EMT - Chapter 16 - Respiratory Emergencies
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16.6.5
You are treating a patient who states that he has been short of breath for the past month. Tonight, his breathing just "got too bad" and he decided to call 911. The 67-year-old male patient is alert and oriented and has a patent airway. He appears to have an adequate tidal volume. His pulse is strong and regular, and his skin is warm. Vital signs are pulse, 92; respirations, 22 breaths/min; blood pressure, 128/66 mmHg; and SpO2, 93% while on home oxygen at 2 lpm. Which instruction would you give to your partner regarding this patient's care?
A.
"Let's go ahead and put the patient on 15 lpm of oxygen."
B.
"Why don't we see how the patient tolerates a nasal airway?"
C.
"The patient seems pretty stable; we can refer him to his family doctor."
D.
"Let's try 4 lpm through a nasal cannula."
D.
"Let's try 4 lpm through a nasal cannula."
16.6.1
A 4-year-old female patient is having great difficulty breathing. She is responsive to verbal stimuli and has an open airway. Her respiratory rate is 40 breaths/min, and she has an SpO2 reading of 88%, which has dropped from 90% despite high-concentration oxygen through a pediatric nonrebreather mask. Her pulse is rapid, and her skin cool to the touch. As a knowledgeable EMT, you would recognize these findings as associated with which condition?
A.
Respiratory failure
B.
Respiratory distress
C.
Respiratory arrest
D.
Cardiopulmonary arrest
A.
Respiratory failure
16.14.10
You have been called to an industrial warehouse for a young adult male patient who was exposed to an unknown chemical gas. The patient was immediately removed from the environment and presents to you with a patent airway, burning to the throat with inspiration, and complaint of shortness of breath. His vital signs are pulse, 120; respirations, 28 breaths/min; blood pressure, 164/60 mmHg; and SpO2, 90%. In addition, you note bilateral wheezing to the lungs. What should be your first action in caring for this patient?
A.
Initiate manual spinal motion restriction
B.
Identify the chemical to which the patient was exposed
C.
Administer supplemental oxygen
D.
Administer a saline mist through a small-volume nebulizer
C.
Administer supplemental oxygen
16.18.9
You realize the EMT is properly ventilating an unresponsive adult male patient when:
A.
You observe the pulse oximeter trending upward
B.
He ventilates smoothly at a rate of 24 breaths/min
C.
He allows 2 seconds between each ventilation
D.
He flexes the patient's head as ventilations are administered
A.
You observe the pulse oximeter trending upward
16.15.2
Within minutes of administering Proventil (albuterol) to a patient through her metered-dose inhaler (MDI), the patient is breathing easier and states that she feels much better. An Emergency Medical Responder on scene asks you how the medication in the MDI helped the patient. Which of these responses would be most appropriate?
A.
"The medication travels to the brain and forces the respiratory rate to increase."
B.
"The medication in the MDI relaxes the throat, allowing more oxygen to enter."
C.
"The medication is an anti-inflammatory and decreases swelling in the lung tissue."
D.
"The medication in the inhaler relaxes and opens up the small airways in the lungs."
D.
"The medication in the inhaler relaxes and opens up the small airways in the lungs."
16.15.8
You are administering a medication through a metered-dose inhaler (MDI) using a spacer. Which of these actions would be most appropriate?
A.
Administer the medication into the spacer and then have the patient inhale
B.
Instruct the patient to inhale slowly just prior to the medication being placed in the spacer
C.
Instruct the patient to exhale slowly as you place the medication into the spacer
D.
Administer the medication into the spacer and then have the patient exhale
A.
Administer the medication into the spacer and then have the patient inhale
16.18.1
When arrive on scene, a family member directs you to a bedroom where a 62-year-old male patient is in respiratory distress. During the scene size-up, which finding would most strongly suggest that the patient suffers from a chronic respiratory disease?
A.
Smell of cigarettes in house and the patient is obese
B.
Furnace turned on high with the humidifier running
C.
Patient in a chair in tripod position and has a barrel-shaped chest
D.
Bottles of aspirin and nitroglycerin on the nightstand
C.
Patient in a chair in tripod position and has a barrel-shaped chest
16.10.1
A 71-year-old female patient complains of the sudden onset of shortness of breath and rapid breathing. She also states that she is experiencing some chest pain that seems to worsen when she takes a deep breath. The primary assessment shows her to be alert and oriented with a patent airway and rapid breathing that is adequate. Her pulse rate is 92 and her blood pressure is 116/68 mmHg. When obtaining a history, which of these statements made by the patient should raise your suspicion that the patient may be experiencing a pulmonary embolism?
A.
"I just started a new blood pressure medication today."
B.
"I had a headache earlier and took an aspirin."
C.
"I had leg surgery five days ago."
D.
"I think that I may also have a fever."
C.
"I had leg surgery five days ago."
16.15.10
You have been called for a patient who complains of shortness of breath. On scene, you find the 41-year-old woman sitting upright in bed with nasal flaring and wheezing. A metered-dose inhaler (MDI) is lying on the nightstand next to her. To assist her with the MDI, which criteria must be met?
A.
The pulse oximeter reading must be less than 90%
B.
High-concentration oxygen must be administered first for 5 minutes
C.
The patient must display altered mental status
D.
The MDI must be prescribed for the patient
D.
The MDI must be prescribed for the patient
16.6.2
You have been called for a 2-year-old male patient who is sick and having a difficult time breathing. On scene, you find the patient in his mother's arms. He appears to have labored breathing and skin that is warm to the touch. Which of these additional assessment findings would you recognize as the most serious?
A.
Grunting noise heard as the child exhales
B.
Slight abdominal movement with breathing
C.
Respiratory rate of 28 breaths/min
D.
Continual crying accompanied by a fever of 99.4degreesF
A.
Grunting noise heard as the child exhales
16.6.4
When assessing a patient who complains of shortness of breath but has an open airway, which action should the EMT perform next?
A.
Get the patient's SpO2 to 100%
B.
Assess the adequacy of the patient's breathing
C.
Determine the cause of the shortness of breath
D.
Ascertain whether the patient has used an MDI
B.
Assess the adequacy of the patient's breathing
16.15.5
After you administer a medication through a metered-dose inhaler (MDI) and the patient has inhaled the medication, it is important that the patient:
A.
Hold her breath for several seconds
B.
Exhale as forcefully as possible
C.
Pant for 10 seconds
D.
Exhale through pursed lips
A.
Hold her breath for several seconds
16.18.7
As you enter the living room of an adult patient who called 911 for shortness of breath, you observe the patient sitting upright in a chair with a panicked look on her face, struggling to breathe, with obvious suprasternal retractions. Her breathing rate appears to be fast and her tidal volume poor. You can hear rhonchi from her lungs without the aid of a stethoscope. Once at her side, your initial care should be to:
A.
Apply oxygen immediately
B.
Assess her airway
C.
Establish her rate of breathing
D.
Auscultate lung sounds
B.
Assess her airway
16.5.1
A patient with a history of COPD is breathing 32 times a minute. Her vital signs are pulse, 140; blood pressure, 168/102 mmHg; and SpO2, 98% on room air. You would classify this patient's condition as:
A.
Bradypnea
B.
Dyspnea
C.
Hypoxia
D.
Apnea
B.
Dyspnea
16.17.9
You have been called for a 3-year-old male patient who is "not breathing right." Aside from a notable expiratory wheeze, which of these findings would be a cause of great concern?
A.
Respiratory rate of 24 breaths/min
B.
Clinging to his mother and crying
C.
Prolonged and forced expiration
D.
Abdominal wall movement with inspiration
C.
Prolonged and forced expiration
16.4.1
You have been dispatched for a young child with difficulty breathing. As you enter the apartment, which scene size-up clue would best indicate that the patient is experiencing a problem in her upper airway?
A.
Low-pitched sobbing and crying
B.
Grunting with exhalation
C.
Stridorous noises with inspiration
D.
Audible wheezing on expiration
C.
Stridorous noises with inspiration
16.2.2
A patient has a medical problem characterized by an increase of interstitial fluid in and around his alveoli. This condition would disrupt normal oxygen and carbon dioxide exchange by creating which type of disturbance?
A.
A perfusion disturbance
B.
A ventilation disturbance
C.
A neurological disturbance
D.
A gas exchange disturbance
D.
A gas exchange disturbance
16.16.1
While you are obtaining a medical history for a patient with generalized weakness and fatigue, she hands you a list of all the medications she is currently taking. Which of these medications should the EMT recognize as a bronchodilator for which the EMT could assist in its administration?
A.
Prednisone
B.
Metformin
C.
Mucomyst
D.
Metaproterenol
D.
Metaproterenol
16.17.3
When a child starts to become hypoxic, the pulse will initially:
A.
Increase
B.
Decrease
C.
Become irregular
D.
Not change
A.
Increase
16.9.2
You are at an extended care facility for the elderly to assess and transport a patient suspected of having pneumonia to the hospital for evaluation. During your pulmonary assessment, which breath sound would you expect to hear that would be most specific to pneumonia versus other pulmonary conditions?
A.
Localized wheezing to one side of the chest
B.
Bilateral rhonchi
C.
Inspiratory stridor
D.
Inspiratory and expiratory crackles to the tops of both lungs
A.
Localized wheezing to one side of the chest
16.6.3
On scene, you find a 2-year-old male patient in significant respiratory distress. He is responsive to painful stimuli and exhibits noisy respirations through an open airway. His breathing is shallow at a rate of 44 breaths/min. His pulse is rapid. Assessment of the skin shows it to be cool and diaphoretic, with cyanosis to the extremities and around the mouth. What is the immediate priority for this patient?
A.
Apply oxygen through a pediatric nonrebreather mask
B.
Move the patient to the ambulance for immediate transport
C.
Insert an oropharyngeal airway
D.
Start positive pressure ventilation
D.
Start positive pressure ventilation
16.14.3
Following a call in which you treated a pediatric patient with croup, a new EMT who is in orientation asks you how you can differentiate croup from epiglottitis. Which of these responses would be most appropriate?
A.
"The swelling associated with epiglottitis typically decreases with exposure to cool air; the swelling with croup does not."
B.
"Croup is typically associated with wheezing; epiglottitis is typically associated with crackles in the lungs."
C.
"Epiglottitis is accompanied by a cough; croup is not associated with a cough."
D.
"The child with epiglottitis is typically drooling; the child with croup rarely, if ever, drools."
D.
"The child with epiglottitis is typically drooling; the child with croup rarely, if ever, drools."
16.18.11
A 26-year-old male patient has summoned EMS after lifting a heavy box and suddenly experiencing shortness of breath and sharp pain to the left side of his chest that worsens with deep inspiration. Given this description, you immediately become suspicious of a pneumothorax. Which action should you perform next to help confirm this suspicion?
A.
Obtain an SpO2 reading
B.
Auscultate breath sounds
C.
Palpate the chest for subcutaneous emphysema
D.
Inquire about past lung problems
B.
Auscultate breath sounds
16.18.8
When assessing an adult patient with difficulty breathing, which of these signs or symptoms would be of most immediate concern?
A.
Temperature of 101.3degreesF
B.
Blue coloration to the lips
C.
Rate between 20 and 24 breaths/min
D.
Cyanosis to the fingernails
B.
Blue coloration to the lips
16.8.1
You are having a hard time getting the past medical history of a patient who is short of breath. Which piece of information would lead the EMT to believe that the patient has a history of chronic lung disease, such as emphysema or chronic bronchitis?
A.
Her respirations are tachypneic
B.
She takes a daily aspirin
C.
She continually coughs
D.
Her chest is barrel shaped
D.
Her chest is barrel shaped
16.14.8
You have been called to a residence for an 18-year-old female patient with shortness of breath and a history of cystic fibrosis. On scene, you find the patient to be very thin and sick looking. Her airway is patent and breathing adequate, although slightly labored. Her radial pulse is strong, and she has a constant cough, which occasionally produces green- and yellow-colored mucus. Auscultation of the lungs reveals rhonchi to the upper portion of both lungs. Vital signs are pulse, 108; respirations, 20 breaths/min; blood pressure, 98/56 mmHg; and SpO2, 92%. Based on these findings, appropriate care should include:
A.
Suctioning of the lower airway to remove mucus
B.
Gentle abdominal thrusts to help the patient expectorate the mucus
C.
A bronchodilator administered via small-volume nebulizer
D.
Humidified oxygen via nasal cannula starting at 2 liters per minute
D.
Humidified oxygen via nasal cannula starting at 2 liters per minute
16.17.8
A 6-year-old female patient is in acute respiratory distress and is still breathing adequately but will not keep the nonrebreather face mask on her face. In this situation, the EMT should:
A.
Start positive pressure ventilation
B.
Immediately transport the patient without oxygen therapy
C.
Secure the mask with tape to the patient's face
D.
Have the mother hold the mask near her daughter's face
D.
Have the mother hold the mask near her daughter's face
16.15.3
Medical direction has ordered you to assist a patient in taking his metered-dose inhaler (MDI). After placing the patient's lips on the mouthpiece, which instruction would be most appropriate?
A.
"Please exhale, hold your breath, and I will administer the medication."
B.
"Please hold your breath and I will administer the medication."
C.
"Please inhale, then hold your breath, and I will give you the medication."
D.
"Please inhale slowly and I will administer the medication, then hold your breath."
D.
"Please inhale slowly and I will administer the medication, then hold your breath."
16.4.8
You are starting to assess a patient's breath sounds and have just listened to the upper right back. You would next listen to the:
A.
Left anterior chest
B.
Left upper back
C.
Left lateral chest
D.
Right lower back
B.
Left upper back
16.1.2
A 48-year-old male patient is short of breath and confused. His airway is open, and his breathing is fast. A radial pulse is easily palpated. His skin is warm to cool and dry. Your partner reports the following vital signs: pulse, 124; respirations, 24 breaths/min; blood pressure, 158/86 mmHg; and SpO2, 89% on room air. The patient's lung sounds indicate slight wheezing. Based on this information, which of these conditions poses the most immediate threat to this patient's well-being?
A.
Hypoxia
B.
Elevated blood pressure
C.
Increased heart rate
D.
Possible infection
A.
Hypoxia
16.14.1
The medication contained within a metered-dose inhaler is in which form?
A.
Viscous gel
B.
Compressed tablet
C.
Pressurized liquid
D.
Aerosolized
D.
Aerosolized
16.18.3
A confused, lethargic, and nonverbal 50-year-old female patient has altered mental status. You are told she has a history of chronic obstructive pulmonary disease (COPD). The primary assessment reveals a respiration rate of 6 breaths/min and cool, clammy skin with cyanosis around the lips. What should be your priority management?
A.
Administer oxygen by nonrebreather mask at 15 lpm
B.
Sit the patient up, assess lung sounds, and obtain a blood pressure
C.
Assist respirations with positive pressure ventilation
D.
Administer oxygen by nasal cannula at 15 lpm
C.
Assist respirations with positive pressure ventilation
16.18.12
The EMT is correctly accessing for accessory muscle use when he examines which part of the body?
A.
Chest
B.
Back
C.
Nares
D.
Inner mouth
A.
Chest
16.11.1
A patient who is nonverbal from a previous stroke is in severe respiratory distress. A family member states that she has multiple medical problems, including high blood pressure, diabetes, and heart failure. When assessing this patient, which sign or symptom would raise your suspicion that the patient has heart failure?
A.
Pursed lip breathing
B.
Diaphoresis
C.
Pulmonary crackles
D.
Edema to left foot
C.
Pulmonary crackles
16.19.2
During your reassessment of the respiratory system and oxygenation status of a patient with a chronic pulmonary condition, which of these would most likely not be part of this reassessment process?
A.
Mental status
B.
Vital signs
C.
Breath sounds
D.
Blood glucose level
D.
Blood glucose level
16.18.10
The EMT is correctly assessing a patient for subcutaneous emphysema when he:
A.
Palpates the anterior and posterior chest
B.
Observes the chest for abnormalities
C.
Examines the neck veins for distention
D.
Listens posteriorly for breath sounds
A.
Palpates the anterior and posterior chest
16.15.11
The EMT is properly using a small-volume nebulizer when she:
A.
Places a spacer on the nebulizer
B.
Shakes the medication canister for 30 seconds prior to administration
C.
Instructs the patient to breathe deeply through his nose
D.
Attaches the nebulizer to oxygen at 8 to 10 lpm
D.
Attaches the nebulizer to oxygen at 8 to 10 lpm
16.13.1
You have arrived on scene to find a 32-year-old male patient who complains of rapid breathing, light-headedness, tachycardia, and numbness and tingling to his lips and hands. Family on scene report that he had just received bad advice from his attorney about a pending divorce when the symptoms started. The patient denies chest pain as well as any other past medical history. His pulse is 124, respirations are 52 breaths/min, and his blood pressure is 158/68 mmHg. What is your first course of action in treating this patient?
A.
Monitor for spasms of the hand muscles and administer nitroglycerin
B.
Have the patient breathe into a paper bag for approximately 5 minutes
C.
Instruct the patient to close his mouth and breathe through his nose
D.
Apply a nonrebreather face mask with low-flow oxygen, allowing the patient to rebreathe his exhaled carbon dioxide
C.
Instruct the patient to close his mouth and breathe through his nose
16.14.7
You have been dispatched to a home for a 16-year-old female patient with shortness of breath. On scene, you find the patient in bed with her mother at her side. Her mother states that her daughter has a fever with a past medical history of cystic fibrosis; she would like to have her daughter transported to the hospital for evaluation of possible pneumonia. As a knowledgeable EMT, you know that the underlying pathophysiology of cystic fibrosis is a:
A.
Contagious disease in which the lungs are damaged by bacteria and excessive coughing
B.
Condition in which excessive and thick mucus often plugs the airways
C.
Hereditary disease in which the lungs are malformed and smaller than normal
D.
Disease in which lifelong antibiotic medications are needed for survival
B.
Condition in which excessive and thick mucus often plugs the airways
16.13.2
On scene, you suspect that a young female patient is suffering from hyperventilation syndrome. Which additional finding would best assist you in confirming this suspicion?
A.
Urinary incontinence
B.
Heart rate of 64 beats/min
C.
Spasm of the hands
D.
Breathing through the mouth
C.
Spasm of the hands
16.4.6
The EMT indicates that he is properly assessing the patient's breath sounds when he gives which of these instructions to the patient?
A.
"Please breathe deeply through your mouth as I listen to your lungs."
B.
"I need to listen to your right lung first and then compare it to your left."
C.
"Please take a deep breath and gently cough as I listen to your lungs."
D.
"Please sit upright and take a deep breath through your nose as I listen to your lungs."
A.
"Please breathe deeply through your mouth as I listen to your lungs."
16.18.2
An alert and oriented 45-year-old female patient complains of shortness of breath. Although her respiratory volume and rate are satisfactory, you note cyanosis in her fingertips and you cannot get the pulse oximeter to show a reading. What should be your next action?
A.
Move the patient to the stretcher for immediate and rapid transport
B.
Place a nasopharyngeal airway and assist respirations
C.
Administer supplemental oxygen
D.
Assist respirations with the bag-valve mask
C.
Administer supplemental oxygen
16.15.1
A 67-year-old male patient complains of shortness of breath. The patient cannot remember how many times he used his inhaler prior to your arrival, but he knows it has been multiple times. He is tachypneic and tachycardic. After administering oxygen, what should be your next action?
A.
Call medical direction for advice
B.
Auscultate the patient's lung sounds and administer the inhaler if you hear wheezing
C.
Assist the patient in the self-administration of his inhaler
D.
Transport the patient to the hospital
A.
Call medical direction for advice
16.19.1
The best way to gauge the effectiveness of oxygen therapy is to monitor the:
A.
Respiratory rate
B.
Mental status
C.
Heart rate
D.
Pulse oximetry
D.
Pulse oximetry
16.15.4
You are assisting a patient in taking her metered-dose inhaler for the first time. Which of these statements about the side effects of the medication would be most appropriate?
A.
"You may experience a runny nose and increase in saliva."
B.
"You may feel anxious and your heart rate may increase."
C.
"The medication may cause you to become very tired and fatigued."
D.
"You will probably not even remember taking the medication."
B.
"You may feel anxious and your heart rate may increase."
16.6.7
A 4-year-old female patient with a decreased level of consciousness is in respiratory distress. Her airway is patent and respirations are 12 per minute. Breath sounds are diminished bilaterally, and there is noted accessory muscle use with inspiration and expiration. Her pulse is 84 and SpO2 88%. What should be your immediate action?
A.
Apply CPAP
B.
Initiate immediate transport to the hospital
C.
Recheck the SpO2 on another finger
D.
Start positive pressure ventilation
D.
Start positive pressure ventilation
16.5.2
A patient with an unknown medical problem is responsive to painful stimuli and breathing poorly at a rate of 8 breaths/min. The airway is patent and the skin warm and moist. The patient's radial pulse is strong and irregular. Breath sounds are absent over the bases of the lungs. Vital signs are pulse, 84; blood pressure, 256/120 mmHg; and SpO2, 81%. The best treatment for this patient's breathing difficulty would be:
A.
2 to 4 liters of oxygen through a nasal cannula
B.
Positive pressure ventilation
C.
High-concentration oxygen through a nonrebreather mask
D.
Continuous positive airway pressure (CPAP)
B.
Positive pressure ventilation
16.7.1
You have been called to a residence for a patient with altered mental status and shortness of breath. On scene, an Emergency Medical Responder meets you and states that he believes the patient had a stroke and is unresponsive. As you enter the room, you see the patient lying in bed with snoring respirations. Oxygen at 15 liters per minute has been applied. Your immediate action when you reach the patient's side would be to:
A.
Perform the head-tilt, chin-lift maneuver
B.
Determine whether the patient has a pulse
C.
Start positive pressure ventilation
D.
Place a nasal airway and suction
A.
Perform the head-tilt, chin-lift maneuver
16.15.9
Your medical director's written protocol instructs you to obtain on-line medical direction prior to assisting a patient with a metered-dose inhaler (MDI). Given this protocol, you must contact:
A.
The medical director after assisting with the MDI
B.
An emergency physician before assisting with the MDI
C.
The patient's family doctor before assisting with the MDI
D.
No one; physician direction is not required when assisting with the MDI
B.
An emergency physician before assisting with the MDI
16.18.13
A patient in respiratory distress is exhibiting pursed lip breathing. You realize that he is doing this to:
A.
Prevent the loss of vapor with exhalation
B.
Keep the small airways open
C.
Inhale additional amounts of oxygen
D.
Exhale increased amounts of CO2
B.
Keep the small airways open
16.3.1
You have been called for a 6-year-old male patient with shortness of breath. On scene, you find the patient with a runny nose and mucus coming from the right nare. Breath sounds are clear and his SpO2 is 99% on room air. When asked, the patient states that his throat is very sore. His vital signs are pulse, 124; respirations, 20 breaths/min; and temperature, 98.9°F. There is no medical history, according to the mother. Which statement or instruction would be most appropriate for this situation?
A.
"Why don't we give him an aspirin for his fever and then you can follow up at your pediatrician's office."
B.
"I am very concerned he may have epiglottitis, so we are going to take him to the hospital with lights and siren."
C.
"He is stable, but we will take him to the hospital. The danger lies in the infection spreading to the lungs."
D.
"Let's give him some oxygen since the heart rate is most likely elevated because his oxygen is low."
C.
"He is stable, but we will take him to the hospital. The danger lies in the infection spreading to the lungs."
16.9.1
An acute infectious disease caused by bacterium or a virus that affects the lower respiratory tract and causes lung inflammation resulting in dyspnea is:
A.
Chronic bronchitis
B.
Asthma
C.
Pneumonia
D.
Emphysema
C.
Pneumonia
16.11.3
An alert and distressed 72-year-old male patient with a history of pulmonary edema from heart failure is in severe respiratory distress, breathing 28 to 32 times per minute. His airway is patent, respirations are labored, crackles are heard in the bases of the lungs, and skin is found to be diaphoretic with a rapid radial pulse. Other vital signs are pulse, 136; blood pressure, 202/110 mmHg; and SpO2, 83%. Cyanosis is evident in the fingertips. The best treatment for this patient's breathing difficulty would be:
A.
Supplemental oxygen via nasal cannula
B.
Nasal airway with high-concentration O2
C.
Albuterol MDI
D.
CPAP
D.
CPAP
16.17.5
What is the typical resting respiratory rate for an elderly patient?
A.
10 breaths/min
B.
20 breaths/min
C.
15 breaths/min
D.
30 breaths/min
B.
20 breaths/min
16.3.2
The EMT understands adequate breathing when he states:
A.
"If the patient is breathing faster than 22 breaths/min, it is inadequate."
B.
"If the respiratory rate is between 10 and 20 breaths/min, with an intact airway and clear breath sounds, it is adequate."
C.
"Normal and adequate breathing is specific to the patient and is determined by assessment."
D.
"If the respiratory rate is between 10 and 20 breaths/min, the breathing is most likely adequate."
C.
"Normal and adequate breathing is specific to the patient and is determined by assessment."
16.12.2
You are delivering positive pressure ventilations to a patient who is breathing poorly and has absent breath sounds in the right lung. Which of these instructions would you provide to those responders who are ventilating the patient?
A.
"If his SpO2 is 85% or greater, let's stop the ventilations and put him on high-concentration oxygen with a face mask."
B.
"Make sure to really get those ventilations into his good lung. He needs the oxygen."
C.
"Use the minimal tidal volume possible, just enough to make the chest rise and fall."
D.
"Let's use just room air for the ventilations. We don't want to cause a tension pneumothorax by giving pure oxygen."
C.
"Use the minimal tidal volume possible, just enough to make the chest rise and fall."
16.6.6
A confused and cyanotic patient is breathing 8 times per minute with poor chest rise and fall. Which instruction would you give your partner about the respiratory care of this patient?
A.
"Deliver a ventilation with the bag-valve mask only when he breathes."
B.
"Since he is breathing, let's go ahead and put him on a nonrebreather mask with 15 lpm of oxygen."
C.
"Ventilate him at 10 times per minute."
D.
"Ventilate him with the bag-valve mask in between each of his breaths."
C.
"Ventilate him at 10 times per minute."
16.17.7
Which of these is considered an early sign of inadequate breathing in children?
A.
Crying
B.
Barrel chest
C.
Blue-gray skin
D.
Nasal flaring
D.
Nasal flaring
16.4.2
A 911 call was placed for a 3-year-old child with difficulty breathing. On scene, you note that the child is upright with slight stridor upon inspiration. He is alert and breathing at a rate of 30 breaths/min. His skin is warm and dry, and his radial pulse strong and regular. His breath sounds are clear and equal. His mother states that he was fine all day until 15 minutes ago, when he was playing with friends in the playroom and suddenly started having difficulty breathing. As an EMT, you should suspect which condition?
A.
Croup
B.
Epiglottitis
C.
Bronchial asthma
D.
Foreign body airway obstruction
D.
Foreign body airway obstruction
16.15.13
When instructing a patient on how to use a small-volume nebulizer, which of these statements would be correct?
A.
"Take nice slow and deep breaths, and try not to cough the medicine out."
B.
"As I depress the trigger on the canister, take in a deep breath."
C.
"It is really important to occasionally cough during the treatment."
D.
"Breathe about 20-30 times per minute so the medication gets into your lungs."
C.
"It is really important to occasionally cough during the treatment."
16.14.4
You arrive on scene for a 9-year-old female patient with a severe cough. Her mother states that she has spoken to her pediatrician, who believes that the child may have whooping cough and should be taken to the hospital for evaluation. Her mother is unsure if her daughter has had all her immunizations. Which of these statements would be most appropriate in regard to the care of this patient?
A.
"She may be contagious, so let's put a surgical mask on her."
B.
"Let's get a full set of vital signs, since this disease can cause heart problems, especially in the young."
C.
"She is probably contagious, so we need to each put on a gown and goggles to protect ourselves."
D.
"Since this condition is caused by a virus, she is not contagious and we just need to transport her."
A.
"She may be contagious, so let's put a surgical mask on her."
16.2.1
Which of these statements regarding ventilation in a healthy patient is true?
A.
Both inspiration and expiration require the same amount of energy
B.
Inspiration and expiration require no energy in a healthy person
C.
Inspiration is an active process that requires energy; expiration requires little to no energy
D.
Inspiration requires little energy; expiration requires much energy
C.
Inspiration is an active process that requires energy; expiration requires little to no energy
16.8.2
You are administering positive pressure ventilation to an elderly male patient with a history of chronic obstructive pulmonary disease (COPD). Which point must you keep in mind as you care for this patient?
A.
High concentrations of oxygen will damage the lungs and must be avoided
B.
High-concentration oxygen is contraindicated for this patient
C.
Use of a CPAP may rupture the lung tissue and cause a pneumothorax
D.
Ventilations must be given with greater force to overcome natural stiffening of the rib cage
C.
Use of a CPAP may rupture the lung tissue and cause a pneumothorax
16.17.4
The mother of a 5-year-old female patient states that her daughter has been "sick" with a sore throat and fever for several days. The mother became concerned tonight and called 911 because the child was "making funny noises" and could not breathe well. Your assessment reveals a lethargic, well-developed child sitting upright and with high-pitched tracheal noises when she breathes in. What should be the priority action for the EMT?
A.
Performing abdominal thrusts
B.
Placing an oropharyngeal airway
C.
Administering supplemental oxygen if indicated
D.
Inspecting the airway with a tongue depressor
C.
Administering supplemental oxygen if indicated
16.14.9
You are transporting a 4-year-old female patient whom you found sitting in a chair with labored respirations, inspiratory stridor, and drooling. Which sign or symptom would warrant immediate reassessment?
A.
The SpO2 drops from 96% to 95%
B.
The patient remains dyspneic
C.
The stridor ceases
D.
The drooling continues.
C.
The stridor ceases
16.14.5
You suspect a patient of being infected with pertussis. While performing the primary assessment, you note a deep cough with clear breath sounds. Her vital signs are pulse, 108; respirations, 16 breaths/min; and SpO2, 96% on room air. Given this scenario, which action by the EMT would be most appropriate?
A.
Assist with use of a metered-dose inhaler
B.
Encourage the patient not to cough
C.
Administer oxygen via nasal cannula
D.
Monitor the patient and transport
D.
Monitor the patient and transport
16.7.3
While talking to your partner one day in between emergency calls, he tells you he has recently read a CE article on pulmonary embolisms. Which of these statements indicates that your partner understands the underlying pathophysiology of how a pulmonary emboli can cause hypoxia?
A.
"The primary cause of a pulmonary emboli is a blood clot from the legs that lodges in the pulmonary veins and prevents blood exiting the alveolar capillary beds from reaching the heart."
B.
"During an embolic process, the alveoli become inflamed and the walls of the alveoli thicken and prevent oxygen transfer, resulting in hypoxia."
C.
"When the pulmonary vasculature becomes blocked by an emboli, then blood cannot reach the alveoli for gas exchange, and hypoxia can result."
D.
"A pulmonary emboli occurs when a small bronchiole of a lung becomes plugged by mucus or a clot in the bloodstream, blocking the movement of air into the alveoli, which results in hypoxia."
C.
"When the pulmonary vasculature becomes blocked by an emboli, then blood cannot reach the alveoli for gas exchange, and hypoxia can result."
16.14.2
A 4-year-old boy in respiratory distress is sitting upright in bed and drooling. His mother states that he complained of a sore throat throughout the day, and tonight became severely short of breath and started drooling. He is alert with adequate breathing. His skin is very warm to the touch. Vital signs are pulse, 132; respirations, 28 breaths/min; and SpO2, 90% on room air. Which is your first action in caring for this child?
A.
Use a tongue depressor to inspect for a foreign body obstruction
B.
Apply supplemental oxygen
C.
Insert an oral airway and start ventilations
D.
Suction the airway of secretions
B.
Apply supplemental oxygen
16.15.6
A patient requires several doses of medication from her metered-dose inhaler. At a minimum, how long should the EMT wait between administrations?
A.
10 minutes
B.
5 minutes
C.
30 seconds
D.
2 minutes
D.
2 minutes
16.4.3
When auscultating breath sounds, the EMT should recognize rhonchi when he hears which type of sound?
A.
Rattling-like noises that change when the patient coughs
B.
Crowing-like sounds that are accompanied by a high-pitched cough
C.
High-pitched whistling-like noises heard more on expiration
D.
Crackling-like noises heard in the upper portion of the lung
A.
Rattling-like noises that change when the patient coughs
16.18.6
A son has called 911 for his father, who is having difficulty breathing. On scene, the 81-year-old patient is lying on a couch in the living room, lethargic, and in obvious respiratory distress. He is confused, but has an open airway. His respirations are 38 breaths/min and shallow, and his skin is extremely diaphoretic with cyanosis in the fingertips. At this time, the EMT should:
A.
Determine the patient's past medical history
B.
Start positive pressure ventilation
C.
Suction the airway of secretions
D.
Assess the patient's breath sounds
B.
Start positive pressure ventilation
16.12.1
You have been called to a home for an 18-year-old male patient, who informs you that he experienced a sudden onset of shortness of breath and back pain while watching television. He has a history of spontaneous pneumothorax, and the current symptoms he is experiencing are identical to those he felt with a previous pneumothorax. Assessment reveals the patient to be slightly dyspneic with breath sounds clear and intact bilaterally. During transport, what is most critical to continually monitor on this patient?
A.
Spasms to the hands
B.
Blood pressure
C.
Breath sounds
D.
Mental status
C.
Breath sounds
16.1.1
Auscultation of breath sounds in a patient complaining of shortness of breath reveals wheezing. Which condition is responsible for this finding?
A.
Significant hypoxia
B.
Mucus in the lungs
C.
Swelling in the throat
D.
Bronchiole constriction
D.
Bronchiole constriction
16.7.2
During an asthma attack, three main pathological changes lead to hypoxia in the patient. Which of these changes is not one of these three?
A.
Decreased alveolar perfusion
B.
Heavy mucus secretion and airway plugging
C.
Bronchospasm
D.
Increased edema to bronchiole walls
A.
Decreased alveolar perfusion
16.4.7
Assessment of a 67-year-old male patient reveals absent lung sounds to the right lung, accompanied by sharp chest pain to the same side. When obtaining a history, which of these statements made by the patient's wife would the EMT recognize as most important?
A.
"He has been in bed for 12 hours."
B.
"He did not take his medications today."
C.
"He has emphysema."
D.
"He had a fever last night."
C.
"He has emphysema."
16.11.2
You are by the side of a 77-year-old male patient with a complaint of shortness of breath. Auscultation of his lungs indicates crackles in the bases. In addition, both of his feet are swollen. His SpO2 on room air is 82%. The remainder of his vital signs are pulse, 144; respirations, 26 breaths/min; and blood pressure 168/90, mmHg. The patient reports lower back pain with a history of a "pinched nerve" in that area. He states that he always has this pain. He has difficulty finishing his sentences without gasping for air. What is the most appropriate care for this patient after initiating oxygen?
A.
Provide spinal motion precautions and secure him to a long spine board for back pain
B.
Apply the AED in case he arrests en route to the hospital
C.
Initiate a bronchodilator through a small-volume nebulizer
D.
Transport him in a sitting position
D.
Transport him in a sitting position
16.17.1
What is the most common cause of cardiac arrest in infants and children?
A.
Abuse and neglect
B.
Respiratory compromise
C.
Accidental overdose
D.
Heart birth defect
B.
Respiratory compromise
16.17.2
When assessing a 3-year-old male patient in respiratory distress, the EMT should recognize "see-saw" breathing when he observes:
A.
Movement of the chest and abdomen in opposite directions
B.
Retraction of the muscles between the ribs
C.
Alternate breathing through the nose and mouth
D.
Up-and-down motion of the head as the patient breathes
A.
Movement of the chest and abdomen in opposite directions
16.15.12
After administering a bronchodilator to a patient through a small-volume nebulizer, which of these statements made by the patient should be of most concern to an EMT?
A.
"My chest feels heavy."
B.
"I suddenly feel nervous."
C.
"My mouth is really dry."
D.
"I feel shaky."
A.
"My chest feels heavy."
16.14.6
Which of these pieces of information would heighten the EMT's suspicion that a child with a persistent cough may have whooping cough?
A.
Never had childhood immunizations
B.
Cough for the past six months
C.
Chest pain while coughing
D.
Cough worse during the day
A.
Never had childhood immunizations
16.8.3
Pursed lip breathing is most commonly observed when a patient has:
A.
Croup
B.
Upper airway obstruction
C.
COPD
D.
Pneumonia
C.
COPD
16.18.4
You are called to a motor vehicle collision. A 26-year-old female states that she was unrestrained and struck the steering column with her chest after the car she was driving hit another car from behind. She is somewhat confused, and complains of chest pain and difficult and painful breathing when she inhales. Her airway is patent and her breathing is adequate. Assessment of the radial pulse reveals it to be rapid and very irregular and weak. The patient has cyanosis in her nose and fingertips. Her breath sounds are clear and equal, and her skin is moist and pale. The patient informs you that she has asthma and has a metered-dose inhaler (MDI). What is your best initial action in treating this patient?
A.
Transport the patient in a supine position on a long spine board
B.
Assist the patient with her MDI
C.
Apply CPAP and transport the patient expediently
D.
Apply supplemental oxygen if indicated
D.
Apply supplemental oxygen if indicated
16.4.5
As you enter a room for an unknown medical emergency, you find an unresponsive male with snoring respirations lying supine in bed. Which action should you take immediately?
A.
Take manual spinal motion restriction precautions
B.
Suction the airway of fluids
C.
Perform a head-tilt, chin-lift maneuver
D.
Start positive pressure ventilation
C.
Perform a head-tilt, chin-lift maneuver
16.15.7
At a health fair, a patient informs you that she has just been prescribed a metered-dose inhaler (MDI) for her asthma. She is confused about how to take the medication when needed. Which of these statements about the MDI would be most appropriate for you to make?
A.
"You should take the medication only after calling your doctor."
B.
"Take it every 4 hours around the clock, even if you feel fine."
C.
"It is important to shake the inhaler vigorously before taking the medication."
D.
"Make sure to store the metered-dose inhaler in your refrigerator."
C.
"It is important to shake the inhaler vigorously before taking the medication."
16.8.4
Why would a patient with COPD have a higher percentage of red blood cells than a healthy person without COPD?
A.
To help prevent spontaneous bleeding in the lungs
B.
To better fight lung infections
C.
To carry additional oxygen to the cells
D.
To make the blood "thinner"
C.
To carry additional oxygen to the cells
16.4.4
When auscultating the lungs of an elderly patient, you note rhonchi-like noises in the upper regions of both lungs. As a knowledgeable EMT, you would recognize that this finding is caused by:
A.
Edema to the bronchioles
B.
Fluid accumulation in the alveoli
C.
Accumulation of mucus in the bronchi
D.
Narrowing of the larger airways
C.
Accumulation of mucus in the bronchi
16.10.2
A new employee of your EMS system is about to take a protocol test in front of the EMS supervisor. As he is reviewing the protocol from memory, he gets confused about which amount of oxygen to administer to a patient with a suspected pulmonary embolism. How would you respond if he asks you for help?
A.
"Administer supplemental oxygen to the patient of sufficient amount to maintain the pulse oximeter reading at or greater than 94%."
B.
"Since a pulmonary embolism is a vascular problem rather than lung problem, administer oxygen to maintain a pulse oximeter reading of greater than 95%."
C.
"A patient with a pulmonary embolism has a perfusion deficit, not a ventilation deficit, so oxygen will not change things. Simply start ventilations and transport the patient."
D.
"Administer 2 liters per minute by nasal cannula to all patients with suspected pulmonary embolism."
A.
"Administer supplemental oxygen to the patient of sufficient amount to maintain the pulse oximeter reading at or greater than 94%."
16.18.5
A 36-year-old patient has overdosed on an unknown drug and is unresponsive. His breathing is shallow, with a rate of 6 breaths/min. He has cyanosis around his lips and to his fingertips. His skin is cool to the touch, and his radial pulse is rapid. His breath sounds are diminished but clear. The EMT should recognize which respiratory condition from this assessment?
A.
Bronchospasm
B.
Hypoxia
C.
Apnea
D.
Tachypnea
B.
Hypoxia
16.16.2
When administering albuterol to a patient with shortness of breath, the EMT realizes that the therapeutic effect of this medication is achieved by:
A.
Decreasing inflammation
B.
Opening the large airways
C.
Decreasing mucus production
D.
Dilating the small airways
D.
Dilating the small airways
16.17.6
As compared to an adult, how would you describe the respiratory rate of an infant?
A.
Faster than an adult's rate
B.
Same as an adult's rate
C.
Normally slower than an adult's rate, unless dyspnea is present
D.
Slower than an adult's rate
A.
Faster than an adult's rate
16.4.9
Which audible respiratory sounds would make you suspicious of an upper airway problem?
A.
Crackles
B.
Stridor
C.
Wheezing
D.
Rhonchi
B.
Stridor