EMT Chapter 16 Respiratory Emergencies

Dyspnea is MOST accurately defined as:

A. a marked increase in the exhalation phase.

B. shortness of breath or difficulty breathing.

C. a complete cessation of respiratory effort.

D. labored breathing with reduced tidal volume.

B. Shortness of breath or difficulty breathing

In a healthy individual, the brainstem stimulates breathing on the basis of:

A. decreased carbon dioxide levels.

B. increased oxygen levels.

C. decreased oxygen levels.

D. increased carbon dioxide levels.

D. increased carbon dioxide levels

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 supplemental oxygen, you should:

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

B. contact medical control and administer an antihistamine.

C. call medical control and ask how to proceed with treatment.

D. place her in a recumbent position to facilitate breathing.

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

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

A. profound cyanosis.

B. audible stridor.

C. expiratory wheezing.

D. rales and rhonchi.

B. audible stridor

Alkalosis is a condition that occurs when:

A. the level of carbon dioxide in the blood increases.

B. slow, shallow breathing eliminates too much carbon dioxide.

C. blood acidity is reduced by excessive breathing.

D. dangerous acids accumulate in the bloodstream.

C. blood acidity is reduced by excessive breathing

A 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?

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

B. Positive-pressure ventilations and immediate transport to the closest hospital

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

D. Oxygen via nonrebreathing mask and a focused secondary assessment

D. Oxygen via nonrebreathing mask and a focused secondary assessment

The two processes that occur during respiration are:

A. diffusion and oxygenation.

B. oxygenation and ventilation.

C. inspiration and expiration.

D. ventilation and diffusion.

C. inspiration and expiration

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

A. an overdose of aspirin.

B. a respiratory infection.

C. high blood glucose levels.

D. a narcotic overdose.

D. a narcotic overdose

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

A. albuterol.

B. epinephrine.

C. a beta-antagonist.

D. an antihistamine.

B. epinephrine

Which of the following statements regarding pulse oximetry is correct?

A. Caution must be exercised when using the pulse oximeter on a patient with carbon monoxide poisoning because falsely low readings are common.

B. The pulse oximeter is a valuable assessment tool that measures the percentage of red blood cells that contain hemoglobin molecules.

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%.

C. Pulse oximetry measures the percentage of hemoglobin that is saturated with oxygen but does not measure the actual hemoglobin content of the blood.

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

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

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

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

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

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

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?

A. Rapid breathing

B. Cyanosis of the skin

C. Jugular vein distention

D. Altered mental status

C. Jugular vein distention

Harsh, high-pitched inspiratory sounds are characteristic of:

A. stridor.

B. wheezing.

C. rhonchi.

D. rales.

A. stridor

A pleural effusion is MOST accurately defined as:

A. diffuse collapsing of the alveoli.

B. a bacterial infection of the lung tissue.

C. fluid accumulation outside the lung.

D. a unilaterally collapsed lung.

C. fluid accumulation outside the lung

When the level of arterial carbon dioxide rises above normal:

A. respirations decrease in rate and depth.

B. respirations increase in rate and depth.

C. exhalation lasts longer than inhalation.

D. the brain stem inhibits respirations.

B. respirations increase in rate and depth

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

A. toxic chemical inhalation.

B. right-sided heart failure.

C. an upper airway infection.

D. severe hyperventilation.

A. toxic chemical inhalation

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?

A. Acute asthma attack

B. Early pulmonary edema

C. Widespread atelectasis

D. Aspiration pneumonia

D. Aspiration pneumonia

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 of exposure.

D. The signs of anaphylaxis are caused by widespread vasoconstriction.

B. Anaphylaxis is characterized by airway swelling and hypotension

The respiratory distress that accompanies emphysema is caused by:

A. repeated exposure to cigarette smoke.

B. acute fluid accumulation in the alveoli.

C. massive constriction of the bronchioles.

D. chronic stretching of the alveolar walls.

D. chronic stretching of the alveolar walls

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

A. Pulmonary edema, history of hypertension, and anxiety

B. Conscious and alert patient with an oxygen saturation of 85%

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

D. Difficulty breathing, two-word dyspnea, and tachycardia

C. Shortness of breath and a blood pressure of 76/56 mmHg

Which of the following is MOST characteristic of adequate breathing?

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

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

C. 30 breaths/min with supraclavicular retractions and clammy skin

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

B. 24 breaths/min with bilaterlaly equal breath sounds and pink skin

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

A. diminished breath sounds.

B. abnormal breath sounds.

C. normal breath sounds.

D. an absence of breath sounds.

B. abnormal breath sounds

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. respiratory insufficiency.

B. adequate air exchange.

C. an obstructed airway.

D. respiratory difficulty.

B. adequate air exchange

Asthma is caused by a response of the:

A. endocrine system.

B. cardiovascular system.

C. respiratory system.

D. immune system.

D. immune system

In what area of the lungs does respiration occur?

A. Capillaries

B. Alveoli

C. Bronchi

D. Trachea

B. Alveoli

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:

A. immediately reapply the oxygen mask and reassess his condition.

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

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

D. advise him to exhale forcefully to ensure medication absorption.

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

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

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

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

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

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

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

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

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

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

C. begin with a low oxygen flow rate, even if the patient is unresponsive, because high-flow 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.

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

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. apply a pulse oximeter and assess her vital signs.

B. assist her ventilations with a bag-mask device.

C. obtain a complete list of all of her medications.

D. administer oxygen via a nonrebreathing mask.

B. assist her ventilations with a bag-mask device

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%. You should suspect:

A. right-sided heart failure.

B. spontaneous pneumothorax.

C. acute pulmonary embolism.

D. acute pulmonary edema.

C. acute pulmonary embolism

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

A. Severe anxiety

B. Pulmonary edema

C. Pleural effusion

D. Narcotic overdose

A. severe anxiety

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. Spontaneous pneumothorax

C. Acute pulmonary embolism

D. Exacerbation of his COPD

B. Spontaneous pneumothorax

In order for efficient pulmonary gas exchange to occur:

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

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

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

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

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

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 a nasopharyngeal airway and begin assisted ventilation.

B. apply oxygen via a nonrebreathing mask and transport at once.

C. insert an oropharyngeal airway and perform oral suctioning.

D. place her in the recovery position and monitor for vomiting.

A. insert a nasopharyngeal airway and begin assisted ventilation

Albuterol is a generic name for:

A. Atrovent.

B. Alupent.

C. Singulair.

D. Ventolin.

D. ventolin

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. request a paramedic to give her a sedative.

B. position her on her left side and transport at once.

C. provide reassurance and give oxygen as needed.

D. have her breathe into a paper or plastic bag.

C. provide reassurance and give oxygen as needed

Common signs and symptoms of acute hyperventilation syndrome include:

A. tachypnea and tingling in the extremities.

B. unilateral paralysis and slurred speech.

C. altered mental status and bradycardia.

D. anxiety, dizziness, and severe bradypnea.

A. tachypnea and tingling in the extremities

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

A. rapid and shallow.

B. slow and shallow.

C. slow and deep.

D. deep and rapid.

D. deep and rapid

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:

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

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

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

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

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

A 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?

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

B. Oxygen via nonrebreathing mask and a focused secondary assessment

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

D. Positive-pressure ventilations and immediate transport to the closest hospital

B. oxygen via a nasal cannula, vital signs, and prompt transport to the hospital