Chapter 16 pre test, post test and Chapter test

During an asthma​ attack, three main pathological changes lead to hypoxia in the patient. Which of these changes is not one of these​ three?

Decreased alveolar perfusion

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

As compared to an​ adult, how would you describe the respiratory rate of an​ infant?

Faster than an​ adult's rate

Which assessment finding in a patient who is dyspneic is a clear indication of​ hypoxia?

Cyanosis

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.

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 of the following is an easily recognizable prescribed medication for a patient for a respiratory​ disease?

Levalbuterol

Which area of the brain is responsible for the gross rate and rhythm of the breathing​ pattern?

Medulla oblongata

While you are obtaining a medical history for a patient with generalized weakness and​ fatigue, she hands you a list of all the medications she is currently taking. Which of these medications should the EMT recognize as a bronchodilator for which the EMT could assist in its​ administration?

Metaproterenol

Which of these pieces of information would heighten the​ EMT's suspicion that a child with a persistent cough may have whooping​ cough?

Never had childhood immunizations

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

The EMT is correctly assessing a patient for subcutaneous emphysema when​ he

Palpates the anterior and posterior chest

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

A patient who is nonverbal from a previous stroke is in severe respiratory distress. A family member states that she has multiple medical​ problems, including high blood​ pressure, diabetes, and heart failure. When assessing this​ patient, which sign or symptom would raise your suspicion that the patient has heart​ failure?

Pulmonary crackles

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

When auscultating breath​ sounds, the EMT should recognize rhonchi when he hears which type of​ sound?

Rattling-like noises that change when the patient coughs

What is the most common cause of cardiac arrest in infants and​ children?

Respiratory compromise

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

While you are listening to breath​ sounds, the patient should be in what anatomic position whenever​ possible?

Sitting upright

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.

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.

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.

A normal pulse oximeter reading is

greater than 94

Each of the following may indicate that apnea is​ imminent, EXCEPT

hypertension.

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 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.

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​ 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.

A​ 4-year-old female patient with a decreased level of consciousness is in respiratory distress. Her airway is patent and respirations are 12 per minute. Breath sounds are diminished​ bilaterally, and there is noted accessory muscle use with inspiration and expiration. Her pulse is 84 and SpO2​ 88%. What should be your immediate​ action?

. Start positive pressure ventilation

Which of the following is NOT a contraindication to administering a bronchodilator by MDI to a patient with​ asthma?

A. An MDI is not prescribed for the patient. B. The patient has already taken the maximum allowable dose. C. CORRECT ANSWER The patient is in severe respiratory distress. D. The patient is not responsive enough to use the MDI

Which of the following patients would be at risk for a primary spontaneous​ pneumothorax?

A. A​ short, obese​ 65-year-old woman who smokes B. A short​ 15-year-old female patient with Marfan syndrome C. A​ tall, overweight​ 60-year-old man with COPD D. Correct Answer A​ tall, thin​ 18-year-old male athlete

All of the following are considered chronic obstructive pulmonary​ diseases, EXCEPT:

A. chronic bronchitis. B. emphysema. C. Correct Answer pulmonary embolism. D. black lung disease.

An alert and oriented​ 45-year-old female patient complains of shortness of breath. Although her respiratory volume and rate are​ satisfactory, you note cyanosis in her fingertips and you cannot get the pulse oximeter to show a reading. What should be your next​ action?

Administer supplemental oxygen

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

Your medical​ director's written protocol instructs you to obtain​ on-line medical direction prior to assisting a patient with a​ metered-dose inhaler​ (MDI). Given this​ protocol, you must​ contact:

An emergency physician before assisting with the MDI

A patient with which of the following signs indicates respiratory​ failure?

Central​ cyanosis, one- to​ two-word dyspnea, pulse oximeter reading of​ 84%

A​ 4-year-old boy in respiratory distress is sitting upright in bed and drooling. His mother states that he complained of a sore throat throughout the​ day, and tonight became severely short of breath and started drooling. He is alert with adequate breathing. His skin is very warm to the touch. Vital signs are​ pulse, 132;​ respirations, 28​ breaths/min; and​ SpO2, 90% on room air. Which is your first action in caring for this​ child?

Apply supplemental oxygen

Which of the following is a sign of hyperventilation​ syndrome?

Carpopedal spasm

You are called to a motor vehicle collision. A​ 26-year-old female states that she was unrestrained and struck the steering column with her chest after the car she was driving hit another car from behind. She is somewhat​ confused, and complains of chest pain and difficult and painful breathing when she inhales. Her airway is patent and her breathing is adequate. Assessment of the radial pulse reveals it to be rapid and very irregular and weak. The patient has cyanosis in her nose and fingertips. Her breath sounds are clear and​ equal, and her skin is moist and pale. The patient informs you that she has asthma and has a​ metered-dose inhaler​ (MDI). What is your best initial action in treating this​ patient?

Apply supplemental oxygen if indicated

As you enter the living room of an adult patient who called 911 for shortness of​ breath, you observe the patient sitting upright in a chair with a panicked look on her​ face, struggling to​ breathe, with obvious suprasternal retractions. Her breathing rate appears to be fast and her tidal volume poor. You can hear rhonchi from her lungs without the aid of a stethoscope. Once at her​ side, your initial care should be​ to:

Assess her airway

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.

Where does the lower airway​ begin?

At the level of the vocal cords

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.

Which of the following is consistent with normal​ breathing?

Bilateral breath sounds

You have been called to a home for an​ 18-year-old male​ patient, who informs you that he experienced a sudden onset of shortness of breath and back pain while watching television. He has a history of spontaneous​ pneumothorax, and the current symptoms he is experiencing are identical to those he felt with a previous pneumothorax. Assessment reveals the patient to be slightly dyspneic with breath sounds clear and intact bilaterally. During​ transport, what is most critical to continually monitor on this​ patient?

Breath sounds

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

You have been called for a​ 2-year-old male patient who is sick and having a difficult time breathing. On​ scene, you find the patient in his​ mother's arms. He appears to have labored breathing and skin that is warm to the touch. Which of these additional assessment findings would you recognize as the most​ serious?

Grunting noise heard as the child exhales

A​ 6-year-old female patient is in acute respiratory distress and is still breathing adequately but will not keep the nonrebreather face mask on her face. In this​ situation, the EMT​ should:

Have the mother hold the mask near her​ daughter's face

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.

You are having a hard time getting the past medical history of a patient who is short of breath. Which piece of information would lead the EMT to believe that the patient has a history of chronic lung​ disease, such as emphysema or chronic​ bronchitis?

Her chest is barrel shaped

You have been called to a residence for an​ 18-year-old female patient with shortness of breath and a history of cystic fibrosis. On​ scene, you find the patient to be very thin and sick looking. Her airway is patent and breathing​ adequate, although slightly labored. Her radial pulse is​ strong, and she has a constant​ cough, which occasionally produces​ green- and​ yellow-colored mucus. Auscultation of the lungs reveals rhonchi to the upper portion of both lungs. Vital signs are​ pulse, 108;​ respirations, 20​ breaths/min; blood​ pressure, 98/56​ mmHg; and​ SpO2, 92%. Based on these​ findings, appropriate care should​ include:

Humidified oxygen via nasal cannula starting at 2 liters per minute

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 receptors detect when the​ alveolar-capillary beds become engorged with​ blood?

Juxta-capillary receptors

A patient in respiratory distress is exhibiting pursed lip breathing. You realize that he is doing this​ to:

Keep the small airways open

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.

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.

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.

You are by the side of a​ 77-year-old male patient with a complaint of shortness of breath. Auscultation of his lungs indicates crackles in the bases. In​ addition, both of his feet are swollen. His SpO2 on room air is​ 82%. The remainder of his vital signs are​ pulse, 144;​ respirations, 26​ breaths/min; and blood pressure​ 168/90, mmHg. The patient reports lower back pain with a history of a​ "pinched nerve" in that area. He states that he always has this pain. He has difficulty finishing his sentences without gasping for air. What is the most appropriate care for this patient after initiating​ oxygen?

Transport him in a sitting position

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.

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

You are assisting a patient in taking her​ metered-dose inhaler for the first time. Which of these statements about the side effects of the medication would be most​ appropriate?

You may feel anxious and your heart rate may​ increase.

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

You have been called for a​ 6-year-old male patient with shortness of breath. On​ scene, you find the patient with a runny nose and mucus coming from the right nare. Breath sounds are clear and his SpO2 is​ 99% on room air. When​ asked, the patient states that his throat is very sore. His vital signs are​ pulse, 124;​ respirations, 20​ breaths/min; and​ temperature, 98.9°F. There is no medical​ history, according to the mother. Which statement or instruction would be most appropriate for this​ situation?

​"He is​ stable, but we will take him to the hospital. The danger lies in the infection spreading to the​ lungs."

When instructing a patient on how to use a​ small-volume nebulizer, which of these statements would be​ correct?

​"It is really important to occasionally cough during the​ treatment."