NREMT: Airway, respiration, ventilation
Which of the following respiratory conditions in children over 2 years old has similar lung sounds to an infant who has bronchiolitis?
Asthma
Which of the following patients should you suspect needs administration of supplemental oxygen?
A 27-year-old male who complains of difficulty breathing; his vital signs are P 92, R 20, BP 126/74, and SpO2 is 94% on room air
A 64-year-old male is having an asthma attack. Which class of medication can help improve his alveolar ventilation?
Beta2 agonist
How is most of the oxygen transported from the lungs to the cells in a normoxic patient?
Bound to hemoglobin
What causes the prolonged expiratory phase of the respiratory cycle in a patient who is having an asthma attack?
Bronchiole constriction
Why shouldn't you apply CPAP to a patient who is in respiratory arrest?
CPAP doesn't ventilate the patient.
The serum concentration of which of the following gases increases during respiratory failure?
Carbon dioxide
A 23-year-old female was rescued from a house fire. She is coughing up black phlegm and complains of difficulty breathing. You should suspect she inhaled which of the following gases that is difficult for the body to compensate for and can be toxic?
Cyanide
Which of the following may be a direct impact of positive pressure ventilation on perfusion when ventilating an infant?
Decreased preload
You are assessing a 43-year-old female who complains of difficulty breathing. How should you determine if her minute ventilation is adequate?
Evaluate her mental status and tidal volume
An unresponsive 76-year-old female is lying in bed, and you hear snoring respirations. What should you suspect is partially occluding her airway?
Her tongue
A 39-year-old male has had difficulty breathing for two hours. What determines if he is in respiratory distress instead of respiratory failure?
If his body can compensate for its oxygen demands
You are assisting the ventilation of a 17-year-old male who had a severe asthma attack. When your partner reassesses the patient's vital signs, there is a significant reduction in his blood pressure. Which of the following is the likely cause?
Increased intrathoracic pressure
A 10-year-old female complains of difficulty breathing after mixing bleach with another cleaner. Her skin and clothing are dry. You smell a strong odor, and your eyes begin to water. What route of exposure should you suspect is causing her dyspnea?
Inhalation
Why can inhalation exposure to carbon monoxide be toxic?
It displaces oxygen from hemoglobin.
What is the impact on intrathoracic pressure when you squeeze the BVM while ventilating a patient?
It increases airway and intrathoracic pressures.
You are ventilating an unresponsive 47-year-old male who is in respiratory arrest. How should you determine that you are delivering adequate tidal volume?
Look for slight chest rise.
Patients who have chronic bronchitis may have which of the following?
Persistent productive cough, thickening of walls of bronchioles, excessive mucus production
You are preparing to ventilate an 11-month-old female with a BVM. Which of the following ensures that her airway is properly positioned?
Placing her in the sniffing position
A 39-year-old female is lying in bed. When you assess her, which of the following findings indicate an inadequate airway?
She is unresponsive and snoring.
Which process allows gas exchange between the alveoli and capillaries?
Simple diffusion
When assessing lung sounds in an adult who is sitting upright, where should you place your stethoscope to auscultate alveolar ventilation?
Sixth intercostal space, midscapular line
An 83-year-old female is in respiratory arrest. How should you ventilate her to reduce the impact on her cardiac output?
Squeeze the bag to cause visible chest rise at a rate of 10/minute
Why would a 46-year-old male who inhaled steam from a malfunctioning boiler have stridor in his upper airway and wheezes in his lower airway?
Steam can burn both upper and lower airways causing edema.
Which of the following prevents the over-inflation of the lungs during normal respiration?
Stretch receptors
Why do you hear rales when you auscultate the lungs of a patient who has pulmonary edema?
The terminal airways pop open with each inspiration
Why can pulmonary embolisms cause a V/Q mismatch?
They block pulmonary arterial blood flow.
A 66-year-old male complains of difficulty breathing. He tells you that his asthma attack began 20 minutes ago, and his inhaler isn't helping. You auscultate wheezes in all lung fields and good chest rise with accessory muscle use. His vital signs are P 96, R 24, BP 146/88, and SpO2 is 93% on room air. You should suspect his minute ventilation is:
adequate and administer oxygen
An 11-year-old male who has a history of cystic fibrosis complains of difficulty breathing. He tells you he has been coughing up thick mucus. His vital signs are P 92, R 24, BP 118/76, and SpO2 is 91% on room air. You should:
administer humidified oxygen.
A 34-year-old female who is in her third trimester, complains of a sudden onset of feeling light-headed and short of breath. She tells you she has had pain in her left leg for two days. You observe it is swollen and tender to palpation. She tells you she has been on bed rest for the last month for a high-risk pregnancy. Her lungs are clear to auscultation. Her vital signs are P 96, R 20, BP 116/74, and SpO2 is 96% on room air. You should:
administer oxygen
A 73-year-old female complains about night sweats and a recent unexplained weight loss. She denies any past medical problems, other than recently coughing up a little blood. Her vitals are P 92, R 18, BP 140/68, and SpO2 is 93% on room air. After donning the proper PPE, you should:
administer oxygen by nasal cannula and place a surgical mask over her mouth and nose.
A 67-year-old male tells you he has had an upper respiratory infection for two weeks. Today he started to have an episode of uncontrolled coughing. While he is speaking with you, he has a coughing burst of 15-20 episodes with an inspiratory whooping sound. His SpO2 while coughing is 92% on room air. After he stops coughing his vital signs are P 92, R 18, BP 142/90, and SpO2 is 94% on room air. After donning an N-95 mask, you should:
administer oxygen by nasal cannula and place a surgical mask over his mouth and nose.
An 18-year-old male complains of abdominal pain and diarrhea. He tells you he has a history of cystic fibrosis. You auscultate rhonchi in his lower lungs. His vital signs are P 88, R 22, BP 126/78, and SpO2 is 93% on room air. You should:
administer oxygen by nasal cannula.
A 13-year-old male tells you that he has had a cough for two weeks. He has an episode of coughing, and you hear an inspiratory whoop after each cough. You auscultate rhonchi in his left lower lung. His vital signs are P 100, R 22, BP 118/76, and SpO2 is 93% on room air. You should:
administer oxygen by nasal cannula.
A 93-year-old female complains of a sudden onset of difficulty breathing. She tells you that she has a history of breast cancer. She tells you it is easier for her to breathe when she is sitting up. She has decreased lung sounds when you auscultate her left mid-axillary line, sixth intercostal space. Her vital signs are P 86, R 18, BP 144/92, and SpO2 is 95% on room air. You should:
administer oxygen by nasal cannula.
A 39-year-old male starts to have difficulty breathing while hiking at 9000 feet above sea level. He is coughing, and you observe pink, frothy sputum. His skin is pale and moist. You auscultate rales in all fields. His vital signs are P 96, R 22, BP 118/68, and SpO2 is 89% on room air. You should:
administer oxygen by non-rebreather mask while moving him to a lower elevation.
A 25-year-old female complains of difficulty breathing. She tells you she took her inhaler without relief. Her mucous membranes are pale. You auscultate decreased lung sounds in the bases and wheezes in her upper lungs. Her vital signs are P 86, R 24, BP 130/72, and SpO2 is 89% on room air. You should:
administer oxygen by non-rebreather mask.
A 53-year-old female states, "I...can't...breathe!" Her skin is cyanotic. You observe intercostal retractions and auscultate decreased lung sounds in all fields. You should first:
administer oxygen by non-rebreather mask.
A 67-year-old female has a history of emphysema. She tells you that she suddenly started to have sharp right shoulder pain and increased difficulty breathing after placing items on a high shelf. Her skin is pale and diaphoretic. You auscultate slight wheezes in both bases and absent lung sound in the apex of her right lung. Her vital signs are P 88, R 22, BP 138/84, and SpO2 is 87% on home oxygen 3 L/minute by nasal cannula. You should:
administer oxygen by non-rebreather mask.
A 77-year-old female complains of difficulty breathing. She tells you she has had a productive cough for several years. You auscultate coarse rhonchi in the bases of her lungs. You observe her mucous membranes are cyanotic. Her vital signs are P 96, R 26 and labored, BP 148/92, and SpO2 is 88% on home oxygen 3 L/minute by nasal cannula. You should:
administer oxygen by non-rebreather mask.
An 86-year-old male tells you that after a coughing episode, he had a sudden onset of right-sided chest pain and difficulty breathing. He has a history of emphysema. He describes a pleuritic-type chest pain that stops him from taking a deep breath. You auscultate decreased breath sounds over his right apex. His vital signs are P 76, R 20, BP 130/78, and SpO2 is 92% on room air. You should:
administer oxygen.
A 19-year-old female complains of difficulty breathing. She tells you she has a history of cystic fibrosis. Her skin is pale and diaphoretic. You auscultate scattered rhonchi in all fields. Her vital signs are P 78, R 20, BP 118/72, and SpO2 is 92% on room air. You should:
administer oxygen.
A 20-year-old male is coughing after inhaling chlorine gas. He was moved outside to fresh air by coworkers. His only complaints are that his throat is burning, and it is hard to catch his breath because of the coughing. You should first:
administer oxygen.
A 47-year-old male complains of difficulty breathing, and he cannot stop coughing. His conjunctivae are pale and moist. He has a 40 pack-year smoking history. You should first:
administer oxygen.
A 49-year-old male complains of a sore throat and has a muffled voice. He tells you the sore throat started a week ago and has gotten worse. He looks sick, and his skin is hot to the touch. He has a history of asthma. You auscultate a slight high-pitched sound occasionally in his upper airway. His vital signs are P 102, R 16, BP 132/84, and SpO2 is 93% on room air. You should:
administer oxygen.
A 57-year-old male complains of difficulty breathing after a non-stop flight from Asia. He has a history of asthma. He tells you that he started to cough up bloody sputum after his flight landed. His skin is pale and diaphoretic. You auscultate rales on the left side of his chest. His vital signs are P 108, R 26, BP 112/60, and SpO2 is 90% on room air. You should:
administer oxygen.
A 60-year-old female is resting alongside the roadway during a marathon. She tells you that while she was running, she became short of breath, so she sat down. She has been resting for 10 minutes, and she is still short of breath. You should first:
administer oxygen.
A 7-year-old male who has had a cold for a week tells you that he can't breathe. He has had a nonproductive cough for a day, and he is lying on his right side in the fetal position. His skin feels hot to the touch. He has a history of asthma, and you auscultate rhonchi in his right chest. His vital signs are P 118, R 24, BP 82/64, and SpO2 is 91% on room air. You should:
administer oxygen.
A 76-year-old female complains of malaise and decreased appetite. She has a history of asthma. She has a non-productive cough, and you auscultate rhonchi and slight wheezes in her right lower lung. Her vital signs are P 104, R 20, BP 140/96, and SpO2 is 92% on room air. You should:
administer oxygen.
A 6-month-old female does not respond to you when you stimulate her. Her father tells you that she stopped breathing and turned blue. You observe supraclavicular and sternal retractions at a rate of 38. You should first:
assist her ventilation
A confused 60-year-old female is having an asthma attack. She is unable to sit upright and keeps leaning to the side. Her chest is silent on auscultation. She is tachypneic and tachycardic. You should:
assist her ventilation.
An unresponsive 55-year-old female who has a history of amyotrophic lateral sclerosis is lying in bed. Her husband tells you she has progressively been having more difficulty breathing and now he cannot wake her. She is tachypneic with shallow respirations. You should first:
assist her ventilation.
An unresponsive 46-year-old male has severe respiratory distress. His wife tells you he was resuscitated after drowning several hours ago but refused to go to the hospital. You auscultate rales and decreased lung sounds in all fields. You should:
assist his ventilation
A confused 57-year-old male has difficulty breathing. His wife tells you he has been coughing up rust-colored sputum and recently lost weight. His lung sounds are diminished in the bases, and you auscultate fine and coarse crackles over his left upper chest. His vital signs are P 86, R 24 and shallow, BP 136/72, and SpO2 is 88% on room air. You should:
assist his ventilation.
An unresponsive 71-year-old male has difficulty breathing. His wife tells you he has had the flu for five days. His skin is pale and diaphoretic. You observe accessory muscle use and auscultate rhonchi and crackles on his left side. His vital signs are P 110, R 26 and shallow, BP 96/64, and SpO2 is 89% on room air. You should:
assist his ventilation.
An unresponsive 88-year-old male was found by nursing home staff having difficulty breathing. His skin is pale and febrile. You auscultate diminished lung sounds throughout his chest and faint rhonchi in his upper chest. His vital signs are P 104, R 26 and shallow, BP 112/86, and SpO2 is 89 % on room air. You should:
assist his ventilation.
A 65-year-old male who has a history of congestive heart failure is slumped in a chair not responding to you. His wife tells you that his difficulty breathing started an hour ago and has been getting worse. He is tachypneic, and you auscultate rales in all fields. You should first:
assist his ventilation.
A 16-year-old female states, "Help me...I have...asthma and...I...can'tbreathe!" She tells you she used her inhaler once without relief. You auscultate wheezes in all fields. Her vital signs are P 100, R 26 and deep, BP 108/68, and SpO2 is 90% on room air. After administering oxygen, you should next:
assist with the administration of her inhaler.
A 5-year-old female who has a history of asthma complains of trouble breathing. She is exhaling through pursed lips, and you auscultate wheezes. Her vital signs are P 110, R 32, BP 106/68, and SpO2 is 89% on room air. After administering oxygen, you should next:
assist with the administration of her metered dose inhaler.
An 83-year-old female complains of difficulty breathing. She tells you that it started after carrying in her groceries. You observe pursed lips breathing. She is tachypneic, and you auscultate diffuse wheezes. You should suspect:
asthma
A 26-year-old male complains of difficulty breathing after playing basketball. His skin is pale and diaphoretic. You auscultate wheezes in all fields. His vital signs are P 98, R 22, BP 132/72, and SpO2 is 91% on room air. You should suspect:
asthma.
A 69-year-old male has severe difficulty breathing. He states, "Help, I...can't breathe!" He is sitting upright, and you see accessory muscle use. You auscultate wheezes in his upper chest, and no sounds in his lower chest. He denies a cough and indicates that this episode just started 30 minutes ago. You should suspect:
asthma.
An 88-year-old male tells you he is having trouble breathing. He tells you he has a cold that is getting worse. He has a chronic productive cough and a 60 pack-year smoking history. You auscultate rhonchi at the bases of his lungs. His vital signs are P 96, R 20, BP 162/98, and SpO2 is 91% on room air. You should suspect:
chronic bronchitis.
You are assisting the ventilation of a 57-year-old female who is in respiratory failure. Her initial vital signs were P 102, R32, BP 142/84, and SpO2 was 88% on room air. After five minutes of assisted ventilation, her vital signs are P 96, R 18 assisted with slight chest rise, BP 108/80, and SpO2 is 95% on oxygen 15 L/minute by BVM. You should:
decrease your ventilation rate.
A 17-year-old female complains of difficulty swallowing after smoking crack earlier today. Her voice is quiet, and she is leaning forward and drooling. Her lungs are clear to auscultation. Her vital signs are P 16, R 14, BP 116/ 76, and SpO2 is 94% on room air. You should suspect:
epiglottitis.
A 32-year-old male complains of difficulty breathing. He admits to smoking crack cocaine an hour before the problem started. You hear inspiratory stridor and observe drooling. His vital signs are P 108, R 18, BP 142/88, and SpO2 is 95% on room air. You should suspect:
epiglottitis.
A 34-year-old female complains of difficulty swallowing. Her voice is muffled as she tells you that she has had a cold for a week. She is sitting leaning forward, and you hear audible stridor. You should suspect:
epiglottitis.
A 52-year-old male complains of difficulty breathing. He tells you he has a history of asthma. He used his albuterol inhaler twice without relief. You auscultate wheezes in all fields. His vital signs are P 72, R 20, BP 142/78, and SpO2 is 90 % on room air. You should administer oxygen and:
have him use his inhaler.
A 70-year-old male who has a history of emphysema complains of difficulty breathing. He has four-word dyspnea, and you auscultate a slight wheeze in his lower lung fields. His vital signs are P 102, R 22, and BP 152/88. His SpO2 is 92% on home oxygen 2 L/minute by nasal cannula attached to 100 feet of extension tubing. You should:
increase his home oxygen flow rate to 4 L/minute.
A 29-year-old female complains of difficulty breathing and numbness in her lips. She tells you that she has a lot of stress and cannot take it anymore. Her vital signs are P 104, R 28 and deep, BP 118/88, and SpO2 100% on room air. You should suspect:
increased alveolar ventilation.
An unresponsive 24-year-old female is lying on a sofa with an empty vodka bottle nearby. You hear snoring respirations, and when you attempt to insert an oropharyngeal airway, she begins to gag. You should:
insert a nasopharyngeal airway.
An unresponsive 4-year-old female is apneic but has a carotid pulse of 52. You should first:
insert an oropharyngeal airway
An unresponsive 45-year-old male was found lying on the ground outside. You do not see any obvious signs of trauma. He has snoring respirations and a carotid pulse. After opening his airway, you should next:
insert an oropharyngeal airway.
Coworkers call 9-1-1 for a 22-year-old male who was having an asthma attack. The patient tells you that he took his albuterol inhaler prior to your arrival and feels better. You auscultate clear lung sounds. His vital signs are P 92, R 18, BP 130/82, and SpO2 is 93% on room air. You should administer:
oxygen by nasal cannula.
A 55-year-old male complains of difficulty breathing and a cold for a week. His skin is diaphoretic. His temperature is 102 degrees F. He has a nonproductive cough. You auscultate rhonchi over his left axilla in the fifth intercostal space. His vital signs are P 104, P 22, BP 128/88, and SpO2 is 89% on room air. You should first administer:
oxygen by non-rebreather mask.
A 76-year-old male complains of a severe headache that feels like a band around his head. He tells you he has been cooking with his grill in the garage because it is raining. His vital signs are P 88, R 14, BP 142/68, and SpO2 is 99% on room air. You should administer:
oxygen by non-rebreather mask.
Bystanders tell you that an unresponsive 22-year-old male fell 10 feet off a ladder and landed head first. You hear irregular, gasping respirations and palpate a carotid pulse. You should first:
perform a jaw-thrust maneuver.
A 16-year-old female complains of a runny nose and a low-grade fever. She has a burst of rapid coughing with an inspiratory whooping sound. While she is coughing her skin becomes cyanotic. After she stops coughing her skin color returns to normal. You should suspect:
pertussis
A 47-year-old male complains of a sore throat and drooling. He tells you that it is too painful to swallow. He has a history of cancer and is receiving chemotherapy. You auscultate stridor in his upper airway. When transporting him to the hospital, you should:
place him in his position of comfort.
A febrile 37-year-old female who has a history of HIV complains of difficulty breathing. She tells you she has been coughing up yellow phlegm for two days. Her skin is pale and sweaty. You auscultate crackles in her right lower lung. You should suspect:
pneumonia
A 59-year-old female complains of difficulty breathing. She is hiking at high altitude and tells you that she has no past medical problems. When you auscultate her lungs, you hear rales in her lower lungs. Her vital signs are P 78, R 18, BP 138/76, and SpO2 is 94% on room air. You should suspect:
pulmonary edema
A 32-year-old female complains of sharp, stabbing pain to the left side of her chest and difficulty breathing. She recently fractured her left tibia, and she has a cast on her leg. You auscultate clear lung sounds. Her vital signs are P 94, R 26, BP 118/64, and SpO2 is 92% on room air. You should suspect:
pulmonary embolism.
An unresponsive 22-year-old male is lying on the ground outside a bar. You do not see any chest rise but palpate a carotid pulse. You should suspect:
respiratory arrest
An unresponsive 6-year-old male is taking shallow, irregular respirations once every 15 seconds. He has a weak carotid pulse. His mother tells you that he was playing alone in his room and was fine 30 minutes ago. You should suspect:
respiratory arrest.
A 12-year-old male has difficulty breathing. He tells you he has had a cold all week. You auscultate rhonchi in his left lower chest. His vital signs are P 104, R 28, BP 104/74, and SpO2 is 89% on room air. You should suspect:
respiratory distress
An 86-year-old female has difficulty breathing. She tells you she has lung cancer and she is receiving chemotherapy. Her skin is pale, and you auscultate clear lung sounds. Her vital signs are P 68, R 18, BP 126/86, and SpO2 is 92% on room air. Based on your findings, you should suspect:
respiratory distress.
A 24-year-old male complains of difficulty breathing. He is sitting in a chair leaning forward. He tells you that he was exercising when it started. His lung sounds are clear but diminished in the bases bilaterally. His vital signs are P 92, R 22, BP 132/90, and SpO2 is 93% on room air. You should suspect:
respiratory distress.
An 8-year-old female has had trouble breathing for two days. Her father called because she continues to have trouble breathing and he cannot wake her up. You do not hear any sounds when you auscultate her lower lungs and hear faint wheezes in her upper lungs. Her vital signs are P 60, R 26, BP 94/68, and SpO2 is 88% on room air. You should suspect:
respiratory failure
A 55-year-old female is in respiratory arrest. When ventilating her, you should squeeze the bag once every:
six seconds, enough to cause barely visible chest rise.
A 34-year-old female was rescued from a house fire. She complains of difficulty breathing. You do not observe any burns to her face or singed hair, but she is coughing up black tinged phlegm. You should suspect:
smoke inhalation.
A 24-year-old female complains of right-sided chest pain and trouble breathing. She tells you she felt a pop in her chest while coughing before the pain and difficulty breathing started. Her lungs are clear to auscultation. Her vital signs are P 82, R 20, BP 108/72, and SpO2 is 97% on room air. You should suspect:
spontaneous pneumothorax.
A 49-year-old male complains of sudden onset of shortness of breath. He has a 66 pack-year smoking history. He tells you he was sitting in a chair resting when it began. His skin is diaphoretic, and you auscultate diminished breath sounds in his right upper chest. His vital signs are P 96, R 24, BP 148/94, and SpO2 is 93% on room air. You should suspect:
spontaneous pneumothorax.
Which of the following sounds indicates an upper airway obstruction in a child who is in respiratory distress?
stridor
An unresponsive 30-year-old female was the unrestrained driver involved in a car crash. Your partner stabilizes her head and tells you she is breathing and has a carotid pulse. As you examine her airway, you see blood, broken teeth, and hear gurgling sounds. You should first:
suction her airway.
An 86-year-old female who has a history of emphysema complains of chest pain. Her initial SpO2 was 92% on home oxygen by nasal cannula, 3 L/minute. You administered oxygen by non-rebreather, 12 L/minute. Her SpO2 is now 100%, and her chest pain is resolved after aspirin and nitroglycerin administration. You should next:
switch to a simple face mask.
Why are chronic smokers predisposed to spontaneous pneumothorax?
they are more prone to having blebs within the lung parenchyma.
A 59-year-old female was working on a boiler when it vented super-heated air into her face. You see partial thickness burns to her face, and she tells you her throat is swelling up. You auscultate stridor in her upper airway. You should immediately:
transport her.
A febrile 52-year-old female complains of coughing up blood. She tells you that she has had recent unexplained weight loss. You auscultate rhonchi over the right upper lung. Her vital signs are P 86, R 16, BP 138/84, and SpO2 is 95% on room air. You should suspect:
tuberculosis.
A febrile 72-year-old male who lives in an assisted care facility has hemoptysis. He tells you that he has had night sweats and recent weight loss. You should suspect:
tuberculosis.
An unresponsive 94-year-old female was found by her husband in bed. He tells you that she has a history of diabetes. You do not observe chest rise or air movement, but she has a pulse. You should first:
ventilate her with a BVM.
