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)