AIRWAY 5 Flashcards
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 three puffs of her rescue inhaler without effect. She is anxious and restless, is tachypneic, and has audible wheezing. You should:
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.
A: apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.
A 36-year-old man with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta-2 agonist, but his poor respiratory effort is inhibiting effective drug delivery via the nebulizer and his mental status is deteriorating. You should:
A: assist his ventilations and establish vascular access.
B: start an IV of normal saline and administer a steroid.
C: apply high-flow oxygen via a nonrebreathing mask.
D: assist him with a metered-dose inhaler bronchodilator.
A: assist his ventilations and establish vascular access.
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?
A: Oxygen noncompliance
B: Recent antitussive use
C: An underlying infection
D: Acute right heart failure
B: Recent antitussive use
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:
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
C: place her in a position that facilitates breathing.
Abnormal breath sounds associated with pneumonia and congestive heart failure are MOST often heard in the:
A: right middle lobe.
B: bases of the lungs.
C: apices of the lungs.
D: midaxillary line.
B: bases of the lungs.
A hyperventilating patient:
A:may be acidotic and trying to decrease her or his pH level.
B: is most effectively treated by administering a sedative drug.
C: should rebreathe her or his carbon dioxide to effect resolution.
D: presents with tachypnea and marked use of accessory muscles.
A:may be acidotic and trying to decrease her or his pH level.
A patient who is coughing up purulent sputum is MOST likely experiencing:
A: emphysema.
B: dehydration.
C: an infection.
D: pulmonary edema.
C: an infection.
A patient with a history of asthma is at GREATEST risk for respiratory arrest if he or she:
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.
B: was previously intubated for his or her condition.
A patient with status asthmaticus commonly presents with:
A: compensatory respiratory alkalosis and stridor.
B: accessory muscle use and inspiratory wheezing.
C: audible expiratory wheezing and severe cyanosis.
D: physical exhaustion and inaudible breath sounds.
D: physical exhaustion and inaudible breath sounds.
A pulse oximetry reading would be LEAST accurate in a patient:
A: with chronic hypoxia
B: whose extremities are cool.
C: with persistent tachycardia.
D: with poor peripheral perfusion.
D: with poor peripheral perfusion.
Common clinical findings in patients with obstructive lung disease include all of the following, EXCEPT:
A: a decreased expiratory phase.
B: pursed-lip breathing.
C: abdominal muscle use.
D: chronic air trapping in the lungs.
A: a decreased expiratory phase.
COPD is characterized by:
A: narrowing of the smaller airways that is often reversible with prompt treatment.
B: changes in pulmonary structure and function that are progressive and irreversible.
C: small airway spasms during the inhalation phase, resulting in progressive hypoxia.
D: widespread alveolar collapse due to increased pressure during the exhalation phase.
B: changes in pulmonary structure and function that are progressive and irreversible.
Cor pulmonale is defined as:
A: increased preload caused by severe hypertension.
B: left-sided heart failure secondary to mitral valve damage.
C: rupture of the alveoli due to increased surface tension.
D: right-sided heart failure secondary to chronic lung disease.
D: right-sided heart failure secondary to chronic lung disease.
CPAP is used to treat patients with sleep apnea by:
A: improving patency of the lower airway through the use of positive-end expiratory pressure.
B: maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction.
C: increasing the rate and depth of ventilation, thus improving minute volume and mitigating hypoxia.
D: delivering one pressure during the inspiratory phase and a different pressure during the expiratory phase.
B: maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction.
Difficulty with exhalation is MOST characteristic of:
A: supraglottic swelling.
B: upper airway obstruction.
C: a mild asthma attack.
D: obstructive lung disease.
D: obstructive lung disease.
