Chapter 17

Which of the following conditions would be LEAST likely to result in cerebral hypoxia? Question options: A) Methamphetamine overdose B) Benzodiazepine overdose C) Muscular dystrophy D) Acute pulmonary edema

Methamphetamine overdose

Definitive treatment to reduce acute respiratory distress in a patient with a pleural effusion involves: Question options: A) a fluid thoracentesis. B) antibiotic therapy. C) endotracheal intubation. D) needle decompression.

a fluid thoracentesis.

Common side effects of inhaled medications used for acute shortness of breath include all of the following, EXCEPT: Question options: A) sedation. B) tachycardia. C) muscle tremors. D) nervousness.

sedation

Which of the following respiratory medications is exclusively indicated for chronic asthma treatment or as asthma prevention? Question options: A) Proventil B) Alupent C) Atrovent D) Advair

Advair

Which of the following processes occurs during normal inspiration? Question options: A) Air is pulled into the lungs when intrathoracic pressure decreases B) An increase in intrathoracic pressure forces air into the lungs C) The diaphragm contract and ascends, increasing the chest diameter D) The phrenic nerves stimulate the intercostal muscles to contract

Air is pulled into the lungs when intrathoracic pressure decreases

Which of the following physiologic processes occurs during pulmonary respiration? Question options: A) Oxygen moves into the systemic cells. B) Carbon Dioxide moves into the peripheral capillaries. C) Carbon dioxide diffuses into the alveoli. D) Oxygen is metabolized by the body.

Carbon dioxide diffuses into the alveoli.

You are dispatched to the home of a 64-year-old male patient with lung cancer. The patient complains of acute dyspnea; however, as long as he is sitting upright, his breathing is easier. He denies fever and his breath sounds are decreased over the base of the left lung. What is the MOST likely cause of this patient's symptoms? Question options: A) Air in the pleural space with lung collapse B) Localized bronchospasm in the lungs C) Consolidation of fluid within the lung D) Collection of fluid outside of the lung

Collection of fluid outside of the lung

Which of the following is generally NOT indicated when treating a patient with a tension pneumothorax? Question options: A) Paramedic support B) Ventilatory assistance C) Medication therapy D) Intravenous therapy

Medication therapy

You are dispatched to a residence for a 69-year-old female with "breathing problems." When you arrive, the patient's husband directs you to his wife, who is sitting on the couch in obvious respiratory distress. She is semiconscious and has labored, shallow respirations. You auscultate her lungs and hear diffuse rhonchi in all lung fields. Which of the following interventions would be of LEAST benefit to her?

IV therapy with up to a 500 mL normal saline bolus

Which of the following physiologic processes does NOT occur in patients with COPD? Question options: A) Intrapulmonary air trapping B) Mucous production from beta2 cells C) Diffuse alveolar collapse D) Increased surfactant production

Increased surfactant production

All of the following are commonly prescribed medications for patients with a respiratory disease, EXCEPT: Question options: A) Beclovent. B) Inderal. C) Singulair. D) Intal.

Inderal.

Which of the following is the MOST accurate clinical definition of chronic bronchitis? Question options: A) Productive cough for 3 months per year for 3 consecutive years B) Productive cough for 2 months per year for 2 consecutive years C) Nonproductive cough for 2 months per year for 3 consecutive years D) Nonproductive cough for 4 months per year for 1 year

Productive cough for 3 months per year for 3 consecutive years

A 70-year-old male presents with an acute onset of difficulty breathing that woke him from his sleep. He has a history of hypertension, atrial fibrillation, and several heart attacks. During your assessment, you note dried blood around his mouth. The patient tells you that he cannot lie down because he will "smother." What additional assessment findings will you MOST likely discover? Question options: A) Pulmonary rales B) Diffuse wheezing C) Slow respiratory rate D) Fever and chills

Pulmonary rales

Which of the following clinical findings is MOST consistent with inadequate breathing? Question options: A) Regular breathing pattern and respirations of 24 breaths/min B) Respirations of 16 breaths/min and reduced tidal volume C) Symmetrical chest movement and warm, dry skin D) Increased amount of expired air at the nose and mouth

Respirations of 16 breaths/min and reduced tidal volume

What acid-base derangement initially occurs in a tachypneic patient without a physiologic demand for increased oxygen? Question options: A) Metabolic alkalosis B) Respiratory alkalosis C) Metabolic acidosis D) Respiratory acidosis

Respiratory alkalosis

Which of the following statements MOST accurately describes asthma? Question options: A) Irreversible airway disease that results in increased alveolar surface tension B) Chronic respiratory disease caused by long-term exposure to toxic substances C) Reversible airway disease caused by an exaggerated immune response D) Irreversible airway disease that presents with inspiratory wheezing

Reversible airway disease caused by an exaggerated immune response

When assessing a patient with difficulty breathing, which of the following findings would lead you to suspect congestive heart failure as the underlying cause? Question options: A) The onset of the difficulty breathing was acute and the patient takes prescribed diuretics. B) The patient is coughing up thick green sputum and has prescriptions for Atrovent and Advair. C) The patient is receiving home oxygen therapy, has pink skin, and is breathing through pursed lips. D) The patient is a long-term smoker and takes corticosteroid medications on a daily basis.

The onset of the difficulty breathing was acute and the patient takes prescribed diuretics.

The Hering-Breuer reflex is defined as: Question options: A) an increase in respiratory rate and depth secondary to decreased levels of oxygen in the blood. B) a feedback loop that inhibits the inspiratory center, which prevents overexpansion of the lungs. C) a feedback loop that sends signals to the apneustic center, resulting in increased tidal volume. D) a decrease in respiratory rate and depth secondary to decreased carbon dioxide levels in the blood.

a feedback loop that inhibits the inspiratory center, which prevents overexpansion of the lungs.

You are assessing a 52-year-old male with respiratory distress. The MOST ominous sign(s) of severe hypoxemia and imminent cardiac arrest is/are: Question options: A) audible stridor and facial cyanosis. B) a marked decrease in the heart rate. C) minimal-word dyspnea and pallor. D) a marked increase in the heart rate.

a marked decrease in the heart rate.

Approximately 2 weeks following a total hip replacement, a 70-year-old female complains of a sudden onset of dyspnea and pleuritic chest pain. Your assessment reveals perioral cyanosis, blood-tinged sputum, and wheezing to the base of her right lung. As your partner applies high-flow oxygen, the patient states that she has a history of hypertension. You should be MOST suspicious of: Question options: A) an acute asthma attack. B) a pulmonary embolism. C) a simple pneumothorax. D) acute left heart failure.

a pulmonary embolism.

Acute epiglottitis in the adult is characterized by: Question options: A) a productive cough. B) a severe sore throat. C) a seal-bark cough. D) a low-grade fever.

a severe sore throat.

When assessing a patient using a pulse oximeter, it is important to remember that: Question options: A) the pulse oximeter provides an accurate reading of the patient's PaO2. B) abnormally bound hemoglobin may produce inaccurate readings. C) pulse oximetry will determine whether or not to administer oxygen. D) an oxygen saturation of greater than 90% rules out hypoxemia.

abnormally bound hemoglobin may produce inaccurate readings.

A 20-year-old female presents with acute respiratory distress. Auscultation of her lungs reveals diffuse expiratory wheezing. She is in moderate distress and tells you that she has a prescribed inhaler that she uses when this happens. You should suspect: Question options: A) bronchitis exacerbation. B) an acute asthma attack. C) bacterial pneumonia. D) status asthmaticus.

an acute asthma attack.

Approximately 20 minutes after receiving a penicillin injection at the doctor's office, a 41-year-old female presents with acute respiratory distress, facial swelling, and intense itching to her entire body. Her level of consciousness is decreased and her breathing is labored with minimal chest rise. The MOST appropriate treatment for this patient should include: Question options: A) oxygen via a nonrebreathing mask, IV of normal saline, and albuterol. B) insertion of a King LT airway and a 1,000 mL bolus of normal saline. C) assisted ventilations, IV of normal saline, and epinephrine. D) hyperventilation with a bag-mask device and epinephrine via IV push.

assisted ventilations, IV of normal saline, and epinephrine.

Characteristics of adequate breathing in an adult include all of the following, EXCEPT: Question options: A) respirations of 14 breaths/min. B) asymmetrical chest movement. C) audible breath sounds bilaterally. D) pink oral mucous membranes.

asymmetrical chest movement.

When treating a patient who complains of dyspnea, it is important for the AEMT to: Question options: A) closely monitor the patient's cardiac rhythm. B) be prepared to treat the patient's anxiety as well. C) give oxygen via nasal cannula to minimize anxiety. D) routinely request that a paramedic unit respond to the scene.

be prepared to treat the patient's anxiety as well.

You are transporting a 60-year-old male to the hospital for suspected COPD exacerbation. He is receiving 100% oxygen via a nonrebreathing mask. As you reassess him, you note that his respirations have decreased and have become shallow. You should: Question options: A) remove the oxygen mask and reassess. B) apply a nasal cannula at 4 L/min. C) prepare to insert a multilumen airway. D) begin assisting his ventilations.

begin assisting his ventilations.

Chronic carbon dioxide retention, as seen in patients with certain lung diseases, may cause the patient to: Question options: A) breathe on the basis of decreased oxygen. B) develop tachypnea if given 100% oxygen. C) experience acute tidal volume increases. D) develop extended periods of hypocarbia.

breathe on the basis of decreased oxygen.

Patients with emphysema are commonly referred to as "pink puffers" because they: Question options: A) develop polycythemia and often grunt during exhalation. B) breathe through pursed lips and may develop polycythemia. C) grunt when they breathe and maintain high arterial O2 levels. D) produce excess red blood cells and maintain low CO2 levels.

breathe through pursed lips and may develop polycythemia.

The respiratory syncytial virus (RSV) is a common cause of: Question options: A) bronchiolitis and pneumonia. B) asthma and chronic bronchitis. C) pertussis and the flu. D) MRSA and whooping cough.

bronchiolitis and pneumonia

A 60-year-old male presents with shortness of breath and a productive cough of two days' duration. He denies chest pain or any other associated symptoms. Auscultation of his lungs reveals scattered bilateral rhonchi in all fields. His skin is pink, warm, and dry and the pulse oximeter reads 94% on room air. This patient is MOST likely experiencing: Question options: A) bronchitis. B) acute asthma. C) emphysema. D) pneumonia.

bronchitis.

A 56-year-old male complains of difficulty breathing. His wife tells you that he complained of chest discomfort a few days prior, but would not allow her to call EMS. Your assessment reveals rales in the apices and bases of both lungs. This patient's clinical presentation is MOST consistent with: Question options: A) acute pulmonary embolism. B) chronic obstructive pulmonary disease (COPD) exacerbation. C) chronic bronchitis. D) cardiogenic pulmonary edema.

cardiogenic pulmonary edema.

You are assessing a young male with an acute onset of tachypnea. He is conscious and alert with shallow respirations of 40 breaths/min, and complains of numbness and tingling to his face and hands. The patient's girlfriend tells you that he has been very worried about his mother, who was recently diagnosed with cancer. Appropriate treatment for this patient includes: Question options: A) a beta2 agonist if authorized by medical control. B) coached breathing and oxygen as needed. C) a nonrebreathing mask without oxygen. D) carbon dioxide rebreathing with a paper bag.

coached breathing and oxygen as needed.

A 61-year-old female called EMS after suddenly being awakened in the middle of the night with a feeling that she was "smothering." You arrive to find the patient, very apprehensive and restless, sitting on the living room couch in obvious respiratory distress. Her BP is 160/90 mm Hg, pulse is 110 beats/min and irregular, and respirations are 24 breaths/min and labored. Auscultation of her lungs reveals diffuse rales "crackles" in all fields. Treatment for this patient should include: Question options: A) oropharyngeal suctioning and assisted ventilation with a bag-mask device. B) oxygen at 4 to 6 L/min via nasal cannula and up to 3 nebulizer treatments. C) continuous positive airway pressure and an IV line set to keep the vein open. D) an IV line with a 250 mL normal saline bolus and oxygen via a nonrebreathing mask.

continuous positive airway pressure and an IV line set to keep the vein open.

The movement and utilization of oxygen in the body is dependent on all of the following, EXCEPT: Question options: A) efficient off-loading of oxygen in the tissues. B) effective alveolar-capillary osmosis. C) adequate concentration of inspired oxygen. D) adequate number of functional erythrocytes.

effective alveolar-capillary osmosis

Cystic fibrosis is a genetic disorder that results in: Question options: A) acute pulmonary edema and diffuse bronchospasm. B) excess sodium loss and thick pulmonary secretions. C) profound dehydration and a fever greater than 102°F. D) spontaneous collapsing of one or both lungs.

excess sodium loss and thick pulmonary secretions.

In contrast to bronchitis, pneumonia typically presents with: Question options: A) fever and chills. B) fluid in the lungs. C) varying levels of hypoxia. D) a productive cough.

fever and chills.

In cases of pulmonary edema, diffusion is impaired primarily because of: Question options: A) decreased cardiac contractility. B) widespread atelectasis. C) fluid-filled alveoli. D) severe pulmonary vasoconstriction.

fluid-filled alveoli.

More carbon dioxide diffuses out of the bloodstream when: Question options: A) arterial carbon dioxide levels decrease. B) tidal volume is significantly decreased. C) the pulmonary vasculature is constricted. D) fresh oxygen diffuses into the alveoli.

fresh oxygen diffuses into the alveoli.

The MOST significant risk associated with ventilating a patient too rapidly is: Question options: A) excess carbon dioxide elimination. B) inadvertent respiratory alkalosis. C) barotrauma and a pneumothorax. D) gastric distention and regurgitation.

gastric distention and regurgitation.

When assisting a patient with his or her prescribed inhaler, it is important to: Question options: A) avoid a spacer device, as this decreases the medication's efficacy. B) ensure that the medication is slightly below room temperature. C) instruct the patient to hold his or her breath for 20 to 30 seconds. D) have the patient exhale deeply prior to inhaling the medication.

have the patient exhale deeply prior to inhaling the medication.

The two processes that occur during ventilation are: Question options: A) oxygenation and ventilation. B) inspiration and expiration. C) diffusion and perfusion. D) ventilation and diffusion.

inspiration and expiration.

A 30-year-old male presents with respiratory distress that began within minutes of being exposed to an unknown chemical at an industrial site. When caring for this patient, it is MOST important to remember that: Question options: A) he must be properly decontaminated first. B) aggressive airway management may be needed. C) he will likely require frequent suctioning. D) inhalation injuries can cause aspiration pneumonia.

he must be properly decontaminated first.

When assessing the severity of nocturnal dyspnea in a patient with a chronic respiratory disease, you should determine: Question options: A) how far he or she can walk before dyspnea occurs. B) how many pillows he or she sleeps with at night. C) if he or she sleeps on the stomach or back. D) if he or she uses a beta2 agonist at least twice per day.

how many pillows he or she sleeps with at night.

You are treating a 2-year-old boy who is experiencing respiratory distress. During your assessment, you note that the child has mild inspiratory stridor, a barking cough, and a low-grade fever. The child is otherwise conscious, is acting appropriate for his age, and has strong radial pulses. Treatment should include: Question options: A) a beta antagonist. B) assisted ventilation. C) an IV fluid bolus. D) humidified oxygen.

humidified oxygen.

In contrast to an epidemic, a pandemic: Question options: A) is a disease outbreak that occurs on a global scale. B) is usually confined to a specific geographic location. C) is a disease for which a vaccine is readily available. D) occurs in more of the population than was expected.

is a disease outbreak that occurs on a global scale.

A 28-year-old female with a history of poorly controlled hypertension becomes acutely dyspneic, develops profound non radiating pinpoint chest pain. Patient describes the pain as "sharp" in sensation. Patient does have history of smoking 1/2 pack a day. You and your partner are performing the appropriate treatment interventions, you discuss the possible cause of her condition, which is MOST likely a(n): Question options: A) massive atraumatic hemothorax. B) acute myocardial infarction. C) large tension pneumothorax. D) massive pulmonary embolism.

massive pulmonary embolism.

You are dispatched for an elderly male with dyspnea. When you arrive, you find the patient sitting in a chair. He is semiconscious and unable to effectively communicate with you. As you perform a primary assessment, your partner applies 100% oxygen and a pulse oximeter, which reads 85%. The MOST reliable indicator of cerebral hypoxia in this patient is his: Question options: A) complaint of dyspnea. B) decreased oxygen saturation. C) mental status alteration. D) inability to communicate.

mental status alteration.

Typical signs and symptoms of pneumonia include: Question options: A) stridor, chills, shortness of breath, and fever. B) weakness, crushing chest pain, and wheezing. C) dry cough, high fever, and labored breathing. D) pleuritic chest pain, fever, and rhonchi.

pleuritic chest pain, fever, and rhonchi.

A 67-year-old male who smokes three packs of cigarettes per day complains of a productive cough, chills, and generalized weakness. He is in mild respiratory distress; auscultation of his lungs reveals rhonchi to the lower left lobe. This patient's clinical presentation is MOST consistent with: Question options: A) pneumonia. B) heart failure. C) bronchitis. D) emphysema.

pneumonia.

When assessing a female patient with chest pain and shortness of breath, you note that her blood pressure is 80/50 mm Hg, her heart rate is 120 beats/min, and she has cyanosis around her mouth. In addition to supporting her ventilations, you should: Question options: A) establish intravenous access. B) perform a secondary assessment. C) prepare for immediate transport. D) give her a bronchodilator drug.

prepare for immediate transport.

Cardiomyopathy may lead to pulmonary edema due to: Question options: A) a profound decrease in heart rate. B) reduced contractile force of the heart. C) weakening of the right side of the heart. D) acute injury to the myocardium.

reduced contractile force of the heart.

The exchange of oxygen and carbon dioxide, at the cellular level or in the lungs, is called: Question options: A) oxygenation. B) respiration. C) ventilation, D) breathing.

respiration.

A 77-year-old male with a history of emphysema complains of an acute worsening of his shortness of breath and pleuritic chest pain that occurred after a forceful cough. Auscultation of his lungs reveals scattered wheezing on the left side and diminished breath sounds on the right. This patient's clinical presentation is MOST consistent with: Question options: A) acute bacterial pneumonia. B) exacerbated emphysema. C) spontaneous pneumothorax. D) acute pulmonary edema.

spontaneous pneumothorax.

A 77-year-old male with a history of emphysema complains of an acute worsening of his shortness of breath and pleuritic chest pain that occurred after a forceful cough. Auscultation of his lungs reveals scattered wheezing on the left side and diminished breath sounds on the right. This patient's clinical presentation is MOST consistent with: Question options: A) acute pulmonary edema. B) acute bacterial pneumonia. C) spontaneous pneumothorax. D) exacerbated emphysema.

spontaneous pneumothorax.

Emphysema, a degenerative disease, is caused by: Question options: A) excessive mucous production by beta2 cells in the bronchi. B) surfactant destruction and increased alveolar surface tension. C) widespread constriction of the bronchioles and air trapping. D) decreased alveolar surface tension caused by excess surfactant.

surfactant destruction and increased alveolar surface tension.

Cheyne-Stokes respirations are characterized by: Question options: A) irregular tachypnea with occasional periods of apnea. B) tachypnea and hyperpnea with an acetone breath odor. C) impaired respirations with sustained inspiratory effort. D) tachypnea and bradypnea with alternating apneic periods.

tachypnea and bradypnea with alternating apneic periods.

Patients with COPD are highly susceptible to pneumonia because: Question options: A) their immune system is inherently weakened by the disease. B) they cannot effectively expel infected pulmonary secretions. C) their age predisposes them to COPD-related lung infections. D) their hyperactive cough reflex leads to alveolar destruction.

they cannot effectively expel infected pulmonary secretions

An anaphylactic reaction impairs effective breathing secondary to: Question options: A) diffuse alveolar collapse. B) excess fluid in the alveoli. C) catecholamine release. D) upper-airway swelling.

upper-airway swelling.

The process of moving air into and out of the lungs is called A) ventilation B) breathing C) respiration D) oxygenation

ventilation

Cardiac asthma is a condition in which a patient: Question options: A) with congestive heart failure experiences wheezing due to constricted bronchi. B) inadvertently takes too much of his or her beta-blocker, resulting in bronchospasm. C) develops acute respiratory distress when fluid suddenly accumulates in the lungs. D) with a history of asthma develops wheezing caused by an acute cardiac event.

with congestive heart failure experiences wheezing due to constricted bronchi.