Advanced Pt Assessment COPY
An acute increase in PaCO2 of 10 to 15 mm Hg causes a corresponding increase in plasma HCO3 of how many mEq/L?
1
For every 1 C elevation in body temperature, oxygen consumption and carbon dioxide production increased by approximately ___ %
10
What is the normal value of CaO2?
16-20 vol %
What is the appropriate distance for the personal space?
18 inches to 4 feet
An arterial puncture site normally should be compressed for a minimum of ___ minutes after the puncture.
3 to 5
Which of the following definitions is consistent with massive hemoptysis?
400 ml in 3 hours
At what angle should the head of the bed be elevated to assess jugular vein pressure (JVP)?
45 degrees
What is the normal value of arterial pH?
5.35 to 7.45
The peak incidence of snoring in adult males occurs at ages ____ years.
50 to 59
The normal range for oral body temperature in most people is ____F to ___ F
97.0 ; 99.5
What may cause the PMI to shift to the anterior axillary region on the left?
A tension pneumothorax on the right
What breathing pattern is associated with fatigue of the diaphragm?
Abdominal paradox
Which of the following reason has been listed as the number one concern regarding use of the tympanic site for body temperature measurement?
Accuracy
Which of the following mechanisms does not explain why patient with chronic obstructive pulmonary disease (COPD) have poor cough?
Airway obstruction
Which of the following tests is performed to check the collateral circulation of the radial artery before puncture?
Allen's test
What term is used to describe an abnormal collection of fluid in the peritoneal cavity?
Ascites
What should be done just before the patient's ID bracelet is checked?
Ask patient for permission
Which of the following behaviors is not consistent with resistive behavior of a patient?
Asking the purpose of the treatment
Which of the following cardiopulmonary conditions would not be found in the chief complaint list?
Asthma
In postoperative patients, the degree of tachypnea typically is related to the degree of:
Atelectasis
If dehydration is suspected in a patient, which of the following parameters should be monitored often?
Fluid intake and output
Which of the following scales is the gold standard for assessing trends in the neurological function of patients who have suffered head trauma?
Glasgow
Which of the following descriptions does not apply normal vesicular breath sounds?
High pitched as compared with tracheal breath sounds
What pulmonary disorder is associated with visiting or living in Ohio, Maryland, and the central Mississippi Valley?
Histoplasmosis
In patients with severe COPD and hyperinflation, the low, flat diaphragm causes inward movement of the lateral chest walls with inspiration. What is this called?
Hoover's sign
Which of the following conditions is not associated with the presence of pulsus paradoxus?
Hypervolemia
Bradypnea may be caused by which of the following?
Hypothermia Narcotic overdose Head injury (**D. All of the above)
What is a decrease in tissue oxygenation called?
Hypoxia
Dyspnea tends to occur when which of the following is present?
Increase in ventilatory drive to breathe
What problem is associated with nasal flaring?
Increased work of breathing
What is the most common cause of fever above 102 F?
Infection
In which stage of patient-clinician interaction is the patient identification bracelet checked?
Introductory stage
What is the main advantage of tympanic thermometry over the classic forms of temperature measurement?
It is fast, clean, and noninvasive
Which of the following is a true statement regarding the term hypoxemia?
It occurs when the patient's PaO2 is lower than predicted.
Which of the following adventitious lung sounds is associated most closely with restrictive types of lung diseases?
Late-inspiratory crackles
What clinical problem is associated with a gallop rhythm?
Left-to-right shunt Post myocardial infarction Overdistention of the ventricles (**D. ALL OF THE ABOVE)
What change in the heart sounds is associated with a cor pulmonale?
Loud P2
Which of the following characteristics does not apply to normal tracheal breath sounds?
Low pitched
Which of the following conditions is not associated with a characteristics "hacking" cough?
Lung cancer
Cough syncope is associated most often with which of the following types of patients?
Middle-aged men with underlying COPD
What term is used to describe constriction of the pupils of the eye?
Miosis
What type of wheezing is likely to be heard over the chest of a patient with a tumor that is partially obstructing a single airway?
Monophonic wheezing
What is the most probable cause for the significant decrease in blood pressure that occurs during inhalation in some patients?
Negative intrathoracic pressure that diminishes blood flow out of the left ventricle
Which of the following types of questions are preferred for all interactions with the patient?
Neutral questions
Which of the following is not associated with dilated and unresponsive pupils?
Opiates
What term has had confusing history with regard to its use and has been replaced with the term crackles?
Rales
What pattern of breathing is associated with a loss in lung volume?
Rapid and shallow
What mechanism is responsible for production of an abnormal third heart sound?
Rapid filling of the ventricles immediately after systole
Which of the following characteristics should be included in the assessment of a patient's pulse?
Rate, Rhythm and Strength
What site is used to measure body temperature in comatose patients?
Rectal
Which of the following could cause metabolic acidosis?
Renal disease
What clinical condition is associated with central cyanosis?
Respiratory failure
What term describes the sinking inward of the skin overlaying the rib cage with each inspiratory effort?
Retractions
The horizontal fissure that separates the right upper lobe from the right middle lobe begins at what rib in the midsternal line?
Rib 4
Which of the following is not a cause of hypotension?
Right heart failure
Which of the following is the most common use of jugular vein pressure (JVP)?
Right heart failure
What term describes an abnormal lateral curvature of the spine?
Scoliosis
At what site on the chest wall is pulmonic valve best auscultated?
Second left intercostal space near the sternal border
Which of the following is the best definition of sputum?
Secretions from the nose, mouth and tracheobronchial tree
Which of the following is not classified as classic vital sign?
Sensorium
Which of the following is a sign of more severe chronic obstructive pulmonary disease?
Significant use of accessory muscles at rest
Which of the following is responsible for the production of murmurs?
Stenotic AV valves Incompetent AV valves Incompetent semilunar valves (**D. ALL OF THE ABOVE)
What term is used to describe a continuous type of adventitious lung sound heard loudest over the neck of the patient with upper airway obstruction?
Stridor
Which of the following factors most closely relates to the pitch of a wheeze?
The degree of airway compression.
Who writes the initial admission note?
The physician
Who writes the progress notes each day?
The physician, physical therapist and nurse (**ALL OF THE ABOVE)
What issue limits the utility of PvO2, CvO2 and C(a-v)O2?
They all require the placement of a pulmonary arterial catheter.
Which of the following statements is not true about vesicular or normal breath sounds?
They are produced when air enters the alveoli.
Which 0f the following is not a purpose for obtaining the family history?
To determine whether the patient is adopted.
Screening information is:
designed to uncover problem areas that the patient forgot to mention or omitted.
When vital signs are compared with other signs and symptoms to arrive at a conclusion about what is wrong with patient, this is known as the:
differential diagnosis
What is the main purpose of the initial assessment stage?
To verify that the prescribed treatment is still needed and appropriate
Which of the following techniques for expressing genuine concern is the most difficult to use appropriately?
Touch
A patient has the following ABG results: pH 7.25, PaCO2 32 mm Hg, HCO3 16 mEq/L, base excess -10 mEq/L
Uncompensated metabolic acidosis
A 35 years old, 54 kg woman with congestive heart failure enters the emergency department short of breath. An ABG shows the following results: pH 7.50, PaCO2 30 mm Hg, HCO3 23 mEq/L, base excess +2 mEq/L? The patient's ABG results indicate which of the following?
Uncompensated respiratory alkalosis
Which of the following techniques is not associated with the demonstration of active listening?
Use of touch
What is the most common physiologic cause of hypoxemia in patients with lung disease?
V/Q mismatch
Which of the following statements regarding vital signs is most accurate?
Vital signs trend are far more important than a single measurement.
When one is conducting an interview with a patient, which of the following points is most important in facilitating an effective interaction with the patient?
Your ability to project a sense of undivided interest in the patient
An alternating succession of strong and weak pulses that usually is not related to respiratory disease is known as pulsus:
alternans
A pertinent positive is defined as:
an affirmative response to an important interview question about the patient's symptoms
A pertinent negative is defined as:
any negative response by the patient to an important question about possible symptoms.
Dyspnea is defined as:
breathlessness as perceived by the patient.
When patient is interviewed so the chief complaint can be determined, the, best questions that can be asked to elicit this information are:
combination of the above
What type of behavior is least appropriate in the patient's intimate space?
eye contact
The main purpose of the chief complaint is to:
give a brief explanation about why the patient sought health care.
A well-written description of a respiratory therapist's initial observations is beneficial to other healthcare providers because it:
helps them know how to plan care and relate to the patient's needs.
Breathing at a rate and depth in excess of the body's metabolic need is known as:
hyperventilating
Where is the best anatomical place to begin auscultation in most patients?
in the dependent regions
Excessive sputum production is associated with all the following conditions except:
pleural infection
The diastolic blood pressure is reflection of:
pressure exerted during left ventricular relaxation
In the patient's chart the physician documented finding lymphadenopathy in the neck region that is tender to the touch. This problem is consistent with:
respiratory infection
Which of the following is true regarding respiratory alkalosis?
the PaCO2 is less than 35 mm Hg
One disadvantage of using the pack-year method for calculating cigarrette consumption is that:
the method does not reveal how many packs per day were smoked over how many years.
Communication between individuals is affected by all of the following factors except:
time of day
Gastroesophageal reflux disease is defined as reflux that occurs more than:
twice a week
Which of the following term best describe foul-smelling sputum?
Fetid
Which of the following is the most common site for arterial puncture?
Radial artery
What is the most common manifestation of infection in a patient with pulmonary disease?
Fever
Which of the following is not considered a typical site for temperature measurement?
Fingertip
Which of the following shifts the oxyhemoglobin dissociation curve to the left?
Fetal hemoglobin
Which of the following is the best indicator of metabolic acid-base status?
Base excess
Before an ABG is obtained, the patient's clotting parameters should be evaluated because:
Bleeding time may be prolonged if they are abnormal
What is the primary method of transporting oxygen in the blood?
Bound to hemoglobin
What term is used to described the normal breath sounds heard around the sternum on the anterior chest and between the scapulae on the posterior chest?
Bronchovesicular
Digital clubbing is associated with:
COPD cystic fibrosis bronchogenic carcinoma (**D. ALL OF THE ABOVE)
What is common cause of hepatomegaly?
Chronic right heart failure
What is believed to be responsible for production of the first heart sound?
Closure of the atrioventricular (AV) valves.
Which of the following disease is one of the most causes of chronic dyspnea in adults?
Congestive heart failure
What type of murmur is associated with mitral valve stenosis?
Diastolic
What term is used to describe double vision?
Diplopia
The presence of anasarca is associated commonly with which of the following conditions?
Edema
What disorder is associated with a barrel chest?
Emphysema
What disease is most likely to cause a prolonged inspiratory time?
Epiglottitis
Which of the following conditions is believed to be the most common use of hemoptysis?
Erosive bronchitis
What is the goal of the introductory phase?
Establish a rapport with the patient
The patient's general clinical presentation indicates to the respiratory therapist that the patient is in distress. The respiratory therapist's first step should be to:
Evaluate the problem quickly and intervene or locate someone to assist the patient.
Assessing the patient's level of consciousness is important because it:
Evaluates the adequacy of cerebral perfusion and oxygenation
Which of the following should the RT keep in mind when obtaining a pulmonary history?
Evaluation of the patient's entire health status is essential.
How often should vital signs be recorded in the non-intensive care hospitalized patient?
Every 4 to 6 hours
What is often the first clinical sign taht suggests the presence of hypoxemia?
Exertional dyspnea
Your patient has tuberculosis, but his skin test is read as normal. This probably was caused by his weakened immune system, which is the result of AIDS. What terms are used to describe the skin test results?
False negative
Which of the following breathing patterns describes Kussmaul's breathing?
Fast and deep
Which of the following parameters is the respiratory component of acid-base status?
PaCO2
Which of the following formulas should be used to calculate the pack-year history of cigarette consumption?
Pack per day X Years smoked
Which of the following findings is consistent with reduced perfusion?
Peripheral cyanosis
What term is used to describe secretions strictly from the lungs and lower airways?
Phlegm
Which of the following is not a complication of forceful coughing?
Pleural effusion
Which of the following abnormalities would be associated with an increase in vocal resonance?
Pneumonia
Which of the following will cause an increase in vocal fremitus upon palpation?
Pneumonia
In 1996, Congress passed the HIPAA. What does the letter "P" stand for?
Portability
Chronic productive cough is caused most commonly by which of the following clinical conditions?
Postnasal drip
In which of the following stages of patient-clinician interaction is the review of physician orders carried out?
Pre-interaction
What term describes the area of the chest wall that overlies the heart?
Precordium
What does the phrase "Universal Precautions" refer to?
Protecting care givers from contagious disease the patient may have
Which of the following physical examination findings is associated with myasthenia gravis?
Ptosis
Hemoptysis in the patient with sudden onset of chest pain who at risk for venostasis is suggestive of what condition?
Pulmonary embolism
What clinical condition may cause diminished heart sounds?
Pulmonary embolism
Obtaining background information during an interview is very important because it allows the interviewer to:
a. learn the impact of culture, relationships, and finances on his/her health. b.predict whether the patient is willing to cooperate in the treatment of his/her disease. c. develop a basic understanding of the patient's experience with his/her disease. *D. achieve all of the above.
The bell portion of the stethoscope is best designed to listen to ____-pitched ____sounds.
low; heart
The diaphragm portion of the stethoscope is used to listen for:
most lung sounds
An inability to breathe while lying down is known as:
orthopnea
The negative log of the hydrogen ion concentration is defined as which of the following?
pH
What defines acidosis in a human?
pH <7.35
Which of the following is a correct representation of the Henderson-Hasselbach equation?
pH= pK + log HCO3 / (PaCO2 X 0.03)