Chapter 17 Study Plan

What is the normal respiratory rate for an​ infant? A. 25 to 50 breaths per minute B. 6 to 8 breaths per minute C. 50 to 80 breaths per minute D. 12 to 20 breaths per minute

A. 25 to 50 breaths per minute The normal respiratory rate for an infant is 25 to 50 breaths per minute.

Following the administration of a​ bronchodilator, what would the EMT expect to hear during auscultation if the medication had its desired​ effect? A. Diminishment in wheezing B. Diminishment in rales​ (crackles) C. Slight increase in tracheal sounds D. Slight increase in heart tones

A. Diminishment in wheezing A bronchodilator is designed to relax the bronchioles and allow for better airflow through them. This should decrease audible wheezing heard upon auscultation.

What is the typical effect of a lack of oxygen in an adult​ patient? A. Increased pulse B. Decreased BP C. Decreased pulse D. Increased BP

A. Increased pulse The pulse in adults will usually increase when there is a lack of oxygen.

Which of the following BEST describes the process of expiration in normal​ breathing? A. Passive B. Active C. Contraction of diaphragm D. Contraction of rib muscles

A. Passive Exhalation is a passive​ process, resulting in the relaxation of rib muscles and the diaphragm.

What is the best position for a patient with​ dyspnea? A. Position of comfort B. Trendelenburg C. Lateral recumbent D. Supine

A. Position of comfort Patients who are experiencing dyspnea but still breathing adequately should be placed in the position of comfort.

Which of the following is a leading killer of infants and​ children? A. Respiratory problems B. Congestive heart failure C. Myocardial infarction D. Stroke

A. Respiratory problems Respiratory problems are a leading cause of cardiac arrest in infants and children.

Which of the following statements about the differences between adults and children is​ TRUE? A. The trachea is​ smaller, softer, and more flexible in infants and children. B. All airway structures of the adult are more easily blocked. C. The tongue of an adult is more apt to block the airway. D. The diaphragm is more heavily used in the adult.

A. The trachea is​ smaller, softer, and more flexible in infants and children. The trachea is​ smaller, softer, and more flexible in infants and children than in adults. Children rely more heavily on the diaphragm during breathing. Since children have a proportionately larger​ tongue, it can more easily block the airway

Which of the following lung sounds is the result of narrowed bronchioles of the lower​ airway? A. Wheezing B. Stridor C. Rhonchi D. Rales

A. Wheezing Wheezing is a​ high-pitched, musical, whistling sound that is best heard initially on exhalation but may also be heard during inhalation in more severe cases. It is an indication of swelling and constriction of the inner lining of the bronchioles. Rhonchi result from an accumulation of fluid and mucus in the larger airways. Rales are caused by fluid in the smallest airways. Stridor is caused by narrowing of tissues in the upper airway.

Your patient is complaining of respiratory distress. She also tells you that her feet and ankles are unusually swollen. This swelling​ is: A. an associated symptom. B. the chief complaint. C. an irrelevant distraction. D. a pertinent negative.

A. an associated symptom. The chief complaint is respiratory distress. The swelling is an associated symptom and a quite relevant finding. There are no pertinent negatives in this situation.

If the patient has difficulty breathing that is leading to​ hypoxia, it is likely that her color will​ be: A. cyanotic. B. red. C. flushed. D. pale.

A. cyanotic. Hypoxia patients will most likely have cyanosis​ (peripherally and/or​ centrally). Red and flushed skin typically represents hyperthermia and increased blood flow to the peripheral tissues. Pale skin is typically associated with shock.

A respiratory disease that affects the​ mucus-secreting glands of the​ lungs, sweat​ glands, pancreas,​ liver, and intestines is​ called: A. cystic fibrosis. B. pulmonary edema. C. diabetes. D. CVT.

A. cystic fibrosis. Cystic fibrosis is a hereditary disease that causes pulmonary dysfunction as a result of changes in the​ mucus-secreting glands of the lungs. It also affects the sweat​ glands, the​ pancreas, the​ liver, and the intestines.

A​ 65-year-old conscious female is in severe pulmonary edema. You have determined the appropriate need for CPAP. You should​ NEXT: A. explain the device to the patient. B. begin​ positive-pressure ventilations. C. ensure that the patient has no allergies. D. apply the mask to the​ patient's face.

A. explain the device to the patient. CPAP is an intimidating therapy. Before applying​ CPAP, be sure to explain the device to the patient. This will increase the likelihood that the patient will tolerate the intervention enough to experience therapeutic benefit. Once the patient has been​ readied, you can proceed with applying the mask.

To ensure that the MOST medication is absorbed when the EMT is assisting the patient with an​ inhaler, the EMT should try to encourage the patient​ to: A. hold the medicine in his or her lungs as long as possible. B. take​ short, shallow breaths. C. hyperventilate. D. spray the medicine on the inside of the mouth.

A. hold the medicine in his or her lungs as long as possible. When administering a bronchodilator to the​ patient, the EMT should encourage the patient to hold the medicine in his or her lungs for as long as possible.

An​ 89-year-old male complains of an acute onset of shortness of breath. He notes it came on suddenly and awoke him from sleep. You note he is​ alert, has severe difficulty breathing and you auscultate rales when listening to his lung sounds. His vital signs are P​ 128, R​ 44, BP​ 210/150. You​ should: A. initiate CPAP B. assist the patient with his albuterol inhaler. C. await the arrival of ALS D. initiate positive pressure ventilations

A. initiate CPAP The signs and symptoms described point to acute pulmonary​ edema, most likely associated with congestive heart failure. As​ such, you should immediately initiate CPAP. As he is​ alert, he probably does not yet need positive pressure ventilation. In most​ cases, inhaled bronchodilators are not indicated in pulmonary edema. Although ALS is certainly​ indicated, you should not delay CPAP while awaiting their arrival.

Patients with wheezing are most likely​ experiencing: A. narrowed airway passages. B. fluid buildup in the alveoli. C. upper airway obstruction. D. apnea.

A. narrowed airway passages. Wheezing is a lower airway sound and indicates narrowed airway passages. Upper airway problems are typically associated with stridor and snoring. Fluid in the alveoli is typically associated with rales. Apnea produces no sounds

If your patient is breathing adequately but with​ difficulty, you should​ first: A. provide supplemental oxygen. B. begin artificial ventilations. C. verify breathing difficulty by using a pulse oximeter. D. contact medical control for permission to administer nitroglycerin.

A. provide supplemental oxygen. The patient is breathing adequately but with difficulty. The correct treatment is supplemental oxygen. Artificial ventilations would be used for a patient who is not breathing adequately. Nitroglycerin is not typically administered by EMTs for​ dyspnea, and although a pulse oximeter is​ helpful, it is not used to verify breathing difficulty.

You respond to the regional airport to remove an elderly patient from a plane that just landed from a long flight. A respiratory condition that may be caused by a deep vein thrombosis after sitting for a long time is​ called: A. pulmonary embolism. B. spontaneous pneumothorax. C. croup. D. asthma attack.

A. pulmonary embolism. Blood clots from the legs can end up in the lungs and cause a pulmonary embolism. Asthma attacks are acute onsets of bronchoconstriction associated with the chronic condition of asthma. A spontaneous pneumothorax occurs when one lung collapses. Croup is an upper airway infection.

A condition in which a lung collapses without any chest trauma is​ called: A. spontaneous pneumothorax. B. vacuous pneumothorax. C. hemopneumothorax. D. random pneumothorax.

A. spontaneous pneumothorax. A spontaneous pneumothorax occurs when there is a perforation in the lung tissue that allows inhaled air to fill the pleural space and start to collapse the lung tissue. A common cause of this is​ emphysema, as this disease weakens the lung tissues and allows the formation of blebs that may rupture.

Which of the following pediatric airway structures is comparatively softer and more flexible compared to that of an​ adult? A. the trachea B. the diaphragm C. the esophagus D. the tongue

A. the trachea The pediatric trachea is significantly softer and more flexible compared to that of an adult. The pediatric tongue is proportionately larger than that of an adult. Although a pediatric patient relies more heavily on the diaphragm for​ breathing, the muscle itself is similar to that of an adult. The esophagus is smaller in pediatrics but similar to adults.

Which of the following patients is MOST susceptible to infections of the upper​ airway, such as​ croup? A. ​3-year-old B. ​27-year-old C. ​19-year-old D. ​43-year-old

A. ​3-year-old Infants and children are most susceptible to upper airway infections than teens and adults are.

A​ 68-year-old male COPD patient complains of​ acute-onset dyspnea and​ right-sided chest pain. When you listen to his​ chest, you hear no lung sounds over the right side. His vital signs are P​ 122, R​ 40, BP​ 140/80. You should first​ administer: A. ​high-concentration oxygen. B. a bronchodilator treatment. C. nitroglycerin for the pain. D. the Cincinnati prehospital stroke scale.

A. ​high-concentration oxygen. This presentation indicates a spontaneous pneumothorax. You should first administer​ high-concentration oxygen, sit the patient​ up, monitor vital​ signs, and intercept with ALS en route to the hospital. Do not delay transport. Bronchodilators and nitroglycerin are not typically indicated in this patient.

A​ 69-year-old male complains of severe respiratory distress. You find him in tripod position and note retractions around his ribs and contraction of the muscles in his neck when he breathes. This finding would best be described​ as: A. Adequate breathing. B. Accessory muscle use. C. Stridor. D. Respiratory failure.

B. Accessory muscle use. The tripod​ position, retraction of intercostal muscles and contraction of neck muscles to aid breathing would best be described as accessory muscle use. Although it can be an indicator of respiratory​ failure, some patients with adequate breathing also display accessory muscle use. Alone this condition does not indicate either adequate or inadequate breathing. Stridor is the sound of a narrowed upper airway

​Sporadic, irregular breathing that is usually seen just before respiratory arrest is otherwise known​ as: A. Cyanosis B. Agonal breathing C. Diaphragmatic breathing D. Crowing

B. Agonal breathing Agonal breathing is the​ sporadic, irregular breathing that is usually seen just before respiratory arrest. Crowing is a sound made by partial obstruction of the upper airway. Cyanosis is the bluish tinting of the skin associated with hypoxia. Diaphragmatic breathing is another term for belly​ breathing, as often seen in infants.

Which of the following patients would MOST likely benefit from use of a prescribed​ inhaler? A. A unresponsive patient with apnea B. An asthma patient with wheezing C. An emphysema patient with decreased LOC D. A CHF patient with pulmonary edema

B. An asthma patient with wheezing Bronchodilator inhalers are typically used by patients with​ asthma, COPD, or other chronic respiratory conditions. The patient must be awake for the EMT to assist in administering medication by MDI. Inhalers are not typically used to treat pulmonary edema.

In which of the following diseases are there episodic flares but the patient can lead a normal life between​ flares? A. Pertussis B. Asthma C. Emphysema D. COPD

B. Asthma Asthma is an episodic disease and can be life​ threatening; however, if it is managed​ properly, the patient can lead a normal life between episodes. COPD and emphysema lead to chronic breakdown of the respiratory system and generally worsen over time. Pertussis is an infection.

Which of the following would be considered a chronic obstructive pulmonary​ disease? A. Pneumonia B. Chronic bronchitis C. Pertussis D. Cystic fibrosis

B. Chronic bronchitis COPD includes​ emphysema, chronic​ bronchitis, asthma,​ asbestosis, and black lung disease. Pertussis and pneumonia are respiratory infections. Cystic fibrosis is a genetic disorder that affects the respiratory system.

Which of the following structures separates the thoracic and abdominal​ cavities? A. Thoracic cage B. Diaphragm C. Transverse line D. Mediastinum

B. Diaphragm The diaphragm is the muscular structure that separates the thoracic and abdominal cavities. The transverse line is not a structure. The mediastinum is the collections of vessels and organs that occupy the midline area of the thorax.

You are treating a patient who has difficulty breathing. He is very thin and has a​ barrel-chested appearance. He is coughing but with little​ sputum, and he has a prolonged exhalation as if he is puffing. What type of disease does he MOST likely​ have? A. Asthma B. Emphysema C. Pneumonia D. Pulmonary embolus

B. Emphysema The emphysema patient is typically thin with a barrel​ chest, has a dry​ cough, and exhales through pursed​ lips, which cause a longer expiratory phase. The typical emphysema patient also has a history of smoking and has been prescribed bronchodilators.

Which of the following would be considered an active phase of breathing under normal​ circumstances? A. Exhalation B. Inhalation C. Expiration D. Provocation

B. Inhalation Under normal​ circumstances, inhalation is the active phase of breathing.​ Expiration, also known as​ exhalation, is a passive phase. Provocation is something that causes a problem to get worse.

Which of the following patients is a candidate for​ CPAP? A. Cardiac asthma patient who is hypotensive B. Pulmonary edema patient who is normotensive but struggling to breathe C. Asthmatic patient who is not breathing adequately D. Emphysemic patient who is tachycardic and disoriented

B. Pulmonary edema patient who is normotensive but struggling to breathe The use of CPAP can be done only if certain clinical parameters are present. These include absence of​ hypotension, spontaneous adequate​ breathing, and no altered mental status.

While listening to breath sounds on a​ patient, you note a crackling sound over the peripheral lung fields that is most prominent at the end of the inhalatory phase. Which of the following terms would best describe the sound you are​ hearing? A. Rhonchi B. Rales C. Pleural friction rub D. Wheezing

B. Rales Rales are​ fine, moist crackling sounds associated with fluid in alveoli. Wheezing is a whistling sound due to narrowing of the airways by​ edema, bronchoconstriction, or foreign materials. Rhonchi are rattling sounds in the larger airways associated with excessive mucus or other material. A pleural friction rub occurs when the pleura become​ inflamed, as in pleurisy.

Which of the following signs of respiratory distress is more common in pediatric patients than in patients in other age​ groups? A. Cyanosis B. Seesaw breathing C. Accessory muscle use D. Tachypnea

B. Seesaw breathing Seesaw breathing is more common in pediatric patients than in patients in other age groups. The other signs are common to all age groups during respiratory distress.

A​ 2-year-old male is having severe respiratory distress caused by a partial obstruction of his upper airway by a foreign object. Which of the following sounds would most likely be associated with this​ condition? A. Gurgling B. Stridor C. Crackles D. Wheezing

B. Stridor Stridor is the high pitch sound caused by partial obstruction of the upper airway. Gurgling is an upper airway​ sound, but it is caused by the presence of fluid. Crackles are caused by fluid in the alveoli and small lower airways. Wheezing is caused by narrowing of the lower airways.

A​ 77-year-old female is in obvious respiratory distress. She is breathing rapidly and has an oxygen saturation of​ 89%. She has a history of COPD. Why should she be placed on supplemental oxygen despite having​ COPD? A. The patient has a low tolerance for elevated carbon dioxide levels. B. The​ patient's hypoxia outweighs the risks of oxygen therapy. C. Without supplemental​ oxygen, COPD patients quickly develop apnea. D. Oxygen administration has no side effects for COPD patients.

B. The​ patient's hypoxia outweighs the risks of oxygen therapy. ​Short-term exposure to supplemental oxygen poses little risk to the COPD patient. In​ fact, it poses substantially less risk than prolonged hypoxia. Although there can be detrimental​ effects, in an hypoxic​ patient, you should always titrate oxygen to restore normal saturation

Which of the following would be a specific symptom associated with a spontaneous​ pneumothorax? A. Coughing B. Unequal lung sounds C. Stridor D. Fever

B. Unequal lung sounds A spontaneous pneumothorax is a collapsed lung. As a​ result, it is commonly associated with unequal lung sounds in the chest. Although coughing can be​ possible, unequal lung sounds would be more specific to the pneumothorax. It is not typically associated with fever or stridor.

When administering​ CPAP, start with a low level of CPAP such​ as: A. between 10 and 12 cm H2O. B. between 2 and 5 cm H2O. C. between 0 and 2 cm H2O. D. between 5 and 10 cm H2O.

B. between 2 and 5 cm H2O. Many systems start between 2 and 5 cm H2O and go up if needed. Follow local protocol.

A patient with COPD may present with elements of both pulmonary emphysema​ and: A. pneumonia. B. chronic bronchitis. C. pulmonary retraction. D. hyperlipidemia.

B. chronic bronchitis. Since the etiologies of emphysema and chronic bronchitis are largely the​ same, typically a patient will not have one or the other COPD disease process​ specifically; rather, the patient will have a combination of the two.

A​ 16-year-old male has been found unconscious after a motor vehicle crash. As you approach the patient you hear gurgling. You should​ suspect: A. respiratory arrest. B. fluid in the upper airway. C. lower airway obstruction. D. complete airway obstruction.

B. fluid in the upper airway. Gurgling is the sound of fluid in the upper airway. As he is breathing​ (breathing causes the gurgling​ sound) he is not in respiratory arrest nor does he have a complete airway obstruction. Wheezing is the sound of lower airway obstruction.

While assessing a patient with breathing​ difficulty, you see that the patient is​ restless, anxious, and somewhat confused about what is going on. These signs are often caused​ by: A. shock due to bleeding within the lungs. B. hypoxia affecting the brain. C. fear due to the severity of the situation. D. overuse of the​ patient's metered-dose inhaler​ (MDI).

B. hypoxia affecting the brain. Since the brain cannot store​ oxygen, as soon as the blood oxygen content​ drops, the patient will display neurological findings of dysfunction such as confusion. The restlessness and anxiousness may be due to the sympathetic discharge that would accompany hypoxia.

An inadequate supply of oxygen is known​ as: A. apnea. B. hypoxia. C. dyspnea. D. shock.

B. hypoxia. Shortness of​ breath, abnormal upper airway​ sounds, faster- or​ slower-than-normal breathing​ rates, poor chest rise and​ fall, and other signs and symptoms of respiratory distress may be indications that the cells of the body are not getting an adequate supply of​ oxygen, a condition known as hypoxia. Although related to​ hypoxia, shock refers to perfusion. Apnea is a term that is used to describe an absence of breathing. Dyspnea is a term that is used to describe difficulty breathing.

A​ 71-year-old female presents with respiratory distress. She has diminished lung sounds and​ slow, shallow respirations. You note that she is cyanotic and confused. The patient is presenting​ with: A. tachypnea. B. inadequate breathing. C. adequate breathing. D. apnea.

B. inadequate breathing. The​ slow, shallow breathing and the cyanosis and confusion indicate that the patient is presenting with inadequate breathing. Apnea is the absence of breathing. Tachypnea is rapid breathing.

Nasal​ flaring, grunting, and seesaw breathing are most commonly seen​ in: A. elderly patients. B. pediatric patients. C. cystic fibrosis patients. D. pneumonia patients.

B. pediatric patients. These signs are either unique to or more prominent in infants and children.

The accumulation of fluid in the alveoli is known​ as: A. pneumothorax. B. pulmonary edema. C. pertussis. D. pulmonary embolism.

B. pulmonary edema. The accumulation of fluid in the lungs is pulmonary edema. It is​ often, but not​ always, caused by congestive heart failure. An embolism is a blockage in the blood flow to the lungs. A pneumothorax is a collapse of a lung. Pertussis is a respiratory infection.

A​ 45-year-old male has dyspnea associated with a suspected pulmonary embolism. Which of the following would be the MOST important​ treatment? A. CPAP B. ​High-concentration oxygen C. Assist with a bronchodilator D. ​Fowler's position

B. ​High-concentration oxygen A severe pulmonary embolism can cause profound hypoxia. Therefore the patient needs​ high-flow oxygen. Bronchodilators are not typically used with this condition. CPAP could be helpful but not before supplemental oxygen.​ Fowler's position would likely not be tolerated.

At what rate per minute should you ventilate an​ infant? A. 12 B. 20 C. 24 D. 16

B. 20 An infant should be ventilated at a rate of 20 per minute.

Which of the following is the MOST serious indication of​ hypoxia? A. Repeated coughing B. Preference to sit in an upright position C. Altered mental status D. Nasal flaring

C. Altered mental status While all the findings here do indicate a person who is working hard to​ breath, the fact that the patient has an altered mental status or wants to lie down are both clear indications of worsening hypoxia and fatigue. A patient who becomes unresponsive or wants to lie down from a pulmonary cause will likely need to be artificially ventilated in the very near future.

Where does the exchange of oxygen and carbon dioxide take​ place? A. Larynx B. Diaphragm C. Alveoli D. Carina

C. Alveoli The exchange of gases takes place in the alveoli. The carina is the bifurcation of the right and left bronchi. The diaphragm is a muscle that forms the lower border of the thoracic cavity. The larynx is the structure that houses the vocal cords and glottis opening.

Which of the following is TRUE about adult and pediatric​ patients? A. The​ child's tongue is proportionally smaller than that of the adult. B. The adult trachea is more flexible. C. Children depend more heavily on the diaphragm for respiration. D. The airway of the adult is more rigid and therefore more easily obstructed.

C. Children depend more heavily on the diaphragm for respiration. Children depend more heavily on the diaphragm for respiration than adults do. The pediatric trachea is commonly more flexible than an​ adult's. A​ child's tongue is proportionately​ larger, and airway obstructions are far more common in children

Which of the following sounds is created by the presence of fluid in the alveoli and the very small airways of the​ lungs? A. Gurgling B. Stridor C. Crackles D. Wheezes

C. Crackles Crackles are caused by the presence of fluid in the alveoli and very small airways. Wheezes are the high pitched sound associated with narrowing of the lower airways. Stridor and gurgling are associated with the upper airway.

Which of the following side effects of CPAP would likely be of MOST concern to the​ EMT? A. Drying of the eyes B. Discomfort C. Hypotension D. Dry mouth

C. Hypotension Although all these issues are of​ concern, the EMT must monitor the patient carefully for development of​ hypotension, which can lead to​ life-threatening problems.

What is the MOST severe consequence of reduced airflow from​ COPD? A. GI distress B. Tachycardia C. Hypoxia D. Hypotension

C. Hypoxia The most severe consequence of reduced airflow from COPD is hypoxia.

When administering a​ metered-dose inhaler​ (MDI), the EMT should instruct the patient​ to: A. not shake the canister. B. depress the canister just before inhaling. C. Inhale deeply as the inhaler is depressed. D. breathe in and out quickly.

C. Inhale deeply as the inhaler is depressed. Be sure the patient is breathing in through his or her mouth. The patient should shake the canister before administration and depress the canister after beginning to inhale.

A​ 3-year-old male complains of breathing difficulty. You assess stridor and excessive drooling. Which of the following steps should you avoid in caring for this​ patient? A. Application of​ high-concentration oxygen B. Placing the patient in the position of comfort C. Inspection of the throat D. Monitoring vital signs

C. Inspection of the throat If the patient may have​ epiglottitis, do not open the mouth and stimulate with a tongue​ depressor, as this may cause a laryngospasm. The patient will have significant pain when​ swallowing, and that is why he is drooling.​ High-concentration oxygen, monitoring vital​ signs, and placing the patient in a position of comfort would all be recommended.

What is the pathophysiology of cystic​ fibrosis? A. Swelling of the tongue B. Bronchodilation of the lower airways C. Overabundant production of mucus in lower airways D. Ankle edema

C. Overabundant production of mucus in lower airways In cystic​ fibrosis, there is an overabundance of mucus production in the lower airways causing​ infection, scarring, and ongoing pulmonary damage.

Your patient woke up in the middle of the night with extreme shortness of breath. He says that he has a​ "cardiac history" and always sleeps with three pillows. He denies any chest pain. What is MOST likely his​ condition? A. Pulmonary embolism B. Spontaneous pneumothorax C. Pulmonary edema D. Pneumonia

C. Pulmonary edema Patients with a cardiac history often have left heart​ failure, which builds up in the middle of the​ night, causing severe breathing difficulty due to pulmonary edema. Pulmonary embolisms are usually associated with risk factors such as deep vein thrombosis or recent injury. Pneumothorax is usually identified with changes in lung sounds on one side of the chest. Pneumonia is characterized by a chronic onset and typically characterized by coughing and fever.

Which of the following would be considered an appropriate reason to use a spacer in assisting a patient with a rescue​ inhaler? A. Spacers increase drug concentration. B. Spacers require the patient to breathe less deeply. C. Spacers make exact timing less important. D. Spacers allow administration of lower doses.

C. Spacers make exact timing less important. Spacers draw the inhaled medication into a chamber and therefore reduce the need for exact timing. They are particularly useful in children and in patients who are having difficulty taking deep breaths.

Why should the EMT explain the CPAP device to the​ patient? A. Insurance will typically not cover the​ treatment, and permission must be given. B. The treatment may lead to COPD. C. The device might cause the patient to feel smothered and anxious. D. The patient must understand how a CPAP machine works.

C. The device might cause the patient to feel smothered and anxious. The EMT should explain the CPAP device to the patient because the tight seal of the mask might make the patient feel smothered and anxious. These feelings commonly cause the patient to be reluctant to allow the therapy and can sometimes prevent the benefits of CPAP.

A​ 19-year-old female patient complains of an acute onset asthma attack. She is alert and notes shortness of breath and a cough. You hear wheezes when you listen to her chest. Her vital signs are P​ 118, R​ 30, BP​ 112/68. Her pulse oximetry is 91. You should​ first: A. initiate positive pressure ventilation. B. assist her with her Ventolin inhaler. C. administer supplemental oxygen. D. assist her with an albuterol small volume inhaler.

C. administer supplemental oxygen. As this patient is​ alert, she is likely breathing adequately. She does not yet need positive pressure ventilations. She does however have a lower than normal pulse oximetry reading and as such should first receive supplemental oxygen. Inhaled bronchodilators will be​ helpful, but not before oxygen.

Your​ 44-year-old patient has a decreased level of​ consciousness, respiratory​ distress, and shallow breathing. You should​ immediately: A. ask the patient whether she has an inhaler. B. apply a NRB mask. C. assist ventilations. D. apply a nasal cannula.

C. assist ventilations. The patient has inadequate breathing and requires immediate​ positive-pressure ventilation assistance. With altered mental​ status, inadequate breathing is​ demonstrated; therefore, supplemental oxygen is no longer treatment enough.

When a patient is wheezing and you believe that it is due to partial lower airway​ obstruction, the appropriate management would​ include: A. placing the patient in Trendelenburg position. B. administering four baby aspirin. C. assisting the patient with his or her bronchodilator per protocol. D. administering one nitroglycerin pill.

C. assisting the patient with his or her bronchodilator per protocol. Patients who are wheezing need to be evaluated to see whether they have upper or lower airway obstruction. If they have asthma and​ bronchoconstriction, they may benefit from a treatment if your protocols allow. If they have upper airway obstruction and a history of severe allergic reactions they may carry an EpiPen.

En route to the​ hospital, it is important to perform an ongoing assessment of the patient with breathing difficulty. While reevaluating your​ patient, remember​ that: A. moist skin usually correlates with an improving condition. B. a decrease in accessory muscle use is concerning. C. decreased wheezing may not indicate improvement. D. the use of an MDI may normally cause the heart rate to slow.

C. decreased wheezing may not indicate improvement. If the​ patient's wheezing is getting​ quieter, either the bronchioles are relaxing or the patient is going into respiratory arrest and is not moving enough air to cause wheezing. Look at the total patient​ picture, and if the wheezing is quiet but the patient is​ unresponsive, has a low pulse ox​ reading, has significant vital sign​ changes, or is becoming increasingly​ cyanotic, the decreased wheezing is not a sign of​ improvement!

A permanent disease process that is characterized by destruction of the alveolar walls and distention of the alveolar sacs is a type of COPD​ called: A. epiglottitis. B. pneumonia. C. emphysema. D. asthma.

C. emphysema. Emphysema is a permanent disease process distal to the terminal bronchiole that is characterized by destruction of the alveolar walls and distention of the alveolar sacs and a gradual destruction of the pulmonary capillary beds with a severe reduction in the​ alveolar/capillary area for gas exchange to occur.

A​ 65-year-old female complains of respiratory distress. You wish to obtain a​ "room air" pulse oximetry reading but realize the pulse oximeter is in the ambulance. You​ should: A. immediately move the patient to the ambulance. B. withhold oxygen as a pulse oximetry reading is necessary. C. immediately administer supplemental oxygen. D. wait to administer oxygen until your partner can retrieve the oximeter.

C. immediately administer supplemental oxygen. You should never withhold oxygen in a patient with respiratory distress if a pulse oximeter is not immediately available. Here you should administer oxygen and titrate it once the pulse oximeter becomes available.

A​ 75-year-old woman complains of acute onset shortness of breath. She states she began to have chest pain and then it rapidly began to be difficult for her to breath. The patient notes a history of COPD and prior episodes of a​ "collapsed lung." When you auscultate her chest you note absent lung sounds on the left side. You should​ next: A. initiate CPAP. B. administer aspirin. C. initiate transport. D. assist the patient with her Ventolin inhaler

C. initiate transport. The history of collapsed lung paired with absent lung sounds on the left side point clearly to spontaneous pneumothorax. You should immediately initiate transport to provide this patient access to advanced personnel. CPAP and positive pressure ventilations are not indicated in this patient. Aspirin is likely not helpful to the​ patient's condition.

Which of the following is an infection of one or both lungs caused by​ bacteria, viruses, or​ fungi? A. pulmonary embolism B. cystic fibrosis C. pneumonia D. COPD

C. pneumonia Pneumonia is an infection of one or both lungs caused by​ bacteria, viruses, or fungi. It results from the inhalation of certain microbes that grow in the lungs and cause inflammation. Cystic fibrosis is a genetic disease and although it can lead to viral and bacterial respiratory​ infections, it is not itself an infection. COPD is a chronic disease and is not an infection. Pulmonary embolisms are blockages in the blood supply to the lungs.

Patients with COPD often get progressively worse and call an ambulance because​ of: A. pulmonary embolism. B. upper airway obstruction. C. recent upper respiratory infection. D. pneumothorax.

C. recent upper respiratory infection. Upper respiratory infection is a common reason COPD patients get worse.

When treating a patient who had a sudden onset of sharp chest pain and difficulty breathing while doing physical​ exercise, the EMT should be concerned about the possibility of a pulmonary embolus​ or: A. stroke. B. pneumonia. C. spontaneous pneumothorax. D. congestive heart failure.

C. spontaneous pneumothorax. Patients who have sharp pain and a sudden onset of breathing difficulty may have a spontaneous pneumothorax. Although stroke and congestive heart failure are​ possibilities, the chest pain would point to the pneumothorax. Pneumonia does not typically occur acutely.

The possible side effects of albuterol include increased heart​ rate, nervousness,​ and: A. excessive salivation. B. hemiparalysis. C. tremors. D. drowsiness.

C. tremors. Common side effects of albuterol include​ tachycardia, tremors, and nervousness.

You are caring for an asthma patient with dyspnea. Which of the following would MOST likely benefit this​ patient? A. Artificial ventilations B. CPAP C. An epinephrine​ auto-injector D. A bronchodilator medication

D. A bronchodilator medication A bronchodilator medication​ (such as a prescription​ inhaler) would likely benefit this patient. If the​ patient's condition deteriorates to respiratory​ failure, both epinephrine and artificial ventilations may be​ important, but beta agonists commonly prevent these alternatives.

Which of the following is the best way to assess the severity of your​ patient's respiratory​ distress? A. Lay the patient supine and monitor for changes. B. Ask the patient what he or she was doing when the problem began. C. Remove the oxygen and assess the patient for changes. D. Ask the patient to rate his or her level of difficulty on a 1 to 10 scale.

D. Ask the patient to rate his or her level of difficulty on a 1 to 10 scale. Using the 1 to 10 scale is an effective way to trend the​ patient's distress. You should never withhold oxygen to assist in assessment. Although a history will be​ important, the 1 to 10 scale provides a more immediate idea of severity.

Why are nausea and vomiting a contraindication to​ CPAP? A. The corneas of the eyes may become dried. B. CPAP may lead to a pneumothorax. C. A nauseated person cannot tolerate the mask. D. CPAP may cause an increased risk of aspiration.

D. CPAP may cause an increased risk of aspiration. CPAP may push air into the​ stomach, resulting in gastric distension. This can lead to vomiting and may cause aspiration.

Which of the following is a genetic disease that typically develops during​ childhood? A. Pulmonary edema B. Sleep apnea C. Congestive heart failure D. Cystic fibrosis

D. Cystic fibrosis Cystic fibrosis is a genetic disease that typically develops during childhood. Pulmonary edema and congestive heart failure are conditions that are associated most commonly with cardiac disease. Sleep apnea is not commonly a genetic condition.

Your patient is complaining of respiratory distress. Which of the following statements is correct about management of this​ patient? A. A pulse oximeter reading over​ 90% is considered normal. B. Withhold oxygen unless the pulse oximeter reads below​ 90%. C. Do NOT administer oxygen until a pulse oximeter reading has been obtained. D. Do NOT delay administration of oxygen for a patient in respiratory distress.

D. Do NOT delay administration of oxygen for a patient in respiratory distress. Do not delay administration of oxygen from a patient who is in respiratory distress to obtain a pulse oximeter reading. Although oxygen saturation is important​ data, the more important finding is the respiratory distress.

Which of the following is a common side effect associated with overly aggressive​ positive-pressure ventilation? A. Pneumonia B. Increased heart rate C. Increase in cardiac output D. Gastric distension

D. Gastric distension The esophagus is a​ soft, flexible structure. During normal​ ventilation, the esophagus remains​ collapsed, and no air moves into it.​ Positive-pressure ventilation can overcome the esophageal opening​ pressure, allowing air to enter the esophagus and filling the stomach with air during ventilation. This leads to gastric distention and the possibility of​ regurgitation, which increases the risk of compromising the airway and aspiration of gastric contents. Aggressive positive pressure ventilation can cause a decrease in cardiac output. It does not typically affect the heart rate.

Which of the following medications is commonly prescribed for a respiratory​ disease? A. Pentothal B. Pravachol C. Metoprolol D. Ipratropium

D. Ipratropium Ipratropium is a bronchodilating drug that patients with a respiratory disease may be prescribed. With proper medical​ authorization, the EMT can assist with the administration of this medication.

Which of the following would be considered a common DISADVANTAGE of a Venturi mask CPAP​ system? A. It is heavier. B. It requires a charged battery. C. It works only on adult patients. D. It uses oxygen quickly.

D. It uses oxygen quickly. The Venturi mask CPAP device is lighter in weight and does not require a power source.​ However, it does use oxygen quickly. It can be used on all patients and does not require a battery.

During your reassessment of a patient with respiratory​ distress, which of the following would be a clinical indication that you need to initiate​ positive-pressure ventilation with supplemental​ oxygen? A. Equal rise and fall of the chest B. Deep respirations at 14 per minute C. Clear lung sounds D. Shallow respirations at 6 per minute

D. Shallow respirations at 6 per minute ​Slow, shallow respirations are signs of inadequate breathing and indicate the need for artificial ventilations.

What effect does​ long-standing COPD, particularly​ emphysema, have on the​ body's regulation of carbon​ dioxide? A. There is no change in CO2 levels as oxygen onloading in the RBC prevents an elevation in CO2. B. There is no change in CO2 levels as long as the patient keeps ventilating enough to meet oxygenation needs. C. There is a drop in CO2 levels in the bloodstream from lowered metabolism. D. There is a rise in CO2 levels in the bloodstream from damaged central chemoreceptors.

D. There is a rise in CO2 levels in the bloodstream from damaged central chemoreceptors. In the emphysemic​ patient, the alveolar destruction precludes effective offloading of carbon dioxide. Over​ time, the PaCO2 levels keep rising to the point at which the central chemoreceptors are damaged and are no longer responsive to the elevations in carbon dioxide.

What is the BEST way to determine whether artificial ventilations are​ adequate? A. The​ patient's color will improve. B. The​ patient's SpO2 will increase. C. The​ patient's LOC will improve. D. The​ patient's chest will rise and fall with each ventilation.

D. The​ patient's chest will rise and fall with each ventilation. When artificial ventilations are​ adequate, the​ patient's chest will rise and fall with each breath. There may be additional improvements in the other areas​ noted, but none are more important than ensuring quality chest rise and fall.

A​ 71-year-old male complains of an acute onset of severe respiratory distress. He is anxious but alert and​ states, "I feel like I am​ dying." His vital signs are P​ 122, R​ 40, BP​ 210/108. His pulse oximetry reads​ 89%. You should​ first: A. administer 6 lpm oxygen via a simple face mask. B. administer 6 lpm oxygen via a nasal cannula. C. initiate positive pressure ventilations. D. administer 15 lpm oxygen via nonrebreather mask.

D. administer 15 lpm oxygen via nonrebreather mask. This patient is in severe respiratory distress but is most likely breathing adequately​ (normal mental​ status, ability to​ speak, etc.). As​ such, he is not yet a candidate for positive pressure ventilations. You should first administer high concentration oxygen via a nonrebreather mask. A nasal cannula or simple face mask would likely be inadequate in this situation.

A​ 25-year-old male is complaining of difficulty breathing after a submersion​ (near drowning) injury. He says that the breathing difficulty​ "came on all of a​ sudden." You note rales when listening to his chest. His vital signs are P​ 120, R​ 36, BP​ 130/88. You should​ NEXT: A. administer nitroglycerin. B. initiate​ positive-pressure ventilations. C. assist with a bronchodilator inhaler. D. administer CPAP.

D. administer CPAP. Submersion injuries can sometimes result in episodes of pulmonary edema. In this​ patient, this can be seen by his​ history, the acute onset of shortness of​ breath, and the rales. As a​ result, CPAP is the correct intervention. Although he may require​ PPV, CPAP may prevent this alternative. Bronchodilators and nitroglycerin would not be indicated.

A​ 45-year-old female complains of severe respiratory distress. She has not responded to two bronchodilator​ treatments, she has an altered mental​ status, and her head is bobbing. You should​ NEXT: A. assist her with another bronchodilator treatment. B. sit her up and reassess her vital signs. C. initiate CPAP. D. assist ventilations.

D. assist ventilations. The patient is becoming excessively​ fatigued, and the medicine is not​ working, as evidenced by her mental status.​ Next, you will need to begin to assist her ventilations with a​ bag-mask device. CPAP may be helpful but should not be administered if the​ patient's mental status is failing. Additional bronchodilator treatments may also be helpful but not before PPV.

A respiratory condition that was formerly prominent in children who presented with stridor and drooling but is now more often found in adults​ is: A. chronic bronchitis. B. asthma. C. croup. D. epiglottitis.

D. epiglottitis. Epiglottitis has been virtually eliminated as a result of vaccinating infants. At this​ point, most of the cases involving stridor and drooling occur in adult patients. Croup is a much more common upper airway infection in children. Bronchitis and asthma both affect the lower airway.

When a patient has​ dyspnea, the​ EMT's primary focus is to manage the condition before the development​ of: A. tachypnea. B. anxiety. C. tachycardia. D. inadequate breathing.

D. inadequate breathing. The​ EMT's primary focus in a respiratory distress patient is to prevent the onset of inadequate breathing.

Your​ 26-year-old female patient has breathing difficulty and has been prescribed a MDI bronchodilator. All the requirements to administer the medication have been met. The steps in administering the bronchodilator​ include: A. leaving the oxygen off the patient until you can assess whether the medication worked. B. placing the patient on a nasal cannula for convenience. C. having the patient inhale​ fully, then place her lips around the mouthpiece. D. instructing the patient to hold her breath for as long as is comfortable after inhaling the medication.

D. instructing the patient to hold her breath for as long as is comfortable after inhaling the medication. Instruct the patient to breathe in slowly and deeply. Be sure the patient is breathing in through her mouth.

The major pulmonary dysfunction in a patient with cystic fibrosis is caused​ by: A. blockage of the airways because of increased swelling. B. narrowing of the airways because of decreased mucus production. C. narrowing of the airways because of inflammation. D. narrowing of the airways because of increased mucus production.

D. narrowing of the airways because of increased mucus production. Most of the respiratory tree has a mucous lining. It is normally watery and helps to warm and humidify inspired air. In cystic​ fibrosis, an abnormal gene alters the functioning of the mucous glands that line the respiratory​ system, and there is an overabundant production of​ mucus, which is very thick and sticky. As this thick mucus layer​ develops, there is blockage of the airways as well as an increase in the incidence of lung​ infections, since bacteria can readily grow in the thick mucus.

Your patient has stopped breathing but still has a pulse. You should​ immediately: A. request ALS. B. question bystanders. C. start compressions. D. provide artificial ventilations.

D. provide artificial ventilations. When respiratory arrest​ occurs, the patient must be supported with artificial ventilations. Compressions would not be initiated if the patient still had a pulse. Although ALS and bystander information will be​ important, they are not more important than artificial ventilations.

While forming your general impression of a patient who is suffering respiratory​ difficulty, you note that the patient is sitting in the tripod position and speaking in full sentences. This usually​ indicates: A. respiratory arrest. B. respiratory tachypnea. C. respiratory failure. D. respiratory distress.

D. respiratory distress. A patient who is having difficulty breathing but has an adequate tidal volume and respiratory rate is said to be in respiratory distress. Because the tidal volume and respiratory rate are still​ adequate, the patient is​ compensating, often by assuming a tripod position.​ Nevertheless, because there are signs of respiratory​ distress, supplemental oxygen should be administered.

An​ 89-year-old female is being treated for pneumonia. Staff notes that she has had a cough for three days as well as a fever. Upon entering the room you hear a​ loud, wet rattling sound as the patient breathes. This sound is most​ likely: A. crackles. B. wheezing. C. stridor. D. rhonchi.

D. rhonchi. Rhonchi are​ course, wet sounds associated with fluid in the large upper airways. They are commonly associated with pneumonia and can be differentiated from crackles because they are louder and more obvious. Wheezing is the sound of narrowed lower airways. Stridor is the sound of a partially obstructed upper airway.

A​ 29-year-old female complains of a sore throat and runny nose for three days. Today she notes she is having difficulty breathing due to frequent and severe coughing spells. She is alert and oriented and her vital signs are P​ 84, R​ 20, BP​ 122/80. Given her​ symptoms, you should​ suspect: A. asthma B. pulmonary embolism C. COPD D. viral respiratory infection

D. viral respiratory infection A history of runny nose and sore throat points to the development of a viral infection. Coughing associated with difficulty breathing further confirms this suspicion. Although she could have​ COPD, signs of these diseases are typically far more chronic and develop over years. Asthma is also a​ possibility, but it is usually associated with wheezing and an acute onset of shortness of breath. Although a pulmonary embolism can be associated with​ coughing, it is not typically preceded by sore throat and runny nose.