Chapter 16
According to the AHA's current recommendation, at what levels should oxygen saturation be maintained? A. 100% B. 96% to 100% C. 94% to 99% D. 90% to 93%
C
You are providing care for a 54-year-old female patient who is complaining of a sudden onset severe shortness of breath and a sharp pain in the left side of her chest. The patient is quite cyanosed and has clear air entry in all lung fields. Her skin color does not seem to change with oxygen therapy. Based on this information, your patient is most likely suffering from: A. pneumothorax. B. pleural effusion. C. pulmonary embolism. D. pneumonia.
C
Pneumonitis is especially common in older patients with: A. frequent infections. B. a history of a stroke. C. immunocompromise. D. chronic food aspiration.
D
You are responding to a 74-year-old man with ashen-gray skin who is diaphoretic and struggling to breathe. The patient lives alone and is speaking in one- to two-word sentences. It's evident to you that this patient is struggling to breathe. He tells you that he woke up suddenly with difficulty breathing and weakness. When you initially listen to the patient's lungs, you hear crackles in the apices and diminished lung sounds in the bases. His pulse is weak and rapid. No medication bottles are in obvious view.What is your working diagnosis? A. Asthma B. Bronchitis C. Pneumonia D. Pulmonary edema
D
__________ is a severe, prolonged attack that cannot be stopped with conventional treatment. A. Atelectasis B. Bronchial Edema C. Reactive airway disease D. Status Asthmaticus
D
Inhaling ammonia results in ________. A. acute upper airway irritation B. delayed onset pulmonary edema C. frothy, pink-tinged sputum D. barotrauma
A
Paradoxical respiratory movement is characterized by: A. the epigastrium and thorax moving in opposite directions. B. bulging of the intercostal muscles during deep inhalation. C. pulling upward of the suprasternal notch during inhalation. D. a marked decrease in movement in one of the hemithoraces.
A
You are providing care for a 46-year-old male patient in respiratory distress. The patient is in a sitting position leaning forward with his arm on the table in front of him. Based on this information, all of the following statements are true except: A. perfusion is increased to the apex of the lungs. B. the scapulae are rotated outward. C. there is a little more space for airflow in the lung apices D. the abdominal structures are drawn away from the diaphragm.
A
You are providing care to a 4-year-old female patient complaining of shortness of breath. The patient is sitting up and you can hear high-pitched noises with each breath. Her parents tell you that she has had a harsh, barking cough all night. Your patient is most likely experiencing: A. croup. B. inflammation of the palatine tonsils. C. aspiration. D. retropharyngeal abscess.
A
A condition that causes distention the jugular veins when the liver is gently pressed specific to right-sided heart failure is A. Cor pulmonale B. Hepatojugular reflux C. Hypoxic drive D. Pulsus paradoxus
B
A patient with respiratory distress who is willing to lie flat: A. should be intubated at once. B. may be acutely deteriorating. C. has minimal fluid in the lungs. D. likely has basilar pneumonia.
B
Patients with obvious respiratory failure require immediate: A. intubation. B. ventilation support. C. passive oxygenation. D. bronchodilator therapy.
B
The wheezing you hear during an asthma attack is primarily caused by what? A. Air trapped in the lungs B. Air forced through constricted tubes, which causes them to vibrate C. Air moving normally in lungs D. Air moving through mucus in the lungs
B
When auscultating the lungs of a patient with early pulmonary edema, you will MOST likely hear: A. inspiratory rhonchi to the bilateral apices of the lungs. B. crackles in the bases of the lungs at the end of inspiration. C. faint rhonchi to all lung fields on inspiration and expiration. D. coarse crackles to the bases of the lungs during inspiration.
B
When listening for abnormal breathing sounds, you should listen to the __________ A. Upper lobs at the anterior chest B. Bases at the back C. Left-right differentiation at the midaxillary line D. Right middle lobe at the right breast
B
Which of the following is NOT a classic sign of emphysema? A., Barrel chest B. Profound hypoxia C. Pursed-lip breathing D. Tachypnea
B
Which of the following patients would benefit from intubation? A. A 30-year-old woman suffering an acute asthma attack B. An unconscious 18-year-old adult with no gag reflex C. A middle-aged man who overdosed on opioids D. A combative 24-year-old adult in respiratory distress
B
Which of the following statements regarding epiglottitis is correct? A. Unlike croup, epiglottitis most commonly occurs in the middle of the night, when the outside temperature is cool. B. Epiglottitis has become relatively rare in children due to vaccinations against the Haemophilus influenzae type b bacterium. C. Most cases of epiglottitis are progressive in their onset and result in severe swelling of the larynx, trachea, and bronchi. D. Characteristic signs of epiglottitis include a low-grade fever, a seal-like barking cough, and varying degrees of respiratory distress.
B
Why is asthma considered a reactive airway disease? A. The patient reacts poorly to asthma. B. The asthma attack occurs most often when the patient is exposed to a trigger. C. Asthma interacts with other diseases the patient has. D. Patients experience asthma only in response to environmental triggers.
B
You are providing care for a 65-year-old male patient complaining of shortness of breath with the occasional audible wheeze. The patient has been feeling tired lately, and the shortness of breath has been coming on gradually over the last several days. The patient is a very large man. He has been coughing up greenish sputum for several days but this is not unusual for him as this happens frequently. The patient is most likely suffering from: A. an acute presentation of asthma. B. an acute presentation of chronic bronchitis. C. an acute presentation of emphysema. D. an acute presentation of a restrictive disease process.
B
A 21-year-old woman experienced an acute onset of pleuritic chest pain and dyspnea while playing softball. She 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. performing a needle decompression to the right side of her chest. B. assisting his ventilations in order to increase her oxygen saturation. C. administering high-flow supplemental oxygen and transporting at once. D. applying a CPAP unit and starting an IV line en route to the hospital.
C
All of the following statements are true of bronchodilator administration by aerosol except: A. particles of approximately 5 micrometers ride laminar air flow into the lower respiratory tract. B. most nebulizers require a gas flow of at least 6 L/min to be effective. C. bronchodilator therapy is effective in the management of all causes of shortness of breath. D. can be administered to patients with a tracheostomy.
C
Cardiogenic pulmonary edema may result from all of the following conditions except: A. chronic hypertension. B. dysrhythmias like ventricular tachycardia or supraventricular tachycardia. C. toxins or drugs in the bloodstream. D. diseases such as myocarditis.
C
The barrel-chest appearance classically seen in emphysemic patients is secondary to: A. widespread atelectasis. B. chest wall hypertrophy. C. air trapping in the lungs. D. carbon dioxide retention.
C
The traditional approach to the management of hyperventilation is to have the patient rebreathe into a paper bag. This is now considered dangerous for all of the following reasons except: A. the amount of oxygen in the gas that the patient is breathing gets rapidly depleted. B. it interferes with a normal respiratory compensatory mechanism. C. it is difficult to establish and maintain an effective seal. D. rebreathing carbon dioxide creates hypoxia.
C
Which of the following changes in the patient's breath sounds would cause you the most concern? A. Change from polyphonic to monophonic wheezing B. Change from wheezing to clear, vesicular breath sounds C. Change from wheezing to a silent chest (no breath sounds) D. Change from wheezing to scattered crackles
C
Which of the following conditions would MOST likely cause hyperpnea? A. Hypoglycemia B. Heroin overdose C. Increased intracranial pressure D. Cardiac arrest
C
Which of the following is NOT associated with asthma? A. Bronchospasm B. Increased mucus production C. Peripheral airway edema D. Localized crackles
D
Which of the following statements is true about hyperventilation? A. Hyperventilation is a result of the patient getting too much oxygen. B. Hyperventilation is a result of the patient getting too little oxygen. C. Hyperventilation is a result of the patient getting too much carbon dioxide. D. Hyperventilation is a result of the patient getting too little carbon dioxide.
D
You are treating a 65-year-old man who is cyanotic even though you are providing supplemental oxygen. This is an indication of a(n) ________. A. paroxysmal nocturnal dyspnea B. plural effusion C. pneumothorax D. pulmonary embolism
D
You respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the recent past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient's daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically looking. You should: A. apply a nonrebreathing mask, assess his oxygen saturation level, and prepare for immediate transport. B. provide aggressive airway management unless the daughter can produce a valid DNR order. C. intubate him at once, begin transport, and advise the daughter to notify the hospital when she finds the DNR order. D. recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.
D
