Chapter 16 Respiratory Emergencies

Question 1

The most obvious external landmark of the larynx is the:
A) cricoid cartilage.
B) hyoid bone.
C) arytenoid cartilage.
D) thyroid cartilage.

Answer 1

D) thyroid cartilage.

Question 2

On either side of the glottis, tissue forms a pocket called the:
A) vallecula.
B) piriform fossae.
C) cuneiform cartilage.
D) hypopharyngeal space.

Answer 2

B) piriform fossae.

Question 3

The \_\_\_\_\_\_\_\_\_ cartilage forms a complete ring and maintains the trachea in an open position.
A) cricoid
B) thyroid
C) arytenoid
D) laryngeal

Answer 3

A) cricoid

Question 4

Which of the following statements regarding anatomic dead space is correct?
A) Anatomic dead space is about 1 mL per pound of body weight.
B) Air in the dead space participates in pulmonary gas exchange.
C) The amount of dead space increases as tidal volume increases.
D) If tidal volume is 500 mL, 200 mL remains in the dead space.

Answer 4

A) Anatomic dead space is about 1 mL per pound of body weight.

Question 5

The mainstem bronchus ends at the level of the:
A) lobar bronchi.
B) bronchioles.
C) segmental bronchi.
D) subsegmental bronchi.

Answer 5

B) bronchioles.

Question 6

\_\_\_\_\_\_\_\_ cells are found in the lining of the airways and produce a blanket of mucus that covers the entire lining of the conducting airways.
A) Kupfer
B) Alveolar
C) Ciliary
D) Goblet

Answer 6

D) Goblet

Question 7

What function do the nasal turbinates serve?
A) Separating the left and right nostrils
B) Warming and humidifying inhaled air
C) Decreasing the surface area of the nasopharynx
D) Secreting mucus that traps viruses and bacteria

Answer 7

B) Warming and humidifying inhaled air

Question 8

What type of medication dries secretions in the airway and prevents the cilia from removing them effectively?
A) Diuretic
B) Antibiotic
C) Antipyretic
D) Antihistamine

Answer 8

D) Antihistamine

Question 9

Wheezing is resolved with medications that:
A) dry up secretions in the lower airway.
B) reduce soft tissue swelling in the larynx.
C) relax the smooth muscle of the bronchioles.
D) cause bronchoconstriction and improved airflow.

Answer 9

C) relax the smooth muscle of the bronchioles.

Question 10

If the amount of pulmonary surfactant is decreased:
A) alveolar surface tension increases.
B) diffuse alveolar hyperinflation occurs.
C) alveoli are able to expand more easily.
D) pulmonary gas exchange is enhanced.

Answer 10

A) alveolar surface tension increases.

Question 11

A patient who is experiencing an allergic reaction states that his tongue "feels thick" and speaks at a low volume. You should immediately evaluate for:
A) angioedema.
B) hypotension.
C) a gag reflex.
D) adventitious breath sounds.

Answer 11

A) angioedema.

Question 12

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

Answer 12

B) bases of the lungs.

Question 13

Polycythemia is a condition in which:
A) excess red blood cells are produced in response to chronic hypoxia.
B) an abundance of red blood cells causes severe thinning of the blood.
C) fewer red blood cells are produced, resulting in decreased oxygenation.
D) increased platelet production causes the blood to become abnormally thick.

Answer 13

A) excess red blood cells are produced in response to chronic hypoxia.

Question 14

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.

Answer 14

D) right-sided heart failure secondary to chronic lung disease.

Question 15

A patent airway:
A) is evidenced by visible chest rise.
B) should be prophylactically suctioned.
C) does not equate to adequate ventilation.
D) is characterized by adequate tidal volume

Answer 15

C) does not equate to adequate ventilation

Question 16

Hypoventilating patients:
A) eliminate too much carbon dioxide.
B) become hypercapneic and acidotic.
C) experience an increase in blood pH.
D) typically do not have an open airway.

Answer 16

B) become hypercapneic and acidotic

Question 17

Hyperpnea and tachypnea:
A) cause an increase in minute ventilation.
B) are caused by decreased diaphragmatic function.
C) are characterized by shallow chest wall movement.
D) result from decreased negative-pressure ventilation.

Answer 17

A) cause an increase in minute ventilation.

Question 18

In contrast to negative-pressure ventilation, positive-pressure ventilation:
A) is the forcing of air into the lungs.
B) occurs when the diaphragm descends.
C) is provided with a nonrebreathing mask.
D) can only be provided to intubated patients.

Answer 18

A) is the forcing of air into the lungs.

Question 19

Difficulty with exhalation is MOST characteristic of:
A) supraglottic swelling.
B) upper airway obstruction.
C) a mild asthma attack.
D) obstructive lung disease.

Answer 19

D) obstructive lung disease.

Question 20

Apneustic breathing is characterized by:
A) a sustained pattern of tachypnea and increased tidal volume.
B) short, brisk inhalations with a long pause before exhalation.
C) regular respirations with a normal rate and adequate tidal volume.
D) a crescendo-decrescendo pattern of breathing with apneic periods.

Answer 20

B) short, brisk inhalations with a long pause before exhalation.

Question 21

\_\_\_\_\_\_\_\_\_\_\_ respirations are characterized by a grossly irregular pattern of breathing that may be accompanied by lengthy periods of apnea.
A) Biot
B) Agonal
C) Eupneic
D) Cheyne-Stokes

Answer 21

A) Biot

Question 22

An unresponsive patient who overdosed on a central nervous system depressant drug would be expected to have \_\_\_\_\_\_\_\_\_\_ respirations.
A) eupneic
B) hyperpneic
C) bradypneic
D) Kussmaul

Answer 22

C) bradypneic

Question 23

The oropharynx and nasopharynx meet in the back of the throat at the:
A) larynx.
B) hyoid bone.
C) hypopharynx.
D) glottic opening.

Answer 23

C) hypopharynx.

Question 24

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

Answer 24

B) Hering-Breuer

Question 25

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

Answer 25

D) carbon dioxide.

Question 26

Respiratory alkalosis is the result of:
A) carbon dioxide retention.
B) slow and shallow respirations.
C) increased hydrogen ion production.
D) excess carbon dioxide elimination.

Answer 26

D) excess carbon dioxide elimination.

Question 27

If a patient's hemoglobin level is only 10 g/dL, \_\_\_ % would have to be desaturated before he or she would appear cyanotic.
A) 10
B) 25
C) 30
D) 50

Answer 27

D) 50

Question 28

A patient with orthopnea:
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 28

A) seeks a sitting position when short of breath.

Question 29

The barrel-chest appearance classically seen in emphysemic patients is secondary to:
A) widespread atelectasis.
B) chest wall hypertrophy.
C) air trapping in the lungs.
D) carbon dioxide retention.

Answer 29

C) air trapping in the lungs.

Question 30

If a patient’s initial presentation makes you suspicious about a particular respiratory condition, you must:
A) begin immediate treatment based on your suspicion.
B) make your field impression based on the presentation.
C) confirm your suspicions with a thorough assessment.
D) immediately perform a focused physical examination.

Answer 30

C) confirm your suspicions with a thorough assessment.

Question 31

A patient with respiratory distress who is willing to lie flat:
A) should be intubated at once.
B) may be acutely deteriorating.
C) has minimal fluid in the lungs.
D) likely has basilar pneumonia.

Answer 31

B) may be acutely deteriorating.

Question 32

Retractions of the sternum or ribs during inhalation:
A) are common in patients with emphysema.
B) are signs of acute respiratory failure in adults.
C) occur when soft tissue is pulled in around the bones.
D) are especially common in infants and small children.

Answer 32

D) are especially common in infants and small children.

Question 33

Paradoxical respiratory movement is characterized by:
A) the epigastrium and thorax moving in opposite directions.
B) bulging of the intercostal muscles during deep inhalation.
C) pulling upward of the suprasternal notch during inhalation.
D) a marked decrease in movement in one of the hemithoraces.

Answer 33

A) the epigastrium and thorax moving in opposite directions.

Question 34

A patient with quiet tachypnea is MOST likely experiencing:
A) shock.
B) asthma.
C) alkalosis.
D) airway swelling.

Answer 34

A) shock.

Question 35

In contrast to decreased PO2 levels, increased PCO2 levels typically manifest as:
A) anxiety.
B) combativeness.
C) sedation or sleepiness.
D) restlessness or confusion.

Answer 35

C) sedation or sleepiness.

Question 36

An otherwise healthy adult whose normal hemoglobin level is 12 to 14 g/dL typically will begin to exhibit cyanosis when:
A) hemoglobin levels fall below 12 g/dL.
B) about 5g/dL of hemoglobin is desaturated.
C) his or her oxygen saturation falls below 50%.
D) 10% of his or her hemoglobin is desaturated.

Answer 36

B) about 5 g/dL of hemoglobin is desaturated.

Question 37

The MOST clinically significant finding when questioning a patient with a chronic respiratory disease is:
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 37

D) prior intubation for the same problem.

Question 38

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

Answer 38

A) Pneumonia

Question 39

Hepatojugular reflux occurs when:
A) left-sided heart failure causes blood to accumulate in the patient’s liver.
B) the jugular veins collapse in response to palpation of the right upper quadrant.
C) mild pressure placed on the patient’s liver further engorges the jugular veins.
D) a patient’s jugular veins are markedly engorged when lying in a supine position.

Answer 39

C) mild pressure placed on the patient’s liver further engorges the jugular veins.

Question 40

Hepatomegaly and jugular venous distention are MOST suggestive of:
A) left-sided heart failure.
B) right-sided heart failure.
C) pulmonary edema.
D) severe pneumonia.

Answer 40

B) right-sided heart failure.

Question 41

Common effects of gag reflex stimulation include all of the following, EXCEPT:
A) vomiting.
B) tachycardia.
C) bradycardia.
D) increased intracranial pressure.

Answer 41

B) tachycardia.

Question 42

Digital clubbing is MOST indicative of:
A) acute hypoxemia.
B) chronic hypoxia.
C) right heart failure.
D) peripheral vascular disease.

Answer 42

B) chronic hypoxia

Question 43

The diaphragm of the stethoscope is designed to auscultate:
A) heart tones.
B) low-pitched sounds.
C) bowel sounds.
D) high-pitched sounds.

Answer 43

D) high-pitched sounds.

Question 44

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.

Answer 44

B) bases of the lungs.

Question 45

\_\_\_\_\_\_\_\_\_\_ breath sounds are the MOST commonly heard breath sounds and have a much more obvious inspiratory component.
A) Vesicular
B) Bronchial
C) Tracheal
D) Bronchovesicular

Answer 45

A) Vesicular

Question 46

Inspiratory and expiratory\_\_\_\_\_\_\_\_\_\_ sounds are both loud, but the inspiratory sounds are shorter than the expiratory sounds.
A) tracheal
B) bronchial
C) vesicular
D) bronchovesicular

Answer 46

B) bronchial

Question 47

The presence of diffuse rhonchi (low-pitched crackles) in the lungs indicates:
A) right-sided congestive heart failure.
B) isolated consolidation of secretions.
C) thick secretions in the large airways.
D) air being forced through narrowed airways.

Answer 47

C) thick secretions in the large airways.

Question 48

A patient who is coughing up purulent sputum is MOST likely experiencing:
A) emphysema.
B) dehydration.
C) an infection.
D) pulmonary edema.

Answer 48

C) an infection.

Question 49

Frothy sputum that has a pink tinge to it is MOST suggestive of:
A) tuberculosis.
B) antihistamine use.
C) chronic bronchitis.
D) congestive heart failure.

Answer 49

D) congestive heart failure.

Question 50

If a patient's hemoglobin level is 8 g/dL due to hemorrhage and all of the hemoglobin molecules are attached to oxygen, the patient's oxygen saturation would MOST likely read:
A) above 95%.
B) between 90% and 95%
C) between 85% and 90%.
D) significantly lower than 85%.

Answer 50

A) above 95%.

Question 51

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.

Answer 51

D) with poor peripheral perfusion.

Question 52

When present at low levels, oxygen binds easily to hemoglobin molecules, resulting in:
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 52

B) large changes in oxygen saturation when small changes in PaO2 occur.

Question 53

With regard to pulse oximetry, the more hypoxic a patient becomes:
A) the slower his or her PaO2 will fall.
B) the faster he or she will desaturate.
C) the slower he or she will desaturate.
D) the less reliable the pulse oximeter is.

Answer 53

B) the faster he or she will desaturate.

Question 54

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

Answer 54

A) Less than 0.5%

Question 55

A sudden increase in end-tidal CO2 may be the earliest indicator of:
A) ineffective chest compressions.
B) inadvertent ET tube dislodgment.
C) return of spontaneous circulation.
D) developing respiratory alkalosis.

Answer 55

C) return of spontaneous circulation.

Question 56

Why are children more prone to croup when they acquire a viral infection than adults infected with the same virus?
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 56

C) A child’s airway is narrower than an adult’s, and even minor swelling can result in obstruction.

Question 57

Which of the following statements regarding epiglottitis is correct?
A) Unlike croup, epiglottitis most commonly occurs in the middle of the night, when the outside temperature is cool.
B) Epiglottitis has become relatively rare in children due to vaccinations against the Haemophilus influenzae type b bacterium.
C) Most cases of epiglottitis are progressive in their onset and result in severe swelling of the larynx, trachea, and bronchi.
D) Characteristic signs of epiglottitis include a low-grade fever, a seal-like barking cough, and varying degrees of respiratory distress.

Answer 57

B) Epiglottitis has become relatively rare in children due to vaccinations against the Haemophilus influenzae type b bacterium.

Question 58

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

Answer 58

D) chronic food aspiration.

Question 59

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.

Answer 59

B) changes in pulmonary structure and function that are progressive and irreversible.

Question 60

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.

Answer 60

A) a decreased expiratory phase.

Question 61

Reactive airway disease is characterized by:
A) bronchospasm, edema, and mucus production.
B) chronic bronchoconstriction of varying severity.
C) acute, reversible swelling of the laryngeal muscles.
D) excessive mucus production and a chronic cough.

Answer 61

A) bronchospasm, edema, and mucus production.

Question 62

The primary treatment of bronchospasm is:
A) assisted ventilation.
B) humidified oxygen.
C) bronchodilator therapy.
D) corticosteroid therapy.

Answer 62

C) bronchodilator therapy.

Question 63

Unlike bronchodilator therapy, corticosteroid therapy:
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 63

B) takes a few hours to reduce bronchial edema.

Question 64

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.

Answer 64

D) physical exhaustion and inaudible breath sounds.

Question 65

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.

Answer 65

B) was previously intubated for his or her condition.

Question 66

Emphysema is caused by:
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 66

B) chronic destruction of the alveolar walls.

Question 67

The classic presentation of chronic bronchitis is:
A) excessive mucus production and a chronic or recurrent productive cough.
B) a thin male with pursed-lip breathing and a history of heavy cigarette smoking.
C) a dry, hacking cough and a barrel chest due to chronic pulmonary air trapping.
D) expiratory wheezing and jugular venous distention due to pulmonary hypertension.

Answer 67

A) excessive mucus production and a chronic or recurrent productive cough.

Question 68

Which of the following clinical findings is MOST suggestive of pneumonia in a patient with COPD?
A) Nonproductive cough
B) White sputum and rales
C) Fever and localized crackles
D) Dyspnea and diffuse wheezing

Answer 68

C) Fever and localized crackles

Question 69

Patients with COPD typically experience an acute exacerbation of their condition because of:
A) a secondary condition such as congestive heart failure or a pneumothorax.
B) progressively worsening pneumonia that results in a diminished cough reflex.
C) chronic noncompliance with their prescribed medications and home oxygen.
D) environmental changes such as weather or the inhalation of trigger substances.

Answer 69

D) environmental changes such as weather or the inhalation of trigger substances.

Question 70

The hypoxic drive is a phenomenon in which:
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 70

D) bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance.

Question 71

Patients with decompensated asthma or COPD who require positive-pressure ventilation:
A) should be ventilated routinely at a rate that is slightly faster than the rate for a patient without an underlying pulmonary disease.
B) may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly.
C) should be intubated promptly and ventilated at a rate of 20 to 24 breaths/min to eliminate excess carbon dioxide.
D) should be given forceful positive-pressure breaths because their primary problem is difficulty with inhalation.

Answer 71

B) may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly.

Question 72

An increase in the number of EMS calls for patients with chronic respiratory problems MOST commonly occurs:
A) during sudden weather changes.
B) during an influenza outbreak.
C) when the relative humidity is low.
D) when people travel during a holiday.

Answer 72

A) during sudden weather changes.

Question 73

A patient who is coughing up thick pulmonary secretions should NOT take:
A) a diuretic.
B) antihistamines.
C) an antitussive.
D) bronchodilators.

Answer 73

C) an antitussive.

Question 74

Intrapulmonary shunting occurs when:
A) nonfunctional alveoli inhibit pulmonary gas exchange.
B) the volume of anatomic dead space suddenly increases.
C) hyperinflated alveoli retain high levels of carbon dioxide.
D) resistance to airflow increases due to bronchoconstriction.

Answer 74

A) nonfunctional alveoli inhibit pulmonary gas exchange.

Question 75

Bedridden patients with excessive pulmonary secretions are MOST prone to developing:
A) pneumonia.
B) bronchospasm.
C) a pneumothorax.
D) a pulmonary embolism.

Answer 75

A) pneumonia.

Question 76

Patients with pneumonia often experience a coughing fit when they roll from one side to the other because:
A) movement loosens pulmonary secretions and stimulates coughing.
B) most cases of pneumonia occur in conjunction with bronchospasm.
C) the secretions in their lungs suddenly disperse and impair breathing.
D) pneumonia often occurs in the lung bases, typically on only one side.

Answer 76

D) pneumonia often occurs in the lung bases, typically on only one side.

Question 77

Uncontrollable coughing and hemoptysis in a cigarette smoker are clinical findings MOST consistent with:
A) emphysema.
B) lung cancer.
C) pleural effusion.
D) acute bronchitis.

Answer 77

B) lung cancer.

Question 78

When auscultating the lungs of a patient with early pulmonary edema, you will MOST likely hear:
A) inspiratory rhonchi to the bilateral apices of the lungs.
B) crackles in the bases of the lungs at the end of inspiration.
C) faint rhonchi to all lung fields on inspiration and expiration.
D) coarse crackles to the bases of the lungs during inspiration.

Answer 78

B) crackles in the bases of the lungs at the end of inspiration.

Question 79

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

Answer 79

C) a pneumothorax.

Question 80

One of the hallmarks of a pulmonary embolism is:
A) the disappearance of radial pulses during inhalation.
B) pleuritic chest pain that occurs after a strong cough.
C) cyanosis that does not resolve with oxygen therapy.
D) jugular venous distention while in a supine position.

Answer 80

C) cyanosis that does not resolve with oxygen therapy.

Question 81

Pickwickian syndrome is a condition in which respiratory compromise results from:
A) extreme obesity.
B) pulmonary edema.
C) cervical spine injury.
D) diaphragmatic rupture.

Answer 81

A) extreme obesity

Question 82

You would MOST likely observe a grossly low respiratory rate and volume in a patient who overdosed on:
A) LSD.
B) ibuprofen.
C) Prozac.
D) heroin.

Answer 82

D) heroin.

Question 83

A hyperventilating patient:
A) may be acidotic and is trying to decrease his or her pH level.
B) is most effectively treated by administering a sedative drug.
C) should rebreathe his or her carbon dioxide to effect resolution.
D) presents with tachypnea and marked use of accessory muscles.

Answer 83

A) may be acidotic and is trying to decrease his or her pH level.

Question 84

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

Answer 84

B) ventilation support.

Question 85

Intubation of a patient with severe asthma:
A) is clearly indicated if the patient’s condition does not resolve following field corticosteroid therapy.
B) is often a last resort because asthmatics are difficult to ventilate and are prone to pneumothoraces.
C) should only be performed after hyperventilating the patient with a bag-mask device for 2 to 3 minutes.
D) is generally contraindicated because weaning the patient off of a ventilator can take several days.

Answer 85

B) is often a last resort because asthmatics are difficult to ventilate and are prone to pneumothoraces.

Question 86

Use of a spacer device in conjunction with a metered-dose inhaler:
A) is only indicated in children under 6 years of age, who are generally not able to use the inhaler effectively.
B) may be required when assisting a patient who is breathing inadequately, but generally results in less medication delivery to the lungs.
C) collects medication as it is released from the canister, allowing more to be delivered to the lungs and less to be lost to the environment.
D) requires the patient to time his or her inhalation to coincide with the discharge of the metered-dose inhaler.

Answer 86

C) collects medication as it is released from the canister, allowing more to be delivered to the lungs and less to be lost to the environment.

Question 87

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

Answer 87

B) 6

Question 88

Which of the following medications is a parasympathetic bronchodilator?
A) Alupent
B) Albuterol
C) Bronkosol
D) Ipratropium

Answer 88

D) Ipratropium

Question 89

CPAP in the emergency setting is used to treat patients with certain obstructive airway diseases 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.

Answer 89

A) improving patency of the lower airway through the use of positive-end expiratory pressure.

Question 90

A critical step when using a CPAP unit to treat a patient with severe respiratory distress is:
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 90

A) ensuring an adequate mask seal with minimal leakage.

Question 91

Use of an automated transport ventilator is NOT appropriate for patients who are:
A) in cardiac arrest.
B) apneic with a pulse.
C) chemically paralyzed.
D) breathing spontaneously.

Answer 91

D) breathing spontaneously.

Question 92

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.

Answer 92

C) place her in a position that facilitates breathing.

Question 93

You are dispatched to a residence for a 59-year-old man with difficulty breathing. The patient, who has a history of COPD, is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. This patient is MOST likely experiencing:
A) bronchitis.
B) pneumonia.
C) end-stage COPD.
D) COPD exacerbation.

Answer 93

B) pneumonia.

Question 94

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

Answer 94

B) Recent antitussive use

Question 95

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:
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 95

A) apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.

Question 96

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?
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 96

D) Sit him up or place him on his side.

Question 97

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:
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 97

C) administering high-flow supplemental oxygen and transporting at once.

Question 98

You are transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should:
A) remove the nonrebreathing mask and apply a nasal cannula.
B) administer a sedative and a paralytic and then intubate his trachea.
C) begin assisting his ventilations with a bag-mask and 100% oxygen.
D) insert a nasal airway, apply a CPAP unit, and notify medical control.

Answer 98

C) begin assisting his ventilations with a bag-mask and 100% oxygen.

Question 99

An elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate tidal volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her right upper abdominal quadrant. She tells you that she takes a “water pill” and Vasotec for high blood pressure. You should:
A) expect to hear crackles when you auscultate her lungs.
B) suspect acute right-sided heart failure and administer oxygen.
C) start an IV of normal saline and give her a 250-mL bolus.
D) conclude that she has been noncompliant with her diuretic.

Answer 99

B) suspect acute right-sided heart failure and administer oxygen.

Question 100

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.

Answer 100

A) assist his ventilations and establish vascular access.

Question 101

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:
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 101

B) remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.

Question 102

A known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. You should:
A) suction his oropharynx, perform intubation, and then administer naloxone via slow IV push.
B) preoxygenate him with a bag-mask device for 2 to 3 minutes and then intubate his trachea.
C) apply oxygen via nonrebreathing mask, administer naloxone, and be prepared to assist ventilations.
D) assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.

Answer 102

D) assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.

Question 103

The cricothyroid membrane:
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 103

C) is relatively avascular and is covered by skin and minimal subcutaneous tissue.

Question 104

Which of the following conditions would LEAST likely present with a rapid onset of dyspnea?
A) Pulmonary embolism
B) Pneumothorax
C) Pneumonia
D) Anaphylaxis

Answer 104

C) Pneumonia

Question 105

What type of medication can cause thick sputum?
A) Diuretic
B) Antihistamine
C) Antibiotic
D) Antipyretic

Answer 105

B) Antihistamine

Question 106

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) An underlying infection
B) Acute right heart failure
C) Oxygen noncompliance
D) Recent antitussive use

Answer 106

D) Recent antitussive use

Question 107

Which of the following medications is an anticholinergic bronchodilator?
A) Alupent
B) Albuterol
C) Ipratropium
D) Bronkosol

Answer 107

C) Ipratropium

Question 108

Residual corticosteroid in the pharynx following a metered-dose inhaler treatment can predispose the patient to:
A) bronchospasm
B) bleeding
C) thrush
D) laryngospasm

Answer 108

B) thrush

Question 109

What type of medication is montelukast (Singulair)?
A) Leukotriene blocker
B) Selective beta-2 agonist
C) Glucocorticoid
D) Corticosteroid

Answer 109

A) Leukotriene blocker

Question 110

You are dispatched to a residence for a young woman with difficulty breathing.  When you arrive, you find the patient sitting in a tripod position, noticeably dyspneic and tachypneic.  She tells you that she experienced a sudden sharp pain to the left side of her chest and then started having trouble breathing.  She states that her left leg has been painful, red, and swollen.  Based on this patient's clinical presentation, you should suspect:
A) spontaneous pneumothorax
B) a pleural effusion
C) acute pulmonary embolism
D) hyperventilation syndrome

Answer 110

C) acute pulmonary embolism

Question 111

CPAP is used to treat patients with sleep apnea by:
A) increasing the rate and depth of ventilation, thus improving minute volume and mitigating hypoxia
B) improving patency of the lower airway through the use of positive-end expiratory pressure
C) maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction
D) delivering one pressure during the inspiratory phase and a different pressure during the expiratory phase

Answer 111

C) maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction

Question 112

Apneustic breathing is characterized by:
A) a sustained pattern of tachypnea and increased tidal volume.
B) a prolonged inspiratory hold that resembles a fish breathing
C) regular respirations with a normal rate and adequate tidal volume.
D) a crescendo-decrescendo pattern of breathing with apneic periods.

Answer 112

B) a prolonged inspiratory hold that resembles a fish breathing

Question 113

A 31-year-old man is experiencing a severe asthma attack. His wife reports that he 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 his rescue inhaler without effect. He is anxious and restless, is tachypneic, and has audible wheezing. You should:
A) attempt to slow his breathing with respiratory coaching, administer a nebulized bronchodilator, and transport.
B) start an IV of normal saline, administer methylprednisolone via IV push, and transport as soon as possible.
C) begin assisting his ventilations with a bag-mask device and 100% oxygen and prepare to intubate his trachea.
D) apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.

Answer 113

D) apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital/