Ch. 14 Respiratory emergencies

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:

a marked decrease in the heart rate.

The MOST significant risk associated with ventilating a patient too rapidly is:

A. gastric distention and regurgitation

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:

A. assisted ventilations, IV of normal saline, and epinephrine

In cases of pulmonary edema, diffusion is impaired primarily because of:

A. fluid-filled alveoli

More carbon dioxide diffuses out of the bloodstream when:

A. fresh oxygen diffuses into the alveoli

Emphysema, a degenerative disease, is caused by:

A. surfactant destruction and increased alveolar surface tension

Patients with COPD are highly susceptible to pneumonia because:

A. they cannot effectively expel infected pulmonary secretions

Cardiac asthma is a condition in which a patient:

A. with congestive heart failure experiences wheezing due to constricted bronchi

Characteristics of adequate breathing in an adult include all of the following, EXCEPT:

Asymmetrical chest movement

Which of the following conditions would be LEAST likely to result in cerebral hypoxia?

Methamphetamine overdose

Which of the following physiologic processes occurs during pulmonary respiration?

Carbon dioxide diffuses into the alveoli.

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:

Cardiogenic pulmonary edema

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?

Collection of fluid outside of the lung

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?

Increased surfactant production

All of the following are commonly prescribed medications for patients with a respiratory disease, EXCEPT:

Inderal

Typical signs and symptoms of pneumonia include:

Pleuritic chest pain, fever and ronchi Dypnsea cough, Dark sputum

Which of the following is the MOST accurate clinical definition of chronic bronchitis?

Productive cough for 3 months per year for 3 consecutive years

When assessing a patient with difficulty breathing, which of the following findings would lead you to suspect congestive heart failure as the underlying cause?

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

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?

Pulmonary rales

Which of the following clinical findings is MOST consistent with inadequate breathing?

Respirations of 16 breaths/min and reduced tidal volume

Which of the following statements MOST accurately describes asthma?

Reversible airway disease caused by an exaggerated immune response

Definitive treatment to reduce acute respiratory distress in a patient with a pleural effusion involves:

a fluid thoracentesis

The Hering-Breuer reflex is defined as:

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

When assessing a patient using a pulse oximeter, it is important to remember that:

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:

an acute asthma attack

Cystic fibrosis is a genetic disorder that results in:

excess sodium loss and thick pulmonary secretions

When treating a patient who complains of dyspnea, it is important for the AEMT to:

be prepared to treat the patient's anxiety as well

Patients with emphysema are commonly referred to as "pink puffers" because they:

breathe through pursed lips and may develop polycythemia.

The respiratory syncytial virus (RSV) is a common cause of:

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:

bronchitis

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 rhonchi in all fields. Treatment for this patient should include:

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:

effective alveolar-capillary osmosis.

In contrast to bronchitis, pneumonia typically presents with:

fever and chills

When assisting a patient with his or her prescribed inhaler, it is important to:

have the patient exhale deeply prior to inhaling the medication

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:

he must be properly decontaminated first

When assessing the severity of nocturnal dyspnea in a patient with a chronic respiratory disease, you should determine:

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:

humidified oxygen

The two processes that occur during respiration are:

inspiration and expiration

A 59-year-old female with a history of poorly controlled hypertension becomes acutely dyspneic, develops profound cyanosis to the upper chest, and becomes unresponsive. She is pulseless and apneic upon your arrival. As you and your partner are performing the appropriate treatment interventions, you discuss the possible cause of her condition, which is MOST likely a(n):

massive pulmonary embolism

Which of the following is generally NOT indicated when treating a patient with a tension pneumothorax?

medication and therapy

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:

mental status alteration.

Cheyne-Stokes respirations are characterized by:

tachypnea and bradypnea with alternating apneic periods

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:

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:

prepare for immediate transport.

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:

pulmonary embolism

Cardiomyopathy may lead to pulmonary edema due to:

reduced contractile force of the heart

The exchange of oxygen and carbon dioxide, at the cellular level or in the lungs, is called:

respiration

What acid-base derangement initially occurs in a tachypneic patient without a physiologic demand for increased oxygen?

respiratory alkalosis

Acute epiglottitis in the adult is characterized by:

severe sore throat

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:

spontaneous pneumothorax

An anaphylactic reaction impairs effective breathing secondary to:

upper airway swelling

The process of moving air into and out of the lungs is called:

ventilation