RCA 141- Basics of Asepsis and Patient Assessment Part 1
What is the normal range for systolic blood pressure in the adult patient? Question options: A) 90 to 140 mm Hg B) 80 to 100 mm Hg C) 75 to 100 mm Hg D) 60 to 100 mm Hg
A) 90 to 140 mm Hg In general, the normal range for systolic blood pressure in the adult is 90 to 140 mm Hg.
Which of the following diseases is transmitted through direct contact? Question options: A) HIV B) Pertussis C) Hepatitis B D) Hepatitis C
A) HIV The only one of those diseases that is transmitted through direct contact is HIV. Hepatitis B and C are both indirect contact, and pertussis is through droplet transmission.
Which of the following is a common cause of pulsus paradoxus? Question options: A) Acute asthma attack B) Severe pneumonia C) Congestive heart failure D) Myocardial infarction
A) Acute asthma attack Pulsus paradoxus can be quantified with a blood pressure cuff and is common in patients with acute obstructive pulmonary disease, especially those suffering from an asthma attack.
During examination of a patient's extremities, you press firmly for a brief period on a fingernail. You observe that it takes approximately 5 sec for the color to return to the nail bed. This finding is most consistent with which of the following? Question options: A) Reduction in cardiac output or poor peripheral perfusion B) Presence of a disorder causing chronic hypoxemia C) Reduction in venous return to the right side of the heart D) Presence of a disorder causing systemic hypertension
??? When cardiac output is reduced and digital perfusion is poor, capillary refill is slow, taking several seconds to complete. In healthy individuals with good cardiac output and digital perfusion, capillary refill time is less than 3 sec.
What term is used to describe the chest pain associated with blockage of the coronary arteries? Question options: A) Angina B) Myocarditis C) Myalgia D) Infarction
A) Angina A common cause of nonpleuritic chest pain is angina, which classically is a pressure sensation with exertion or stress and results from coronary artery occlusion.
An increase in intensity and clarity of vocal resonance because of enhanced transmission of sound is referred to as which of the following? Question options: A) Bronchophony B) Vesicularity C) Pectoriloquy D) Egophony
A) Bronchophony An increase in the intensity and clarity of vocal resonance produced by enhanced transmission of vocal vibrations is called bronchophony.
What disease is associated with a barrel chest? Question options: A) Emphysema B) Heart failure C) Pneumonia D) Pleural effusions
A) Emphysema This abnormal increase in anteroposterior diameter is called barrel chest and is associated with emphysema.
What is the most common cause of hypothermia? Question options: A) Exposure to cold environment B) Head injury C) Stroke D) Thyroid gland dysfunction
A) Exposure to cold environment The most common cause of hypothermia is prolonged exposure to cold.
If you are caring for a patient who is suspected of having SARS, at what distance from the patient is it recommended to wear an effective filtration mask? Question options: A) 6 ft B) 10 ft C) 12 ft D) 15 ft
A) 6 ft Current HICPAC guidelines state it may be prudent to don a mask when within 6 ft of the patient or upon entry into the room of a patient who is on droplet isolation.
What should be used to wipe down the surface of devices that cannot be immersed in water? Question options: A) 70% ethyl alcohol B) Warm soapy water C) Strong detergent D) Bleach
A) 70% ethyl alcohol
While percussing a patient's chest wall, you detect an abnormal increase in resonance. Which of the following are possible causes of this finding? 1. Asthma 2. Pneumothorax 3. Emphysema 4. Pneumonia Question options: A) 1, 2, and 3 only B) 2 and 4 only C) 1, 3, and 4 only D) 1, 2, 3, and 4
A) 1, 2, and 3 only Increased resonance can be detected in patients with hyperinflated lungs. Hyperinflation can result from acute or chronic bronchial obstruction, such as asthma or emphysema.
In which of the following conditions might the intensity of the heart sounds be reduced? 1. Heart failure 2. Severe cachexia 3. Pneumothorax 4. Pleural effusion Question options: A) 1, 3, and 4 only B) 2 and 4 only C) 2, 3, and 4 only D) 1, 2, and 3 only
A) 1, 3, and 4 only Pulmonary hyperinflation, pleural effusion, pneumothorax, and obesity make identification of both S1 and S2 difficult. The intensity of S1 and S2 also decreases when the force of ventricular contraction is poor, as in heart failure, or when valvular abnormalities exist.
In which of the following conditions would late-inspiratory crackles be most likely to occur? 1. Emphysema 2. Pulmonary fibrosis 3. Pneumonia 4. Pulmonary edema Question options: A) 2, 3, and 4 only B) 1, 3, and 4 only C) 3 and 4 only D) 1 and 2 only
A) 2, 3, and 4 only Late-inspiratory crackles are most common in patients with respiratory disorders that reduce lung volume. These disorders include atelectasis, pneumonia, pulmonary edema, and pulmonary fibrosis (Table 16-4).
While palpating the thorax of a patient who repeats the words "ninety-nine," you note a localized area of decreased tactile fremitus on the lower right side. Which of the following could explain this finding? 1. Atelectasis on the right 2. Right-sided lower pneumothorax 3. Right-sided lower pleural effusion 4. Obstruction of a bronchus in the right lung Question options: A) 2, 3, and 4 only B) 1 and 3 only C) 3 and 4 only D) 1, 3, and 4 only
A) 2, 3, and 4 only Tactile fremitus is reduced most often in patients who are obese or overly muscular. In addition, when the pleural space lining the lung becomes filled with air (pneumothorax) or fluid (pleural effusion), fremitus is significantly reduced or absent.
What term is used to describe the breathing pattern seen in COPD patients in whom the lower costal margins of the chest wall draw inward with each inspiration? Question options: A) Hoover's sign B) Kussmaul's sign C) Abdominal paradox sign D) Respiratory alternans sign
A) Hoover's sign Contraction of a flat diaphragm tends to draw in the lateral costal margins, instead of expanding them (Hoover's sign), and does little to help move air into the thorax.
In auscultating the precordium of a patient, you hear a high-pitched "whooshing" noise occurring simultaneously with S1. This finding is most consistent with which of the following? Question options: A) Incompetent mitral valve B) Stenotic tricuspid valve C) Incompetent pulmonic valve D) Stenotic mitral valve
A) Incompetent mitral valve Systolic murmurs are produced by an incompetent atrioventricular (AV) valve or a stenotic semilunar valve. An incompetent AV valve allows a backflow of blood into the atrium, usually producing a high-pitched "whooshing" noise simultaneously with S1.
What is the most common route of pathogen transmission in the hospital setting? Question options: A) Indirect contact B) Droplet transmission C) Airborne transmission D) Surgical transmission Indirect contact transmission is the most frequent mode of transmission in the health care environment.
A) Indirect contact Indirect contact transmission is the most frequent mode of transmission in the health care environment.
Which of the following diseases travels through droplet mode? Question options: A) Influenza B) Rickettsia C) Malaria D) Lyme disease
A) Influenza Influenza travels through droplet mode. Rickettsia, Lyme disease, and malaria are vector-borne.
What breathing pattern is associated with diabetic ketoacidosis? Question options: A) Kussmaul breathing B) Apneustic breathing C) Biot's breathing D) Apnea
A) Kussmaul breathing Patients with diabetic ketoacidosis often breathe with a deep and rapid pattern, which is called Kussmaul breathing.
Which of the following is the most common source of patient infections? Question options: A) Large volume nebulizers B) Small volume nebulizers C) Internal circuits of a ventilator D) Oxygen therapy devices
A) Large volume nebulizers Large volume nebulizers are the worst offenders.
Which of the following changes in the characteristics of wheezing indicate improvement in airway obstruction following bronchodilator therapy? Question options: A) Lower pitch, shorter duration B) Higher pitch, shorter duration C) Lower pitch, longer duration D) Higher pitch, longer duration
A) Lower pitch, shorter duration It is useful to monitor the pitch and duration of wheezing. Improved expiratory flow is associated with a decrease in the pitch and length of the wheezing. For example, if high-pitched wheezing is present during the entire expiratory time before treatment but becomes lower pitched and occurs only late in exhalation after therapy, the pitch and duration of the wheeze have diminished. This suggests that the degree of airway obstruction has decreased.
What term is used to describe difficult breathing in the reclining position? Question options: A) Orthopnea B) Platypnea C) Eupnea D) Apnea
A) Orthopnea Dyspnea may be present only when the patient assumes the reclining position, in which case it is referred to as orthopnea.
What is indicated by the presence of central cyanosis? Question options: A) Respiratory failure B) Circulatory failure C) Anemia D) Hypotension
A) Respiratory failure When respiratory disease reduces arterial oxygen content, cyanosis (a bluish discoloration of the tissues) may be detected, especially around the lips and in the oral mucosa of the mouth (central cyanosis).
In patients with chronic respiratory disease, what does pedal edema indicate? Question options: A) Right ventricular failure B) Impaired pulmonary diffusion C) Systemic hypertension D) Left ventricular hypertrophy
A) Right ventricular failure Pedal edema most often results from heart failure, which causes an increase in the hydrostatic pressure of the venous system and leaking of fluid from the vessels into the surrounding tissues.
What is the most common cause of jugular venous distention (JVD)? Question options: A) Right-sided heart failure B) Arterial hypoxemia C) Tension pneumothorax D) Acute systemic hypertension
A) Right-sided heart failure The most common cause of JVD is the failure of the right side of the heart.
Which of the following is most commonly associated with tripodding? Question options: A) Severe pulmonary hyperinflation B) Congestive heart disease C) Pneumonia D) Pulmonary fibrosis
A) Severe pulmonary hyperinflation The patient with severe pulmonary hyperinflation tends to sit upright while bracing his or her elbows on a table. This helps the accessory muscles gain a mechanical advantage for breathing and is called tripodding.
What term best describes a loud, high-pitched continuous sound heard (often with the unaided ear) primarily over the larynx or trachea during inhalation in patients with upper airway obstruction? Question options: A) Stridor B) Rhonchi C) Crackles D) Wheeze
A) Stridor Another continuous type of adventitious lung sounds heard in certain situations, primarily over the larynx and trachea during inhalation, is stridor. Stridor is a loud, high-pitched sound, which sometimes can be heard without a stethoscope. Most common in infants and small children, stridor is a sign of obstruction in the trachea or larynx. Stridor is most often heard during inspiration.
On palpating the neck region of a patient on a mechanical ventilator, you notice a crackling sound and sensation. What is the most likely cause of this observation? Question options: A) Subcutaneous emphysema B) Upper bronchial obstruction C) Pneumonia of the upper lobes D) Atelectasis of the upper lobes
A) Subcutaneous emphysema Subcutaneous emphysema is caused by air trapped in the subcutaneous tissues and is usually due to an air leak from the lung.
Which of the following is a true statement about the cause of systemic hypertension in adult patients? Question options: A) The cause is often unknown. B) The cause is often related to poor diet. C) The cause is often related to a lack of exercise. D) The cause is often related to sleep apnea.
A) The cause is often unknown. Hypertension is a common medical problem in adults, and the cause is often unknown.
Soft, muffled sounds heard mainly during inspiration over the peripheral lung parenchyma best describe which of the following breath sounds? Question options: A) Vesicular B) Bronchovesicular C) Bronchial D) Tracheal
A) Vesicular When auscultating over the lung parenchyma of a healthy individual, soft, muffled sounds are heard. These normal breath sounds, referred to as vesicular breath sounds, are lower in pitch and intensity than bronchovesicular breath sounds. Vesicular sounds are heard primarily during inhalation, with only a minimal exhalation component (Table 16-2).
What is the recommended dilution level of bleach according to the CDC for cleaning up blood spills? Question options: A) 1:1 B) 1:5 C) 1:10 D) 1:20
C) 1:10 The CDC recommends a 1:10 dilution of bleach (or an Environmental Protection Agency [EPA]-registered disinfectant) to disinfect blood spills.
Which of the following organisms is NOT destroyed by a disinfection agent? Question options: A) Gram-negative cocci B) Bacterial spores C) Gram-positive rods D) Viruses
B) Bacterial spores Disinfection describes a process that destroys the vegetative form of all pathogenic organisms on an inanimate object except bacterial spores.
What is the normal range for diastolic blood pressure in the adult patient? Question options: A) 40 to 80 mm Hg B) 60 to 90 mm Hg C) 80 to 110 mm Hg D) 60 to 110 mm Hg
B) 60 to 90 mm Hg Diastolic pressure is the force in the major arteries remaining after relaxation of the ventricles; it is normally 60 to 90 mm Hg.
Loud, tubular breath sounds with an expiratory component equal to the inspiratory component best describes which of the following breath sounds? Question options: A) Adventitious B) Bronchial C) Vesicular D) Bronchovesicular
B) Bronchial When the expiratory component of harsh breath sounds equals the inspiratory component, they are described as bronchial breath sounds.
What is the first step in equipment processing for reuse on another patient? Question options: A) Drying the equipment B) Cleaning the equipment C) Disinfecting the equipment D) Sterilizing the equipment
B) Cleaning the equipment Cleaning is the first step in all equipment processing.
Inspiratory crackles in patients without excess secretions are most commonly associated with which of the following? Question options: A) Reduced chest-wall sound transmission B) Airways popping open during inspiration C) Complete obstruction of the upper airway D) Mucosal edema or inflammation
B) Airways popping open during inspiration Crackles also may be heard in patients without excess secretions. These crackles occur when collapsed airways pop open during inspiration. Airway collapse or closure can occur in peripheral bronchioles or in larger, more proximal bronchi.
What is indicated by retractions? Question options: A) An increase in PaCO2 B) An increase in the work of breathing C) A decrease in blood flow to the lungs D) Reduction in lung volumes
B) An increase in the work of breathing Increased work of breathing also can result in retractions.
Which of the following represent proper chest auscultation technique? 1. The practitioner should begin auscultation at the lung bases. 2. The patient should be instructed to breathe through an open mouth. 3. The patient should be placed in a comfortable upright position. 4. The patient should avoid deeply inhaling because it can mask certain lung sounds. Question options: A) 1 and 4 only B) 1, 2, and 3 only C) 3 only D) 1, 2, and 4 only
B) 1, 2, and 3 only When possible, the patient should be sitting upright in a relaxed position. Instruct the patient to breathe a little more deeply than normal through an open mouth. Inhalation should be active, with exhalation passive. Place the bell or diaphragm directly against the chest wall when possible, because clothing may produce distortion. The tubing must not be allowed to rub against any objects, because this may produce extraneous sounds, which could be mistaken for adventitious lung sounds.
Which of the following are common causes of tachypnea? 1. Hypoxemia 2. Exercise 3. Narcotic overdose 4. Metabolic acidosis Question options: A) 2, 3, and 4 only B) 1, 2, and 4 only C) 2 and 3 only D) 1 and 4 only
B) 1, 2, and 4 only Rapid respiratory rates are associated with exertion, fever, arterial hypoxemia, metabolic acidosis, anxiety, atelectasis, and pain.
Which of the following abnormalities should the practitioner be on the lookout for during inspection of the extremities? 1. Digital clubbing 2. Peripheral cyanosis 3. Ascites 4. Impaired capillary refill Question options: A) 1 and 2 only B) 1, 2, and 4 only C) 3 and 4 only D) 2 only
B) 1, 2, and 4 only Respiratory disease may cause several abnormalities of the extremities, including digital clubbing, cyanosis, and pedal edema.
Which of the following are causes of hypotension? 1. Heart failure 2. Hypovolemia 3. Mild tachycardia 4. Peripheral vasoconstriction Question options: A) 2 and 4 only B) 1, 2, and 4 only C) 3 and 4 only D) 1, 2, 3, and 4
B) 1, 2, and 4 only The usual causes are left ventricular failure, low blood volume, and peripheral vasodilation.
Which of the following are categories under Expanded Precautions? 1. Contact Precautions 2. Droplet Precautions 3. Standard Precautions 4. Airborne Infection Isolation Question options: A) 1 and 2 only B) 1, 2, and 4 only C) 2, 3, and 4 only D) 1, 2, 3, and 4
B) 1, 2, and 4 only There are four categories of Expanded Precautions: Contact Precautions, Droplet Precautions, Airborne Infection Isolation, and Protective Environment.
What is the minimum recommended time for handwashing in the health care environment? Question options: A) 5 sec B) 15 sec C) 30 sec D) 60 sec
B) 15 sec Hand hygiene includes handwashing with both plain or antiseptic-containing soap and water for at least 15 sec.
Approximately what percent of hospitalized patients develop a health care-associated infection? Question options: A) 1% B) 4% C) 10% D) 25%
B) 4% Patients are at risk for developing infections during their hospital stay. A recent study estimated that 4% of hospitalized patients in the United States develop a health care-associated infection.
A creaking or grating sound that increases in intensity with deep breathing and is similar to coarse crackles, but is not affected by coughing, best describes which of the following? Question options: A) Rhonchi B) Friction rub C) Rales D) Wheezing
B) Friction rub A pleural friction rub is a creaking or grating sound that occurs when the pleural surfaces become inflamed and the roughened edges rub together during breathing, as in pleurisy. It may be heard only during inhalation but often is identified during both phases of breathing.
Which of the following terms is used to describe coughing up blood-streaked sputum? Question options: A) Hematemesis B) Hemoptysis C) Hemolysis D) Hemostasis
B) Hemoptysis Coughing up blood or blood-streaked sputum from the lungs is referred to as hemoptysis.
Which of the following is considered the primary source of infection in the health care setting? Question options: A) Medical equipment B) Humans C) Food and water D) Carpet
B) Humans Humans (patients, personnel, or visitors) are the primary sources for infectious agents in the health care setting.
What term is used to describe shortness of breath in the upright position? Question options: A) Orthopnea B) Platypnea C) Eupnea D) Apnea
B) Platypnea Shortness of breath in the upright position is known as platypnea.
Which of the following would cause an increase in tactile fremitus? Question options: A) Pleural effusion B) Pneumonia C) Emphysema D) Pneumothorax
B) Pneumonia Any condition that increases the density of the lung, such as the consolidation (or alveolar filling) that occurs in pneumonia, increases the intensity of fremitus.
What is the advantage of COPD patients breathing through pursed lips during exhalation? Question options: A) Helps the patient focus on breathing. B) Promotes more complete emptying of the lungs. C) Reduces the patient's anxiety level. D) Improves arterial pH levels.
B) Promotes more complete emptying of the lungs. Breathing through pursed lips during exhalation creates resistance to flow. The increased resistance causes development of a slight backpressure in the small airways during exhalation, which prevents their premature collapse and allows more complete emptying of the lung.
How do endotracheal tubes increase the risk of infection? Question options: A) By increasing bleeding risks B) Providing surfaces for biofilms to develop C) By reducing neutrophil effectiveness D) By increasing mucociliary escalator clearance
B) Providing surfaces for biofilms to develop Endotracheal tubes allow pathogens to increase the risk of infection by impeding local host defenses and providing biofilms that may facilitate adherence of pathogens.
What breathing pattern is associated with severe atelectasis? Question options: A) Rapid and deep B) Rapid and shallow C) Slow and shallow D) Slow and deep
B) Rapid and shallow A significant reduction in lung volume, such as that which occurs with atelectasis, usually results in rapid, shallow breathing.
What two factors determine cardiac output? Question options: A) Ventricular filling and heart rate B) Stroke volume and heart rate C) Stroke volume and respiratory rate D) Heart rate and tidal volume
B) Stroke volume and heart rate The amount of blood circulated per minute (cardiac output) is a function of heart rate and stroke volume.
Why should the respiratory therapist perform a blood pressure assessment fairly quickly? Question options: A) The procedure is expensive. B) The procedure cuts off blood flow to the forearm temporarily. C) The respiratory therapist has other procedures to do. D) The procedure is billed by the time involved.
B) The procedure cuts off blood flow to the forearm temporarily. The clinician must perform the procedure rapidly, because the pressurized cuff impairs circulation to the forearm and hand.
Which of the following is an example of indirect contact transmission involving fomites? Question options: A) Use of a sterile needle on a pneumonia patient B) Use of a dirty laryngoscope blade on another patient C) Drinking tap water D) Inhaling tuberculosis pathogens in the emergency department
B) Use of a dirty laryngoscope blade on another patient Instruments that have been inadequately cleaned between patients before disinfection or sterilization are an example of indirect contact transmission involving fomites.
Which of the following characteristics are typical for pleuritic chest pain? 1. Located laterally. 2. Sharp and stabbing in nature. 3. Increases with breathing. 4. Radiates to the arm. Question options: A) 3 and 4 only B) 1 and 3 only C) 1, 2, and 3 only D) 1, 2, and 4 only
C) 1, 2, and 3 only Pleuritic chest pain usually is located laterally or posteriorly. It worsens when the patient takes a deep breath and is described as a sharp, stabbing type of pain.
Which of the following is the simplest level of infection control based on the recognition that all blood, body fluids, secretions, and excretions may contain transmissible infections agents? Question options: A) Contact Precautions B) Droplet Precautions C) Standard Precautions D) Airborne Infection Isolation
C) Standard Precautions The term Standard Precautions refers to the simplest level of infection control based on the recognition that all blood, body fluids, secretions, and excretions (with the exception of sweat) may contain transmissible infectious agents.
What is the most common, efficient, and easiest sterilization method? Question options: A) ETO B) Flash sterilization C) Steam sterilization D) Use of hydrochlorofluorocarbon
C) Steam sterilization Moist heat in the form of steam under pressure is the most common, efficient, and easiest sterilization method.
Which of the following can be considered a purpose of the interview the RT performs? 1. To collect diagnostic information 2. To establish a rapport with the patient 3. To identify plans for payment 4. To identify the effect of therapy Question options: A) 1 and 4 only B) 2 and 3 only C) 1, 2, and 4 only D) 1, 2, 3, and 4
C) 1, 2, and 4 only Interviewing furnishes unique information because it provides the patient's perspective. It serves the following three related purposes: (1) to establish a rapport between clinician and patient, (2) to obtain essential diagnostic information, and (3) to help monitor changes in the patient's symptoms and response to therapy.
During auscultation of a patient's chest, you hear abnormal discontinuous "bubbling" sounds at the lung bases. Which of the following chart entries best describes this finding? Question options: A) "Bronchial sounds heard at lung bases." B) "Wheezes heard at lung bases." C) "Crackles heard at lung bases." D) "Rhonchi heard at lung bases."
C) "Crackles heard at lung bases." Discontinuous adventitious lung sound types are described as crackles.
Which of the following can cause decreased breath sounds? 1. Air or fluid in the pleural space 2. Hyperinflation of lung tissue 3. Mucus plugging of the airways 4. Shallow or slow breathing Question options: A) 2 and 4 only B) 1, 2, and 3 only C) 1, 2, 3, and 4 D) 2, 3, and 4 only
C) 1, 2, 3, and 4 Airways plugged with mucus and hyperinflated lung tissue attenuate sounds through the lungs. Air or fluid in the pleural space and obesity also reduce sound transmission through the chest wall.
Which of the following are associated with diaphoresis? 1. Fever 2. Severe stress 3. Acute anxiety 4. Hemoptysis Question options: A) 2 and 3 only B) 1 and 4 only C) 1, 2, and 3 only D) 2, 3, and 4 only
C) 1, 2, and 3 only Diaphoresis (sweating) can indicate fever, pain, severe stress, increased metabolism, or acute anxiety.
Which of the following are common causes of an increase in the drive to breathe, which would increase the sensation of dyspnea? 1. Hypoxemia 2. Acidosis 3. High fever 4. Hypocapnia Question options: A) 1 and 4 only B) 2 and 4 only C) 1, 2, and 3 only D) 2, 3, and 4 only
C) 1, 2, and 3 only Increases in the drive to breathe occur with hypoxemia, acidosis, fever, exercise, or anxiety.
A clinician unsuccessfully tried to take the pulse of a patient who is suffering from an asthma attack in the ER. The patient's breath sounds are diminished to absent bilaterally with a BP of 110 mm Hg systolic and 90 mm Hg diastolic. What can be concluded about this patient's condition? 1. Abdominal paradox is present. 2. Lung hyperinflation is present. 3. Pulsus paradoxus is present. 4. Pulse pressure is greater than 30 mm Hg. Question options: A) 2 and 3 only B) 1 and 2 only C) 2 only D) 1, 3, and 4 only
C) 2 only When the pulse pressure is less than 30 mm Hg during spontaneous inhalation, the peripheral pulse is difficult to detect, which is called pulsus paradoxus, or paradoxical pulse. Pulsus paradoxus is the consequence of lung hyperinflation experienced during a severe asthma attack or status asthmaticus.
While percussing a patient's chest wall, you encounter an area that produces a decreased resonance to percussion. Which of the following are potential causes of this finding? 1. Pneumothorax 2. Pleural effusion 3. Pneumonia 4. Atelectasis Question options: A) 2 and 3 only B) 2 and 4 only C) 2, 3, and 4 only D) 1, 2, 3, and 4
C) 2, 3, and 4 only Any abnormality that increases lung tissue density, such as pneumonia, tumor, or atelectasis, results in a loss of resonance and decreased resonance to percussion over the affected area. Pleural spaces filled with fluid, such as blood or water, also produce decreased resonance to percussion.
What is the normal range for pulse pressure? Question options: A) 20 to 35 mm Hg B) 30 to 60 mm Hg C) 30 to 40 mm Hg D) 30 to 60 mm Hg
C) 30 to 40 mm Hg A normal pulse pressure is 30 to 40 mm Hg.
Which of the following statements is false regarding the use of ETO for sterilization? Question options: A) It is harmless to rubber and plastics. B) It will penetrate prewrapping. C) Acute exposure is of little consequence. D) It is useful for equipment that cannot be autoclaved.
C) Acute exposure is of little consequence. Unfortunately, acute exposure to ETO gas can cause airway inflammation, nausea, diarrhea, headache, dizziness, and even convulsions.
Normal heart sounds are created primarily by which of the following? Question options: A) Opening of the heart valves B) Rush of blood during systole C) Closing of the heart valves D) Electrical conduction in the heart
C) Closing of the heart valves Normal heart sounds are created by closure of the heart valves.
Which of the following pulmonary disorders is most likely to result in hepatomegaly? Question options: A) Pulmonary atelectasis B) Acute viral infections C) Cor pulmonale D) Acute asthma
C) Cor pulmonale An enlarged liver is called hepatomegaly and may be caused by right-sided heart failure from chronic hypoxemia (cor pulmonale), although many other causes exist.
What is the most common cause of pedal edema? Question options: A) Liver failure B) Kidney failure C) Heart failure D) Electrolyte imbalances
C) Heart failure Swelling of the lower extremities is known as pedal edema. It most often occurs with heart failure, which causes an increase in the hydrostatic pressure of the blood vessels in the lower extremities.
What vaccination does OSHA require hospital employers to provide? Question options: A) Tuberculosis B) Smallpox C) Hepatitis B D) Streptococcus pneumoniae
C) Hepatitis B OSHA mandates that employers offer hepatitis B vaccination.
What term is used to describe an abnormal anteroposterior curvature of the spine? Question options: A) Scoliosis B) Pectus excavatum C) Kyphosis D) Pectus carinatum
C) Kyphosis Kyphosis is a spinal deformity in which the spine has an abnormal anteroposterior curvature.
In palpating a patient's feet and hands, you note extreme coolness to the touch. This finding is most consistent with which of the following? Question options: A) Presence of a disorder causing chronic hypoxemia B) Reduction in venous return to the right side of the heart C) Peripheral vasoconstriction due to inadequate perfusion D) Presence of a disorder causing systemic hypertension
C) Peripheral vasoconstriction due to inadequate perfusion When perfusion is poor (as in heart failure or shock), the compensatory vasoconstriction in the extremities helps shunt blood to the vital organs. This reduction in peripheral perfusion causes the extremities to become cool to the touch. The extent to which the coolness to touch extends toward the body is an indication of the degree of circulatory failure.
A patient with asthma would tend to exhibit which of the following? Question options: A) Prolonged inhalation B) Slow and shallow breathing C) Prolonged exhalation D) Deep and fast breathing
C) Prolonged exhalation Obstruction of the intrathoracic airways (as occurs with asthma) results in a prolonged exhalation time because airways within the chest tend to narrow more on exhalation.
Which of the following conditions is most likely to cause a dry, nonproductive cough? Question options: A) Chronic bronchitis B) Cystic fibrosis C) Pulmonary fibrosis D) Chronic obstructive pulmonary disease
C) Pulmonary fibrosis For example, a dry, nonproductive cough is typical for restrictive lung diseases such as congestive heart failure or pulmonary fibrosis.
What term is used to describe sputum that has pus in it? Question options: A) Fetid B) Mucoid C) Purulent D) Tenacious
C) Purulent Sputum that contains pus cells is said to be purulent, suggesting a bacterial infection.
Which of the following may cause the trachea to shift to the right? Question options: A) Right-sided tension pneumothorax B) Right-sided large pleural effusion C) Right upper lobe atelectasis D) Left lower lobe pneumonia
C) Right upper lobe atelectasis The trachea shifts away from areas with increased air, fluid, or tissue (e.g., in tension pneumothorax or large pleural effusion) and toward atelectasis. In general, abnormalities in the lung bases do not shift the trachea.
Which of the following statements is NOT true regarding the use of soaps to clean equipment? Question options: A) Soaps act by lowering the surface tension. B) Soaps work poorly in hard water. C) Soaps have good bactericidal activity. D) Soaps can help remove organic material.
C) Soaps have good bactericidal activity. Soaps act by lowering surface tension and forming an emulsion with organic matter. Unfortunately, soaps have little bactericidal activity and work poorly in hard water. A detergent refers to a substance (usually a chemical agent but sometimes a physical one) applied to inanimate objects that destroys disease-causing pathogens but not spores.
What does the presence of stridor indicate? Question options: A) Lower airway obstruction B) Increased secretions in the large airways C) Upper airway obstruction D) Bronchial spasm
C) Upper airway obstruction Another continuous type of adventitious lung sounds heard in certain situations, primarily over the larynx and trachea during inhalation, is stridor. Stridor is a loud, high-pitched sound, which sometimes can be heard without a stethoscope. Most common in infants and small children, stridor is a sign of obstruction in the trachea or larynx. Stridor is most often heard during inspiration.
What is the purpose of an inspiratory HEPA filter in a ventilator circuit? Question options: A) The purpose is to serve as a heated thermistor that prevents condensation from forming in the circuits. B) It prevents pathogens from being expelled into the surroundings. C) When placed between the ventilator and the circuit, it can eliminate bacteria. D) None of the above.
C) When placed between the ventilator and the circuit, it can eliminate bacteria. The purpose of an inspiratory HEPA filter, when it is placed between the ventilator and the external circuit, is to eliminate bacteria from the driving gas and prevent retrograde contamination back into the ventilator.
Which of the following organisms has/have been associated with health care-associated infections in patients using a poorly disinfected bronchoscope? 1. M. tuberculosis 2. Pseudomonas aeruginosa 3. Klebsiella Question options: A) 3 only B) 2 and 3 only C) 1, 2, and 3 D) 1 and 2 only
D) 1 and 2 only Health care-associated infections associated with bronchoscopes have been most commonly reported with M. tuberculosis, nontuberculosis mycobacterium, and P. aeruginosa.
Which of the following factors increase the risk of surgical patients for developing postoperative pneumonia? 1. Obesity 2. Prolonged intubation 3. History of smoking 4. Elderly Question options: A) 1 and 3 only B) 2 and 4 only C) 2, 3, and 4 only D) 1, 2, 3, and 4
D) 1, 2, 3, and 4 Patients at highest risk include elderly persons, the severely obese, those with chronic obstructive pulmonary disease (COPD) or a history of smoking, and those having an artificial airway in place for long periods. Strong cough mechanism actually helps to prevent atelectasis and pneumonia.
Which of the following statements is/are true regarding the use of disposable respiratory care equipment? 1. Recent research supports their use as a cost-effective measure. 2. Many quality issues exist. 3. Reusing the equipment is often done. Question options: A) 1 and 3 only B) 2 and 3only C) 2 only D) 1, 2, and 3
D) 1, 2, and 3 Three major issues are involved in using disposables: cost, quality, and reuse.
In which of the following disorders is digital clubbing a common physical sign? 1. Congenital heart disease 2. Lung cancer 3. Chronic obstructive pulmonary disease 4. Pancreatic cancer Question options: A) 3 only B) 1, 3 and 4 only C) 1, 2, and 4 only D) 1, 2, and 3 only
D) 1, 2, and 3 only Many causes of clubbing exist, including infiltrative or interstitial lung disease, bronchiectasis, various cancers (including lung cancer), congenital heart problems that cause cyanosis, chronic liver disease, and inflammatory bowel disease.
Which of the following are true of early inspiratory crackles? 1. They most often occur in COPD patients. 2. They generally indicate severe airway obstruction. 3. They are affected by coughing or positional change. 4. They are usually scant (few in number). Question options: A) 2 and 4 only B) 1, 2, and 3 only C) 3 and 4 only D) 1, 2, and 4 only
D) 1, 2, and 4 only Early inspiratory crackles are usually scanty but may be loud or faint. They often are transmitted to the mouth and are not silenced by a cough or a change in position. They most often occur in patients with COPD, such as chronic bronchitis, emphysema, or asthma, and usually indicate a severe airway obstruction.
While palpating the chest of a patient who repeats the words "ninety-nine," you note an area of increased tactile fremitus over the left lower lobe. Which of the following could explain this finding? 1. Pneumothorax 2. Emphysema 3. Pneumonia 4. Pleural effusions Question options: A) 2 only B) 1 and 4 only C) 1, 2, and 4 D) 3 only
D) 3 only Tactile fremitus is increased when the lung becomes consolidated as with pneumonia because sound vibrations travel better through a more solid medium.
What term is used to describe the absence of breathing? Question options: A) Orthopnea B) Platypnea C) Eupnea D) Apnea
D) Apnea Apnea is the term used to describe no breathing and is typically caused by cardiac arrest, narcotic overdose, and severe brain trauma.
You observe a patient's breathing pattern as very irregular and interspersed with long periods of apnea. Which of the following is the most likely cause of this problem? Question options: A) Arterial hypoxemia B) Cardiac Arrest C) Chest Trauma D) Central Nervous system disorder
D) Central Nervous system disorder Table 16-2 describes some of the common abnormal patterns of breathing and their causes.
What is indicated by the breathing pattern known as abdominal paradox? Question options: A) Obstructive lung disease B) Restrictive lung disease C) Heart failure D) Diaphragm fatigue
D) Diaphragm fatigue This is recognized by inward movement of the anterior abdominal wall during inspiratory efforts and is seen best with the patient in the supine position. This sign is called abdominal paradox.
Which of the following is least likely to cause tachycardia? Question options: A) Fever B) Severe pain C) Hypotension D) Hypothermia
D) Hypothermia Common causes of tachycardia are exercise, fear, anxiety, low blood pressure, anemia, fever, reduced arterial blood oxygen levels, and certain medications.
During auscultation of a patient's chest, you hear coarse crackles throughout both inspiration and expiration. These sounds clear when the patient coughs. Which of the following is the most likely cause of these adventitious sounds? Question options: A) Opening of closed smaller airways or alveoli B) Opening of collapsed large, proximal airways C) Variable obstruction to flow in the upper airway D) Movement of excessive secretions in the airways
D) Movement of excessive secretions in the airways Excessive mucus in the airways causes crackles that are usually coarse (low pitched) and heard during inspiration and expiration. These crackles often clear when the patient coughs or when the upper airway is suctioned.
Small volume nebulizers produce bacterial aerosols that have been commonly associated with which of the following diseases? Question options: A) Pseudomonas aeruginosa B) Measles C) Small pox D) Nosocomial pneumonia
D) Nosocomial pneumonia Small volume nebulizers produce bacterial aerosols that have been associated with nosocomial pneumonia.
In auscultating the heart sounds of a patient with chronic hypoxemia, you notice a marked increase in the intensity of the second heart sound (S2) and no splitting during inhalation. This finding is most consistent with which of the following? Question options: A) Mitral insufficiency B) Left ventricular hypertrophy C) Tricuspid valve stenosis D) Pulmonary hypertension
D) Pulmonary hypertension Pulmonary hypertension produces an increased intensity of S2. This sound is referred to as a loud P2 and is a result of more forceful closure of the pulmonic valve.
Which of the following factors has minimal or no impact on the effectiveness of the patient's cough? Question options: A) Lung recoil B) Airways resistance C) Lung volume D) Pulmonary vascular resistance
D) Pulmonary vascular resistance The effectiveness of a cough depends on the individual's ability to take a deep breath, his or her lung recoil, the strength of his or her expiratory muscles, and the level of airway resistance.
Which of the following is true of peripheral cyanosis? Question options: A) Reliable indicator of tissue hypoxia. B) Develops early in patients with anemia. C) Develops late in patients with polycythemia. D) Sign of inadequate tissue perfusion.
D) Sign of inadequate tissue perfusion. Cyanosis of the digits is referred to as peripheral cyanosis and is mainly the result of poor blood flow, especially in the extremities.
Which of the following statements is false regarding the use of alcohol disinfectants? Question options: A) Their activity drops when diluted below 50% concentration. B) Alcohols are good for surface cleaning of stethoscope bells and diaphragms. C) They can damage rubber tubing. D) They are considered sporicidal.
D) They are considered sporicidal. Alcohol disinfectants in the health care setting refer to either ethyl alcohol or isopropyl alcohol. Neither is considered a high-level disinfectant as a single agent, they are not sporicidal, and they do not penetrate protein-rich materials. Their activity drops when diluted below 50% concentration. Alcohols are inactivated by protein and can damage rubber, plastics, and the shellac mounting of lensed instruments. Alcohol wipes are a good choice for disinfecting small surfaces, such as medication vial tops. Alcohols are also useful as surface disinfectants for stethoscopes, ventilators, and manual ventilation bags.
