Respitory Questions

Your patient presents complaining of difficulty breathing. He is tachypneic, tripoding, breathing through pursed lips, and has a 30-year history of cigarette smoking. You note diminished lung sounds with inspiratory and expiatory wheezing in all lung fields. Based on this information, he is most likely suffering from:

 

emphysema.

 

chronic bronchitis.

 

pulmonary embolism.

 

pneumonia.

A

Your patient presents complaining of an acute onset of dyspnea. She is tachypneic, tachycardic, and hypotensive. You note jugular venous distention, a oxygen saturation of 89% on room air, and clear and equal lung sounds. Based on this information, she is most likely suffering from:

 

acute pulmonary edema.

 

hyperventilation syndrome.

 

pulmonary embolism.

 

spontaneous pneumothorax.

C

Your patient presents complaining of difficulty breathing. You note a respiratory rate of 24 with adequate tidal volume and 98% oxygen saturation on room air. Based on this information, your patient is most likely experiencing:

 

respiratory distress.

 

cardiac arrest.

 

respiratory arrest.

 

respiratory failure.

A

our patient presents with a respiratory rate of 28 with shallow tidal volume and 90% oxygen saturation. Based on this information, your patient is most likely experiencing:

 

respiratory failure.

 

respiratory distress.

 

cardiac arrest.

 

respiratory arrest.

A

Inadequate oxygen levels in tissue cells is termed:

 

hypoxia.

 

alkalosis.

 

acidosis

 

hypoxemia.

A

Your patient presents conscious and alert complaining of difficulty breathing and chest pain. She states that the pain is on the right side, sharp, and reproducible with breathing. Her vital signs are heart rate 88 per minute, respirations 12 per minute, blood pressure 124/88mmHg. There are wheezes in all lung fields. She has a history of asthma and a heart attack. She has her prescribed metered-dose inhaler and nitroglycerine with her. You should:

 

administer aspirin.

 

assist the patient with her nitroglycerine.

 

assist the patient with her metered-dose inhaler.

 

administer bag-mask device ventilations.

C

A patient presents responsive to painful stimuli only. He has snoring respirations corrected with a head-tilt chin-lift. You note a respiratory rate of 24 with shallow tidal volume, diminished lung sounds with rales in all fields, and a SpO2 of 84% on room air. You should:

 

insert an oropharyngeal airway.

 

administer oxygen via nonrebreather mask.

 

administer continuous positive airway pressure (CPAP).

 

assist ventilations with a bag-mask device.

B

Pursed-lipped breathing is an advantage to the patient with emphysema because it:

 

helps reduce the work of breathing.

 

corrects hypoxia.

 

improves ventilation.

 

improves mental status.

C

A patient with a history of asthma presents with a respiratory rate of 20 per minute with good tidal volume, wheezing in all lung fields, and a SpO2 of 92% on room air. Of the following, the best question to ask would be:

 

“do you have a history of asthma in your family?”

 

“do you have any other past medical history?”

 

“are you allergic to any medications?”

 

“have you used your meter-dose inhaler?”

D

Which of the following positions would be best for a conscious, alert, and oriented patient in respiratory distress secondary to pulmonary edema?

 

Fowler’s

 

sitting straight up

 

semi-Fowler’s

 

supine

B

Which of the following sounds would you expect to hear when percussing the chest of a patient with severe air trapping secondary to asthma?

 

dull

 

flat

 

tympanic

 

hyperresonant

D

In which of the following diseases would you be most likely to identify pulses paradoxus during your clinical exam?

 

pneumonia

 

pertussis

 

hyperventilation syndrome

 

emphysema

D

Inadequate breathing will most immediately result in:

 

hypoxemia.

 

respiratory arrest.

 

cardiac arrest.

 

hypotension.

A

In which of the following diseases would you be most likely to identify barrel chest during your clinical exam?

 

asthma

 

chronic bronchitis

 

epiglottitis

 

emphysema

D

In which of the following diseases would you be most likely to identify subcutaneous emphysema during your clinical exam?

 

acute pulmonary edema

 

epiglottitis

 

emphysema

 

spontaneous pneumothorax

D

Which of the following best indicates that a patient with difficulty breathing is hypoxic?

 

nasal flaring

 

altered mental status

 

tripod position

 

diaphoresis

B

A patient presents to you with a left-sided spontaneous pneumothorax. Which of the following would best suggest that a tension pneumothorax was developing?

 

SpO2 = 96% on room air

 

jugular venous distention

 

hypertension

 

decreased lung sounds on the left

B

The advantage of using a spacer when administering medication via a meter dose inhaler is that a spacer will:

 

remind the patient to hold her breath after inhaling the medication.

 

deliver a greater amount of the medication to the patient.

 

encourage the patient to take a deep breath.

 

allow the patient to exhale more slowly.

A

A patient presents complaining of chest tightness, dizziness, and shortness of breath. Your exam reveals a respiratory rate of 32 per minute with good tidal volume, carpopedal spasms, and an SpO2 of 98% on room air. You should:

 

administer continuous positive airway pressure (CPAP).

 

apply oxygen via a nonrebreather mask.

 

withhold oxygen and coach the patient to slow his breathing.

 

assist ventilations with a BVM.

B

Why is it important to not overventilate a patient suffering from respiratory failure secondary to asthma?

 

decreased cardiac output can result in hypertension.

 

decreased tidal volume can result in increased intrathoracic pressure.

 

air trapping in the lungs can result in decreased preload.

 

increased intrathoracic pressure can create a hemothorax.

C

A patient with a history of asthma and left heart failure presents conscious and alert with a respiratory rate of 22 per minute with adequate tidal volume. You note rales (crackles) up to the middle lobes of both lungs, and her skin is clammy with peripheral cyanosis. The best way to correct the patients underlying problem is to:

 

administer oxygen via nonrebreather mask.

 

assist the patient with a meter dose inhaler.

 

administer continuous positive airway pressure (CPAP).

 

initiate bag-mask device ventilation.

C

A patient with a history of COPD presents conscious though lethargic and confused. You note a respiratory rate of 30 per minute and shallow with diminished lung sounds and wheezing in all lung fields. SpO2 = 82% on room air. You should:

 

administer continuous positive airway pressure (CPAP).

 

assist ventilations with a bag-mask device.

 

administer oxygen via nonrebreather mask.

 

administer oxygen via nasal cannula.

B

Lung sounds produced by mucus in the larger conducting airways of the respiratory tract are termed:

 

rales.

 

stridor.

 

ronchi.

 

wheezing.

C

A patient presents sitting up on the edge of his bed, leaning forward, drooling, with stridorous respirations. His respiratory rate is 20 per minute with adequate tidal volume, and his skin is hot, dry, and pale. You should:

 

insert an oropharyngeal airway.

 

assist ventilations with a bag-mask device.

 

administer oxygen via nonrebreather mask.

 

use a tongue depressor to inspect the airway for obstructions.

C

A patient with a history of asthma presents with an acute onset of dsypnea. She has no other past medical history but does smoke. Her medications include an albuterol meter dose inhaler and birth control pills. Your exam revels clear and equal lung sounds bilaterally, a respiratory rate of 20/minute with adequate tidal volume, and an oxygen saturation of 90% on room air. You should:

 

assist ventilations with a bag-mask device.

 

administer oxygen via nonrebreather mask.

 

have the patient use her meter dose inhaler.

 

administer continuous positive airway pressure (CPAP).

B

A patient with a history of asthma presents conscious though lethargic with a respiratory rate of 6 and shallow. You note very diminished lung sounds with wheezes in all fields. You should:

 

initiate bag-mask device ventilations.

 

assist with the patient’s meter dose inhaler.

 

administer continuous positive airway pressure (CPAP).

 

administer oxygen via nonrebreather mask.

A

A patient with a history of asthma presents in respiratory distress with wheezing in all lung fields. She has her metered dose inhaler with her. You should:

 

assist the patient with using the metered dose inhaler.

 

obtain a full set of vital signs.

 

perform a full secondary exam.

 

ensure that the medication has not expired.

ensure that the medication has not expired.

The direct threat to life with epiglottitis is:

 

airway obstruction.

 

bronchoconstriction.

 

decreased perfusion.

 

alveolar destruction.

A

The accumulation of fluid within and between the alveoli as a result on inadequate cardiac function best describes the pathophysiology of:

 

pulmonary edema.

 

spontaneous pneumothorax.

 

pulmonary embolism.

 

pneumonia.

A

Infection and inflammation of lung tissue with accumulation of fluid and pus best describes the pathophysiology of:

 

pertussis.

 

pneumonia.

 

chronic bronchitis.

 

epiglottitis.

B

Destruction of the alveolar walls, loss of lung tissue elasticity, and air trapping best describe the pathophysiology of:

 

asthma.

 

chronic bronchitis.

 

emphysema.

 

pneumonia.

C

Shortness of breath, chest tightness, and cramping of the fingers are most

characteristic of:

 

pulmonary edema.

 

hyperventilation syndrome.

 

chronic obstructive pulmonary disease.

 

pulmonary embolism.

B

Inadequate perfusion of the pulmonary capillary beds by occlusion of a pulmonary artery best describes the pathophysiology of:

 

hyperventilation syndrome.

 

pneumonia.

 

pulmonary embolism.

 

chronic bronchitis.

C

Bubbly, crackling sounds associated with fluid in the distal airway and lung parenchyma are known as:

 

stridor.

 

wheezing.

 

ronchi.

 

rales.

D

Increased mucus production and edema of the bronchi and bronchioles best describes the pathophysiology of:

 

pneumonia.

 

chronic bronchitis.

 

emphysema.

 

pulmonary edema.

B

Bronchospasm, airway edema, and increased mucus production in the lower airways best describes the pathophysiology of:

 

emphysema.

 

asthma.

 

chronic bronchitis.

 

pneumonia.

B

Continuos positive airway pressure (CPAP) is contraindicated in patients with:

 

asthma.

 

chronic obstructive pulmonary disease (COPD)

 

apnea.

 

congestive heart failure.

C

Which of the following best indicates that a patient is in severe respiratory distress?

 

diaphoresis

 

tripoding

 

tachypnea

 

tachycardia

 

B

Your patient presents in respiratory distress. Your exam reveals an oxygen saturation of 90% on room air, expiratory wheezing to all lung fields, and a nonproductive cough. Based on this information, she is most likely suffering from:

 

chronic bronchitis.

 

pneumonia.

 

pulmonary embolism.

 

asthma.

D

Your patient presents sitting up in a chair complaining of difficulty breathing. She describes waking up from sleep because “I felt like I was being smothered while I was laying down”. Auscultation of the lungs reveals rales (crackles) to the bases bilaterally. Based on this information, she is most likely suffering from:

 

emphysema.

 

acute pulmonary edema.

 

pulmonary embolism.

 

pneumonia.

B

Your patient presents complaining of a rapid onset of fever, fatigue, sore throat with difficulty swallowing. You note that he is sitting forward and drooling and has inspiratory stridor. Based on this information, he is most likely suffering from:

 

epiglottitis.

 

pneumonia.

 

acute pulmonary edema.

 

asthma.

A

A 30 year-old male presents complaining of an acute onset of difficulty breathing. He has no significant medical history, but does smoke 2 packs of cigarettes a day. Lung sounds are clear, but decreased on the left. Based on this information, he is most likely suffering from:

 

chronic bronchitis.

 

emphysema.

 

pulmonary embolism.

 

spontaneous pneumothorax.

D

A 24 year-old male presents with a two-day history of dyspnea with exertion, nonproductive cough, right sided chest pain with deep inspiration, and fever. You note rales (crackles) and rhonchi to the middle right lobe. Based on this information, he is most likely suffering from:

 

spontaneous pneumothorax.

 

chronic bronchitis.

 

asthma.

 

pneumonia.

D

Your patient presents with a one-week history of flu-like symptoms and upper respiratory infection. Tonight, he is experiencing frequent, severe episodes of coughing followed by inspiratory stridor. Based on this information, he is most likely suffering from:

 

epiglottitis.

 

asthma.

 

pneumonia.

 

pertussis.

D

All of the following can result in poor gas exchange across the pulmonary-capillary membrane except:

 

filling of the alveoli with fluid.

 

inadequate pulmonary capillary perfusion.

 

decreased oxygen carrying capacity of the red blood cells.

 

All of the following can result in poor gas exchange across the pulmonary-capillary

membrane except:

D

Dyspnea is MOST accurately defined as:

a complete cessation of respiratory effort.

labored breathing with reduced tidal volume.

shortness of breath or difficulty breathing.

a marked increase in the exhalation phase.

C

what area of the lungs does respiration occur?

Bronchi

Alveoli

Capillaries

Trachea

B

The two processes that occur during respiration are:

diffusion and oxygenation.

oxygenation and ventilation.

inspiration and expiration.

ventilation and diffusion.

B

In order for efficient pulmonary gas exchange to occur:

the percentage of inhaled carbon dioxide must exceed the percentage of inhaled oxygen.

the pulmonary capillaries must be completely constricted and the alveoli must be collapsed.

oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane.

there must be low quantities of pulmonary surfactant to allow for full alveolar expansion.

C

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.

C

When the level of arterial carbon dioxide rises above normal:

the brain stem inhibits respirations.

exhalation lasts longer than inhalation.

respirations increase in rate and depth.

respirations decrease in rate and depth.

C

Which of the following is MOST characteristic of adequate breathing?

24 breaths/min with bilaterally equal breath sounds and pink skin

22 breaths/min with an irregular pattern of breathing and cyanosis

20 breaths/min with shallow movement of the chest wall and pallor

30 breaths/min with supraclavicular retractions and clammy skin

A

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:

• adequate air exchange.

respiratory insufficiency.

an obstructed airway.

respiratory difficulty.

A

Which of the following statements regarding the hypoxic drive is correct?

100% supplemental oxygen will always cause apnea in. patients with a hypoxic drive.

The hypoxic drive serves as the primary stimulus for. breathing in healthy individuals.

Chronic carbon dioxide elimination often results in activation of the hypoxic drive.

The hypoxic drive stimulates a person to breathe on the basis of low oxygen levels.

D

When administering supplemental oxygen to a hypoxemic patient with a chronic lung disease, you should:

avoid positive-pressure ventilation because the majority of patients with chronic lung disease are at increased risk for lung trauma.

adjust the flow rate accordingly until you see symptom improvement, but be prepared to assist his or her ventilations.

begin with a low oxygen flow rate, even if the patient is unresponsive, because high-flow oxygen may depress his or her breathing.

recall that most patients with chronic lung diseases are stimulated to breathe by increased carbon dioxide levels.

B

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

Narcotic overdose

Severe anxiety

Pleural effusion

Pulmonary edema

B

Treatment with continuous positive airway pressure (CPAP) would MOST likely be contraindicated in which of the following situations?

Difficulty breathing, two-word dyspnea, and tachycardia

Shortness of breath and a blood pressure of 76/56 mm Hg

Conscious and alert patient with an oxygen saturation of 85%

Pulmonary edema, history of hypertension, and anxiety

B

Acute pulmonary edema would MOST likely develop as the result of:

an upper airway infection.

right-sided heart failure.

toxic chemical inhalation.

severe hyperventilation.

C

respiratory distress that accompanies emphysema is caused by:

repeated exposure to cigarette smoke.

acute fluid accumulation in the alveoli.

massive constriction of the bronchioles.

chronic stretching of the alveolar walls.

D

Asthma is caused by a response of the:

immune system.

respiratory system.

cardiovascular system.

endocrine system.

A

the onset of an acute asthma attack, patients commonly experience difficulty breathing and:

rales and rhonchi.

profound cyanosis.

• expiratory wheezing.

audible stridor.

C

Which of the following statements regarding anaphylaxis is correct?

The signs of anaphylaxis are caused by widespread vasoconstriction.

Most anaphylactic reactions occur within 60 minutes of exposure.

Patients with asthma are at lower risk of developing anaphylaxis.

Anaphylaxis is characterized by airway swelling and hypotension.

D

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 high-flow oxygen, the MOST important treatment for this patient is:

O epinephrine.

a beta-antagonist.

an antihistamine.

albuterol.

A

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?

Acute pulmonary embolism

• Exacerbation of his COPD.

Rupture of the diaphragm

• Spontaneous pneumothorax

D

pleural effusion is MOST accurately defined as:

diffuse collapsing of the alveoli.

fluid accumulation outside the lung.

a bacterial infection of the lung tissue.

a unilaterally collapsed lung.

B

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%. You should suspect:

right-sided heart failure.

acute pulmonary embolism.

spontaneous pneumothorax.

acute pulmonary edema.

B

Hyperventilation could be associated with all of the following, EXCEPT:

high blood glucose levels.

a respiratory infection.

a narcotic overdose.

an overdose of aspirin.

C

young female is unconscious after intentionally ingesting a large amount of aspirin. You will MOST likely find her respirations:

slow and deep.

rapid and shallow.

slow and shallow.

deep and rapid.

D

Alkalosis is a condition that occurs when:

slow, shallow breathing eliminates too much carbon dioxide.

blood acidity is reduced by excessive breathin

the level of carbon dioxide in the blood increases.

dangerous acids accumulate in the bloodstream.

B

signs and symptoms of acute hyperventilation syndrome include:

anxiety, dizziness, and severe bradypnea.

tachypnea and tingling in the extremities.

altered mental status and bradycardia.

unilateral paralysis and slurred speech.

B

60-year-old male presents with acute respiratory distress.

He is conscious and alert, has pink and dry skin, and has respirations of 22 breaths/min with adequate depth. Which of the following treatments is MOST appropriate for this patient?

Oxygen via nonrebreathing mask and a focused secondary assessment

Assisted ventilation with a bag-valve mask and a head-to-toe exam

Oxygen via a nasal cannula, vital signs, and prompt transport to the hospital

Positive-pressure ventilations and immediate transport to the closest hospital

A

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:

administer oxygen via a nonrebreathing mask.

assist her ventilations with a bag-mask device.

apply a pulse oximeter and assess her vital signs.

obtain a complete list of all of her medications.

B

auscultating the lungs of a patient with respiratory distress, you hear adventitious sounds. This means that the patient has:

diminished breath sounds.

an absence of breath sounds.

normal breath sounds.

abnormal breath sounds.

D

assessing for fluid collection in the lungs during auscultation of lung sounds, you should:

start at the lower lung fields and determine at which level you start hearing clear breath sounds.

auscultate the posterior chest first and compare the apex of one lung to the base of the opposite lung.

note the presence of a high-pitched whistling sound, which is an indicator of fluid in the lungs.

pay special attention to the exhalation phase because this is when you will likely hear rales or rhonchi.

A

While auscultating an elderly woman's breath sounds, you hear low-pitched "rattling" sounds at the bases of both of her lungs. This finding is MOST consistent with which of the following conditions?

Aspiration pneumonia

• Early pulmonary edema.

• Widespread atelectasis

Acute asthma attack

A

Harsh, high-pitched inspiratory sounds are characteristic of:

wheezing.

rales.

stridor.

rhonchi.

C

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 supplemental oxygen, you should:

call medical control and ask how to proceed with treatment.

determine if she has been prescribed a beta-agonist inhaler.

place her in a recumbent position to facilitate breathing.

contact medical control and administer an antihistamine.

B

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:

insert a nasopharyngeal airway and begin assisted ventilation.

apply oxygen via a nonrebreathing mask and transport at once.

insert an oropharyngeal airway and perform oral suctioning.

place her in the recovery position and monitor for vomiting.

A

Albuterol is a generic name for:

Ventolin.

Atrovent.

Singulair.

Alupent.

A

You are assisting an asthma patient with his prescribed metered-dose inhaler. After the patient exhales, and before inhaling, the patient should put his or her lips around the inhaler, take a deep breath, and depress the inhale. You should:

immediately reapply the oxygen mask and reassess his condition.

allow him to breathe room air and assess his oxygen. saturation.

instruct him to hold his breath for as long as he comfortably can.

advise him to exhale forcefully to ensure medication absorption.

C

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:

provide reassurance and give oxygen as needed.

have her breathe into a paper or plastic bag.

position her on her left side and transport at once.

request a paramedic to give her a sedative.

A

62-year-old man with a history of congestive heart failure presents with severe respiratory distress and with 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:

place him in a position of comfort, deliver oxygen via nasal cannula, and closely monitor his breathing.

force fluid from his alveoli by hyperventilating him with a bag-valve mask at a rate of at least 20 breaths/min.

apply a CPAP device, monitor his blood pressure, and observe him for signs of improvement or deterioration.

place him in a supine position and assist his ventilations. with a bag-valve mask and high-flow oxygen.

C

You are assessing a patient with respiratory distress and are unsure if the cause is congestive heart failure or chronic obstructive pulmonary disease (COPD). Which of the following clinical signs would be the MOST helpful in determining whether the patient has chronic heart failure or COPD?

Jugular vein distention
Altered mental status
Rapid breathing
Cyanosis of the skin

A