Chapt 16
Where does the lower airway begin?
At the level of the vocal cords
Which of the following is consistent with normal breathing?
Bilateral breath sounds
Which of the following is a sign of hyperventilation syndrome?
Carpopedal spasm
Which area of the brain is responsible for the gross rate and rhythm of the breathing pattern?
Medulla oblongata
While you are listening to breath sounds, the patient should be in what anatomic position whenever possible?
Sitting upright
A condition in which a lung collapses without any chest trauma is called:
spontaneous pneumothorax.
When treating a COPD 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:
spontaneous pneumothorax.
There are many problems that can cause chest pain. A symptom that usually signals pneumonia rather than another cause of chest pain is:
the presence of a fever.
A 25-year-old woman appears to be suffering from hyperventilation syndrome. You should
try to calm the patient.
The patient who has pneumonia usually has all of the following, EXCEPT:
vomiting blood.
Which receptors detect when the alveolar-capillary beds become engorged with blood?
Juxta-capillary receptors
If you are going to assist in the administration of a beta 1-agonist inhaled stimulant, what are the breath sounds you are likely to hear upon auscultation that would warrant the drug and what causes them?
Wheezing; narrowed bronchioles
A normal pulse oximeter reading is
94 percent.
As the lead EMT on a call for a dyspneic patient, you are reviewing the medications the patient takes. If the clinical criteria are met for assisting the patient with the administration of a bronchodilator, which of the following would the EMT be unable to use?
Advair
You are treating a 45-year-old woman who has been struggling in trying to breathe. She has a history of COPD from years of smoking more than two packs of cigarettes a day. Aside from administering the appropriate amount of oxygen, what else is an appropriate treatment?
Assist the patient with her bronchodilator according to your protocols.
Which of the following patients would be at risk for a primary spontaneous pneumothorax?
A tall, thin 18-year-old male athlete
You are assessing a 45-year-old woman who was in severe respiratory distress. She has not responded to two bronchodilator treatments, she has an altered mental status, and her head is bobbing. What should you do NEXT for this patient?
Begin assisting her ventilations.
A patient with which of the following signs indicates respiratory failure?
Central cyanosis, one- to two-word dyspnea, pulse oximeter reading of 84%
A 22-year-old woman tells you she is having a panic attack. Her vital signs are P110, R 36, BP 132/76, and her SPO2 is 99%. Which of the following is the appropriate treatment for this patient?
Coach her to slow her breathing.
Which assessment finding in a patient who is dyspneic is a clear indication of hypoxia?
Cyanosis
After administration of a bronchodilator, what would the EMT expect to hear during auscultation if the medication had its desired effect on the body?
Diminishment in wheezing
Which of the following is a sign of cardiogenic pulmonary edema?
Distended neck veins
You are treating a patient who has difficulty breathing. He is very thin and has a barrel-chest appearance. He is coughing but with little sputum and has a prolonged exhalation as if he is puffing. What type of disease does he MOST likely have?
Emphysema
After administering the 45-year-old female patient's bronchodilator, you notice that she continues to have considerable distress and her mental status is becoming altered. Aside from administering oxygen, what else should you be considering?
Getting out the bag-valve mask and preparing to assist ventilations
Which of the following is NOT a recommended part of the procedure for listening to breath sounds?
Have the patient breathe through the nose to avoid having the patient vocalize.
You are caring for a patient with a history of emphysema who has a primary complaint of shortness of breath and the following findings: pulse oximeter reading of 93 percent, heart rate 110, blood pressure 180/86, and respiratory rate 26/minute. You find the patient's skin to be diaphoretic with ashen fingers and toes. There are bilaterally diminished breath sounds with a slight expiratory wheeze, but alveolar sounds are still present. Given these findings, how would you characterize this patient's current ventilation adequacy?
He displays respiratory distress, and he is at risk for deterioration.
Which of the following conditions can initially present with lethargy and confusion?
Hypercarbia
What is the MOST severe consequence of reduced airflow from COPD?
Hypoxia
Which of the following is consistent with adequate breathing?
Intact airway
Which of the following is true about hyperventilation syndrome?
It is commonly associated with emotions.
Which of the following is an easily recognizable prescribed medication for a patient for a respiratory disease?
Levalbuterol
The EMT will encounter many patients with respiratory distress. Which of the following will be the most common cause?
Obstructive lung disease
What is the pathophysiology of cystic fibrosis?
Overabundant production of mucus in the lower airways
Which of the following conditions stimulates receptors in the lungs?
Pneumonia
Your 68-year-old male patient complains of shortness of breath that has been getting worse over the past few days. He denies any history of COPD and has not experienced any penetrating trauma. He does have a low-grade fever. He says that he feels weak and has some chest pain. What is MOST likely to be his problem?
Pneumonia
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 his MOST likely condition?
Pulmonary edema
A patient who just completed an international flight complains of a sudden onset of shortness of breath. The patient has no previous medical history. Which of the following is the likely cause of the distress?
Pulmonary embolism
Which of the following medications is the EMT NOT allowed to use for the acute management of a patient with bronchoconstriction, wheezing, and a history of asthma?
Salmeterol xinafoate
You are reassessing a patient to whom you have administered oxygen and an MDI for respiratory distress. During your reassessment, you find that there is only slight expiratory wheezing, the pulse oximeter reading is 97 percent, the patient is speaking in full sentences, and the patient's color is good. Given this, which of the following characterizes the patient?
She is displaying mild respiratory distress.
You are standing by at a local 5K race when you are asked to take a look at a runner who did not complete the race. He is a 29-year-old skinny man who describes a sudden onset of sharp chest pain on the right side with shortness of breath. What is the MOST likely problem?
Spontaneous pneumothorax
You are managing a patient who you believe is severely hypoxic, and the pulse oximeter is not functioning properly. Given this information, what is the BEST thing you could do for the patient?
Start high-flow oxygen.
Which of the following is NOT a contraindication to administering a bronchodilator by MDI to a patient with asthma?
The patient is in severe respiratory distress.
Besides the symptom of respiratory distress, how would an EMT know that a patient may have a viral infection affecting the respiratory system?
The presence of a fever
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?
There are no alveolar breath sounds.
Which of the following is true in relation to a pulmonary embolism?
There is decreased blood flow to the alveoli.
Drugs that are commonly prescribed for patients to assist in the long-term control of a pulmonary pathology but are NOT used during acute deterioration by the EMT have what property?
They contain a steroidal compound.
Which of the following includes the proper way to assess for breath sounds?
Use the diaphragm end of the stethoscope, listen over bare skin, and instruct the patient to cough first.
Pulmonary edema can be caused by all of the following EXCEPT:
a stroke.
You suspect that a 66-year-old female patient has pneumonia. Vital signs are P110, R20, BP 110/84 and her SpO2 is 92% on room air. You should first
administer oxygen at 2 lpm via nasal cannula.
When a patient who was in respiratory failure stops breathing, this is called:
apnea
The complete cessation of breathing effort is known as respiratory:
arrest
Emergency medical care for a child who is experiencing significant difficulty breathing may include:
beginning positive pressure ventilations if breathing becomes inadequate.
Most patients you encounter as an emergency medical technician (EMT):
breathe normally.
In treating the patient with a history of asthma, it is helpful to assist the patient with:
bronchodilator medication.
When a patient who has COPD develops a viral respiratory infection, he will often need:
bronchodilator treatments.
If the patient has an SPO2 below 90 percent, it is likely that his color will be:
cyanotic.
En route to the hospital, it is important to perform an ongoing assessment of the patient with breathing difficulty. While you are reevaluating your patient, remember that:
decreased wheezing always indicates improvement.
When a blood clot ends up in the lungs, the patient may have sudden development of:
dyspnea
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:
emphysema
A condition that can cause obstruction of an infant's upper airway is swelling of the epiglottis from an infection. This condition is known as:
epiglottitis
Each of the following may indicate that apnea is imminent, EXCEPT:
hypertension
If the cells of the body are not getting an adequate supply of oxygen, they begin to die. This state of inadequate oxygen supply is called:
hypoxia
While assessing a patient with breathing difficulty, you see that the patient is restless, anxious, and somewhat confused as to what's going on. These signs are often caused by:
hypoxia affecting the brain.
If you are treating a patient with respiratory complaints and the patient is cyanotic, it could indicate that the patient is:
in respiratory failure.
If you are assessing a patient who is having breathing difficulty as well as stridor and drooling, you should be careful NOT to:
inspect the airway.
Your 26-year-old female patient has breathing difficulty and has been prescribed an MDI bronchodilator. If all the requirements to administer the medication have been met, the steps include:
instructing the patient to hold her breath for as long as is comfortable after inhaling the medication.
Signs of respiratory failure in an infant or child include:
loss of muscle tone.
In the asthma patient, all of the following contribute to the increasing resistance to airflow and difficulty breathing, EXCEPT:
malaise and decreasing appetite.
Your patient is exhibiting minimal use of accessory muscles while breathing. This is a sign of
normal breathing.
A 65-year-old man complains of shortness of breath. He is speaking in two-word sentences. You hear crackles when you auscultate lung sounds. Vital signs are P 98, R 26, BP 210/114, and his SPO2 is 86%. You should administer:
positive pressure ventilations via a bag-valve-mask (BVM) device.
If your patient is breathing adequately but with difficulty and the pulse oximeter reads 84 percent, you should:
provide oxygen by a nonrebreather mask at 15 lpm.
All of the following are considered chronic obstructive pulmonary diseases, EXCEPT:
pulmonary embolism.
You respond to a call from the regional airport to remove an elderly patient experiencing respiratory distress from a plane that just landed after a long flight. A respiratory condition that may be caused by a deep vein thrombosis that develops when a person has been sitting for a long time is:
pulmonary embolism.
While you are obtaining your patient's blood pressure, you notice that the needle drops more than 10 mm/Hg each time the patient inhales. This is called:
pulsus paradoxus.
When a patient has dyspnea, the EMT's primary focus is to manage the condition before the development of:
respiratory failure.
Early signs of breathing difficulty in the infant or child include:
retractions during inspiration.
