to expedite immediate definitive intervention?

1. Vital sign trends, an ECG rhythm strip, and the full medical history

   Vital sign trends, a rhythm strip and the full history do not decide whether the team activates for thrombectomy before arrival.
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2. Exact last known well time, current NIHSS, and current anticoagulant status

   Last known well sets eligibility for thrombolysis and thrombectomy, the NIHSS grades the deficit, and anticoagulant use decides whether lytics are possible or reversal is needed, so the team can be ready at the door.
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3. Prehospital stroke scale, total transport time, and recorded allergies

   A screening scale tells the team less than an NIHSS, and allergies and flight time do not decide eligibility for treatment.
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4. Exact time of symptom recognition, baseline pupil reactivity, and home medications

   Symptom recognition can come hours after onset, so that time misplaces the treatment window; pupil reactivity and a home medication list are secondary details.
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The flight team is preparing a patient on ECMO for transfer. Which of the following is the highest priority before initiating transport?

1. Clamp the circuit for the stretcher move

   Clamping the circuit stops ECMO support entirely; clamps are kept at hand for emergencies such as air entry or decannulation, not used for a routine move.
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2. Check console settings and alarm limits

   An ECMO patient lives on the circuit, so flow, sweep, alarm limits and backup power are verified before the move; a problem found in the aircraft is far harder to fix.
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3. Turn off the sweep gas until loaded

   With the sweep off the oxygenator stops removing CO2 and adding oxygen, so the patient loses gas exchange during the most hazardous part of the transfer.
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4. Lower pump flow to protect the cannulas

   Lowering flow cuts the support the patient depends on; cannulas are protected by securing them and watching them during the move, not by reducing flow.
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A 58-year-old male with inferior ST-elevation myocardial infarction becomes hypotensive (80/50 mmHg) during transport. His 12-lead ECG shows ST elevation in leads II, III, aVF, and V4R. Lung sounds are clear. Which of the following is the most appropriate initial intervention?

1. Administer sublingual nitroglycerin

   Nitrates drop preload and can cause profound hypotension in right ventricular infarction.
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2. Give a 250 mL isotonic fluid bolus

   ST elevation in V4R with clear lungs marks right ventricular infarction, where output depends on preload; a fluid bolus comes first for hypotension, with inotropes only if it fails.
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3. Start a dopamine infusion at 5 mcg/kg/min

   A pressor or inotrope comes after volume has been tried; starting it first skips the cause, which is inadequate filling.
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4. Begin dobutamine at 5 mcg/kg/min

   Dobutamine can support the right ventricle once preload is restored, but given first it vasodilates and worsens the hypotension.
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An intubated patient with blast lung is being ventilated with rising peak pressures. Shortly after PEEP is increased, he develops asymmetric pupils, new ST elevation in the inferior leads, and blanching of the tongue, with an abrupt drop in BP. What is the most likely cause?

1. Primary blast brain injury

   A primary brain injury from the blast would not appear suddenly after a PEEP change, nor cause ST elevation and tongue blanching.
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2. Arterial gas embolism

   Blast-damaged alveoli under rising positive pressure can let air into the pulmonary veins; air in cerebral and coronary arteries explains unequal pupils, inferior ST elevation, tongue blanching and sudden hypotension.
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3. Hemorrhagic stroke

   A hemorrhagic stroke does not explain simultaneous coronary ischemia and patchy blanching of the tongue.
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4. Tension pneumothorax

   Tension pneumothorax can follow rising airway pressures and drop the BP, but it does not cause unequal pupils, ST elevation or tongue blanching.
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A helicopter crew reaches a victim of blunt trauma after a rollover. He is apneic and pulseless, the monitor shows asystole, and there are no signs of life. The ground crew has not started CPR. What is the most appropriate action?

1. Withhold resuscitation efforts

   Blunt trauma with apnea, pulselessness, asystole and no signs of life on arrival meets field criteria for withholding resuscitation; survival in this group is essentially zero.
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2. Scene thoracotomy, then CPR

   Resuscitative thoracotomy is not indicated for blunt arrest in asystole, even in a hospital, let alone at the roadside.
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3. CPR and fly for organ donation

   Flying an unsalvageable arrest for possible donation exposes the crew to flight risk without a patient-care purpose.
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4. CPR and fly to the trauma center

   Transporting a blunt traumatic arrest in asystole with CPR running does not change survival and adds flight risk.
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After 6 units of PRBCs and 6 of plasma, a trauma patient is oozing from every puncture site. Fibrinogen 90 mg/dL, platelets 110,000/mm3, INR 1.6, temperature 36.4°C, ionized calcium normal. Which product most specifically addresses the remaining defect?

1. Vitamin K IV

   Vitamin K acts over hours and only restores vitamin K-dependent factors; it does nothing for dilutional loss of fibrinogen.
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2. Additional plasma units

   Plasma holds fibrinogen at roughly blood concentration, so lifting a level of 90 takes large volumes; cryoprecipitate concentrates it.
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3. Cryoprecipitate

   Fibrinogen of 90 mg/dL is well below the 150–200 mg/dL target in bleeding trauma patients; cryoprecipitate, or fibrinogen concentrate, replaces it most directly.
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4. Platelet concentrate

   A count of 110,000/mm3 is above common transfusion thresholds in bleeding, so platelets are not the main defect.
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A 28-week patient with PPROM has temperature 38.8°C, maternal HR 124, fetal HR 175/min, uterine tenderness and foul-smelling fluid. What is the most appropriate management during transport?

1. Broad-spectrum antibiotics and expedited transport

   Fever, maternal and fetal tachycardia, uterine tenderness and foul fluid define intraamniotic infection; antibiotics start now, and delivery rather than prolonging pregnancy becomes the goal, so transport is expedited.
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2. Terbutaline tocolysis and routine transport

   Tocolysis is contraindicated with intraamniotic infection, because prolonging pregnancy leaves the fetus in an infected uterus.
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3. Acetaminophen, with antibiotics deferred to arrival

   Acetaminophen treats only the fever; holding antibiotics lets maternal sepsis and fetal injury progress.
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4. A magnesium load as the first priority

   Magnesium for fetal neuroprotection does not take precedence over treating the infection that is driving maternal and fetal tachycardia.
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A woman at 32 weeks' gestation is secured supine on a long board after a car crash. HR 118, BP 84/50, SpO2 96%, GCS 15, and there is no external bleeding. What is the most appropriate initial intervention?

1. Norepinephrine infusion to a MAP of 65 mmHg

   Norepinephrine does not relieve caval compression and reduces uterine blood flow; positioning comes first.
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2. Left lateral tilt with a wedge

   At 32 weeks the uterus compresses the vena cava when she lies supine, cutting preload; wedging the long board 15–30 degrees to the left, or displacing the uterus by hand, is the first fix.
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3. 2-L crystalloid bolus before repositioning

   Running 2 L while the cava stays compressed delays the one fix that works at once; fluid comes after the tilt if it is still needed.
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4. Trendelenburg positioning

   Trendelenburg positioning leaves the uterus on the vena cava and adds breathing compromise.
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During transport of an injured 6-year-old, the flight paramedic notes bruises in different stages of healing and patterned burns on both palms. The sending physician says, 'We'll let the receiving team decide whether to report.' What is the flight paramedic's obligation?

1. Report personally as a mandated reporter

   Reporting personally is required: the duty to report a reasonable suspicion of abuse belongs to each mandated reporter and cannot be handed to the sending physician or the receiving team.
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2. Leave the report to the receiving team

   Leaving the report to the receiving team, as the sending physician suggests, does not discharge the paramedic's own legal duty.
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3. Question the caregivers to confirm abuse

   Investigation belongs to child protective services and law enforcement; confronting caregivers can put the child at further risk.
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4. Document the findings in the chart only

   Documenting the findings in the chart is not a report; the child protective agency learns nothing until someone calls.
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A 5-week-old male presents with a two-week history of progressively forceful, non-bilious projectile vomiting after feeds and is now lethargic and dehydrated. Which acid-base and electrolyte disturbance do you most expect?

1. High-anion-gap metabolic acidosis with ketosis

   Ketotic acidosis belongs to conditions such as DKA; losing stomach acid drives the pH up, not down.
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2. Hypernatremic respiratory alkalosis

   Gastric losses cause a metabolic, not respiratory, alkalosis, and sodium is usually normal or low.
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3. Hyperchloremic metabolic acidosis

   Hyperchloremic acidosis follows diarrhea or large saline loads, the opposite of losing chloride-rich gastric fluid.
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4. Hypochloremic, hypokalemic metabolic alkalosis

   Repeated vomiting of gastric acid removes hydrogen and chloride, and the kidneys trade potassium to hold sodium, giving the hypochloremic, hypokalemic alkalosis of pyloric stenosis.
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Compared with a narrative review, a systematic review is characterized by:

1. Reliance chiefly on expert opinion over data

   Expert opinion sits low on the evidence hierarchy; a systematic review is built on the studies themselves.
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2. A single author's informal summary of favorite studies

   An informal, selective summary is what a narrative review can become; the systematic method exists to prevent that.
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3. A predefined, reproducible search and appraisal method

   A systematic review fixes its question, search strategy, inclusion criteria and appraisal method in advance so others can reproduce it, which limits selective citation.
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4. Exclusion of all quantitative data by design

   Systematic reviews often pool numbers in a meta-analysis; nothing excludes quantitative data by design.
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A colleague confides ongoing hopelessness and thoughts of not wanting to live. Your most appropriate immediate response is to:

1. Report it only to scheduling so their shifts get reduced

   Fewer shifts do nothing for the underlying risk, and telling scheduling alone breaks trust without getting care.
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2. Stay with them and connect them to professional help now

   Hopelessness with thoughts of not wanting to live calls for an immediate, direct response: stay with the person and link them to help now, such as an employee assistance program, the 988 crisis line or emergency care.
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3. Advise them to take a long vacation and revisit it later

   Advising a long vacation puts off help and leaves a person with suicidal thoughts alone with the risk.
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4. Keep it confidential and simply watch their behavior for now

   Suicide risk is an exception to keeping a confidence, and waiting and watching can miss the window to help.
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A patient with an unrecognized 200 mL pneumothorax is flown in an unpressurized helicopter from sea level (760 mmHg) to an altitude where the barometric pressure is 500 mmHg. Assuming constant temperature, what is the new volume of the trapped gas?

1. 132 mL

   132 mL comes from inverting the pressure ratio (200 × 500 ÷ 760); trapped gas expands, not shrinks, as pressure falls.
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2. 200 mL

   200 mL assumes the gas ignores the pressure change; an enclosed pocket of gas expands as ambient pressure drops.
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3. 400 mL

   400 mL assumes the volume doubles, which needs the pressure to halve to about 380 mmHg (near 18,000 ft), not fall to 500 mmHg.
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4. 304 mL

   Boyle's law keeps P × V constant: 200 mL × 760 ÷ 500 = 304 mL, about one and a half times the sea-level volume.
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A 160-cm woman is intubated with a 7.0 ETT secured at 27 cm at the teeth. Breath sounds are absent on the left, PIP 38 cmH2O, SpO2 90%, BP 128/78, trachea midline. What is the most appropriate action?

1. Withdraw the tube to about 21 cm

   At 27 cm in a 160-cm woman the tube has almost certainly entered the right mainstem, silencing the left lung and raising airway pressure; pulling back to about 3 × the tube size (≈21 cm) and reassessing fixes it.
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2. Perform needle decompression on the left

   Needle decompression treats tension pneumothorax, which a normal blood pressure and a midline trachea make unlikely; the deep tube is the cause, and a needle adds injury.
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3. Increase PEEP to 10 cmH2O

   PEEP cannot open a lung that the tube is not ventilating at all.
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4. Advance the tube 2 cm and reassess

   Advancing a tube that is already too deep pushes it further into the right bronchus.
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A 68-year-old trauma patient receives packed red blood cells during transport. Thirty minutes into the transfusion, he develops severe dyspnea, hypoxia (SpO2 84%), and bilateral crackles. His blood pressure rises from 110/70 to 180/100 mmHg, with bounding pulses and prominent jugular venous distention. His temperature is 37.1°C. The transfusion is stopped. Which complication is most likely, and what is the most appropriate next action?

1. Lung injury; administer high-dose corticosteroids

   Transfusion-related acute lung injury is a capillary leak that usually brings fever and hypotension with flat neck veins, and corticosteroids are not its treatment.
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2. Anaphylaxis; administer IM epinephrine

   Anaphylaxis causes hypotension, wheeze, angioedema or hives; a rising blood pressure with jugular distention points the other way.
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3. Circulatory overload; administer IV furosemide

   Hypertension, bounding pulses, distended neck veins and crackles during a transfusion in an older patient indicate transfusion-associated circulatory overload; with the unit stopped, a loop diuretic and oxygen support treat it.
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4. Hemolysis; administer IV epinephrine

   Acute hemolysis brings fever, hypotension, pain and dark urine, and epinephrine is not its treatment.
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A 28-year-old intubated patient with severe TBI is being transported with propofol and fentanyl infusions at unchanged rates. Suddenly, the heart rate drops to 48 bpm and blood pressure rises to 168/94 mmHg. The patient is ventilated in volume-control mode; EtCO₂ is 34 mmHg, SpO₂ 96%. No recent suctioning or medication changes. Pupils are 3 mm and reactive. Which of the following is the most likely cause?

1. Neurogenic shock

   Neurogenic shock pairs bradycardia with hypotension from lost sympathetic tone; this patient is hypertensive.
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2. Propofol effect

   Propofol lowers blood pressure, and its infusion rate has not changed.
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3. Vagal stimulation

   Vagal bradycardia follows a trigger such as suctioning, which did not happen, and it lowers rather than raises blood pressure.
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4. A Cushing reflex

   Hypertension with bradycardia in a sedated TBI patient, with no drug change or suctioning, is the Cushing response to rising intracranial pressure; it signals impending herniation and calls for immediate ICP measures.
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While transporting a patient with an intra-aortic balloon pump (IABP) inserted via the left femoral artery, you note that the left foot has become pale, cold, and pulseless, and the patient reports increasing left leg pain. What is the most appropriate course of action?

1. Elevate the affected leg above the heart

   Raising the leg above the heart lowers arterial inflow to a limb that is already ischemic; the problem is arterial, not venous.
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2. Deflate the balloon and pull out the IABP catheter

   Pulling the catheter out in flight risks major bleeding at the arterial site and ends circulatory support; removal belongs at the receiving hospital.
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3. Check catheter position, alert the receiving team

   A pale, cold, pulseless leg on the side of a femoral balloon is limb ischemia from catheter migration, occlusion or clot; the crew checks the catheter's position and depth, keeps the hip straight and alerts the receiving team so a vascular plan, often removal or repositioning, is ready on arrival.
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4. Give more IV analgesia and continue transport

   More IV analgesia alone hides the warning sign while the limb loses viability.
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A 62-year-old woman is in severe cardiogenic shock with a blood pressure of 72/40 mmHg. The sending provider recommends a continuous milrinone infusion to improve contractility during transport. What is the primary risk of starting it without other pharmacological support?

1. It causes bradycardia that lowers cardiac output

   Milrinone tends to cause tachycardia and arrhythmias, not bradycardia.
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2. It raises pulmonary vascular resistance

   Milrinone lowers pulmonary vascular resistance, which is why it is used in right-sided failure.
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3. It constricts the coronary arteries

   As a phosphodiesterase-3 inhibitor, milrinone relaxes vascular smooth muscle, coronary vessels included.
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4. It vasodilates and worsens hypotension

   Milrinone is an inodilator: it strengthens contraction but relaxes systemic and pulmonary vessels, so at 72/40 it vasodilates and worsens the hypotension unless a vasopressor runs alongside.
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You are transporting a 90-kg patient who sustained 50% TBSA burns exactly 8 hours ago. The sending facility has completed the first half of the Parkland formula resuscitation. At what rate should lactated Ringer's run for the remainder of the 24 hours?

1. 1,125 mL/h

   1,125 mL/h is the first-phase rate (9,000 mL over 8 hours); continuing it after hour 8 overloads the patient.
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2. 563 mL/h

   Parkland gives 4 mL × 90 kg × 50 = 18,000 mL in 24 hours; the second 9,000 mL runs over the remaining 16 hours, about 563 mL/h, adjusted afterward to urine output.
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3. 750 mL/h

   750 mL/h spreads all 18,000 mL evenly over 24 hours, ignoring that half has already been given.
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4. 281 mL/h

   281 mL/h spreads the remaining 9,000 mL over 32 hours instead of the 16 left in the first day.
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Before a long interfacility flight, a malnourished patient with sepsis has a total calcium of 7.4 mg/dL and an albumin of 2.0 g/dL. She has no tetany, and the QTc is normal. What is her albumin-corrected calcium?

1. About 7.4 mg/dL

   7.4 mg/dL is the measured total, which reads low because less albumin is carrying calcium; taken at face value it overstates hypocalcemia.
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2. About 5.8 mg/dL

   5.8 mg/dL comes from subtracting the albumin correction instead of adding it.
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3. About 11.4 mg/dL

   11.4 mg/dL uses 2 mg/dL per gram of albumin instead of 0.8, which inflates the result into the hypercalcemic range.
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4. About 9.0 mg/dL

   Each 1 g/dL of albumin below 4.0 lowers the total calcium by about 0.8 mg/dL, so 7.4 + 0.8 × (4.0 − 2.0) = 9.0 mg/dL, a normal value; an ionized calcium confirms it when it matters.
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