Chapter 16

Wheezing is resolved with medications that: A. cause bronchoconstriction and improved airflow. B. dry up secretions in the lower airway. C. relax the smooth muscle of the bronchioles. D. reduce soft tissue swelling in the larynx.

C. relax the smooth muscle of the bronchioles.

A hyperventilating patient: A. may be acidotic and is trying to decrease his or her pH level. B. should rebreathe his or her carbon dioxide to effect resolution. C. presents with tachypnea and marked use of accessory muscles. D. is most effectively treated by administering a sedative drug.

A. may be acidotic and is trying to decrease his or her pH level.

Difficulty with exhalation is MOST characteristic of: A. obstructive lung disease. B. a mild asthma attack. C. upper airway obstruction. D. supraglottic swelling.

A. obstructive lung disease.

A sudden increase in end-tidal CO2 may be the earliest indicator of: A. return of spontaneous circulation. B. inadvertent ET tube dislodgment. C. ineffective chest compressions. D. developing respiratory alkalosis.

A. return of spontaneous circulation.

________ cells are found in the lining of the airways and produce a blanket of mucus that covers the entire lining of the conducting airways. A. Goblet B. Kupfer C. Alveolar D. Ciliary

A. Goblet

The most obvious external landmark of the larynx is the: A. thyroid cartilage. B. arytenoid cartilage. C. cricoid cartilage. D. hyoid bone.

A. thyroid cartilage.

What function do the nasal turbinates serve? A. Warming and humidifying inhaled air B. Secreting mucus that traps viruses and bacteria C. Separating the left and right nostrils D. Decreasing the surface area of the nasopharynx

A. Warming and humidifying inhaled air

Abnormal breath sounds associated with pneumonia and congestive heart failure are MOST often heard in the: A. bases of the lungs. B. apices of the lungs. C. right middle lobe. D. midaxillary line.

A. bases of the lungs.

An unresponsive patient who overdosed on a central nervous system depressant drug would be expected to have __________ respirations. A. bradypneic B. hyperpneic C. Kussmaul D. eupneic

A. bradypneic

Frothy sputum that has a pink tinge to it is MOST suggestive of: A. congestive heart failure. B. chronic bronchitis. C. antihistamine use. D. tuberculosis.

A. congestive heart failure.

Polycythemia is a condition in which: A. an abundance of red blood cells causes severe thinning of the blood. B. increased platelet production causes the blood to become abnormally thick. C. fewer red blood cells are produced, resulting in decreased oxygenation. D. excess red blood cells are produced in response to chronic hypoxia.

D. excess red blood cells are produced in response to chronic hypoxia.

The oropharynx and nasopharynx meet in the back of the throat at the: A. glottic opening. B. hyoid bone. C. larynx. D. hypopharynx.

D. hypopharynx.

Hepatojugular reflux occurs when: A. left-sided heart failure causes blood to accumulate in the patient's liver. B. the jugular veins collapse in response to palpation of the right upper quadrant. C. a patient's jugular veins are markedly engorged when lying in a supine position. D. mild pressure placed on the patient's liver further engorges the jugular veins.

D. mild pressure placed on the patient's liver further engorges the jugular veins.

Which of the following clinical findings is MOST suggestive of pneumonia in a patient with COPD? A. White sputum and rales B. Fever and localized crackles C. Dyspnea and diffuse wheezing D. Nonproductive cough

B. Fever and localized crackles

Which of the following medications is a parasympathetic bronchodilator? A. Albuterol B. Ipratropium C. Alupent D. Bronkosol

B. Ipratropium

On either side of the glottis, tissue forms a pocket called the: A. cuneiform cartilage. B. vallecula. C. hypopharyngeal space. D. piriform fossae.

D. piriform fossae.

A patient who is coughing up thick pulmonary secretions should NOT take: A. a diuretic. B. an antitussive. C. antihistamines. D. bronchodilators.

B. an antitussive.

A patient who is experiencing an allergic reaction states that his tongue "feels thick" and speaks at a low volume. You should immediately evaluate for: A. a gag reflex. B. angioedema. C. adventitious breath sounds. D. hypotension.

B. angioedema.

Hypoventilating patients: A. eliminate too much carbon dioxide. B. become hypercapneic and acidotic. C. experience an increase in blood pH. D. typically do not have an open airway.

B. become hypercapneic and acidotic.

One of the hallmarks of a pulmonary embolism is: A. pleuritic chest pain that occurs after a strong cough. B. cyanosis that does not resolve with oxygen therapy. C. the disappearance of radial pulses during inhalation. D. jugular venous distention while in a supine position.

B. cyanosis that does not resolve with oxygen therapy.

A critical step when using a CPAP unit to treat a patient with severe respiratory distress is: A. holding the mask to the noncompliant patient's face. B. ensuring an adequate mask seal with minimal leakage. C. setting the oxygen flow rate to at least 6 L/min. D. starting with CPAP levels above 10 to 15 cm of water.

B. ensuring an adequate mask seal with minimal leakage.

Intrapulmonary shunting occurs when: A. hyperinflated alveoli retain high levels of carbon dioxide. B. nonfunctional alveoli inhibit pulmonary gas exchange. C. resistance to airflow increases due to bronchoconstriction. D. the volume of anatomic dead space suddenly increases.

B. nonfunctional alveoli inhibit pulmonary gas exchange.

A patient with status asthmaticus commonly presents with: A. compensatory respiratory alkalosis and stridor. B. physical exhaustion and inaudible breath sounds. C. audible expiratory wheezing and severe cyanosis. D. accessory muscle use and inspiratory wheezing.

B. physical exhaustion and inaudible breath sounds.

Cor pulmonale is defined as: A. rupture of the alveoli due to increased surface tension. B. right heart failure secondary to chronic lung disease. C. increased preload caused by severe hypertension. D. left heart failure secondary to mitral valve damage.

B. right heart failure secondary to chronic lung disease.

Common effects of gag reflex stimulation include all of the following, EXCEPT: A. vomiting. B. tachycardia. C. increased intracranial pressure. D. bradycardia.

B. tachycardia.

A pulse oximetry reading would be LEAST accurate in a patient: A. with chronic hypoxia. B. with poor peripheral perfusion. C. with persistent tachycardia. D. whose extremities are cool.

B. with poor peripheral perfusion.

Hepatomegaly and jugular venous distention are MOST suggestive of: A. severe pneumonia. B. left heart failure. C. pulmonary edema. D. right heart failure.

D. right heart failure.

___________ respirations are characterized by a grossly irregular pattern of breathing that may be accompanied by lengthy periods of apnea. A. Agonal B. Eupneic C. Biot D. Cheyne-Stokes

C. Biot

Common clinical findings in patients with obstructive lung disease include all of the following, EXCEPT: A. chronic air trapping in the lungs. B. abdominal muscle use. C. a decreased expiratory phase. D. pursed-lip breathing.

C. a decreased expiratory phase.

An otherwise healthy adult whose normal hemoglobin level is 12 to 14 g/dL typically will begin to exhibit cyanosis when: A. 10% of his or her hemoglobin is desaturated. B. his or her oxygen saturation falls below 50%. C. about 5 g/dL of hemoglobin is desaturated. D. hemoglobin levels fall below 12 g/dL.

C. about 5 g/dL of hemoglobin is desaturated.

The barrel-chest appearance classically seen in emphysemic patients is secondary to: A. chest wall hypertrophy. B. carbon dioxide retention. C. air trapping in the lungs. D. widespread atelectasis.

C. air trapping in the lungs.

If the amount of pulmonary surfactant is decreased: A. diffuse alveolar hyperinflation occurs. B. pulmonary gas exchange is enhanced. C. alveolar surface tension increases. D. alveoli are able to expand more easily.

C. alveolar surface tension increases.

You are transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should: A. remove the nonrebreathing mask and apply a nasal cannula. B. insert a nasal airway, apply a CPAP unit, and notify medical control. C. begin assisting his ventilations with a bag-mask and 100% oxygen. D. administer a sedative and a paralytic and then intubate his trachea.

C. begin assisting his ventilations with a bag-mask and 100% oxygen.

The hypoxic drive is a phenomenon in which: A. a relatively large percentage of patients with COPD become acutely apneic after receiving high-flow oxygen. B. a chronically hypoxic patient's primary respiratory drive is stimulated by increased levels of carbon dioxide in the arterial blood. C. bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance. D. high levels of oxygen rapidly depress a COPD patient's respiratory rate and depth, leading to worsened hypoxia and severe acidosis.

C. bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance.

Use of an automated transport ventilator is NOT appropriate for patients who are: A. chemically paralyzed. B. in cardiac arrest. C. breathing spontaneously. D. apneic with a pulse.

C. breathing spontaneously.

Reactive airway disease is characterized by: A. acute, reversible swelling of the laryngeal muscles. B. chronic bronchoconstriction of varying severity. C. bronchospasm, edema, and mucus production. D. excessive mucus production and a chronic cough.

C. bronchospasm, edema, and mucus production.

Pickwickian syndrome is a condition in which respiratory compromise results from: A. pulmonary edema. B. cervical spine injury. C. extreme obesity. D. diaphragmatic rupture.

C. extreme obesity.

CPAP in the emergency setting is used to treat patients with certain obstructive airway diseases by: A. maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction. B. delivering one pressure during the inspiratory phase and a different pressure during the expiratory phase. C. improving patency of the lower airway through the use of positive-end expiratory pressure. D. increasing the rate and depth of ventilation, thus improving minute volume and mitigating hypoxia.

C. improving patency of the lower airway through the use of positive-end expiratory pressure.

You are transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should: A. decrease the amount of positive-end expiratory pressure that you are delivering and reassess. B. suspect that he has developed a pneumothorax and prepare to perform a needle chest decompression. C. remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him. D. continue the CPAP treatment and administer a diuretic to remove fluids from his lungs quickly.

C. remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.

In contrast to decreased PO2 levels, increased PCO2 levels typically manifest as: A. combativeness. B. restlessness or confusion. C. sedation or sleepiness. D. anxiety.

C. sedation or sleepiness.

A patient with orthopnea: A. generally has a slow, shallow respiratory pattern. B. is awakened from sleep with severe dyspnea. C. seeks a sitting position when short of breath. D. prefers to lie flat in order to facilitate breathing.

C. seeks a sitting position when short of breath.

Apneustic breathing is characterized by: A. a sustained pattern of tachypnea and increased tidal volume. B. regular respirations with a normal rate and adequate tidal volume. C. a crescendo-decrescendo pattern of breathing with apneic periods. D. short, brisk inhalations with a long pause before exhalation.

D. short, brisk inhalations with a long pause before exhalation.

Unlike bronchodilator therapy, corticosteroid therapy: A. is the primary treatment for acute bronchospasm. B. is administered exclusively in a hospital setting. C. causes immediate improvement in breathing. D. takes a few hours to reduce bronchial edema.

D. takes a few hours to reduce bronchial edema.

Paradoxical respiratory movement is characterized by: A. bulging of the intercostal muscles during deep inhalation. B. a marked decrease in movement in one of the hemithoraces. C. pulling upward of the suprasternal notch during inhalation. D. the epigastrium and thorax moving in opposite directions.

D. the epigastrium and thorax moving in opposite directions.

If a patient's hemoglobin level is only 10 g/dL, ___ % would have to be desaturated before he or she would appear cyanotic. A. 30 B. 25 C. 10 D. 50

D. 50

Which of the following statements regarding anatomic dead space is correct? A. If tidal volume is 500 mL, 200 mL remains in the dead space. B. Air in the dead space participates in pulmonary gas exchange. C. The amount of dead space increases as tidal volume increases. D. Anatomic dead space is about 1 mL per pound of body weight.

D. Anatomic dead space is about 1 mL per pound of body weight.

Which of the following statements regarding epiglottitis is correct? A. Characteristic signs of epiglottitis include a low-grade fever, a seal-like barking cough, and varying degrees of respiratory distress. B. Most cases of epiglottitis are progressive in their onset and result in severe swelling of the larynx, trachea, and bronchi. C. Unlike croup, epiglottitis most commonly occurs in the middle of the night, when the outside temperature is cool. D. Epiglottitis has become relatively rare in children due to vaccinations against the Haemophilus influenzae type b bacterium.

D. Epiglottitis has become relatively rare in children due to vaccinations against the Haemophilus influenzae type b bacterium.

If a colorimetric ETCO2 detector turns purple during the exhalation phase through an ET tube, approximately how much carbon dioxide is being exhaled? A. Between 2% and 5% B. More than 5% C. Between 1% and 2% D. Less than 0.5%

D. Less than 0.5%

Emphysema is caused by: A. progressive weakening of the lung parenchyma. B. an abundance of pulmonary surfactant. C. excessive mucus production in the bronchi. D. chronic destruction of the alveolar walls.

D. chronic destruction of the alveolar walls.

The _________ cartilage forms a complete ring and maintains the trachea in an open position. A. thyroid B. arytenoid C. laryngeal D. cricoid

D. cricoid

Respiratory alkalosis is the result of: A. slow and shallow respirations. B. carbon dioxide retention. C. increased hydrogen ion production. D. excess carbon dioxide elimination.

D. excess carbon dioxide elimination.

If a patient's hemoglobin level is 8 g/dL due to hemorrhage and all of the hemoglobin molecules are attached to oxygen, the patient's oxygen saturation would MOST likely read: A. significantly lower than 85%. B. between 85% and 90%. C. between 90% and 95% D. above 95%.

D. above 95%.

A 21-year-old man experienced an acute onset of pleuritic chest pain and dyspnea while playing softball. He is noticeably dyspneic, has an oxygen saturation of 93% on room air, and has diminished breath sounds to the upper right lobe. The MOST appropriate treatment for this patient involves: A. assisting his ventilations in order to increase his oxygen saturation. B. applying a CPAP unit and starting an IV line en route to the hospital. C. performing a needle decompression to the right side of his chest. D. administering high-flow supplemental oxygen and transporting at once.

D. administering high-flow supplemental oxygen and transporting at once.

A 29-year-old woman is experiencing a severe asthma attack. Her husband reports that she was admitted to an intensive care unit about 6 months ago, and had a breathing tube in place. Prior to your arrival, the patient took 3 puffs of her rescue inhaler without effect. She is anxious and restless, is tachypneic, and has audible wheezing. You should: A. start an IV of normal saline, administer methylprednisolone via IV push, and transport as soon as possible. B. attempt to slow her breathing with respiratory coaching, administer a nebulized bronchodilator, and transport. C. begin assisting her ventilations with a bag-mask device and 100% oxygen and prepare to intubate her trachea. D. apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.

D. apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.

The mainstem bronchus ends at the level of the: A. subsegmental bronchi. B. lobar bronchi. C. segmental bronchi. D. bronchioles.

D. bronchioles.