Chapter 16: Respiratory Emergencies - Emergency Care and Transportation of the Sick and Injured, 12e

Asthma is caused by a response of the:

Select one:

A. respiratory system.

B. immune system.

C. cardiovascular system.

D. endocrine system.

The correct answer is: immune system.

The process in which oxygen and carbon dioxide are exchanged in the lungs is called:

A. respiration.

B. ventilation.

C. metabolism.

D. inhalation.

A. respiration.

Which of the following respiratory diseases causes obstruction of the lower airway?

A. Croup

B. Asthma

C. Epiglottitis

D. Laryngitis

B. Asthma

Which of the following diseases is potentially drug resistant and is thought to be transmitted by coughing?

A. Tuberculosis

B. Croup

C. Diphtheria

D. Epiglottitis

A. Tuberculosis

All of the following are causes of acute dyspnea, EXCEPT:

A. asthma.

B. emphysema.

C. pneumothorax.

D. pulmonary embolism.

B. emphysema.

Bronchospasm is MOST often associated with:

a. asthma.

b. bronchitis.

c. pneumonia.

d. pneumothorax.

a. asthma.

A sudden onset of difficulty breathing, sharp chest pain, and cyanosis that persists despite supplemental oxygen is MOST consistent with:

A. severe pneumonia.

B. myocardial infarction.

C. a pulmonary embolism.

D. a spontaneous pneumothorax.

C. a pulmonary embolism.

Albuterol, a beta-2 agonist, is the generic name for:

A. Alupent.

B. Metaprel.

C. Brethine.

D. Ventolin.

D. Ventolin.

An acute bacterial infection that results in swelling of the flap that covers the larynx during swallowing is called:

A. croup.

B. laryngitis.

C. epiglottitis.

D. diphtheria.

C. epiglottitis.

A 70-year-old man recently had a heart attack and now complains of severe difficulty breathing, especially when lying flat. He is coughing up pink, frothy secretions. This patient is MOST likely experiencing:

A. acute right heart failure.

B. severe left heart failure.

C. an acute onset of bronchitis.

D. an acute pulmonary embolism.

B. severe left heart failure.

Which of the following patients is breathing adequately?

A. 36-year-old man with cyanosis around the lips and irregular respirations

B. 29-year old woman with respirations of 20 breaths/min, who is conscious and alert

C. 22-year-old man with labored respirations at a rate of 28 breaths/min and pale skin

D. 59-year-old woman with difficulty breathing, whose respirations are rapid and shallow

B. 29-year old woman with respirations of 20 breaths/min, who is conscious and alert

It is mid-February and you respond to a local movie theater for a 42-year-old man with respiratory distress. Upon arrival, you and your partner are directed to the lobby where you observe a patient who appears to be having trouble breathing. The patient is leaning forward and speaking in short bursts. You notice the patient is using accessory muscles in his neck to help with breathing. The patient informs you he was standing outside in the cold for over 20 minutes waiting for a friend. He has a remote history of asthma, but has not had an attack in several years. The patient denies any other past medical history, takes no medications, and has no allergies. Vital signs show: pulse, 106 beats/min; respirations, 26 breaths/min and labored; blood pressure, 142/88 mm Hg; and Spo2, 91%. Your physical examination reveals obvious accessory muscle use to the chest and neck and diffuse wheezing in all lung fields. 1. Which of the following medications can be used for the treatment of an acute asthma attack?

A. Cromolyn

B. Albuterol

C. Fluticasone

D. Salmeterol

B. Albuterol

2. Which of the following statements is true regarding asthma? A. Asthma involves accumulation of air in the pleural space. B. Asthma involves a collection of fluid in the pleural space. C. Asthma involves spasms of the bronchi and bronchioles. D. Asthma involves a collection of fluid in the alveoli.

C - spasms of the bronchi and bronchioles

3. The patient is exhibiting signs of respiratory distress, such as accessory muscle use and difficulty speaking. Which of the following is also a sign of respiratory distress?

A. Pursed lip breathing

B. Respiratory rate of 16 breaths/min

C. Warm, pink skin

D. Clear and equal breath sounds

A. Pursed lip breathing

4. You ask your partner to administer oxygen therapy. What is the most appropriate method for oxygen delivery to this patient?

A. Nasal cannula at 2 to 6 L/min

B. Nonrebreathing mask at 15 L/min

C. Venturi mask at 8 L/min

D. Bag-mask device at 15 L/min

B. Nonrebreathing mask at 15 L/min

5. When assisting an patient who has asthma with a small-volume nebulizer attached to oxygen, what is the appropriate flow rate for the oxygen?

A. 2 L/min

B. 4 L/min

C. 6 L/min

D. 10 L/min

C. 6 L/min

6. In addition to asthma, which of the following conditions is associated with wheezing?

A. Croup

B. Epiglottitis

C. Pulmonary embolism

D. Bronchitis

D. Bronchitis

7. While administering a nebulizer of albuterol to your patient, you assess for possible side effects to the medication. Which of the following is typically NOT a side effect of nebulized albuterol?

A. Vomiting

B. Increased pulse rate

C. Nervousness

D. Muscle tremors

A. Vomiting

8. In addition to asthma, wheezing can be caused by COPD. What are the underlying causes of chronic bronchitis and emphysema?

Answer: Chronic bronchitis is a condition resulting in ongoing irritation of the trachea and bronchi. Excess mucus production causes obstruction of the smaller airways. Further weakening of the airways results from a loss of protective cells and mechanisms needed to remove foreign particles from the airways. Although there are numerous causes of chronic bronchitis, cigarette smoking is the most notorious. Emphysema, also predominately caused by tobacco smoke, involves the loss of elastic material around the air spaces as a result of chronic stretching of the alveoli when inflamed. As a result of diminished elasticity, air is no longer expelled rapidly from the alveoli, and the walls of the alveoli and surrounding small airways bloat to trap air and collapse easily after exhalation.

9. What are the signs and symptoms of a pulmonary embolism?

9. Answer: • Dyspnea • Acute chest pain • Hemoptysis (coughing up blood) • Cyanosis • Tachypnea • Varying degrees of hypoxia

10. Explain why carbon monoxide has been called "the silent killer."

10. Answer: Unlike many other toxic gases, carbon monoxide is odorless, colorless, and tasteless. Carbon monoxide results from incomplete oxidation of carbon in combustion. Commonly produced by household appliances, such as gas water heaters, grills, and generators, this toxic gas is the leading cause of accidental poisoning deaths in the United States. Symptoms of carbon monoxide poisoning are vague and mimic other conditions such as the flu, making it very difficult to recognize. Carbon monoxide poisoning results in hypoxia to tissues of body and can result in permanent organ damage and death. EMS providers need to take extreme caution when carbon monoxide poisoning is suspected to protect themselves from possible exposure.

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. Call medical control and ask how to proceed with treatment

B. Contact medical control and administer an antihistamine

C. Determine if she had been prescribed a beta-agonist inhaler

D. Place her in a recumbent position to facilitate breathing

C. Determine if she had been prescribed a beta-agonist inhaler

A pleural effusion is MOST accurately defined as:

Select one:

A. a unilaterally collapsed lung.

B. fluid accumulation outside the lung.

C. diffuse collapsing of the alveoli.

D. a bacterial infection of the lung tissue.

B. Fluid accumulation outside the lung

Albuterol is a generic name for:

Select one:

A. Alupent.

B. Ventolin.

C. Atrovent.

D. Singulair.

B. Ventolin.

Alkalosis is a condition that occurs when:

Select one:

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.

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:

Select one:

A. adequate air exchange.

B. respiratory insufficiency.

C. respiratory difficulty.

D. an obstructed airway.

A. adequate air exchange.

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

Select one:

A. audible stridor.

B. expiratory wheezing.

C. rales and rhonchi.

D. profound cyanosis.

The correct answer is: audible stridor.

Common signs and symptoms of acute hyperventilation syndrome include: Select one:

A. altered mental status and bradycardia.

B. tachypnea and tingling in the extremities.

C. unilateral paralysis and slurred speech.

D. anxiety, dizziness, and severe bradypnea.

B. tachypnea and tingling in the extremities.

Dyspnea is MOST accurately defined as:

Select one:

A. shortness of breath or difficulty breathing.

B. a marked increase in the exhalation phase.

C. labored breathing with reduced tidal volume.

D. a complete cessation of respiratory effort.

The correct answer is: shortness of breath or difficulty breathing.

Harsh, high-pitched inspiratory sounds are characteristic of:

Select one:

A. stridor.

B. rales.

C. rhonchi.

D. wheezing.

The correct answer is: stridor.

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

A. a narcotic overdose.

B. high blood glucose levels.

C. an overdose of aspirin.

D. a respiratory infection.

The correct answer is: a narcotic overdose.

In order for efficient pulmonary gas exchange to occur:

Select one:

A.

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

B.

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

C.

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

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.

In what area of the lungs does respiration occur?

Select one:

A. Capillaries

B. Bronchi

C. Alveoli

D. Trachea

The correct answer Is: Alveoli

The correct answer Is: Alveoli

The two processes that occur during respiration are:

Select one:

A. diffusion and oxygenation.

B. oxygenation and ventilation.

C. inspiration and expiration.

D. ventilation and diffusion.

The correct answer is: inspiration and expiration.

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

Select one:

A.

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

B.

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

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.

The correct answer is: start at the lower lung fields and determine at which level you start hearing clear breath sounds.

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

Select one:

A. diminished breath sounds.

B. normal breath sounds.

C. an absence of breath sounds.

D. abnormal breath sounds.

The correct answer is: abnormal breath sounds.

When the level of arterial carbon dioxide rises above normal:

Select one:

A. exhalation lasts longer than inhalation.

B. respirations increase in rate and depth.

C. the brain stem inhibits respirations.

D. respirations decrease in rate and depth.

The correct answer is: respirations increase in rate and depth.

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

Select one:

A. Severe anxiety

B. Pleural effusion

C. Pulmonary edema

D. Narcotic overdose

The correct answer is: Severe anxiety

Which of the following is MOST characteristic of adequate breathing?

Select one:

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

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

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

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

The correct answer is: 24 breaths/min with bilaterally equal breath sounds and pink skin

Which of the following statements regarding pulse oximetry is correct?

Select one:

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%.

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