Chapter 16 - Respiratory Emergencies

Question 1

“PASTE” is an alternate assessment tool for ___________.

Select one:

A. cardiac patients
B. respiratory patients
C. stroke patients
D. seizure patients

Answer 1

B. respiratory patients

P - Progression
A - Associated Chest Pain
S - Sputum Production (Color)
T - Talking & Tiredness
E - Exacerbation

Progression. Similar to the O in OPQRST, you want to know if the problem started suddenly or has worsened over time.

Associated chest pain. Dyspnea can be a significant symptom of a cardiac problem.

Sputum. Has the patient been coughing up sputum? Mucus-like sputum could indicate a respiratory infection, pink frothy sputum is indicative of fluid in the lungs, and a problem like a pulmonary embolus may not result in any sputum at all.

Talking tiredness. This is an indicator of how much distress the patient is in. Ask the patient to repeat a sentence and see how many words he or she can speak without needing to take a breath. The assessment results would be reported as the patient “speaks in full sentences” or, perhaps, “speaks in two-to-three-word sentences.”

Exercise tolerance. Ask the patient a question about what he or she was able to do before this problem started, like walk across the room, and then ask if the patient could do it now. If the answer is “no,” then it is another indicator that your patient is in distress. Exercise tolerance will decrease as the breathing problem and hypoxia incease.

Question 2

A 30-year-old male presents with acute shortness of breath, widespread hives, and facial swelling. He denies any past medical history and takes no medications.

During your assessment, you hear wheezing over all the lung fields. His blood pressure is 90/50 mm Hg and his heart rate is 110 beats/min. In addition to giving him high-flow oxygen, the MOST important treatment for this patient is:

Select one:

A. a beta-antagonist.
B. epinephrine.
C. albuterol.
D. an antihistamine.

Answer 2

B. epinephrine.

Question 3

A 59-year-old male with a history of emphysema complains of an acute worsening of his dyspnea and pleuritic chest pain following a forceful cough.

Your assessment reveals that he has a barrel-shaped chest, unilaterally diminished breath sounds, and tachycardia. What is the MOST likely cause of this patient’s condition?

Select one:

A. Rupture of the diaphragm
B. Spontaneous pneumothorax
C. Exacerbation of his COPD
D. Acute pulmonary embolism

Answer 3

B. Spontaneous pneumothorax

Question 4

A pleural effusion is MOST accurately defined as:

Select one:

A. a bacterial infection of the lung tissue.
B. diffuse collapsing of the alveoli.
C. fluid accumulation outside the lung.
D. a unilaterally collapsed lung.

Answer 4

C. fluid accumulation outside the lung.

Question 5

Asthma is caused by a response of the:

Select one:

A. endocrine system.
B. respiratory system.
C. immune system.
D. cardiovascular system

Answer 5

C. immune system.

Question 6

Crackles (rales) are caused by _________.

Select one:

A. narrowing of the upper airways
B. air passing through fluid
C. mucus in the larger airways
D. severe bronchoconstriction

Answer 6

B. air passing through fluid

Question 7

His parents tell you that their son has had a chest infection for the past two days and when they took him to their family doctor, they were told it was likely due to the respiratory syncytial virus (RSV).

They have kept him well hydrated, but the infection seems to have gotten worse. On auscultation, you hear decreased air entry bilaterally with fine expiratory wheezes and the occasional coarse wet crackle. Based on this information, your patient is most likely suffering from:

Select one:

A. bronchiolitis.
B. epiglottitis.
C. pertussis.
D. croup.

Answer 7

A. bronchiolitis.

Question 8

In order for efficient pulmonary gas exchange to occur:

Select one:

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

B. oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane.

C. there must be low quantities of pulmonary surfactant to allow for full alveolar expansion.

D. the pulmonary capillaries must be completely constricted and the alveoli must be collapsed.

Answer 8

B. oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane.

Question 9

In what area of the lungs does respiration occur?

Select one:

A. Capillaries
B. Bronchi
C. Trachea
D. Alveoli

Answer 9

D. Alveoli

Question 10

Treatment with continuous positive airway pressure (CPAP) would MOST likely be contraindicated in which of the following situations?

Select one:

A. Shortness of breath and blood pressure of 76/56 mm Hg

B. Conscious and alert patient with an oxygen saturation of 85%

C. Pulmonary edema, history of hypertension, and anxiety

D. Difficulty breathing, two-word dyspnea, and tachycardia

Answer 10

A. Shortness of breath and blood pressure of 76/56 mm Hg

Question 11

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. abnormal breath sounds.
C. an absence of breath sounds.
D. normal breath sounds.

Answer 11

B. abnormal breath sounds.

Question 12

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

Select one:

A. Pleural effusion
B. Narcotic overdose
C. Pulmonary edema
D. Severe anxiety

Answer 12

D. Severe anxiety

Question 13

Which of the following is a genetic disorder that predisposes the patient to repeated lung infections?

Select one:

A. Cystic fibrosis
B. Celiac sprue
C. Severe acute respiratory syndrome
D. Multiple sclerosis

Answer 13

A. Cystic fibrosis

Question 14

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

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

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

Answer 14

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

Question 15

Which of the following must be assessed in every respiratory patient?

Select one:

A. Distal pulse, motor, sensation
B. Lung sounds
C. Blood glucose levels
D. Orthostatic vital signs

Answer 15

B. Lung sounds

Question 16

While auscultating an elderly woman’s breath sounds, you hear low-pitched “rattling” sounds at the bases of both of her lungs. This finding is MOST consistent with which of the following conditions?

Select one:

A. Aspiration pneumonia
B. Widespread atelectasis
C. Early pulmonary edema
D. Acute asthma attack

Answer 16

A. Aspiration pneumonia

Question 17

You are assisting an asthma patient with his prescribed metered-dose inhaler. After the patient takes a deep breath and depresses the inhaler, you should:

Select one:

A. immediately reapply the oxygen mask and reassess his condition.

B. instruct him to hold his breath for as long as he comfortably can.

C. allow him to breathe room air and assess his oxygen saturation.

D. advise him to exhale forcefully to ensure medication absorption.

Answer 17

B. instruct him to hold his breath for as long as he comfortably can.

Question 18

You are attending to a 3-year-old male patient who is presenting with severe shortness of breath. His parents report that he has had a cough and cold with a low-grade fever for the past two days.

They became worried today, as his level of distress has increased dramatically. On assessment, the patient is sitting upright and making high-pitched noises with each breath. Based on this information, the patient is most likely suffering from:

Select one:

A. inflammation of the bronchioles.
B. inflammation of the lower respiratory tract and bronchospasm.
C. viral infection of the upper respiratory tract.
D. bacterial infection of the epiglottis.

Answer 18

C. viral infection of the upper respiratory tract.

Question 19

You are attending to a 54-year-old female patient in a homeless shelter. The patient tells you that she had the flu a couple of weeks ago, and she has not gotten over it.

She has been tired and keeps waking up at night, sweating. She has been coughing up green sputum occasionally and has been experiencing episodes of chest pain that get worse when she breathes. Based on this information, your patient is most likely suffering from:

Select one:

A. influenza Type A.
B. chronic obstructive pulmonary disease (COPD).
C. pneumonia.
D. tuberculosis.

Answer 19

D. tuberculosis.

Question 20

Your patient has a chronic respiratory condition. His stimulus to breathe is triggered by low oxygen levels in the blood. This is known as the ___________.

Select one:

A. COPD drive
B. hypoxic drive
C. alternate drive
D. CO2 drive

Answer 20

B. hypoxic drive

Question 21

The Hering-Breuer reflex is stimulated when:

Select one:

A. excess carbon dioxide needs to be eliminated from the body.

B. stretch receptors in the chest wall detect that the lungs are too full.

C. the dorsal respiratory group (DRG) stops and the process of expiration begins.

D. the brain stem senses that there is a low amount of oxygen in the blood.

Answer 21

B. stretch receptors in the chest wall detect that the lungs are too full.

Question 22

Gas exchange in the lungs is facilitated by:

Select one:

A. adequate amounts of surfactant.
B. water or blood within the alveoli.
C. surfactant-destroying organisms.
D. pulmonary capillary constriction.

Answer 22

A. adequate amounts of surfactant.

Question 23

How does CPAP improve oxygenation and ventilation in patients with certain respiratory problems?

Select one:

A. It forces the alveoli open and pushes more oxygen across the alveolar membrane.

B. It pushes thick, infected pulmonary secretions into isolated areas of the lung tissue.

C. It decreases intrathoracic pressure, which allows more room for the lungs to expand.

D. It prevents alveolar collapse by pushing air into the lungs during the inhalation phase.

Answer 23

A. It forces the alveoli open and pushes more oxygen across the alveolar membrane.

Question 24

Proper technique for suctioning the oropharynx of an adult patient includes:

Select one:

A. continuously suctioning patients with copious oral secretions.
B. suctioning while withdrawing the catheter from the oropharynx.
C. removing large, solid objects with a tonsil-tip suction catheter.
D. suctioning for up to 1 minute if the patient is well oxygenated.

Answer 24

B. suctioning while withdrawing the catheter from the oropharynx.

Question 25

Without adequate oxygen, the body’s cells:

Select one:

A. rely solely on glucose, which is completely converted into adenosine triphosphate (ATP).

B. cease metabolism altogether, resulting in carbon dioxide accumulation in the blood.

C. begin to metabolize fat, resulting in the production and accumulation of ketoacids.

D. incompletely convert glucose into energy, and lactic acid accumulates in the blood.

Answer 25

D. incompletely convert glucose into energy, and lactic acid accumulates in the blood.

Question 26

Abdominal thrusts in a conscious child or adult with a severe upper airway obstruction are performed:

Select one:

A. until he or she loses consciousness.
B. in sets of five followed by reassessment.
C. about 1″ below the xiphoid process.
D. until he or she experiences cardiac arrest.

Answer 26

A. until he or she loses consciousness.

Question 27

You are attending to a 28-year-old female patient in severe respiratory distress. The patient has had a high fever all day, and the respiratory distress came on very quickly. Your patient is now sitting in a chair, leaning forward with her hands on her knees. She is making high-pitched sounds with each breath and does not seem to be moving very much air. Based on this information, your patient is likely suffering from:

A. bronchiolitis.
B. acute asthma.
C. epiglottitis.
D. foreign body airway obstruction.

Answer 27

C. epiglottitis.

Question 28

You are assessing a patient with respiratory distress and are unsure if the cause is congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). Which of the following clinical signs would be the MOST helpful in determining whether the patient has CHF or COPD?

A. Rapid breathing
B. Cyanosis of the skin
C. Altered mental status
D. Jugular vein distention

Answer 28

D. Jugular vein distention

Question 29

Albuterol is a generic name for:

A. Alupent.
B. Atrovent.
C. Ventolin.
D. Singulair.

Answer 29

C. Ventolin.

Question 30

During the primary assessment, you determine your patient has a life-threatening emergency. You should now:

A. finish all treatment before
B. complete the secondary assessment.
C. transport rapidly.
D. determine the patient’s hospital preference.

Answer 30

C. transport rapidly.

Question 31

Which of the following statements regarding pulse oximetry is correct?

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%.

Answer 31

C. Pulse oximetry measures the percentage of hemoglobin that is saturated with oxygen, but does not measure the actual hemoglobin content of the blood.

Question 32

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

A. Audible stridor.
B. Rales and rhonchi.
C. Profound cyanosis.
D. Expiratory wheezing.

Answer 32

D. Expiratory wheezing.

Question 33

Your elderly patient recently had surgery. She now complains of a sudden onset of dyspnea and sharp chest pain. You should suspect ___________.

A. pertussis
B. asthma
C. pulmonary embolus
D. emphysema

Answer 33

C. pulmonary embolus

Question 34

Which of the following filters, warms, and humidifies air during inhalation?

A. Upper airway
B. Lower airway
C. Pulmonary capillaries
D. Alveoli

Answer 34

A. Upper airway

Question 35

Your patient is complaining of fatigue. She is breathing at 18 breaths per minute, has equal chest rise and fall, and has clear lung sounds. She is presenting with signs of ___________.

A. Orthopnea
B. Normal breathing
C. Respiratory distress
D. Tachypnea

Answer 35

B. Normal breathing

Question 36

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. place her in a recumbent position to facilitate breathing.
B. contact medical control and administer an antihistamine.
C. call medical control and ask how to proceed with treatment.
D. determine if she has been prescribed a beta-agonist inhaler.

Answer 36

D. determine if she has been prescribed a beta-agonist inhaler.

Albuterol Sulfate is a Beta 2 agonist.

Question 37

You are attending to a 5-year-old male patient who has had a cold and fever for the last two days. His parents became concerned when he started having coughing spells that would last for over a minute, during which he would turn blue. After the coughing attack, his parents reported that he seemed to be sucking the air back in. Based on this information, your patient is most likely suffering from:

A. bronchiolitis.
B. pertussis
C. epiglottitis.
D. respiratory syncytial virus (RSV) infection.

Answer 37

B. pertussis

Question 38

A young female is unconscious after intentionally ingesting a large amount of aspirin. You will MOST likely find her respirations:

A. Slow and deep.
B. Deep and rapid.
C. Slow and shallow.
D. Rapid and shallow.

Answer 38

B. Deep and rapid.

Question 39

The hypoxic drive is the body’s _________.

A. secondary cardiac pacemaker
B. primary respiratory drive
C. secondary respiratory drive
D. primary cardiac pacemaker

Answer 39

C. secondary respiratory drive

Question 40

Which of the following is a common MDI drug?

A. Alupent
B. Acetylsalicylic acid
C. Methylprednisolone
D. Nitroglycerin

Answer 40

A. Alupent

Question 41

In a healthy individual, the brain stem stimulates breathing on the basis of:

A. increased oxygen levels.
B. decreased oxygen levels.
C. increased carbon dioxide levels.
D. decreased carbon dioxide levels.

Answer 41

C. increased carbon dioxide levels.

Question 42

A 60-year-old male presents with acute respiratory distress. He is conscious and alert, has pink and dry skin, and has respirations of 22 breaths/min with adequate depth. Which of the following treatments is MOST appropriate for this patient?

A. Assisted ventilation with a bag-valve mask and a head-to-toe exam
B. Oxygen via nonrebreathing mask and a focused secondary assessment
C. Positive-pressure ventilations and immediate transport to the closest hospital
D. Oxygen via a nasal cannula, vital signs, and prompt transport to the hospital

Answer 42

B. Oxygen via nonrebreathing mask and a focused secondary assessment

Question 43

The respiratory distress that accompanies emphysema is caused by:

A. repeated exposure to cigarette smoke.
B. chronic stretching of the alveolar walls.
C. massive constriction of the bronchioles.
D. acute fluid accumulation in the alveoli.

Answer 43

B. chronic stretching of the alveolar walls.

Question 44

You are attending to a 6-year-old female patient. Her parents tell you that she has been sick for the last three days with the respiratory infection that has been going around her school. They became concerned when she stopped drinking fluids, and they could not get her to take in any liquids. The patient is showing signs of significant dehydration. Based on this information, your patient is most likely suffering from:

A. bronchiolitis.
B. acute asthma.
C. epiglottitis.
D. respiratory syncytial virus (RSV) infection.

Answer 44

D. respiratory syncytial virus (RSV) infection.

Question 45

The process in which oxygen and carbon dioxide are exchanged in the lungs is called:
A. respiration.
B. ventilation.
C. metabolism.
D. inhalation.

Answer 45

A. respiration.

Question 46

Which of the following respiratory diseases causes obstruction of the lower airway?
A. Croup
B. Asthma
C. Epiglottitis
D. Laryngitis

Answer 46

B. Asthma

Asthma is a lower airway disease that causes the bronchioles in the lungs to constrict (bronchospasm), resulting in various degrees of obstruction. Croup, epiglottitis, and laryngitis cause swelling, inflammation, and varying degrees of obstruction of the upper airway.

Question 47

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

Answer 47

A. Tuberculosis

Tuberculosis is a bacterial infection spread by cough. It is dangerous because many strains are resistant to antibiotics.

Question 48

All of the following are causes of acute dyspnea, EXCEPT:
A. asthma.
B. emphysema.
C. pneumothorax.
D. pulmonary embolism

Answer 48

B. emphysema.

Emphysema—a form of COPD—is a chronic respiratory disease; therefore, it presents with progressively worsening dyspnea. Asthma, pulmonary embolism, and pneumothorax are all acute conditions; therefore, they typically present with an acute onset of dyspnea.

Question 49

Bronchospasm is MOST often associated with:
A. asthma.
B. bronchitis.
C. pneumonia.
D. pneumothorax.

Answer 49

A. asthma.

Question 50

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.

Answer 50

C. a pulmonary embolism.

Question 51

Albuterol, a beta-2 agonist, is the generic name for:
A. Alupent.
B. Metaprel.
C. Brethine.
D. Ventolin.

Answer 51

D. Ventolin.

Question 52

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.

Answer 52

C. epiglottitis.

Question 53

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.

Answer 53

B. severe left heart failure.

As a result of his recent heart attack, the left side of this patient’s heart has been severely damaged. The left side of the heart is responsible for pumping oxygenated blood to the rest of the body. When it fails to do this, blood backs up into the lungs, resulting in pulmonary edema. Signs of pulmonary edema include dyspnea (especially when lying flat); rapid and shallow respirations; and, in severe cases, coughing up of pink, frothy sputum.

Question 54

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,whoisconsciousand 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

Answer 54

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

Question 55

You are dispatched to a residence for a 67-year-old female who was awakened by shortness of breath and sharp chest pain. Her husband tells you that she was recently discharged from the hospital after having hip surgery. Your assessment reveals dried blood around her mouth, facial cyanosis, and an oxygen saturation of 88%. You should suspect:
Select one:
A. acute pulmonary embolism.
B. spontaneous pneumothorax.
C. right-sided heart failure.
D. acute pulmonary edema.

Answer 55

A. acute pulmonary embolism.

Question 56

Acute pulmonary edema would MOST likely develop as the result of:
Select one:
A. toxic chemical inhalation.
B. severe hyperventilation.
C. an upper airway infection.
D. right-sided heart failure.

Answer 56

A. toxic chemical inhalation.

Question 57

When administering supplemental oxygen to a hypoxemic patient with a chronic lung disease, you should:
Select one:
A. adjust the flow rate accordingly until you see symptom improvement, but be prepared to assist his or her ventilations.
B. begin with a low oxygen flow rate, even if the patient is unresponsive, because high-flow oxygen may depress his or her breathing.
C. recall that most patients with chronic lung diseases are stimulated to breathe by increased carbon dioxide levels.
D. avoid positive-pressure ventilation because the majority of patients with chronic lung disease are at increased risk for lung trauma

Answer 57

A. adjust the flow rate accordingly until you see symptom improvement, but be prepared to assist his or her ventilations.

Question 58

A 22-year-old female patient is complaining of dyspnea and numbness and tingling in her hands and feet after an argument with her fiancé. Her respirations are 40 breaths/min. You should:
Select one:
A. request a paramedic to give her a sedative.
B. position her on her left side and transport at once.
C. provide reassurance and give oxygen as needed.
D. have her breathe into a paper or plastic bag.

Answer 58

C. provide reassurance and give oxygen as needed.