chapter 16 (pre and post)

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? A. Pulmonary embolus B. Pneumonia C. Spontaneous pneumothorax D. Pulmonary edema

Pneumonia

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: A. having the patient inhale​ fully, then place her lips around the mouthpiece. B. leaving the oxygen off the patient until you can assess whether the medication worked. C. instructing the patient to hold her breath for as long as is comfortable after inhaling the medication. D. placing the patient on a nasal cannula for convenience.

instructing the patient to hold her breath for as long as is comfortable after inhaling the medication.

Which of the following is consistent with adequate​ breathing? A. Intact airway B. Tachypnea C. Use of accessory muscles D. Absent breath sounds

intact airway

Which of the following is true about hyperventilation​ syndrome? A. It causes CO2 to be​ retained, causing cramping in hands and feet. B. Minimal assessment is required to diagnose hyperventilation syndrome. C. It is commonly associated with emotions. D. Having the patient breathe into a paper bag is beneficial.

it is commonly associated with emotions

Which receptors detect when the​ alveolar-capillary beds become engorged with​ blood? A. Venous receptors Your answer is not correct. B. Stretch receptors C. ​Juxta-capillary receptors D. ​Alveolar-capillary receptors

juxta-capillary receptors

Which of the following is an easily recognizable prescribed medication for a patient for a respiratory​ disease? A. Cozaar B. Levalbuterol C. Trilafon D. Fenofibrate

levalbuterol

Signs of respiratory failure in an infant or child​ include: A. hypertension. B. inconsolability. C. loss of muscle tone. D. tachycardia.

loss of muscle tone

In the asthma​ patient, all of the following contribute to the increasing resistance to airflow and difficulty​ breathing, EXCEPT: A. malaise and decreasing appetite. B. edema of the inner lining in the airways. C. bronchoconstriction. D. mucus that causes plugging of the smaller airways

malaise and decreasing appetite The most common complaint of the asthma patient is severe shortness of breath. Many asthma patients are aware of their condition and have medication to manage the disease and its signs and symptoms. You may be called to the scene for a patient who is suffering an​ early-onset asthma attack or one in which the​ patient's medication is not reversing the attack. Asthma involves​ bronchoconstriction, edema of the inner lining in the​ airways, and increased secretion of mucus that causes plugging of the smaller airways.

Which area of the brain is responsible for the gross rate and rhythm of the breathing​ pattern? A. Midbrain B. Cerebellum C. Medulla oblongata D. Stretch receptors

medulla oblongata Accessory structures that are part of the respiratory system include the inspiratory and expiratory centers in the medulla and​ pons, located in the​ brainstem, which exert nervous control of breathing. The medulla houses the neural respiratory centers that are responsible for the gross rate and rhythm of the breathing pattern.

Your patient is exhibiting minimal use of accessory muscles while breathing. This is a sign of A. normal breathing. B. respiratory collapse. C. respiratory distress. D. respiratory failure.

normal breathing When a patient exhibits minimal use of accessory muscles while​ breathing, it is a sign of normal breathing.

Which of the following is a sign of hyperventilation​ syndrome? A. Carpopedal spasm B. Decreased SpO2 levels C. Wheezing D. Hypertension

Carpopedal spasm

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? A. Administer an epinephrine​ self-injector. B. Assist the patient with her bronchodilator according to your protocols. C. Administer four baby aspirins. D. Lay the patient down and raise her legs.

Assist the patient with her bronchodilator according to your protocols. Administer a bronchodilator to the patient by​ metered-dose inhaler​ (MDI) or​ small-volume nebulizer​ (SVN). The patient must exhibit signs and symptoms of breathing difficulty​ (respiratory distress). The patient must have a​ physician-prescribed metered-dose inhaler containing a medication that was specifically prepared to be delivered by nebulization. The EMT must have received approval from medical​ direction, whether​ on-line or​ off-line, to administer the medication.

A patient with which of the following signs indicates respiratory​ failure? A. Central​ cyanosis, one- to​ two-word dyspnea, pulse oximeter reading of​ 84% B. Respiratory rate of​ 32/minute, intercostal retractions​ noted, and tachycardia C. Absent alveolar breath sounds to left apical​ zone, pulse oximeter reading of​ 89%, mild confusion D. Pale​ skin, expiratory​ wheezing, respiratory rate of​ 26/minute

Central​ cyanosis, one- to​ two-word dyspnea, pulse oximeter reading of​ 84% All of these are indications of difficulty in breathing.​ However, a patient with​ cyanosis, one- to​ two-word dyspnea, and a pulse oximeter reading in the​ mid-80s is most in need of positive pressure​ ventilation, as he displays classic findings of respiratory failure. The patient is said to be in respiratory failure because the respiratory tidal volume or rate is no longer able to provide an adequate ventilator effort. This requires you to immediately begin ventilation with a​ bag-valve-mask device or other ventilation device. Supplemental oxygen must be delivered through the ventilation device. Inadequate breathing that is not treated promptly is likely to deteriorate to respiratory arrest.

incorrect,Pre Test 16.4.1 Which of the following is NOT a recommended part of the procedure for listening to breath​ sounds? A. Instruct the patient to cough one or two times before you start the auscultation. Your answer is not correct. B. Use the diaphragm end of the​ stethoscope, not the bell. C. Have the patient breathe through the nose to avoid having the patient vocalize. D. Instruct the patient to sit up if possible.

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? A. He displays respiratory​ distress, and he is at risk for deterioration. B. He is breathing​ inadequately, and significant findings of inadequacy are present. C. He is breathing​ adequately, and no indications of respiratory failure are present. D. He is breathing inadequately but shows signs of improving.

He displays respiratory​ distress, and he is at risk for deterioration. 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.​ However, because there are signs of respiratory​ distress, supplemental oxygen should be administered. Oxygen via a nasal cannula at 2 to 4 lpm can be used to increase or maintain the SPO2 reading at 94 percent or higher. Oxygen administration should be based on the​ patient's oxygenation status as measured and primarily guided by the pulse oximetry instead of using predetermined devices and flow rates for all patients. The patient who presents with moderate to severe respiratory distress and who is awake and alert may benefit from continuous positive pressure ventilation​ (CPAP). A patient who is presenting with a severely decreased SPO2 reading and obvious signs of severe hypoxia may benefit from higher concentrations of oxygen delivered by a nonrebreather mask at 15 lpm.

Which of the following conditions can initially present with lethargy and​ confusion? A. Hypercarbia B. Anoxia C. Dyspnea D. Hypoxia

Hypercarbia​ Initially, hypercarbia​ (too much carbon dioxide in the​ bloodstream) causes​ confusion, disorientation, and lethargy. The patient who is hypoxic​ (insufficient oxygen in the​ bloodstream) typically presents with confusion and anxiety from heightened sympathetic tone. Decreasing consciousness and bradypnea indicate severe hypercarbia and the progression from respiratory distress to impending respiratory failure. Anoxia is a severe form of​ hypoxia, indicating a total depletion of oxygen. Dyspnea is shortness of breath.

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

Hypoxia

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

Overabundant production of mucus in the lower airways Cystic fibrosis is a hereditary disease. Although it commonly 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. In cystic​ fibrosis, an abnormal gene alters the functioning of the mucous glands lining 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, as bacteria can readily grow in the thick mucus.

Which of the following conditions stimulates receptors in the​ lungs? A. Croup B. Facial trauma C. Pneumonia D. Epiglottitis

Pneumonia

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? A. Isoetharine B. Salmeterol xinafoate C. Albuterol D. Levalbuterol

Salmetertol xinafoate A drug that is commonly prescribed for patients with uncontrolled asthma is the Advair Diskus. Unlike the​ short-acting beta 2 agonists​ (e.g., albuterol,​ Proventil, Xopenex,​ Bronkosol) that can be delivered with the assistance of the EMT via an MDI or​ SVN, Advair is a​ long-acting beta​ 2-specific drug​ (salmeterol xinafoate) that also contains a steroid​ (fluticasone propionate) that is used as a maintenance drug. Even though Advair is used to treat​ asthma, it is not to be used as a rescue inhaler for a patient who is experiencing an acute asthma attack.

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. The patient has a respiratory rate of​ 32/minute. B. The patient is sitting in a tripod position to breathe. C. There are no alveolar breath sounds. D. You see chest movement but cannot hear or feel air movement due to a blocked airway.

There are no alveolar breath sounds.

Which of the following includes the proper way to assess for breath​ sounds? A. Use the diaphragm end of the​ stethoscope, listen over bare​ skin, and instruct the patient to cough first. B. Tell the patient to sit​ upright, use the bell end of the​ stethoscope, and listen to the posterior side only. C. Expose the​ patient's skin and use the bell end of the stethoscope on bare skin as you instruct the patient to breathe with the mouth open. D. Instruct the patient to breathe through the nose as you​ listen, and listen for three complete breaths.

Use the diaphragm end of the​ stethoscope, listen over bare​ skin, and instruct the patient to cough first. Whenever​ feasible, have the patient sit​ upright, and while using the diaphragm end of your stethoscope over bare skin​ (never auscultate over​ clothing), instruct the patient to cough one or two times and then take deep rhythmic breaths​ (inhalation and​ exhalation) with her mouth open and not to talk.

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: A. the use of an MDI may cause the heart rate to slow. B. a decreasing heart rate in a patient who is tachycardic may indicate that the patient is worsening. C. moist skin usually correlates with an improving condition. D. decreased wheezing always indicates improvement

a decreasing heart rate in a pt who is tachycardic may indicate that the pt is worsening

Pulmonary edema can be caused by all of the following​ EXCEPT: A. left heart failure. B. narcotic overdose. C. a stroke. D. ​high-altitude sickness.

a stroke Pulmonary edema is most often seen in patients with cardiac dysfunction leading to congestive heart failure. Other disease​ processes, such as altitude sickness and narcotic​ overdose, could also lead to pulmonary edema as well. The most significant problem associated with pulmonary edema is hypoxia.

Which of the following patients would be at risk for a primary spontaneous​ pneumothorax? A. A​ tall, overweight​ 60-year-old man with COPD B. A​ short, obese​ 65-year-old woman who smokes C. A​ tall, thin​ 18-year-old male athlete D. A short​ 15-year-old female patient with Marfan syndrome

a tall, thin 18 year old male athlete

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 A. administer oxygen at 15 lpm via BVM. B. assist her with a metered dose inhaler. C. administer oxygen at 2 lpm via nasal cannula. D. assist her ventilations with a BVM.

administer oxygen at 2 lpm via nasal cannula

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? A. Advair B. Xopenex C. Proventil D. Bronkosol

advair A drug that is commonly prescribed for patients with uncontrolled asthma is the Advair Diskus. Unlike the​ short-acting beta 2 agonists​ (e.g., albuterol,​ Proventil, Xopenex,​ Bronkosol) that can be delivered with the assistance of the EMT via an MDI or​ SVN, Advair is a​ long-acting beta​ 2-specific drug​ (salmeterol xinafoate) that also contains a steroid​ (fluticasone propionate) that is used as a maintenance drug. Even though Advair is used to treat​ asthma, it is not to be used as a rescue inhaler for a patient who is experiencing an acute asthma attack.

When a patient who was in respiratory failure stops​ breathing, this is​ called: A. obstruction. B. hyperventilation. C. apnea. D. agitation.

apnea

The complete cessation of breathing effort is known as​ respiratory: A. collapse. B. failure. C. arrest. D. distress.

arrest

Where does the lower airway​ begin? A. At the level of the vocal cords This is the correct answer. B. At the bronchial bifurcation C. At the bronchiole branches D. At the uvula

at the level of the vocal cords The respiratory system can be divided into three portions. The first two are the upper and lower​ airways, the vocal cords​ (or glottic​ opening) being the transition between the two. The primary purpose of the upper and lower airways is to conduct air into and out of the lungs. The third portion of the respiratory system consists of the lungs and accessory​ structures, which work in concert with the upper and lower airways to allow the oxygenation of body cells and the elimination of carbon dioxide from the bloodstream.

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? A. Begin assisting her ventilations. B. Sit her​ up, and reassess her vital signs. C. Place her on the CPAP. D. Ask her to​ self-administer another bronchodilator treatment.

begin assisting her ventilations

Emergency medical care for a child who is experiencing significant difficulty breathing may​ include: A. beginning positive pressure ventilations if breathing becomes inadequate. B. applying a nasal cannula if the patient will not tolerate a nonrebreather mask and is in respiratory arrest. C. removing the child from the parent and securing the child to the ambulance stretcher. D. reassessing the patient every 15 minutes while en route to the hospital.

beginning ppv if breathing becomes inadequate If at any time the infant or​ child's breathing becomes inadequate​ (respiratory failure), remove him from the​ parent, establish an open​ airway, and begin positive pressure ventilation with supplemental oxygen.

Which of the following is consistent with normal​ breathing? A. Bilateral breath sounds B. Diaphoretic skin C. Decreased mental status D. Altered mental status

bilateral breath sounds Bilateral breath sounds are consistent with normal breathing.

Most patients you encounter as an emergency medical technician​ (EMT): A. complain of dyspnea. B. suffer from respiratory compromise. C. have bronchoconstriction. D. breathe normally.

breathe normally

In treating the patient with a history of​ asthma, it is helpful to assist the patient​ with: A. ​bag-mask ventilation. B. an epinephrine injection. C. four baby aspirins. D. bronchodilator medication.

bronchodilator medication

When a patient who has COPD develops a viral respiratory​ infection, he will often​ need: A. four baby aspirins to chew. B. a nitroglycerin pill or spray under the tongue for pain. C. bronchodilator treatments. D. an epinephrine​ self-injector pen.

bronchodilator treatments

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? A. Coach her to slow her breathing. B. Administer supplemental oxygen at 10 lpm via a nonrebreather​ (NRB) mask. C. Have her breathe into a paper bag. D. Assist her with a bronchodilator.

coach her to slow her breathing One technique is to have the patient close her mouth and breathe through her nose. You might need to coach the patient to help her slow her rate of breathing. Do not have the patient breathe into a paper bag or oxygen mask not connected to oxygen to allow her to rebreathe carbon dioxide.

Which assessment finding in a patient who is dyspneic is a clear indication of​ hypoxia? A. Cyanosis B. Nasal flaring C. Rambling speech D. Diaphoresis

cyanosis Cyanosis​ (bluish gray skin​ color) is a clear indication of hypoxia but also a sign that may occur late. Look at the area around the nose and mouth when getting the general impression. You will examine many other areas for cyanosis in the physical examination. A patient with respiratory distress commonly is diaphoretic and may present with flaring nostrils.

If the patient has an SPO2 below 90​ percent, it is likely that his color will​ be: A. red. B. gray. C. cyanotic. D. yellow.

cyanotic

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

diminishment in wheezing A bronchodilator is designed to relax the bronchioles and allow for better airflow through them. Improved air movement in the lungs will produce clearer and louder breath sounds on both sides of the chest.​ Conversely, if the​ patient's condition​ deteriorates, the breath sounds become diminished to absent. Note that decreased wheezing may not indicate​ improvement; it may actually indicate severe bronchoconstriction with less air movement

Which of the following is a sign of cardiogenic pulmonary​ edema? A. ​Hot, dry skin B. Distended neck veins C. Yellow sputum D. Rhonchi

distended neck veins

If you are assessing a patient who is having breathing difficulty as well as stridor and​ drooling, you should be careful NOT​ to: A. monitor the vital signs. B. inspect the airway. C. place the patient in the position of comfort. D. apply​ high-concentration oxygen.

inspect the airway

When a blood clot ends up in the​ lungs, the patient may have sudden development​ of: A. GI symptoms. B. ​"crushing" chest pain. C. dyspnea. D. a fever.

dyspnea Pulmonary embolism is a sudden blockage of blood flow through a pulmonary artery or one of its branches. The embolism is usually caused by a blood​ clot, but it may also be caused by an air​ bubble, a fat​ particle, a foreign​ body, or amniotic fluid. The embolism prevents blood from flowing to the lung. As a​ result, some areas of the lung have oxygen in the alveoli​ (adequate ventilation) but are not receiving any blood flow​ (reduced perfusion). Pulmonary embolism can cause sudden onset 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: A. asthma. B. chronic bronchitis. C. emphysema. D. pneumonia.

emphysema

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? A. Emphysema B. Pulmonary embolus C. Asthma D. Chronic bronchitis

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: A. epiglottitis. B. chronic obstructive pulmonary disease​ (COPD). C. asthma. D. croup

epiglottitis ​Epiglottitis, an inflammation that affects the upper​ airway, can be an​ acute, severe,​ life-threatening condition if left untreated. In​ epiglottitis, the​ epiglottis, the area around the​ epiglottis, and the base of the tongue become infected. As the condition​ progresses, these structures become inflamed and​ swollen, leading to a compromised airway and resultant respiratory compromise. If​ untreated, this​ partial-to-complete airway obstruction leads to ineffective gas exchange in the​ lungs, hypoxia,​ acidosis, and eventually death.​ Croup, also commonly seen in​ children, involves swelling of the​ larynx, trachea, and​ bronchi, causing breathing difficulty. Asthma is characterized by increased sensitivity of the lower airways to irritants and​ allergens, causing bronchospasm. COPD is not considered an infant illness.

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? A. Getting out the​ bag-valve mask and preparing to assist ventilations Your answer is correct. B. Administering another bronchodilator treatment C. Using CPAP D. Administering an epinephrine​ self-injector

getting out the bvm and preparing to assist ventilations Respiratory emergencies may range from shortness of​ breath, or​ dyspnea, to complete respiratory​ arrest, or​ apnea, in which the patient is no longer breathing. If either the tidal volume or the respiratory rate is inadequate or becomes​ inadequate, the​ patient's respiratory status becomes inadequate. The patient is said to be in respiratory​ failure, since the respiratory tidal volume or rate is no longer able to provide an adequate ventilatory effort. This is evident when the bronchodilator does not work and the​ patient's mental status becomes more altered. In this​ case, the patient may go into respiratory​ arrest, so get your​ bag-valve mask out and be ready to assist ventilations. Supplemental oxygen must be delivered through the ventilation device.

Each of the following may indicate that apnea is​ imminent, EXCEPT: A. head bobbing. B. hypertension. C. bradycardia. D. diminished breath sounds.

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: A. dyspnea. B. hypoxia. C. apnea. D. shock.

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. Respiratory emergencies may range from shortness of​ breath, or​ dyspnea, to complete respiratory​ arrest, or apnea. Both of these conditions lead to hypoxia. Shock has its root in 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: A. fear due to the severity of the situation. Your answer is not correct. B. hypoxia affecting the brain. C. shock due to bleeding within the lungs. D. overuse of the​ patient's metered-dose inhaler​ (MDI).

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: A. in respiratory failure. B. having an altered mental status. C. in need of a respiratory treatment. D. having an AMI.

in respiratory failure

The EMT will encounter many patients with respiratory distress. Which of the following will be the most common​ cause? A. Hemorrhagic lung disease B. Infectious lung disease C. Cancerous lung disease D. Obstructive lung disease

obstructive lung disease Responding to a call for a patient complaining of shortness of breath who has an obstructive pulmonary​ (lung) disease is common in the prehospital environment. An obstructive lung disease causes an obstruction of airflow through the respiratory​ tract, leading to a reduction in gas exchange. The most severe consequence of reduced airflow is hypoxia. The three most commonly encountered obstructive pulmonary diseases are​ emphysema, chronic​ bronchitis, and asthma.

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: A. bronchodilators via a small volume nebulizer​ (SVN). B. oxygen at 2 lpm via nasal cannula. C. positive pressure ventilations via a​ bag-valve-mask (BVM) device. D. oxygen at 10 lpm via a nonrebreather​ (NRB) mask.

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: A. provide oxygen by a nonrebreather mask at 15 lpm. B. contact medical control for permission to administer nitroglycerin. C. administer a bronchodilator. D. apply supplemental oxygen by cannula at 1 to 6 lpm.

provide oxygen by a nonrebreather mask at 15 lpm. Do not take the time to try to determine the exact cause of the breathing difficulty unless your patient is a trauma patient with a possible chest injury that must be managed in addition to the breathing difficulty itself. If the breathing is adequate​ (adequate chest rise and​ fall, good volume of air being breathed in and​ out, good breath sounds​ bilaterally, and an adequate​ rate) but the patient complains of difficulty in breathing​ (respiratory distress) with a poor pulse​ oximeter, administer supplemental oxygen and assess the baseline vital signs.

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? A. Pneumonia B. Pulmonary edema C. Spontaneous embolism D. Pulmonary embolism

pulmonary edema Pulmonary edema is most frequently seen in patients with cardiac dysfunction leading to congestive heart failure. Acute pulmonary edema occurs when an excessive amount of fluid collects in the spaces between the alveoli and the capillaries. Patients with a cardiac history often have left heart failure that builds up in the middle of the​ night, causing severe breathing difficulty due to 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? A. Croup B. Pulmonary embolism C. Pneumonia D. Severe acute respiratory syndrome​ (SARS)

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: A. asthma attack. B. pulmonary embolism. C. spontaneous pneumothorax. D. croup.

pulmonary embolism In pulmonary​ embolism, an obstruction of blood flow in the pulmonary arteries leads to hypoxia. Patients who are at risk for suffering a pulmonary embolism are those who experience long periods of immobility​ (e.g., bedridden​ individuals, those who travel for a long period confined in one​ position, those with splints to​ extremities) as well as those with heart​ disease, recent​ surgery, long-bone​ fractures, venous pooling associated with​ pregnancy, cancer, deep vein thrombosis​ (development of clots in the​ veins, most commonly in the​ legs), estrogen​ therapy, clotting​ disorders, or history of previous pulmonary embolism and those who smoke.

All of the following are considered chronic obstructive pulmonary​ diseases, EXCEPT: A. black lung disease. B. emphysema. C. pulmonary embolism. D. chronic bronchitis.

pulmonary embolism. An obstructive lung disease causes an obstruction of airflow through the respiratory​ tract, leading to a reduction in gas exchange. The most severe consequence of reduced airflow is hypoxia. COPD includes​ emphysema, chronic​ bronchitis, asthma,​ asbestosis, and black lung disease. In pulmonary​ embolism, an obstruction of blood flow in the pulmonary arteries leads to hypoxia. Pulmonary embolism is a sudden blockage of blood flow through a pulmonary artery or one of its branches. The embolism is usually caused by a blood​ clot, but it may also be caused by an air​ bubble, a fat​ particle, a foreign​ body, or amniotic fluid. The embolism prevents blood from flowing to the lung. As a​ result, some areas of the lung have oxygen in the alveoli​ (adequate ventilation) but are not receiving any blood flow​ (reduced perfusion).

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: A. pulsus paradoxus. B. pulsus alternans. C. pressus invertus. D. ​hypoxia-induced tachycardia.

pulsus paradoxus If the EMT notes a drop in the systolic pressure during​ inhalation, it may be from a drastic increase in pressure inside the chest due to a pulmonary dysfunction. If the needle drops more than 10 mmHg when the patient​ inhales, it is a significant finding of a severe respiratory condition such as obstructive lung disease. This finding is referred to as pulsus paradoxus. You may also note this as a sudden decrease in the amplitude​ (strength) of the pulse when the patient inhales. As the patient​ exhales, the pulse strength returns. Pulsus alternans is a finding on a​ 12-lead ECG that can also be found with this condition. Tachycardia is a sign of hypoxia.

When a patient has​ dyspnea, the​ EMT's primary focus is to manage the condition before the development​ of: A. a dysrhythmia. B. respiratory failure. C. cardiac distress. D. emphysema.

respiratory failure

Early signs of breathing difficulty in the infant or child​ include: A. shortened exhalation. B. grunting heard during inhalation. C. retractions during inspiration. D. bradycardia

retractions during inspiration

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? A. She is displaying mild respiratory failure. B. She is displaying mild respiratory distress. C. She is in respiratory arrest. D. She is displaying mild respiratory arrest.

she is displaying mild respiratory distress Respiratory emergencies may range from shortness of​ breath, or​ dyspnea, to complete respiratory​ arrest, or​ apnea, in which the patient is no longer breathing. A patient who is having some 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​ adequate, the patient is compensating well now. Because there are still signs of respiratory​ distress, however, supplemental oxygen should be continued. A nasal cannula at 2 to 4 lpm can be used to maintain the SpO2 reading at 94 percent or higher. Oxygen administration should be based on the​ patient's oxygenation status as measured and primarily guided by the pulse oximetry instead of by using predetermined devices and flow rates for all patients. Ongoing monitoring of the patient would be warranted at this time.

While you are listening to breath​ sounds, the patient should be in what anatomic position whenever​ possible? A. Lying down on their side B. Positioned supine in a bed C. Standing erect D. Sitting upright

sitting upright To achieve the most accurate interpretation of breath​ sounds, it is important to auscultate in the appropriate fashion. Whenever​ feasible, have the patient sit​ upright, and while using the diaphragm end of your stethoscope over bare skin​ (never auscultate over​ clothing), instruct the patient to cough one or two times and then take deep rhythmic breaths​ (inhalation and​ exhalation) with his mouth open and not to talk.

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: A. stroke. B. spontaneous pneumothorax. C. acute myocardial infarction. D. congestive heart failure.

spontaneous pneumothorax

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? A. Pulmonary embolism B. Spontaneous pneumothorax C. STEMI D. Embolic stroke

spontaneous pneumothorax A spontaneous pneumothorax is a sudden rupture of a portion of the visceral lining of the​ lung, not caused by​ trauma, which causes the lung to partially collapse. In spontaneous​ pneumothorax, a portion of the visceral pleura ruptures without any trauma having been applied to the chest. This allows air to enter the pleural​ cavity, disrupting its normally negative pressure and causing the lung to collapse. The lung collapse causes a disturbance in gas exchange and can lead to hypoxia.

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

spontaneous pneumothorax A sudden rupture of a portion of the visceral lining of the​ lung, not caused by​ trauma, causes the lung to partially collapse. Many patients with a spontaneous pneumothorax have a history of cigarette smoking or a connective tissue disorder such as Marfan syndrome or​ Ehlers-Danlos syndrome. Patients with a history of COPD are more prone to spontaneous pneumothorax as a result of areas of weakened lung tissue called blebs.

A​ 25-year-old woman appears to be suffering from hyperventilation syndrome. You should A. provide positive pressure ventilations. B. have her breathe into a paper bag. C. try to calm the patient. D. apply a nonrebreather without oxygen attached.

try to calm the patient The primary management of hyperventilation syndrome is to get the patient to calm down and slow his breathing.

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? A. Place the patient in a tripod position. B. Initiate artificial ventilation. C. Start​ high-flow oxygen. D. Start​ low-flow oxygen at 4 lpm via face mask.

start high-flow oxygen Regardless of the​ cause, a complaint of breathing difficulty requires your immediate intervention. If severe hypoxia is​ present, time is critical because of the detrimental effects of severely or prolonged low oxygen levels on all cells and organs.​ Typically, the EMT will use the pulse oximeter reading to help identify oxygenation​ needs, but if the pulse oximeter is unavailable or not working​ properly, the EMT will still have to make a decision about oxygen use. If the patient is breathing adequately but has other objective findings of​ hypoxia, place the patient in a sitting position and start oxygen via NRB. If the patient is not breathing​ adequately, initiate PPV with​ high-flow supplemental oxygen.

There are many problems that can cause chest pain. A symptom that usually signals pneumonia rather than another cause of chest pain​ is: A. weakness. B. dyspnea. C. tachypnea. D. the presence of a fever.

the presence of a fever Pneumonia is primarily an acute infectious disease caused by a bacterium or virus that affects the lower respiratory tract and causes lung inflammation and​ fluid- or​ pus-filled alveoli. This leads to a ventilation disturbance in the alveoli with poor gas​ exchange, hypoxemia, and eventual cellular hypoxia. The signs and symptoms of pneumonia vary with the cause and the​ patient's age. The patient generally appears ill and may complain of fever and severe chills.

Besides the symptom of respiratory​ distress, how would an EMT know that a patient may have a viral infection affecting the respiratory​ system? A. The presence of a​ purple-colored bruise on the arm B. The presence of a rash across the chest C. The presence of leaking blisters on the lips D. The presence of a fever

the presence of a fever Viral respiratory infections affect the pulmonary system. These include​ bronchiolitis, colds, and the flu. In most situations for​ adults, viral respiratory infections are fairly​ mild, self-limiting, and confined to the upper respiratory system. In​ children, however, the infection has a greater propensity to spread into the lower​ airways, where more significant infections can occur that will result in patient deterioration. Some of the symptoms of a viral respiratory infection are nasal​ congestion, sore or scratchy​ throat, mild respiratory distress and​ coughing, fever​ (usually around 101°F to 102°​F), ​malaise, headaches, and body aches. There are no specific treatments for viral infections that the EMT can administer. The mainstay of emergency treatment for respiratory distress secondary to a viral respiratory infection is supportive.

Which of the following is NOT a contraindication to administering a bronchodilator by MDI to a patient with​ asthma? A. The patient has already taken the maximum allowable dose. B. The patient is not responsive enough to use the MDI. C. The patient is in severe respiratory distress. D. An MDI is not prescribed for the patient.

the pt is in severe respiratory distress The fact that the patient is in respiratory distress and has a history of asthma is actually an indication for use of a​ metered-dose inhaler​ (MDI). However, if the patient is​ unresponsive, is not the patient to whom the MDI is​ prescribed, or has already reached the maximum number of​ doses, the patient should not receive the medication.

Which of the following is true in relation to a pulmonary​ embolism? A. The alveoli are surrounded by fluid. B. The alveoli are collapsed. C. There is decreased blood flow to the alveoli. D. The alveoli are unoxygenated.

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? A. They contain a steroidal compound. B. They contain oxygen. C. They contain a beta​ 2-specific medication. D. They contain a​ short-acting bronchodilator.

they contain a steroidal compound

The patient who has pneumonia usually has all of the​ following, EXCEPT: A. malaise. B. fever. C. decreased appetite. D. vomiting blood.

vomiting blood Pneumonia is primarily an acute infectious disease caused by a bacterium or virus that affects the lower respiratory tract and causes lung inflammation and​ fluid- or​ pus-filled alveoli. This leads to a ventilation disturbance in the alveoli with poor gas​ exchange, hypoxemia, and eventual cellular hypoxia. Pneumonia can also be caused by inhalation of toxic irritants or aspiration of vomitus and other substances. It can present with​ malaise, decreased​ appetite, and fever but does not typically involve vomiting of blood.

If you are going to assist in the administration of a beta​ 2-agonist inhaled​ stimulant, what are the breath sounds you are likely to hear upon auscultation that would warrant the drug and what causes​ them? A. ​Wheezing; narrowed bronchioles B. ​Crackles; fluid in the alveoli C. ​Rhonchi; mucus in the larger airways D. Pleural friction​ rub; inflamed pleural lining

wheezing; narrowed bronchioles

A normal pulse oximeter reading is A. ≥ 90 percent. B. ≥ 96 percent. C. ≥ 94 percent. D. ≥ 92 percent.

≥ 94 percent.