Resp HW 1c

Question 1

The hypoxic drive is a phenomenon in which:
Choose one answer.
A. a chronically hypoxic patient’s primary respiratory drive is stimulated by increased levels of carbon dioxide in the arterial blood.
B. a relatively large percentage of patients with COPD become acutely apneic after receiving high-flow oxygen.
C. high levels of oxygen rapidly depress a COPD patient’s respiratory rate and depth, leading to worsened hypoxia and severe acidosis.
D. bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance.

Answer 1

D

Question 2

Pneumonitis is especially common in older patients with:
Choose one answer.
	 A. frequent infections.  	
	 B. a history of a stroke.  	
	 C. immunocompromise.  	
	 D. chronic food aspiration.

Answer 2

D

Question 3

A 66-year-old man with chronic bronchitis presents with severe respiratory distress. The patient's wife tells you that he takes medications for high blood pressure and bronchitis, is on home oxygen therapy, and has recently been taking an over-the-counter antitussive. She further tells you that he has not been compliant with his oxygen therapy. Auscultation of his lungs reveals diffuse rhonchi. What is the MOST likely cause of this patient's respiratory distress?
Choose one answer.
	 A. Oxygen noncompliance  	
	 B. Recent antitussive use  	
	 C. An underlying infection  	
	 D. Acute right heart failure

Answer 3

B

Question 4

A 21-year-old man experienced an acute onset of pleuritic chest pain and dyspnea while playing softball. He is noticeably dyspneic, has an oxygen saturation of 93% on room air, and has diminished breath sounds to the upper right lobe. The MOST appropriate treatment for this patient involves:
Choose one answer.
A. performing a needle decompression to the right side of his chest.
B. assisting his ventilations in order to increase his oxygen saturation.
C. administering high-flow supplemental oxygen and transporting at once.
D. applying a CPAP unit and starting an IV line en route to the hospital.

Answer 4

C

Question 5

A person who experiences sharp chest pain followed by increasing dyspnea after he or she coughs MOST likely has:
Choose one answer.
	 A. pleurisy.  	
	 B. a pleural effusion.  	
	 C. a pneumothorax.  	
	 D. acute pneumonia.

Answer 5

C

Question 6

When present at low levels, oxygen binds easily to hemoglobin molecules, resulting in:
Choose one answer.
A. small changes in oxygen saturation when large changes in PaO2 occur.
B. large changes in oxygen saturation when small changes in PaO2 occur.
C. small changes in oxygen saturation when small changes in PaO2 occur.
D. large changes in oxygen saturation when large changes in PaO2 occur.

Answer 6

B

Question 7

The by-product of cellular respiration is:
Choose one answer.
	 A. oxygen.  	
	 B. lactic acid.  	
	 C. pyruvic acid.  	
	 D. carbon dioxide.

Answer 7

D

Question 8

A 76-year-old woman with emphysema presents with respiratory distress that has worsened progressively over the past 2 days. She is breathing through pursed lips and has a prolonged expiratory phase and an oxygen saturation of 76%. She is on home oxygen at 2 L/min. Your initial action should be to:
Choose one answer.
A. increase her oxygen flow rate to 6 L/min.
B. administer a beta-2 agonist via nebulizer.
C. place her in a position that facilitates breathing.
D. auscultate her lungs for adventitious breath sounds.

Answer 8

C

Question 9

When administering a nebulized bronchodilator, the oxygen flow rate should be set to at least \_\_\_\_ liters per minute.
Choose one answer.
	 A. 4  	
	 B. 6  	
	 C. 8  	
	 D. 10

Answer 9

B

Question 10

Why are children more prone to croup when they acquire a viral infection than adults infected with the same virus?
Choose one answer.
A. Children’s immune systems are not as developed as adults’, so they are more prone to infection.
B. Adults were vaccinated against the virus that causes croup, whereas most children were not.
C. A child’s airway is narrower than an adult’s, and even minor swelling can result in obstruction.
D. The virus that causes croup replicates far more aggressively in children than it does in adults.

Answer 10

C

Question 11

Patients with obvious respiratory failure require immediate:
Choose one answer.
	 A. intubation.  	
	 B. ventilation support.  	
	 C. passive oxygenation.  	
	 D. bronchodilator therapy.

Answer 11

B

Question 12

Stretch receptors in the lungs are responsible for the \_\_\_\_\_\_\_\_\_\_\_\_ reflex, which causes you to cough if you take too deep a breath.
Choose one answer.
	 A. Cushing  	
	 B. Hering-Breuer  	
	 C. pneumotaxic  	
	 D. yawning

Answer 12

B

Question 13

Which of the following conditions would LEAST likely present with an acute onset of respiratory distress?
Choose one answer.
	 A. Pneumonia  	
	 B. Anaphylaxis  	
	 C. Pneumothorax  	
	 D. Pulmonary embolism

Answer 13

A

Question 14

The cricothyroid membrane:
Choose one answer.
A. is a cartilaginous structure located between the thyroid and cricoid cartilages.
B. serves as the primary entry point to the airway when a patient is not breathing.
C. is relatively avascular and is covered by skin and minimal subcutaneous tissue.
D. is a thin membrane that can be palpated easily just above the thyroid cartilage.

Answer 14

C

Question 15

In a person who is not bedridden, most pulmonary infections occur in the:
Choose one answer.
	 A. middle lobes of the lungs.  	
	 B. bases of the lungs.  	
	 C. apices of the lungs.  	
	 D. upper portion of the lungs.

Answer 15

B

Question 16

A 29-year-old woman is experiencing a severe asthma attack. Her husband reports that she was admitted to an intensive care unit about 6 months ago, and had a breathing tube in place. Prior to your arrival, the patient took 3 puffs of her rescue inhaler without effect. She is anxious and restless, is tachypneic, and has audible wheezing. You should:
Choose one answer.
A. apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.
B. begin assisting her ventilations with a bag-mask device and 100% oxygen and prepare to intubate her trachea.
C. start an IV of normal saline, administer methylprednisolone via IV push, and transport as soon as possible.
D. attempt to slow her breathing with respiratory coaching, administer a nebulized bronchodilator, and transport.

Answer 16

A

Question 17

Unlike bronchodilator therapy, corticosteroid therapy:
Choose one answer.
A. causes immediate improvement in breathing.
B. takes a few hours to reduce bronchial edema.
C. is administered exclusively in a hospital setting.
D. is the primary treatment for acute bronchospasm.

Answer 17

B

Question 18

A morbidly obese man called 9-1-1 because of difficulty breathing. When you arrive, you find the 39-year-old patient lying supine in his bed. He is in marked respiratory distress and is only able to speak in two-word sentences. He has a history of hypertension, but denies any respiratory conditions. What should you do FIRST?
Choose one answer.
A. Begin assisting his ventilations.
B. Assess his oxygen saturation level.
C. Administer a beta-2 agonist drug.
D. Sit him up or place him on his side.

Answer 18

D

Question 19

A critical step when using a CPAP unit to treat a patient with severe respiratory distress is:
Choose one answer.
A. ensuring an adequate mask seal with minimal leakage.
B. holding the mask to the noncompliant patient’s face.
C. starting with CPAP levels above 10 to 15 cm of water.
D. setting the oxygen flow rate to at least 6 L/min.

Answer 19

A

Question 20

A patient with orthopnea:
Choose one answer.
A. seeks a sitting position when short of breath.
B. is awakened from sleep with severe dyspnea.
C. prefers to lie flat in order to facilitate breathing.
D. generally has a slow, shallow respiratory pattern.

Answer 20

A

Question 21

You are transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should:
Choose one answer.
A. continue the CPAP treatment and administer a diuretic to remove fluids from his lungs quickly.
B. remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.
C. suspect that he has developed a pneumothorax and prepare to perform a needle chest decompression.
D. decrease the amount of positive-end expiratory pressure that you are delivering and reassess.

Answer 21

B

Question 22

Emphysema is caused by:
Choose one answer.
A. an abundance of pulmonary surfactant.
B. chronic destruction of the alveolar walls.
C. excessive mucus production in the bronchi.
D. progressive weakening of the lung parenchyma.

Answer 22

B

Question 23

If a colorimetric ETCO2 detector turns purple during the exhalation phase through an ET tube, approximately how much carbon dioxide is being exhaled?
Choose one answer.
	 A. Less than 0.5%  	
	 B. Between 1% and 2%  	
	 C. Between 2% and 5%  	
	 D. More than 5%

Answer 23

A

Question 24

The MOST clinically significant finding when questioning a patient with a chronic respiratory disease is:
Choose one answer.
A. medication use prior to your arrival.
B. a recent medication regimen change.
C. a recent emergency department visit.
D. prior intubation for the same problem.

Answer 24

D

Question 25

A patient with a history of asthma is at GREATEST risk for respiratory arrest if he or she:
Choose one answer.
A. takes a bronchodilator and a corticosteroid.
B. was previously intubated for his or her condition.
C. was recently evaluated in an emergency department.
D. has used his or her inhaler twice in the previous week.

Answer 25

B