Respiratory Emergencies Answers

Chapter 13 Multiple Choice 1. A. B. C. D. Dyspnea is MOST accurately defined as: shortness of breath or difficulty breathing. a complete cessation of respiratory effort. a marked increase in the exhalation phase. labored breathing with reduced tidal volume. Answer: A Question Type: General Knowledge Page: 475 2. A. B. C. D. In what area of the lungs does respiration occur? alveoli trachea bronchi capillaries Answer: A Question Type: General Knowledge Page: 475 3. A. B. C. D. The two processes that occur during respiration are: ventilation and diffusion. inspiration and expiration. diffusion and oxygenation. oxygenation and ventilation. Answer: B Question Type: General Knowledge Page: 476 4. In order for efficient pulmonary gas exchange to occur: A. the percentage of inhaled carbon dioxide must exceed the percentage of inhaled oxygen. B. there must be low quantities of pulmonary surfactant to allow for full alveolar expansion. C. the pulmonary capillaries must be completely constricted and the alveoli must be collapsed. D. oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane. Answer: D Question Type: General Knowledge Page: 476 5. A. B. C. D. In a healthy individual, the brain stem stimulates breathing on the basis of: increased oxygen levels. decreased oxygen levels. increased carbon dioxide levels. decreased carbon dioxide levels. Answer: C Question Type: General Knowledge Page: 476 6. A. B. C. D. When the level of arterial carbon dioxide rises above normal: the brain stem inhibits respirations. respirations increase in rate and depth. exhalation lasts longer than inhalation. respirations decrease in rate and depth. Answer: B Question Type: General Knowledge Page: 476 7. A. B. C. D. Which of the following is MOST characteristic of adequate breathing? 22 breaths/min with an irregular pattern of breathing and cyanosis 20 breaths/min with shallow movement of the chest wall and pallor 24 breaths/min with bilaterally equal breath sounds and pink skin 30 breaths/min with supraclavicular retractions and clammy skin Answer: C Question Type: General Knowledge Page: 478 8. An alert patient presents with a regular pattern of inhalation and exhalation and breath sounds that are clear and equal on both sides of the chest. These findings are consistent with: A. an obstructed airway. B. adequate air exchange. C. respiratory difficulty. D. respiratory insufficiency. Answer: B Question Type: General Knowledge Page: 478 9. A. B. C. D. Which of the following statements regarding the hypoxic drive is MOST correct? The hypoxic drive stimulates a person to breathe on the basis of low oxygen levels. Chronic carbon dioxide elimination often results in activation of the hypoxic drive. The hypoxic drive serves as the primary stimulus for breathing in healthy individuals. 100% supplemental oxygen will always cause apnea in patients with a hypoxic drive. Answer: A Question Type: General Knowledge Page: 478 10. When administering supplemental oxygen to a hypoxemic patient with a chronic lung disease, you should: A. recall that most patients with chronic lung diseases are stimulated to breathe by increased carbon dioxide levels. B. adjust the flow rate accordingly until you see symptom improvement, but be prepared to assist his or her ventilations. C. begin with a low oxygen flow rate, even if the patient is unresponsive, because highflow oxygen may depress his or her breathing. D. avoid positive-pressure ventilation because the majority of patients with chronic lung disease are at increased risk for lung trauma. Answer: B Question Type: General Knowledge Page: 478–479 11. Paroxysmal nocturnal dyspnea (PND), rales, and dependent edema are clinical indicators of: A. emphysema. B. severe pneumonia. C. bronchitis or asthma. D. congestive heart failure. Answer: D Question Type: General Knowledge Page: 479 12. Which of the following conditions would LEAST likely result in hypoxia? A. pleural effusion B. severe anxiety C. pulmonary edema D. prolonged seizures Answer: B Question Type: General Knowledge Page: 479 13. Which of the following statements regarding severe acute respiratory syndrome (SARS) is correct? A. Multiple bacteria have been identified as being the cause of SARS. B. SARS is most commonly transmitted by direct contact with blood. C. The onset of SARS is typically marked by acute, severe pneumonia. D. SARS is a viral infection that often begins with flulike symptoms. Answer: D Question Type: General Knowledge Page: 481 14. Acute pulmonary edema would MOST likely develop as the result of: A. right-sided heart failure. B. severe hyperventilation. C. toxic chemical inhalation. D. an upper airway infection. Answer: C Question Type: General Knowledge Page: 482 15. Weakening of the airway in patients with chronic bronchitis is the result of: A. destruction of protective mechanisms that remove foreign particles. B. loss of the lubricating substance that facilitates alveolar expansion. C. airway irritation caused by a marked decrease in mucus production. D. acute constriction of the bronchioles caused by an external irritant. Answer: A Question Type: General Knowledge Page: 483 16. The respiratory distress that accompanies emphysema is caused by: A. repeated exposure to cigarette smoke. B. chronic stretching of the alveolar walls. C. massive constriction of the bronchioles. D. acute fluid accumulation in the alveoli. Answer: B Question Type: General Knowledge Page: 483 17. Asthma is caused by a response of the: A. immune system. B. endocrine system. C. respiratory system. D. cardiovascular system. Answer: A Question Type: General Knowledge Page: 485 18. At the onset of an acute asthma attack, patients commonly experience difficulty breathing and: A. audible stridor. B. rales and rhonchi. C. profound cyanosis. D. expiratory wheezing. Answer: D Question Type: General Knowledge Page: 485 19. Which of the following statements regarding anaphylaxis is correct? A. Patients with asthma are at lower risk of developing anaphylaxis. B. Anaphylaxis is characterized by airway swelling and hypotension. C. Most anaphylactic reactions occur within 60 minutes after exposure. D. The signs of anaphylaxis are caused by widespread vasoconstriction. Answer: B Question Type: General Knowledge Page: 486 20. A 30-year-old male presents with acute shortness of breath, widespread hives, and facial swelling. He denies any past medical history and takes no medications. During your assessment, you hear wheezing over all lung fields. His blood pressure is 90/50 mm Hg and his heart rate is 110 beats/min. In addition to giving him 100% oxygen, the MOST important treatment for this patient is: A. albuterol. B. epinephrine. C. an antihistamine. D. a beta-antagonist. Answer: B Question Type: Critical Thinking Page: 486 21. A 59-year-old male with a history of emphysema complains of an acute worsening of his dyspnea and pleuritic chest pain following a forceful cough. Your assessment reveals that he has a barrel-shaped chest, unilaterally diminished breath sounds, and tachycardia. What is the MOST likely cause of this patient’s condition? A. rupture of the diaphragm B. exacerbation of his COPD C. acute pulmonary embolism D. spontaneous pneumothorax Answer: D Question Type: Critical Thinking Page: 487 22. A pleural effusion is MOST accurately defined as: A. a unilaterally collapsed lung. B. diffuse collapsing of the alveoli. C. fluid accumulation outside the lung. D. a bacterial infection of the lung tissue. Answer: C Question Type: General Knowledge Page: 487 23. You are dispatched to a residence for a 67-year-old female who was awakened by shortness of breath and sharp chest pain. Her husband tells you that she was recently discharged from the hospital after having hip surgery. Your assessment reveals dried blood around her mouth, facial cyanosis, and an oxygen saturation of 88%. This patient’s presentation is MOST consistent with: A. acute pulmonary edema. B. right-sided heart failure. C. acute pulmonary embolism. D. spontaneous pneumothorax. Answer: C Question Type: Critical Thinking Page: 489 24. Hyperventilation could be associated with all of the following, EXCEPT: A. a narcotic overdose. B. a respiratory infection. C. an overdose of aspirin. D. high blood glucose levels. Answer: A Question Type: General Knowledge Page: 489 25. A young female is unconscious after intentionally ingesting a large amount of aspirin. You will MOST likely find her respirations: A. slow and deep. B. deep and rapid. C. slow and shallow. D. rapid and shallow. Answer: B Question Type: General Knowledge Page: 489 26. Alkalosis is a condition that occurs when: A. blood acidity is reduced by excessive breathing. B. dangerous acids accumulate in the bloodstream. C. the level of carbon dioxide in the blood increases. D. slow, shallow breathing eliminates too much carbon dioxide. Answer: A Question Type: General Knowledge Page: 489 27. Common signs and symptoms of acute hyperventilation syndrome include: A. altered mental status and bradycardia. B. unilateral paralysis and slurred speech. C. anxiety, dizziness, and severe bradypnea. D. tachypnea and tingling in the extremities. Answer: D Question Type: General Knowledge Page: 489 28. A 60-year-old male presents with acute respiratory distress. He is conscious and alert, has pink and dry skin, and has respirations of 24 breaths/min with adequate depth. Which of the following treatment modalities is MOST appropriate for this patient? A. assisted ventilation with a bag-mask device and a head-to-toe exam B. oxygen via nonrebreathing mask and a focused secondary assessment C. positive-pressure ventilations and immediate transport to the closest hospital D. oxygen via a nasal cannula, vital signs, and prompt transport to the hospital Answer: B Question Type: Critical Thinking Page: 492 29. You receive a call for a 70-year-old female with respiratory distress. Her husband tells you that she has congestive heart failure; however, he does not think that she has been taking her medications as prescribed. The patient is laboring to breathe, appears tired, and has cyanosis around her lips. You should: A. assist her ventilations with a bag-mask device. B. apply a pulse oximeter and obtain vital signs. C. administer oxygen via a nonrebreathing mask. D. obtain a complete list of all of her medications. Answer: A Question Type: Critical Thinking Page: 492 30. When auscultating the lungs of a patient with respiratory distress, you hear adventitious sounds. This means that the patient has: A. normal breath sounds. B. abnormal breath sounds. C. diminished breath sounds. D. an absence of breath sounds. Answer: B Question Type: General Knowledge Page: 492 31. When assessing for fluid collection in the lungs during auscultation of lung sounds, you should: A. note the presence of a high-pitched whistling sound, which is an indicator of fluid in the lungs. B. pay special attention to the exhalation phase since this is when you will likely hear rales or rhonchi. C. auscultate the posterior chest first and compare the apex of one lung to the base of the opposite lung. D. start at the lower lung fields and determine at which level you start hearing clear breath sounds. Answer: D Question Type: General Knowledge Page: 492 32. While auscultating an elderly woman’s breath sounds, you hear low-pitched “rattling” sounds at the bases of both of her lungs. With which of the following conditions is this finding MOST consistent? A. acute asthma attack B. widespread atelectasis C. aspiration pneumonia D. early pulmonary edema Answer: C Question Type: General Knowledge Page: 493 33. Harsh, high-pitched inspiratory sounds are characteristic of: A. rales. B. stridor. C. rhonchi. D. wheezing. Answer: B Question Type: General Knowledge Page: 493 34. A conscious and alert 29-year-old female with a history of asthma complains of difficulty breathing that began after her morning jog. The temperature outside is 40°F (5°C). On exam, you hear bilateral expiratory wheezing. After providing 100% oxygen, you should: A. place her in a recumbent position to facilitate breathing. B. contact medical control and administer an antihistamine. C. call medical control and ask how to proceed with treatment. D. determine if she has been prescribed a beta-agonist inhaler. Answer: D Question Type: Critical Thinking Page: 495 35. Which of the following statements regarding pulse oximetry is correct? A. The pulse oximeter is a valuable assessment tool that measures the percentage of red blood cells that contain hemoglobin molecules. B. Caution must be exercised when using the pulse oximeter on a patient with carbon monoxide poisoning because falsely low readings are common. C. Pulse oximetry measures the percentage of hemoglobin that is saturated with oxygen, but does not measure the actual hemoglobin content of the blood. D. Most otherwise healthy patients can maintain adequate oxygenation and good skin color with oxygen saturation readings as low as 70% to 80%. Answer: C Question Type: General Knowledge Page: 499 36. You are dispatched to an apartment complex where a 21-year-old female has apparently overdosed on several narcotic medications. She is semiconscious and has slow, shallow respirations. You should: A. insert an oropharyngeal airway and perform oral suctioning. B. apply oxygen via a nonrebreathing mask and transport at once. C. insert a nasopharyngeal airway and begin assisted ventilation. D. place her in the recovery position and monitor for vomiting. Answer: C Question Type: Critical Thinking Page: 499 37. Albuterol is a generic name for: A. Alupent. B. Atrovent. C. Proventil. D. Singulair. Answer: C Question Type: General Knowledge Page: 502 38. You are assisting an asthma patient with his prescribed metered-dose inhaler. After the patient takes a deep breath and depresses the inhaler, you should: A. instruct him to hold his breath for as long as he comfortably can. B. immediately reapply the oxygen mask and reassess his condition. C. advise him to exhale forcefully to ensure medication absorption. D. allow him to breathe room air and assess his oxygen saturation. Answer: A Question Type: Critical Thinking Page: 504 39. A 22-year-old female patient is complaining of dyspnea and numbness and tingling in her hands and feet after an argument with her fiancé. Her respirations are 40 breaths/min. You should: A. have her breathe into a paper or plastic bag. B. provide reassurance and give oxygen as needed. C. request a paramedic to give her a sedative drug. D. position her on her left side and transport at once. Answer: B Question Type: Critical Thinking Page: 507 40. A 62-year-old man with a history of congestive heart failure presents with severe respiratory distress and an oxygen saturation of 82%. When you auscultate his lungs, you hear widespread rales. He is conscious and alert, is able to follow simple commands, and can only speak in two- to three-word sentences at a time. You should: A. place him in a position of comfort, deliver oxygen via nasal cannula, and closely monitor his breathing. B. apply a continuous positive airway pressure (CPAP) device, monitor his blood pressure, and observe him for signs of improvement or deterioration. C. force fluid from his alveoli by hyperventilating him with a bag-mask device at a rate of at least 20 breaths/min. D. place him in a supine position and assist his ventilations with a bag-mask device and high-flow oxygen. Answer: B Question Type: Critical Thinking Page: 512