Chapter 14 Test Questions

Question 1

What acid-base derangement initially occurs in a tachypneic patient without a physiologic demand for increased oxygen?

A. Metabolic acidosis

B. Metabolic alkalosis

C. Respiratory acidosis

D. Respiratory alkalosis

Answer 1

D. Respiratory alkalosis

Question 2

Which of the following is generally NOT indicated when treating a patient with a tension pneumothorax?

A. Paramedic support

B. Medication therapy

C. Intravenous therapy

D. Ventilatory assistance

Answer 2

B. Medication therapy

Question 3

Acute epiglottitis in the adult is characterized by:

A. a productive cough.

B. a low-grade fever.

C. a severe sore throat.

D. a seal-bark cough.

Answer 3

C. a severe sore throat.

Question 4

A 59-year-old female with a history of poorly controlled hypertension becomes acutely dyspneic, develops profound cyanosis to the upper chest, and becomes unresponsive. She is pulseless and apneic upon your arrival. As you and your partner are performing the appropriate treatment interventions, you discuss the possible cause of her condition, which is MOST likely a(n):

A. acute myocardial infarction.

B. massive pulmonary embolism.

C. large tension pneumothorax.

D. massive atraumatic hemothorax.

Answer 4

B. massive pulmonary embolism.

Question 5

You are treating a 2-year-old boy who is experiencing respiratory distress. During your assessment, you note that the child has mild inspiratory stridor, a barking cough, and a low-grade fever. The child is otherwise conscious, is acting appropriate for his age, and has strong radial pulses. Treatment should include:

A. an IV fluid bolus.

B. a beta antagonist.

C. assisted ventilation.

D. humidified oxygen.

Answer 5

D. humidified oxygen.

Question 6

Cystic fibrosis is a genetic disorder that results in:

A. spontaneous collapsing of one or both lungs.

B. excess sodium loss and thick pulmonary secretions.

C. acute pulmonary edema and diffuse bronchospasm.

D. profound dehydration and a fever greater than 102°F.

Answer 6

B. excess sodium loss and thick pulmonary secretions.

Question 7

When assessing a patient with difficulty breathing, which of the following findings would lead you to suspect congestive heart failure as the underlying cause?

A. The patient is a long-term smoker and takes corticosteroid medications on a daily basis.

B. The onset of the difficulty breathing was acute and the patient takes prescribed diuretics.

C. The patient is coughing up thick green sputum and has prescriptions for Atrovent and Advair.

D. The patient is receiving home oxygen therapy, has pink skin, and is breathing through pursed lips.

Answer 7

B. The onset of the difficulty breathing was acute and the patient takes prescribed diuretics.

Question 8

Approximately 20 minutes after receiving a penicillin injection at the doctor’s office, a 41-year-old female presents with acute respiratory distress, facial swelling, and intense itching to her entire body. Her level of consciousness is decreased and her breathing is labored with minimal chest rise. The MOST appropriate treatment for this patient should include:

A. assisted ventilations, IV of normal saline, and epinephrine.

B. oxygen via a nonrebreathing mask, IV of normal saline, and albuterol.

C. insertion of a King LT airway and a 1,000 mL bolus of normal saline.

D. hyperventilation with a bag-mask device and epinephrine via IV push.

Answer 8

A. assisted ventilations, IV of normal saline, and epinephrine.

Question 9

The respiratory syncytial virus (RSV) is a common cause of:

A. pertussis and the flu.

B. MRSA and whooping cough.

C. bronchiolitis and pneumonia.

D. asthma and chronic bronchitis.

Answer 9

C. bronchiolitis and pneumonia.

Question 10

Chronic carbon dioxide retention, as seen in patients with certain lung diseases, may cause the patient to:

A. develop extended periods of hypocarbia.

B. experience acute tidal volume increases.

C. breathe on the basis of decreased oxygen.

D. develop tachypnea if given 100% oxygen.

Answer 10

C. breathe on the basis of decreased oxygen.

Question 11

A 30-year-old male presents with respiratory distress that began within minutes of being exposed to an unknown chemical at an industrial site. When caring for this patient, it is MOST important to remember that:

A. he will likely require frequent suctioning.

B. he must be properly decontaminated first.

C. aggressive airway management may be needed.

D. inhalation injuries can cause aspiration pneumonia.

Answer 11

B. he must be properly decontaminated first.

Question 12

In contrast to bronchitis, pneumonia typically presents with:

A. fever and chills.

B. fluid in the lungs.

C. a productive cough.

D. varying levels of hypoxia.

Answer 12

A. fever and chills.

Question 13

The movement and utilization of oxygen in the body is dependent on all of the following, EXCEPT:

A. effective alveolar-capillary osmosis.

B. adequate concentration of inspired oxygen.

C. adequate number of functional erythrocytes.

D. efficient off-loading of oxygen in the tissues.

Answer 13

A. effective alveolar-capillary osmosis.

Question 14

You are transporting a 60-year-old male to the hospital for suspected COPD exacerbation. He is receiving 100% oxygen via a nonrebreathing mask. As you reassess him, you note that his respirations have decreased and have become shallow. You should:

A. begin assisting his ventilations.

B. apply a nasal cannula at 4 L/min.

C. remove the oxygen mask and reassess.

D. prepare to insert a multilumen airway.

Answer 14

A. begin assisting his ventilations.

Question 15

Which of the following clinical findings is MOST consistent with inadequate breathing?

A. Symmetrical chest movement and warm, dry skin

B. Respirations of 16 breaths/min and reduced tidal volume

C. Increased amount of expired air at the nose and mouth

D. Regular breathing pattern and respirations of 24 breaths/min

Answer 15

B. Respirations of 16 breaths/min and reduced tidal volume

Question 16

Which of the following statements MOST accurately describes asthma?

A. Irreversible airway disease that presents with inspiratory wheezing

B. Reversible airway disease caused by an exaggerated immune response

C. Irreversible airway disease that results in increased alveolar surface tension

D. Chronic respiratory disease caused by long-term exposure to toxic substances

Answer 16

B. Reversible airway disease caused by an exaggerated immune response

Question 17

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

A. Muscular dystrophy

B. Acute pulmonary edema

C. Benzodiazepine overdose

D. Methamphetamine overdose

Answer 17

D. Methamphetamine overdose

Question 18

A 70-year-old male presents with an acute onset of difficulty breathing that woke him from his sleep. He has a history of hypertension, atrial fibrillation, and several heart attacks. During your assessment, you note dried blood around his mouth. The patient tells you that he cannot lie down because he will “smother.” What additional assessment findings will you MOST likely discover?

A. Diffuse wheezing

B. Pulmonary rales

C. Fever and chills

D. Slow respiratory rate

Answer 18

B. Pulmonary rales

Question 19

In contrast to an epidemic, a pandemic:

A. is a disease outbreak that occurs on a global scale.

B. occurs in more of the population than was expected.

C. is usually confined to a specific geographic location.

D. is a disease for which a vaccine is readily available.

Answer 19

A. is a disease outbreak that occurs on a global scale.

Question 20

Cheyne-Stokes respirations are characterized by:

A. irregular tachypnea with occasional periods of apnea.

B. impaired respirations with sustained inspiratory effort.

C. tachypnea and hyperpnea with an acetone breath odor.

D. tachypnea and bradypnea with alternating apneic periods.

Answer 20

D. tachypnea and bradypnea with alternating apneic periods.

Question 21

Cardiac asthma is a condition in which a patient:

A. with a history of asthma develops wheezing caused by an acute cardiac event.

B. with congestive heart failure experiences wheezing due to constricted bronchi.

C. develops acute respiratory distress when fluid suddenly accumulates in the lungs.

D. inadvertently takes too much of his or her beta-blocker, resulting in bronchospasm.

Answer 21

B. with congestive heart failure experiences wheezing due to constricted bronchi.

Question 22

When assessing a female patient with chest pain and shortness of breath, you note that her blood pressure is 80/50 mm Hg, her heart rate is 120 beats/min, and she has cyanosis around her mouth. In addition to supporting her ventilations, you should:

A. establish intravenous access.

B. perform a secondary assessment.

C. prepare for immediate transport.

D. give her a bronchodilator drug.

Answer 22

C. prepare for immediate transport.

Question 23

Patients with COPD are highly susceptible to pneumonia because:

A. they cannot effectively expel infected pulmonary secretions.

B. their immune system is inherently weakened by the disease.

C. their age predisposes them to COPD-related lung infections.

D. their hyperactive cough reflex leads to alveolar destruction.

Answer 23

A. they cannot effectively expel infected pulmonary secretions.

Question 24

Which of the following respiratory medications is exclusively indicated for chronic asthma treatment or as asthma prevention?

A. Advair

B. Atrovent

C. Alupent

D. Proventil

Answer 24

A. Advair

Question 25

A 77-year-old male with a history of emphysema complains of an acute worsening of his shortness of breath and pleuritic chest pain that occurred after a forceful cough. Auscultation of his lungs reveals scattered wheezing on the left side and diminished breath sounds on the right. This patient’s clinical presentation is MOST consistent with:

A. acute pulmonary edema.

B. exacerbated emphysema.

C. acute bacterial pneumonia.

D. spontaneous pneumothorax.

Answer 25

D. spontaneous pneumothorax.

Question 26

The process of moving air into and out of the lungs is called:

A. breathing.

B. respiration.

C. ventilation.

D. oxygenation.

Answer 26

C. ventilation.

Question 27

Characteristics of adequate breathing in an adult include all of the following, EXCEPT:

A. asymmetrical chest movement.

B. respirations of 14 breaths/min.

C. pink oral mucous membranes.

D. audible breath sounds bilaterally.

Answer 27

A. asymmetrical chest movement.

Question 28

The MOST significant risk associated with ventilating a patient too rapidly is:

A. gastric distention and regurgitation.

B. barotrauma and a pneumothorax.

C. inadvertent respiratory alkalosis.

D. excess carbon dioxide elimination.

Answer 28

A. gastric distention and regurgitation.

Question 29

A 56-year-old male complains of difficulty breathing. His wife tells you that he complained of chest discomfort a few days prior, but would not allow her to call EMS. Your assessment reveals rales in the apices and bases of both lungs. This patient’s clinical presentation is MOST consistent with:

A. chronic obstructive pulmonary disease (COPD) exacerbation.

B. chronic bronchitis.

C. acute pulmonary embolism.

D. cardiogenic pulmonary edema.

Answer 29

D. cardiogenic pulmonary edema.

Question 30

A 20-year-old female presents with acute respiratory distress. Auscultation of her lungs reveals diffuse expiratory wheezing. She is in moderate distress and tells you that she has a prescribed inhaler that she uses when this happens. You should suspect:

A. status asthmaticus.

B. bronchitis exacerbation.

C. an acute asthma attack.

D. bacterial pneumonia.

Answer 30

C. an acute asthma attack.

Question 31

You are dispatched for an elderly male with dyspnea. When you arrive, you find the patient sitting in a chair. He is semiconscious and unable to effectively communicate with you. As you perform a primary assessment, your partner applies 100% oxygen and a pulse oximeter, which reads 85%. The MOST reliable indicator of cerebral hypoxia in this patient is his:

A. complaint of dyspnea.

B. mental status alteration.

C. inability to communicate.

D. decreased oxygen saturation.

Answer 31

B. mental status alteration.

Question 32

The exchange of oxygen and carbon dioxide, at the cellular level or in the lungs, is called:

A. breathing.

B. respiration.

C. ventilation,

D. oxygenation.

Answer 32

B. respiration.

Question 33

Which of the following processes occurs during normal inspiration?

A. An increase in intrathoracic pressure forces air into the lungs

B. The phrenic nerves stimulate the intercostal muscles to contract

C. Air is pulled into the lungs when intrathoracic pressure decreases

D. The diaphragm contract and ascends, increasing the chest diameter

Answer 33

C. Air is pulled into the lungs when intrathoracic pressure decreases

Question 34

You are assessing a young male with an acute onset of tachypnea. He is conscious and alert with shallow respirations of 40 breaths/min, and complains of numbness and tingling to his face and hands. The patient’s girlfriend tells you that he has been very worried about his mother, who was recently diagnosed with cancer. Appropriate treatment for this patient includes:

A. a nonrebreathing mask without oxygen.

B. coached breathing and oxygen as needed.

C. carbon dioxide rebreathing with a paper bag.

D. a beta2 agonist if authorized by medical control.

Answer 34

B. coached breathing and oxygen as needed.

Question 35

Emphysema, a degenerative disease, is caused by:

A. surfactant destruction and increased alveolar surface tension.

B. excessive mucous production by beta2 cells in the bronchi.

C. widespread constriction of the bronchioles and air trapping.

D. decreased alveolar surface tension caused by excess surfactant.

Answer 35

A. surfactant destruction and increased alveolar surface tension.

Question 36

The Hering-Breuer reflex is defined as:

A. an increase in respiratory rate and depth secondary to decreased levels of oxygen in the blood.

B. a feedback loop that sends signals to the apneustic center, resulting in increased tidal volume.

C. a decrease in respiratory rate and depth secondary to decreased carbon dioxide levels in the blood.

D. a feedback loop that inhibits the inspiratory center, which prevents overexpansion of the lungs.

Answer 36

D. a feedback loop that inhibits the inspiratory center, which prevents overexpansion of the lungs.

Question 37

A 67-year-old male who smokes three packs of cigarettes per day complains of a productive cough, chills, and generalized weakness. He is in mild respiratory distress; auscultation of his lungs reveals rhonchi to the lower left lobe. This patient’s clinical presentation is MOST consistent with:

A. pneumonia.

B. bronchitis.

C. emphysema.

D. heart failure.

Answer 37

A. pneumonia.

Question 38

Common side effects of inhaled medications used for acute shortness of breath include all of the following, EXCEPT:

A. sedation.

B. tachycardia.

C. nervousness.

D. muscle tremors.

Answer 38

A. sedation.

Question 39

You are assessing a 52-year-old male with respiratory distress. The MOST ominous sign(s) of severe hypoxemia and imminent cardiac arrest is/are:

A. minimal-word dyspnea and pallor.

B. audible stridor and facial cyanosis.

C. a marked decrease in the heart rate.

D. a marked increase in the heart rate.

Answer 39

C. a marked decrease in the heart rate.

Question 40

An anaphylactic reaction impairs effective breathing secondary to:

A. catecholamine release.

B. upper-airway swelling.

C. diffuse alveolar collapse.

D. excess fluid in the alveoli.

Answer 40

B. upper-airway swelling.

Question 41

Patients with emphysema are commonly referred to as “pink puffers” because they:

A. develop polycythemia and often grunt during exhalation.

B. produce excess red blood cells and maintain low CO2 levels.

C. grunt when they breathe and maintain high arterial O2 levels.

D. breathe through pursed lips and may develop polycythemia.

Answer 41

D. breathe through pursed lips and may develop polycythemia.

Question 42

Typical signs and symptoms of pneumonia include:

A. pleuritic chest pain, fever, and rhonchi.

B. dry cough, high fever, and labored breathing.

C. weakness, crushing chest pain, and wheezing.

D. stridor, chills, shortness of breath, and fever.

Answer 42

A. pleuritic chest pain, fever, and rhonchi.

Question 43

Which of the following physiologic processes does NOT occur in patients with COPD?

A. Diffuse alveolar collapse

B. Intrapulmonary air trapping

C. Increased surfactant production

D. Mucous production from beta2 cells

Answer 43

C. Increased surfactant production

Question 44

A 60-year-old male presents with shortness of breath and a productive cough of two days’ duration. He denies chest pain or any other associated symptoms. Auscultation of his lungs reveals scattered bilateral rhonchi in all fields. His skin is pink, warm, and dry and the pulse oximeter reads 94% on room air. This patient is MOST likely experiencing:

A. acute asthma.

B. emphysema.

C. bronchitis.

D. pneumonia.

Answer 44

C. bronchitis.

Question 45

When assisting a patient with his or her prescribed inhaler, it is important to:

A. ensure that the medication is slightly below room temperature.

B. have the patient exhale deeply prior to inhaling the medication.

C. instruct the patient to hold his or her breath for 20 to 30 seconds.

D. avoid a spacer device, as this decreases the medication’s efficacy.

Answer 45

B. have the patient exhale deeply prior to inhaling the medication.

Question 46

When assessing a patient using a pulse oximeter, it is important to remember that:

A. an oxygen saturation of greater than 90% rules out hypoxemia.

B. abnormally bound hemoglobin may produce inaccurate readings.

C. pulse oximetry will determine whether or not to administer oxygen.

D. the pulse oximeter provides an accurate reading of the patient’s PaO2.

Answer 46

B. abnormally bound hemoglobin may produce inaccurate readings.

Question 47

You are dispatched to the home of a 64-year-old male patient with lung cancer. The patient complains of acute dyspnea; however, as long as he is sitting upright, his breathing is easier. He denies fever and his breath sounds are decreased over the base of the left lung. What is the MOST likely cause of this patient’s symptoms?

A. Localized bronchospasm in the lungs

B. Consolidation of fluid within the lung

C. Collection of fluid outside of the lung

D. Air in the pleural space with lung collapse

Answer 47

C. Collection of fluid outside of the lung

Question 48

You are dispatched to a residence for a 69-year-old female with “breathing problems.” When you arrive, the patient’s husband directs you to his wife, who is sitting on the couch in obvious respiratory distress. She is semiconscious and has labored, shallow respirations. You auscultate her lungs and hear diffuse rhonchi in all lung fields. Which of the following interventions would be of LEAST benefit to her?

A. Assisted ventilations with a bag-mask device

B. IV therapy with up to a 500 mL normal saline bolus

C. Suction of her airway for up to 15 seconds if needed

D. Prompt transport and consideration of a paramedic intercept

Answer 48

B. IV therapy with up to a 500 mL normal saline bolus

Question 49

When assessing the severity of nocturnal dyspnea in a patient with a chronic respiratory disease, you should determine:

A. if he or she sleeps on the stomach or back.

B. how many pillows he or she sleeps with at night.

C. how far he or she can walk before dyspnea occurs.

D. if he or she uses a beta2 agonist at least twice per day.

Answer 49

B. how many pillows he or she sleeps with at night.

Question 50

Approximately 2 weeks following a total hip replacement, a 70-year-old female complains of a sudden onset of dyspnea and pleuritic chest pain. Your assessment reveals perioral cyanosis, blood-tinged sputum, and wheezing to the base of her right lung. As your partner applies high-flow oxygen, the patient states that she has a history of hypertension. You should be MOST suspicious of:

A. an acute asthma attack.

B. a simple pneumothorax.

C. acute left heart failure.

D. a pulmonary embolism.

Answer 50

D. a pulmonary embolism.

Question 51

Cardiomyopathy may lead to pulmonary edema due to:

A. acute injury to the myocardium.

B. a profound decrease in heart rate.

C. reduced contractile force of the heart.

D. weakening of the right side of the heart.

Answer 51

C. reduced contractile force of the heart.