chapter 16

9. Which of the following statements regarding anatomic dead space is correct? A) Anatomic dead space is about 1 mL per pound of body weight. B) Air in the dead space participates in pulmonary gas exchange. C) The amount of dead space increases as tidal volume increases. D) If tidal volume is 500 mL, 200 mL remains in the dead space.

A) Anatomic dead space is about 1 mL per pound of body weight.

24. ___________ respirations are characterized by a grossly irregular pattern of breathing that may be accompanied by lengthy periods of apnea. A) Biot B) Agonal C) Eupneic D) Cheyne-Stokes

A) Biot

55. If a colorimetric ETCO2 detector turns purple during the exhalation phase through an ET tube, approximately how much carbon dioxide is being exhaled? A) Less than 0.5% B) Between 1% and 2% C) Between 2% and 5% D) More than 5%

A) Less than 0.5%

40. Which of the following conditions would LEAST likely present with an acute onset of respiratory distress? A) Pneumonia B) Anaphylaxis C) Pneumothorax D) Pulmonary embolism

A) Pneumonia

46. __________ breath sounds are the MOST commonly heard breath sounds and have a much more obvious inspiratory component. A) Vesicular B) Bronchial C) Tracheal D) Bronchovesicular

A) Vesicular

61. Common clinical findings in patients with obstructive lung disease include all of the following, EXCEPT: A) a decreased expiratory phase. B) pursed-lip breathing. C) abdominal muscle use. D) chronic air trapping in the lungs.

A) a decreased expiratory phase.

51. If a patient's hemoglobin level is 8 g/dL due to hemorrhage and all of the hemoglobin molecules are attached to oxygen, the patient's oxygen saturation would MOST likely read: A) above 95%. B) between 90% and 95% C) between 85% and 90%. D) significantly lower than 85%.

A) above 95%.

14. If the amount of pulmonary surfactant is decreased: A) alveolar surface tension increases. B) diffuse alveolar hyperinflation occurs. C) alveoli are able to expand more easily. D) pulmonary gas exchange is enhanced.

A) alveolar surface tension increases.

2. A patient who is experiencing an allergic reaction states that his tongue "feels thick" and speaks at a low volume. You should immediately evaluate for: A) angioedema. B) hypotension. C) a gag reflex. D) adventitious breath sounds.

A) angioedema.

96. A 29-year-old woman is experiencing a severe asthma attack. Her husband reports that she was admitted to an intensive care unit about 6 months ago, and had a breathing tube in place. Prior to your arrival, the patient took 3 puffs of her rescue inhaler without effect. She is anxious and restless, is tachypneic, and has audible wheezing. You should: A) apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital. B) begin assisting her ventilations with a bag-mask device and 100% oxygen and prepare to intubate her trachea. C) start an IV of normal saline, administer methylprednisolone via IV push, and transport as soon as possible. D) attempt to slow her breathing with respiratory coaching, administer a nebulized bronchodilator, and transport.

A) apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.

101. A 36-year-old man with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta-2 agonist, but his poor respiratory effort is inhibiting effective drug delivery via the nebulizer and his mental status is deteriorating. You should: A) assist his ventilations and establish vascular access. B) start an IV of normal saline and administer a steroid. C) apply high-flow oxygen via a nonrebreathing mask. D) assist him with a metered-dose inhaler bronchodilator.

A) assist his ventilations and establish vascular access.

62. Reactive airway disease is characterized by: A) bronchospasm, edema, and mucus production. B) chronic bronchoconstriction of varying severity. C) acute, reversible swelling of the laryngeal muscles. D) excessive mucus production and a chronic cough.

A) bronchospasm, edema, and mucus production.

20. Hyperpnea and tachypnea: A) cause an increase in minute ventilation. B) are caused by decreased diaphragmatic function. C) are characterized by shallow chest wall movement. D) result from decreased negative-pressure ventilation.

A) cause an increase in minute ventilation.

7. The _________ cartilage forms a complete ring and maintains the trachea in an open position. A) cricoid B) thyroid C) arytenoid D) laryngeal

A) cricoid

73. An increase in the number of EMS calls for patients with chronic respiratory problems MOST commonly occurs: A) during sudden weather changes. B) during an influenza outbreak. C) when the relative humidity is low. D) when people travel during a holiday.

A) during sudden weather changes.

91. A critical step when using a CPAP unit to treat a patient with severe respiratory distress is: A) ensuring an adequate mask seal with minimal leakage. B) holding the mask to the noncompliant patient's face. C) starting with CPAP levels above 10 to 15 cm of water. D) setting the oxygen flow rate to at least 6 L/min.

A) ensuring an adequate mask seal with minimal leakage.

16. Polycythemia is a condition in which: A) excess red blood cells are produced in response to chronic hypoxia. B) an abundance of red blood cells causes severe thinning of the blood. C) fewer red blood cells are produced, resulting in decreased oxygenation. D) increased platelet production causes the blood to become abnormally thick.

A) excess red blood cells are produced in response to chronic hypoxia.

68. The classic presentation of chronic bronchitis is: A) excessive mucus production and a chronic or recurrent productive cough. B) a thin male with pursed-lip breathing and a history of heavy cigarette smoking. C) a dry, hacking cough and a barrel chest due to chronic pulmonary air trapping. D) expiratory wheezing and jugular venous distention due to pulmonary hypertension.

A) excessive mucus production and a chronic or recurrent productive cough.

82. Pickwickian syndrome is a condition in which respiratory compromise results from: A) extreme obesity. B) pulmonary edema. C) cervical spine injury. D) diaphragmatic rupture.

A) extreme obesity.

90. CPAP in the emergency setting is used to treat patients with certain obstructive airway diseases by: A) improving patency of the lower airway through the use of positive-end expiratory pressure. B) maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction. C) increasing the rate and depth of ventilation, thus improving minute volume and mitigating hypoxia. D) delivering one pressure during the inspiratory phase and a different pressure during the expiratory phase.

A) improving patency of the lower airway through the use of positive-end expiratory pressure.

21. In contrast to negative-pressure ventilation, positive-pressure ventilation: A) is the forcing of air into the lungs. B) occurs when the diaphragm descends. C) is provided with a nonrebreathing mask. D) can only be provided to intubated patients.

A) is the forcing of air into the lungs.

84. A hyperventilating patient: A) may be acidotic and is trying to decrease his or her pH level. B) is most effectively treated by administering a sedative drug. C) should rebreathe his or her carbon dioxide to effect resolution. D) presents with tachypnea and marked use of accessory muscles.

A) may be acidotic and is trying to decrease his or her pH level.

75. Intrapulmonary shunting occurs when: A) nonfunctional alveoli inhibit pulmonary gas exchange. B) the volume of anatomic dead space suddenly increases. C) hyperinflated alveoli retain high levels of carbon dioxide. D) resistance to airflow increases due to bronchoconstriction.

A) nonfunctional alveoli inhibit pulmonary gas exchange.

76. Bedridden patients with excessive pulmonary secretions are MOST prone to developing: A) pneumonia. B) bronchospasm. C) a pneumothorax. D) a pulmonary embolism.

A) pneumonia.

30. A patient with orthopnea: A) seeks a sitting position when short of breath. B) is awakened from sleep with severe dyspnea. C) prefers to lie flat in order to facilitate breathing. D) generally has a slow, shallow respiratory pattern.

A) seeks a sitting position when short of breath.

36. A patient with quiet tachypnea is MOST likely experiencing: A) shock. B) asthma. C) alkalosis. D) airway swelling.

A) shock.

35. Paradoxical respiratory movement is characterized by: A) the epigastrium and thorax moving in opposite directions. B) bulging of the intercostal muscles during deep inhalation. C) pulling upward of the suprasternal notch during inhalation. D) a marked decrease in movement in one of the hemithoraces.

A) the epigastrium and thorax moving in opposite directions.

88. When administering a nebulized bronchodilator, the oxygen flow rate should be set to at least ____ liters per minute. A) 4 B) 6 C) 8 D) 10

B) 6

58. Which of the following statements regarding epiglottitis is correct? A) Unlike croup, epiglottitis most commonly occurs in the middle of the night, when the outside temperature is cool. B) Epiglottitis has become relatively rare in children due to vaccinations against the Haemophilus influenzae type b bacterium. C) Most cases of epiglottitis are progressive in their onset and result in severe swelling of the larynx, trachea, and bronchi. D) Characteristic signs of epiglottitis include a low-grade fever, a seal-like barking cough, and varying degrees of respiratory distress.

B) Epiglottitis has become relatively rare in children due to vaccinations against the Haemophilus influenzae type b bacterium.

26. Stretch receptors in the lungs are responsible for the ____________ reflex, which causes you to cough if you take too deep a breath. A) Cushing B) Hering-Breuer C) pneumotaxic D) yawning

B) Hering-Breuer

95. A 66-year-old man with chronic bronchitis presents with severe respiratory distress. The patient's wife tells you that he takes medications for high blood pressure and bronchitis, is on home oxygen therapy, and has recently been taking an over-the-counter antitussive. She further tells you that he has not been compliant with his oxygen therapy. Auscultation of his lungs reveals diffuse rhonchi. What is the MOST likely cause of this patient's respiratory distress? A) Oxygen noncompliance B) Recent antitussive use C) An underlying infection D) Acute right heart failure

B) Recent antitussive use

1. What function do the nasal turbinates serve? A) Separating the left and right nostrils B) Warming and humidifying inhaled air C) Decreasing the surface area of the nasopharynx D) Secreting mucus that traps viruses and bacteria

B) Warming and humidifying inhaled air

38. An otherwise healthy adult whose normal hemoglobin level is 12 to 14 g/dL typically will begin to exhibit cyanosis when: A) hemoglobin levels fall below 12 g/dL. B) about 5 g/dL of hemoglobin is desaturated. C) his or her oxygen saturation falls below 50%. D) 10% of his or her hemoglobin is desaturated.

B) about 5 g/dL of hemoglobin is desaturated.

15. In a person who is not bedridden, most pulmonary infections occur in the: A) middle lobes of the lungs. B) bases of the lungs. C) apices of the lungs. D) upper portion of the lungs.

B) bases of the lungs.

45. Abnormal breath sounds associated with pneumonia and congestive heart failure are MOST often heard in the: A) right middle lobe. B) bases of the lungs. C) apices of the lungs. D) midaxillary line.

B) bases of the lungs.

19. Hypoventilating patients: A) eliminate too much carbon dioxide. B) become hypercapneic and acidotic. C) experience an increase in blood pH. D) typically do not have an open airway.

B) become hypercapneic and acidotic.

47. Inspiratory and expiratory__________ sounds are both loud, but the inspiratory sounds are shorter than the expiratory sounds. A) tracheal B) bronchial C) vesicular D) bronchovesicular

B) bronchial

10. The mainstem bronchus ends at the level of the: A) lobar bronchi. B) bronchioles. C) segmental bronchi. D) subsegmental bronchi.

B) bronchioles.

60. COPD is characterized by: A) narrowing of the smaller airways that is often reversible with prompt treatment. B) changes in pulmonary structure and function that are progressive and irreversible. C) small airway spasms during the inhalation phase, resulting in progressive hypoxia. D) widespread alveolar collapse due to increased pressure during the exhalation phase.

B) changes in pulmonary structure and function that are progressive and irreversible.

67. Emphysema is caused by: A) an abundance of pulmonary surfactant. B) chronic destruction of the alveolar walls. C) excessive mucus production in the bronchi. D) progressive weakening of the lung parenchyma.

B) chronic destruction of the alveolar walls.

43. Digital clubbing is MOST indicative of: A) acute hypoxemia. B) chronic hypoxia. C) right heart failure. D) peripheral vascular disease.

B) chronic hypoxia.

79. When auscultating the lungs of a patient with early pulmonary edema, you will MOST likely hear: A) inspiratory rhonchi to the bilateral apices of the lungs. B) crackles in the bases of the lungs at the end of inspiration. C) faint rhonchi to all lung fields on inspiration and expiration. D) coarse crackles to the bases of the lungs during inspiration.

B) crackles in the bases of the lungs at the end of inspiration.

86. Intubation of a patient with severe asthma: A) is clearly indicated if the patient's condition does not resolve following field corticosteroid therapy. B) is often a last resort because asthmatics are difficult to ventilate and are prone to pneumothoraces. C) should only be performed after hyperventilating the patient with a bag-mask device for 2 to 3 minutes. D) is generally contraindicated because weaning the patient off of a ventilator can take several days.

B) is often a last resort because asthmatics are difficult to ventilate and are prone to pneumothoraces.

53. When present at low levels, oxygen binds easily to hemoglobin molecules, resulting in: A) small changes in oxygen saturation when large changes in PaO2 occur. B) large changes in oxygen saturation when small changes in PaO2 occur. C) small changes in oxygen saturation when small changes in PaO2 occur. D) large changes in oxygen saturation when large changes in PaO2 occur.

B) large changes in oxygen saturation when small changes in PaO2 occur.

78. Uncontrollable coughing and hemoptysis in a cigarette smoker are clinical findings MOST consistent with: A) emphysema. B) lung cancer. C) pleural effusion. D) acute bronchitis.

B) lung cancer.

33. A patient with respiratory distress who is willing to lie flat: A) should be intubated at once. B) may be acutely deteriorating. C) has minimal fluid in the lungs. D) likely has basilar pneumonia.

B) may be acutely deteriorating.

72. Patients with decompensated asthma or COPD who require positive-pressure ventilation: A) should be ventilated routinely at a rate that is slightly faster than the rate for a patient without an underlying pulmonary disease. B) may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly. C) should be intubated promptly and ventilated at a rate of 20 to 24 breaths/min to eliminate excess carbon dioxide. D) should be given forceful positive-pressure breaths because their primary problem is difficulty with inhalation.

B) may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly.

6. On either side of the glottis, tissue forms a pocket called the: A) vallecula. B) piriform fossae. C) cuneiform cartilage. D) hypopharyngeal space.

B) piriform fossae.

94. You are dispatched to a residence for a 59-year-old man with difficulty breathing. The patient, who has a history of COPD, is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. This patient is MOST likely experiencing: A) bronchitis. B) pneumonia. C) end-stage COPD. D) COPD exacerbation.

B) pneumonia.

102. You are transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should: A) continue the CPAP treatment and administer a diuretic to remove fluids from his lungs quickly. B) remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him. C) suspect that he has developed a pneumothorax and prepare to perform a needle chest decompression. D) decrease the amount of positive-end expiratory pressure that you are delivering and reassess.

B) remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.

42. Hepatomegaly and jugular venous distention are MOST suggestive of: A) left heart failure. B) right heart failure. C) pulmonary edema. D) severe pneumonia.

B) right heart failure.

23. Apneustic breathing is characterized by: A) a sustained pattern of tachypnea and increased tidal volume. B) short, brisk inhalations with a long pause before exhalation. C) regular respirations with a normal rate and adequate tidal volume. D) a crescendo-decrescendo pattern of breathing with apneic periods.

B) short, brisk inhalations with a long pause before exhalation.

100. An elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate tidal volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her right upper abdominal quadrant. She tells you that she takes a "water pill" and Vasotec for high blood pressure. You should: A) expect to hear crackles when you auscultate her lungs. B) suspect acute right heart failure and administer oxygen. C) start an IV of normal saline and give her a 250-mL bolus. D) conclude that she has been noncompliant with her diuretic.

B) suspect acute right heart failure and administer oxygen.

4. Common effects of gag reflex stimulation include all of the following, EXCEPT: A) vomiting. B) tachycardia. C) bradycardia. D) increased intracranial pressure.

B) tachycardia.

64. Unlike bronchodilator therapy, corticosteroid therapy: A) causes immediate improvement in breathing. B) takes a few hours to reduce bronchial edema. C) is administered exclusively in a hospital setting. D) is the primary treatment for acute bronchospasm.

B) takes a few hours to reduce bronchial edema.

54. With regard to pulse oximetry, the more hypoxic a patient becomes: A) the slower his or her PaO2 will fall. B) the faster he or she will desaturate. C) the slower he or she will desaturate. D) the less reliable the pulse oximeter is.

B) the faster he or she will desaturate.

85. Patients with obvious respiratory failure require immediate: A) intubation. B) ventilation support. C) passive oxygenation. D) bronchodilator therapy.

B) ventilation support.

66. A patient with a history of asthma is at GREATEST risk for respiratory arrest if he or she: A) takes a bronchodilator and a corticosteroid. B) was previously intubated for his or her condition. C) was recently evaluated in an emergency department. D) has used his or her inhaler twice in the previous week.

B) was previously intubated for his or her condition.

57. Why are children more prone to croup when they acquire a viral infection than adults infected with the same virus? A) Children's immune systems are not as developed as adults', so they are more prone to infection. B) Adults were vaccinated against the virus that causes croup, whereas most children were not. C) A child's airway is narrower than an adult's, and even minor swelling can result in obstruction. D) The virus that causes croup replicates far more aggressively in children than it does in adults.

C) A child's airway is narrower than an adult's, and even minor swelling can result in obstruction.

69. Which of the following clinical findings is MOST suggestive of pneumonia in a patient with COPD? A) Nonproductive cough B) White sputum and rales C) Fever and localized crackles D) Dyspnea and diffuse wheezing

C) Fever and localized crackles

80. A person who experiences sharp chest pain followed by increasing dyspnea after he or she coughs MOST likely has: A) pleurisy. B) a pleural effusion. C) a pneumothorax. D) acute pneumonia.

C) a pneumothorax.

104. You are dispatched to a residence for a young woman with difficulty breathing. When you arrive, you find the patient sitting in a tripod position, noticeably dyspneic and tachypneic. She tells you that she experienced a sudden sharp pain to the left side of her chest and then started having trouble breathing. She denies any past medical history and states that she only takes birth control pills. Based on this patient's clinical presentation, you should be MOST suspicious for: A) a pleural effusion. B) spontaneous pneumothorax. C) acute pulmonary embolism D) hyperventilation syndrome.

C) acute pulmonary embolism

98. A 21-year-old man experienced an acute onset of pleuritic chest pain and dyspnea while playing softball. He is noticeably dyspneic, has an oxygen saturation of 93% on room air, and has diminished breath sounds to the upper right lobe. The MOST appropriate treatment for this patient involves: A) performing a needle decompression to the right side of his chest. B) assisting his ventilations in order to increase his oxygen saturation. C) administering high-flow supplemental oxygen and transporting at once. D) applying a CPAP unit and starting an IV line en route to the hospital.

C) administering high-flow supplemental oxygen and transporting at once.

31. The barrel-chest appearance classically seen in emphysemic patients is secondary to: A) widespread atelectasis. B) chest wall hypertrophy. C) air trapping in the lungs. D) carbon dioxide retention.

C) air trapping in the lungs.

74. A patient who is coughing up thick pulmonary secretions should NOT take: A) a diuretic. B) antihistamines. C) an antitussive. D) bronchodilators.

C) an antitussive.

49. A patient who is coughing up purulent sputum is MOST likely experiencing: A) emphysema. B) dehydration. C) an infection. D) pulmonary edema.

C) an infection.

99. You are transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should: A) remove the nonrebreathing mask and apply a nasal cannula. B) administer a sedative and a paralytic and then intubate his trachea. C) begin assisting his ventilations with a bag-mask and 100% oxygen. D) insert a nasal airway, apply a CPAP unit, and notify medical control.

C) begin assisting his ventilations with a bag-mask and 100% oxygen.

25. An unresponsive patient who overdosed on a central nervous system depressant drug would be expected to have __________ respirations. A) eupneic B) hyperpneic C) bradypneic D) Kussmaul

C) bradypneic

63. The primary treatment of bronchospasm is: A) assisted ventilation. B) humidified oxygen. C) bronchodilator therapy. D) corticosteroid therapy.

C) bronchodilator therapy.

87. Use of a spacer device in conjunction with a metered-dose inhaler: A) is only indicated in children under 6 years of age, who are generally not able to use the inhaler effectively. B) may be required when assisting a patient who is breathing inadequately, but generally results in less medication delivery to the lungs. C) collects medication as it is released from the canister, allowing more to be delivered to the lungs and less to be lost to the environment. D) requires the patient to time his or her inhalation to coincide with the discharge of the metered-dose inhaler.

C) collects medication as it is released from the canister, allowing more to be delivered to the lungs and less to be lost to the environment.

32. If a patient's initial presentation makes you suspicious about a particular respiratory condition, you must: A) begin immediate treatment based on your suspicion. B) make your field impression based on the presentation. C) confirm your suspicions with a thorough assessment. D) immediately perform a focused physical examination.

C) confirm your suspicions with a thorough assessment.

81. One of the hallmarks of a pulmonary embolism is: A) the disappearance of radial pulses during inhalation. B) pleuritic chest pain that occurs after a strong cough. C) cyanosis that does not resolve with oxygen therapy. D) jugular venous distention while in a supine position.

C) cyanosis that does not resolve with oxygen therapy.

18. A patent airway: A) is evidenced by visible chest rise. B) should be prophylactically suctioned. C) does not equate to adequate ventilation. D) is characterized by adequate tidal volume.

C) does not equate to adequate ventilation.

3. The oropharynx and nasopharynx meet in the back of the throat at the: A) larynx. B) hyoid bone. C) hypopharynx. D) glottic opening.

C) hypopharynx.

8. The cricothyroid membrane: A) is a cartilaginous structure located between the thyroid and cricoid cartilages. B) serves as the primary entry point to the airway when a patient is not breathing. C) is relatively avascular and is covered by skin and minimal subcutaneous tissue. D) is a thin membrane that can be palpated easily just above the thyroid cartilage.

C) is relatively avascular and is covered by skin and minimal subcutaneous tissue.

41. Hepatojugular reflux occurs when: A) left-sided heart failure causes blood to accumulate in the patient's liver. B) the jugular veins collapse in response to palpation of the right upper quadrant. C) mild pressure placed on the patient's liver further engorges the jugular veins. D) a patient's jugular veins are markedly engorged when lying in a supine position.

C) mild pressure placed on the patient's liver further engorges the jugular veins.

93. A 76-year-old woman with emphysema presents with respiratory distress that has worsened progressively over the past 2 days. She is breathing through pursed lips and has a prolonged expiratory phase and an oxygen saturation of 76%. She is on home oxygen at 2 L/min. Your initial action should be to: A) increase her oxygen flow rate to 6 L/min. B) administer a beta-2 agonist via nebulizer. C) place her in a position that facilitates breathing. D) auscultate her lungs for adventitious breath sounds.

C) place her in a position that facilitates breathing.

13. Wheezing is resolved with medications that: A) dry up secretions in the lower airway. B) reduce soft tissue swelling in the larynx. C) relax the smooth muscle of the bronchioles. D) cause bronchoconstriction and improved airflow.

C) relax the smooth muscle of the bronchioles.

56. A sudden increase in end-tidal CO2 may be the earliest indicator of: A) ineffective chest compressions. B) inadvertent ET tube dislodgment. C) return of spontaneous circulation. D) developing respiratory alkalosis.

C) return of spontaneous circulation.

37. In contrast to decreased PO2 levels, increased PCO2 levels typically manifest as: A) anxiety. B) combativeness. C) sedation or sleepiness. D) restlessness or confusion.

C) sedation or sleepiness.

48. The presence of diffuse rhonchi (low-pitched crackles) in the lungs indicates: A) right-sided congestive heart failure. B) isolated consolidation of secretions. C) thick secretions in the large airways. D) air being forced through narrowed airways.

C) thick secretions in the large airways.

29. If a patient's hemoglobin level is only 10 g/dL, ___ % would have to be desaturated before he or she would appear cyanotic. A) 10 B) 25 C) 30 D) 50

D) 50

12. What type of medication dries secretions in the airway and prevents the cilia from removing them effectively? A) Diuretic B) Antibiotic C) Antipyretic D) Antihistamine

D) Antihistamine

11. ________ cells are found in the lining of the airways and produce a blanket of mucus that covers the entire lining of the conducting airways. A) Kupfer B) Alveolar C) Ciliary D) Goblet

D) Goblet

89. Which of the following medications is a parasympathetic bronchodilator? A) Alupent B) Albuterol C) Bronkosol D) Ipratropium

D) Ipratropium

97. A morbidly obese man called 9-1-1 because of difficulty breathing. When you arrive, you find the 39-year-old patient lying supine in his bed. He is in marked respiratory distress and is only able to speak in two-word sentences. He has a history of hypertension, but denies any respiratory conditions. What should you do FIRST? A) Begin assisting his ventilations. B) Assess his oxygen saturation level. C) Administer a beta-2 agonist drug. D) Sit him up or place him on his side.

D) Sit him up or place him on his side.

34. Retractions of the sternum or ribs during inhalation: A) are common in patients with emphysema. B) are signs of acute respiratory failure in adults. C) occur when soft tissue is pulled in around the bones. D) are especially common in infants and small children.

D) are especially common in infants and small children.

103. A known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. You should: A) suction his oropharynx, perform intubation, and then administer naloxone via slow IV push. B) preoxygenate him with a bag-mask device for 2 to 3 minutes and then intubate his trachea. C) apply oxygen via nonrebreathing mask, administer naloxone, and be prepared to assist ventilations. D) assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.

D) assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.

71. The hypoxic drive is a phenomenon in which: A) a chronically hypoxic patient's primary respiratory drive is stimulated by increased levels of carbon dioxide in the arterial blood. B) a relatively large percentage of patients with COPD become acutely apneic after receiving high-flow oxygen. C) high levels of oxygen rapidly depress a COPD patient's respiratory rate and depth, leading to worsened hypoxia and severe acidosis. D) bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance.

D) bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance.

92. Use of an automated transport ventilator is NOT appropriate for patients who are: A) in cardiac arrest. B) apneic with a pulse. C) chemically paralyzed. D) breathing spontaneously.

D) breathing spontaneously.

27. The by-product of cellular respiration is: A) oxygen. B) lactic acid. C) pyruvic acid. D) carbon dioxide.

D) carbon dioxide.

59. Pneumonitis is especially common in older patients with: A) frequent infections. B) a history of a stroke. C) immunocompromise. D) chronic food aspiration.

D) chronic food aspiration.

50. Frothy sputum that has a pink tinge to it is MOST suggestive of: A) tuberculosis. B) antihistamine use. C) chronic bronchitis. D) congestive heart failure.

D) congestive heart failure.

70. Patients with COPD typically experience an acute exacerbation of their condition because of: A) a secondary condition such as congestive heart failure or a pneumothorax. B) progressively worsening pneumonia that results in a diminished cough reflex. C) chronic noncompliance with their prescribed medications and home oxygen. D) environmental changes such as weather or the inhalation of trigger substances.

D) environmental changes such as weather or the inhalation of trigger substances.

28. Respiratory alkalosis is the result of: A) carbon dioxide retention. B) slow and shallow respirations. C) increased hydrogen ion production. D) excess carbon dioxide elimination.

D) excess carbon dioxide elimination.

83. You would MOST likely observe a grossly low respiratory rate and volume in a patient who overdosed on: A) LSD. B) ibuprofen. C) Prozac. D) heroin.

D) heroin.

44. The diaphragm of the stethoscope is designed to auscultate: A) heart tones. B) low-pitched sounds. C) bowel sounds. D) high-pitched sounds.

D) high-pitched sounds.

22. Difficulty with exhalation is MOST characteristic of: A) supraglottic swelling. B) upper airway obstruction. C) a mild asthma attack. D) obstructive lung disease.

D) obstructive lung disease.

65. A patient with status asthmaticus commonly presents with: A) compensatory respiratory alkalosis and stridor. B) accessory muscle use and inspiratory wheezing. C) audible expiratory wheezing and severe cyanosis. D) physical exhaustion and inaudible breath sounds.

D) physical exhaustion and inaudible breath sounds.

77. Patients with pneumonia often experience a coughing fit when they roll from one side to the other because: A) movement loosens pulmonary secretions and stimulates coughing. B) most cases of pneumonia occur in conjunction with bronchospasm. C) the secretions in their lungs suddenly disperse and impair breathing. D) pneumonia often occurs in the lung bases, typically on only one side.

D) pneumonia often occurs in the lung bases, typically on only one side.

39. The MOST clinically significant finding when questioning a patient with a chronic respiratory disease is: A) medication use prior to your arrival. B) a recent medication regimen change. C) a recent emergency department visit. D) prior intubation for the same problem.

D) prior intubation for the same problem.

105. You respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the recent past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient's daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically looking. You should: A) apply a nonrebreathing mask, assess his oxygen saturation level, and prepare for immediate transport. B) provide aggressive airway management unless the daughter can produce a valid DNR order. C) intubate him at once, begin transport, and advise the daughter to notify the hospital when she finds the DNR order. D) recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.

D) recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.

17. Cor pulmonale is defined as: A) increased preload caused by severe hypertension. B) left heart failure secondary to mitral valve damage. C) rupture of the alveoli due to increased surface tension. D) right heart failure secondary to chronic lung disease.

D) right heart failure secondary to chronic lung disease.

5. The most obvious external landmark of the larynx is the: A) cricoid cartilage. B) hyoid bone. C) arytenoid cartilage. D) thyroid cartilage.

D) thyroid cartilage.

52. A pulse oximetry reading would be LEAST accurate in a patient: A) with chronic hypoxia. B) whose extremities are cool. C) with persistent tachycardia. D) with poor peripheral perfusion.

D) with poor peripheral perfusion.