Chapter 15: Respiratory Emergencies
A pneumothorax is a partial or complete accumulation of air in the: A. plueral space. B. alveoli. C. abdomen. D. subcutaneous tissue.
A
Always consider ___________ in patients who were eating just before becoming short of breath. A. upper airway obstruction B. anaphylaxis C. lower airway obstruction D. bronchoconstriction
A
An acute spasm of the smaller airways associated with excessive mucus production and swelling is characteristic of: A. asthma. B. chronic bronchitis. C. emphysema. D. severe acute respiratory syndrome (SARS).
A
Asthma is caused by a response of the: A. immune system. B. endocrine system. C. respiratory system. D. cardiovascular system.
A
Bronchospasm is MOST often associated with: A. asthma. B. bronchitis. C. pneumonia. D. pneumothorax.
A
Dyspnea is MOST accurately defined as: A. shortness of breath or difficulty breathing. B. a complete cessation of respiratory effort. C. a marked increase in the exhalation phase. D. labored breathing with reduced tidal volume.
A
Hyperventilation could be associated with all of the following, EXCEPT: A. a narcotic overdose. B. a respiratory infection. C. an overdose of aspirin. D. high blood glucose levels.
A
Pulmonary edema can develop quickly after a major: A. heart attack. B. episode of syncope. C. brain injury. D. all of the above.
A
The process in which oxygen and carbon dioxide are exchanged in the lungs is called: A. respiration. B. ventilation. C. metabolism. D. inhalation.
A
Weakening of the airway in patients with chronic bronchitis is the result of: A. destruction of protective mechanisms that remove foreign particles. B. loss of the lubricating substance that facilitates alveolar expansion. C. airway irritation caused by a marked decrease in mucus production. D. acute constriction of the bronchioles caused by an external irritant.
A
Which of the following diseases is potentially life threatening and is thought to be transmitted by close person-to-person contact? A. SARS B. Croup C. Diphtheria D. Epiglottitis
A
You are assisting an asthma patient with his prescribed metered-dose inhaler. After the patient takes a deep breath and depresses the inhaler, you should: A. instruct him to hold his breath for as long as he comfortably can. B. immediately reapply the oxygen mask and reassess his condition. C. advise him to exhale forcefully to ensure medication absorption. D. allow him to breathe room air and assess his oxygen saturation.
A
You receive a call for a 70-year-old female with respiratory distress. Her husband tells you that she has congestive heart failure; however, he does not think that she has been taking her medications as prescribed. The patient is laboring to breathe, appears tired, and has cyanosis around her lips. You should: A. assist her ventilations with a bag-mask device. B. apply a pulse oximeter and obtain vital signs. C. administer oxygen via a nonrebreathing mask. D. obtain a complete list of all of her medications.
A
You respond to a home of a 78-year-old man having difficulty breathing. He is sitting at the kitchen table in a classic tripod position, wearing a nasal cannula. He is cyanotic, smoking, and has his shirt unbuttoned. His respirations are 30 breaths/min and shallow, his heart rate is 110 beats/min, and his blood pressure is 136/88 mm Hg. His brain stem senses the level of ____________ in the arterial blood, causing the rapid respirations. A. carbon dioxide B. oxygen C. insulin D. none of the above
A
You respond to a home of a 78-year-old man having difficulty breathing. He is sitting at the kitchen table in a classic tripod position, wearing a nasal cannula. He is cyanotic, smoking, and has his shirt unbuttoned. His respirations are 30 breaths/min and shallow, his heart rate is 110 beats/min, and his blood pressure is 136/88 mm Hg. Proper management of this patient should include: A. supplemental oxygen. B. chest compressions. C. suctioning. D. all of the above
A
_________ is a loss of the elastic material around the air spaces as a result of chronic stretching of the alveoli. A. Emphysema B. Bronchitis C. Pneumonia D. Diphtheria
A
__________ is a sign of hypoxia to the brain. A. Altered mental status B. Decreased pulse rate C. Decreased respiratory rate D. Dalayed capillary refill time
A
An obstruction to the exchange of gases between the alveoli and the capillaries may result from: A. epiglottis. B. pneumonia. C. a cold. D. all of the above.
B
A 60-year-old male presents with acute respiratory distress. He is conscious and alert, has pink and dry skin, and has respirations of 24 breaths/min with adequate depth. Which of the following treatment modalities is MOST appropriate for this patient? A. assisted ventilation with a bag-mask device and a head-to-toe exam B. oxygen via nonrebreathing mask and a focused secondary assessment C. positive-pressure ventilations and immediate transport to the closest hospital D. oxygen via a nasal cannula, vital signs, and prompt transport to the hospital
B
A 62-year-old man with a history of congestive heart failure presents with severe respiratory distress and an oxygen saturation of 82%. When you auscultate his lungs, you hear widespread rales. He is conscious and alert, is able to follow simple commands, and can only speak in two- to three-word sentences at a time. You should: A. place him in a position of comfort, deliver oxygen via nasal cannula, and closely monitor his breathing. B. apply a continuous positive airway pressure (CPAP) device, monitor his blood pressure, and observe him for signs of improvement or deterioration. C. force fluid from his alveoli by hyperventilating him with a bag-mask device at a rate of at least 20 breaths/min. D. place him in a supine position and assist his ventilations with a bag-mask device and high-flow oxygen.
B
A 70-year-old man recently had a heart attack and now complains of severe difficulty breathing, especially when lying flat. He is coughing up pink, frothy secretions. This patient is MOST likely experiencing: A. acute right heart failure. B. severe left heart failure. C. an acute onset of bronchitis. D. an acute pulmonary embolism.
B
A young female is unconscious after intentionally ingesting a large amount of aspirin. You will MOST likely find her respirations: A. slow and deep. B. deep and rapid. C. slow and shallow. D. rapid and shallow.
B
All of the following are causes of acute dyspnea, EXCEPT: A. asthma. B. emphysema. C. pneumothorax. D. pulmonary embolism.
B
An allergic response to certain foods or some other allergen may produce an acute: A. bronchodilation. B. asthma attack. C. vasoconstriction. D. insulin release.
B
Contraindications to helping a patient self-administer a metered-dose inhaler include all of the following EXCEPT: A. failure to obtain permission from medical control. B. noticing that the patient is in the tripod position. C. noticing that the patient has already taken the maximum does of the medication. D. noticing that the medication has expired.
B
If the level of carbon dioxide in the arterial blood rises above normal, the patient breathes: A. normally. B. rapidly and deeply. C. slower and deeply. D. fast and shallow.
B
The letter "S" in the pneumonic PASTE refers to: A. symptoms. B. sputum. C. severity. D. sickness.
B
The patient with COPD usually presents with: A. bloody sputum. B. a green or yellow productive cough. C. a decreased pulse rate. D. pulmonary edema.
B
The respiratory distress that accompanies emphysema is caused by: A. repeated exposure to cigarette smoke. B. chronic stretching of the alveolar walls. C. massive constriction of the bronchioles. D. acute fluid accumulation in the alveoli.
B
When administering supplemental oxygen to a hypoxemic patient with a chronic lung disease, you should: A. recall that most patients with chronic lung diseases are stimulated to breathe by increased carbon dioxide levels. B. adjust the flow rate accordingly until you see symptom improvement, but be prepared to assist his or her ventilations. C. begin with a low oxygen flow rate, even if the patient is unresponsive, because high-flow oxygen may depress his or her breathing. D. avoid positive-pressure ventilation because the majority of patients with chronic lung disease are at increased risk for lung trauma.
B
When auscultating the lungs of a patient with respiratory distress, you hear adventitious sounds. This means that the patient has: A. normal breath sounds. B. abnormal breath sounds. C. diminished breath sounds. D. an absence of breath sounds.
B
When the level of arterial carbon dioxide rises above normal: A. the brain stem inhibits respirations. B. respirations increase in rate and depth. C. exhalation lasts longer than inhalation. D. respirations decrease in rate and depth.
B
Which of the following conditions would LEAST likely result in hypoxia? A. pleural effusion B. severe anxiety C. pulmonary edema D. prolonged seizures
B
Which of the following patients is breathing adequately? A. 36-year-old man with cyanosis around the lips and irregular respirations B. 29-year old woman with respirations of 20 breaths/min, who is conscious and alert C. 22-year-old man with labored respirations at a rate of 28 breaths/min and pale skin D. 59-year-old woman with difficulty breathing, whose respirations are rapid and shallow
B
Which of the following respiratory diseases causes obstruction of the lower airway? A. Croup B. Asthma C. Epiglottitis D. Laryngitis
B
Which of the following statements is FALSE regarding influenza? A. It may worsen chronic medical conditions. B. It is primarily a human respiratory disease that has mutated to infect animals. C. It is transmitted by direct contact with nasal secretion and aerosolized droplets. D. It has the potential to become a pandemic
B
Which of the following statements regarding anaphylaxis is correct? A. Patients with asthma are at lower risk of developing anaphylaxis. B. Anaphylaxis is characterized by airway swelling and hypotension. C. Most anaphylactic reactions occur within 60 minutes after exposure. D. The signs of anaphylaxis are caused by widespread vasoconstriction.
B
You respond to a home of a 78-year-old man having difficulty breathing. He is sitting at the kitchen table in a classic tripod position, wearing a nasal cannula. He is cyanotic, smoking, and has his shirt unbuttoned. His respirations are 30 breaths/min and shallow, his heart rate is 110 beats/min, and his blood pressure is 136/88 mm Hg. Which of the following is NOT a sign or symptom of his inadequate breathing? A. He was cyanotic. B. His shirt was unbuttoned. C. He was in a tripod position. D. His heart rate was over 100 beats/min (tachycardia).
B
_________ is a genetic disorder that affects the lungs and digestive system. A. Chronic obstructive pulmonary disease B. Cystic fibrosis C. Pertussis D. Bronchiolitis
B
___________ is defined as overbreathing to the point that the level of arterial carbon dioxide fails below normal. A. Reactive air syndrome B. Hyperventilation C. Tachycardia D. Pleural effusion
B
A blood clot lodged in a pulmonary artery is referred to as: A. a myocardial infarction. B. a stroke. C. a pulmonary embolism. D. a pulmonary effusion
C
A collection of fluid outside the lungs on one or both sides of the chest is called a: A. pulmonary edema. B. subcutaneous emphysema. C. pleural effusion. D. tension pneoumothorax.
C
A prolonged asthma attack that is unrelieved by epinephrine may progress into a condition known as: A. pleural effusion. B. status epilepticus. C. status asthmaticus. D. reactive airway disease.
C
A sudden onset of difficulty breathing, sharp chest pain, and cyanosis that persists despite supplemental oxygen is MOST consistent with: A. severe pneumonia. B. myocardial infarction. C. a pulmonary embolism. D. a spontaneous pneumothorax.
C
Acute pulmonary edema would MOST likely develop as the result of: A. right-sided heart failure. B. severe hyperventilation. C. toxic chemical inhalation. D. an upper airway infection.
C
An acute bacterial infection that results in swelling of the flap that covers the larynx during swallowing is called: A. croup. B. laryngitis. C. epiglottitis. D. diphtheria.
C
Asthma produces a characteristic ___________ as a patients attempt to exhale through partially obstructed air passages. A. rhonchi B. stridor C. wheezing D. rattle
C
Generic names for popular inhaled medications include: A. ventolin. B. flovent. C. albuterol. D. atrovent.
C
If carbon dioxide levels drops too low, the person automatically breathes: A. normally. B. rapidly and deeply. C. slower and less deeply. D. fast and shallow.
C
In a healthy individual, the brain stem stimulates breathing on the basis of: A. increased oxygen levels. B. decreased oxygen levels. C. increased carbon dioxide levels. D. decreased carbon dioxide levels.
C
Inflammation and swelling of the pharynx, larynx, and trachea resulting in a "seal bark" is typically caused by: A. emphysema. B. chronic bronchitis. C. croup. D. epiglottis.
C
Pulmonary edema may also be produced by: A. cigarette smoking. B. seasonal allergies. C. inhaling toxic chemical fumes. D. carbon monoxide poisoning.
C
Pulse oximeters measure the percentage of hemoglobin saturated with: A. carbon dioxide. B. carbon monoxide. C. oxygen. D. iron.
C
The oxygen-carbon dioxide exchange takes place in the: A. trachea. B. bronchial tree. C. alveoli. D. blood.
C
The rate of breathing is typically increased when: A. oxygen levels increase. B. oxygen levels decrease. C. carbon dioxide levels increase. D. carbon dioxide levels decrease.
C
Which of the following is NOT an indication of inadequate breathing? A. Accessory muscle use B. Cyanosis C. A regular pattern of inspiration D. Unequal chest expansion
C
Which of the following statements regarding pulse oximetry is correct? A. The pulse oximeter is a valuable assessment tool that measures the percentage of red blood cells that contain hemoglobin molecules. B. Caution must be exercised when using the pulse oximeter on a patient with carbon monoxide poisoning because falsely low readings are common. C. Pulse oximetry measures the percentage of hemoglobin that is saturated with oxygen, but does not measure the actual hemoglobin content of the blood. D. Most otherwise healthy patients can maintain adequate oxygenation and good skin color with oxygen saturation readings as low as 70% to 80%. Incorrect
C
You are dispatched to an apartment complex where a 21-year-old female has apparently overdosed on several narcotic medications. She is semiconscious and has slow, shallow respirations. You should: A. insert an oropharyngeal airway and perform oral suctioning. B. apply oxygen via a nonrebreathing mask and transport at once. C. insert a nasopharyngeal airway and begin assisted ventilation. D. place her in the recovery position and monitor for vomiting.
C
A 59-year-old male with a history of emphysema complains of an acute worsening of his dyspnea and pleuritic chest pain following a forceful cough. Your assessment reveals that he has a barrel-shaped chest, unilaterally diminished breath sounds, and tachycardia. What is the MOST likely cause of this patient's condition? A. rupture of the diaphragm B. exacerbation of his COPD C. acute pulmonary embolism D. spontaneous pneumothorax
D
A conscious and alert 29-year-old female with a history of asthma complains of difficulty breathing that began after her morning jog. The temperature outside is 40°F (5°C). On exam, you hear bilateral expiratory wheezing. After providing 100% oxygen, you should: A. place her in a recumbent position to facilitate breathing. B. contact medical control and administer an antihistamine. C. call medical control and ask how to proceed with treatment. D. determine if she has been prescribed a beta-agonist inhaler.
D
Albuterol, a beta-2 agonist, is the generic name for: A. Alupent. B. Metaprel. C. Brethine. D. Ventolin.
D
At the onset of an acute asthma attack, patients commonly experience difficulty breathing and: A. audible stridor. B. rales and rhonchi. C. profound cyanosis. D. expiratory wheezing.
D
Common signs and symptoms of acute hyperventilation syndrome include: A. altered mental status and bradycardia. B. unilateral paralysis and slurred speech. C. anxiety, dizziness, and severe bradypnea. D. tachypnea and tingling in the extremities.
D
Contraindications for continuous positive airway pressure (CPAP) include: A. being alert and able to follow commands. B. a pulse oximetry reading of less than 90%. C. a respiratory rate greater than 26 breaths/min. D. hypotension.
D
In order for efficient pulmonary gas exchange to occur: A. the percentage of inhaled carbon dioxide must exceed the percentage of inhaled oxygen. B. there must be low quantities of pulmonary surfactant to allow for full alveolar expansion. C. the pulmonary capillaries must be completely constricted and the alveoli must be collapsed. D. oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane.
D
Paroxysmal nocturnal dyspnea (PND), rales, and dependent edema are clinical indicators of: A. emphysema. B. severe pneumonia. C. bronchitis or asthma. D. congestive heart failure.
D
Treatment for anaphylaxis and acute asthma attacks includes: A. epinephrine. B. high-flow oxygen. C. antihistamines. D. all of the above.
D
Which of the following is a question you would NOT ask during the history taking and the secondary assessment of a patient with dyspnea? A. What has the patient already done for the breathing problem? B. Does the patient use a prescribed inhaler? C. Does the patient have any allergies? D. What time did the patient wake up this morning?
D
You respond to a home of a 78-year-old man having difficulty breathing. He is sitting at the kitchen table in a classic tripod position, wearing a nasal cannula. He is cyanotic, smoking, and has his shirt unbuttoned. His respirations are 30 breaths/min and shallow, his heart rate is 110 beats/min, and his blood pressure is 136/88 mm Hg. Your first thought as an EMT-B should be to: A. apply a nonrebreathing mask at 15L/min. B. call for back-up. C. assess the airway status. D. determine scene safety.
D
You respond to a home of a 78-year-old man having difficulty breathing. He is sitting at the kitchen table in a classic tripod position, wearing a nasal cannula. He is cyanotic, smoking, and has his shirt unbuttoned. His respirations are 30 breaths/min and shallow, his heart rate is 110 beats/min, and his blood pressure is 136/88 mm Hg. What should you do during the ongoing assessment? A. Assess vital signs every 5 minutes. B. Repeat the initial and focused assessment. C. Reassess interventions performed. D. All of the above.
D
