Module 5

Question 1

The MOST obvious risk associated with extubation is:

A) moderate airway swelling as the ET tube is removed.
B) overestimating the patient’s ability to protect his or her own airway.
C) patient retching and gagging as you remove the ET tube.
D) stimulation of the parasympathetic nervous system with resulting bradycardia

Answer 1

B) overestimating the patient’s ability to protect his or her own airway.

Question 2

The MOST common complication associated with nasotracheal intubation is:

A) bleeding.
B) aspiration.
C) hypoxemia.
D) regurgitation.

Answer 2

A) Bleeding

Question 3

The MOST significant complication associated with the use of an oropharyngeal airway is:

A) soft-tissue trauma with oral bleeding.
B) mild bradycardia in pediatric patients.
C) significant bruising of the hard palate.
D) a tachycardic response in adult patients.

Answer 3

A) soft-tissue trauma with oral bleeding.

Question 4

Which of the following represents the correct sequence for managing a patient’s airway?

A) Open, clear, assess, intervene
B) Clear, open, assess, intervene
C) Assess, clear, open, intervene
D) Open, assess, clear, intervene

Answer 4

A) Open, clear, assess, intervene

Question 5

Physiologic effects of CPAP include:

A) increased intrathoracic pressure.
B) forcing of fluid into the alveoli.
C) increased alveolar surface tension.
D) opening of collapsed alveoli

Answer 5

D) opening of collapsed alveoli

Question 6

During tracheobronchial suctioning, it is MOST important to:

A) apply suction for no longer than 5 seconds in the adult.
B) avoid rotating the catheter as you are suctioning the trachea.
C) monitor the patient’s cardiac rhythm and oxygen saturation.
D) inject 10 mL of saline down the ET tube to loosen secretions

Answer 6

C) monitor the patient’s cardiac rhythm and oxygen saturation.

Question 7

When replacing a dislodged tracheostomy tube, it is MOST important that you:

A) insert the tube 2 cm beyond the cuff.
B) take appropriate standard precautions.
C) lubricate the tube before insertion.
D) use a tracheostomy tube of the same size.

Answer 7

B) take appropriate standard precautions.

Question 8

When suctioning a patient’s stoma, you should:

A) insert the catheter until resistance is felt.
B) ask the patient to inhale as you are suctioning.
C) insert the catheter no more than 15 cm.
D) provide suction for no longer than 20 seconds.

Answer 8

A) insert the catheter until resistance is felt.

Question 9

When two paramedics are ventilating an apneic patient with a bag-mask device, the paramedic not squeezing the bag should:

A) apply posterior cricoid pressure.
B) manually position the patient’s head.
C) continually auscultate breath sounds.
D) maintain an adequate mask-to-face seal.

Answer 9

D) maintain an adequate mask-to-face seal.

Question 10

When ventilating a patient with a bag-mask device, you note increased compliance. This means that:

A) you are meeting resistance when ventilating.
B) air can be forced into the lungs with relative ease.
C) a lower airway obstruction should be suspected.
D) the patient likely has an upper airway obstruction.

Answer 10

B) air can be forced into the lungs with relative ease.

Question 11

When ventilating a patient with facial injuries, it is MOST important to:

A) ventilate with a higher-than-normal volume.
B) suction the oropharynx every 2 to 3 minutes.
C) be alert for changes in ventilation compliance.
D) ensure that a cervical collar has been applied.

Answer 11

C) be alert for changes in ventilation compliance.

Question 12

Laryngospasm is defined as:

A) aspiration of foreign material.
B) spasmodic closure of the vocal cords.
C) voluntary closure of the glottic opening.
D) spontaneous collapsing of the trachea.

Answer 12

B) spasmodic closure of the vocal cords

Question 13

Which of the following conditions would MOST likely cause laryngeal spasm and edema?

A) Croup
B) Inhalation injury
C) Viral pharyngitis
D) Mild asthma attack

Answer 13

B) Inhalation injury

Question 14

Under normal conditions, the central chemoreceptors in the brain increase the rate and depth of breathing when the:

A) PaO2 level falls quickly.
B) pH of the CSF decreases.
C) PaCO2 decreases slowly.
D) pH of the CSF increases

Answer 14

D) pH of the CSF increases

Question 15

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 15

D) congestive heart failure.

Question 16

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 16

A) during sudden weather changes.

Question 17

The ______________ is the lowest portion of the pharynx and opens into the larynx anteriorly and the esophagus posteriorly.

A. oropharynx
B. nasopharynx
C. hypopharynx
D. laryngopharynx

Answer 17

D. laryngopharynx

Question 18

The ____________ are pyramid-like structures that form the posterior attachment of the vocal cords.

A. palatine tonsils
B. pyriform fossae
C. arytenoid cartilages
D. hypoepiglottic ligaments

Answer 18

C. arytenoid cartilages

Question 19

A patient who is coughing up thick pulmonary secretions should NOT take:

A) a diuretic.
B) antihistamines.
C) an antitussive.
D) bronchodilators.

Answer 19

C) an antitussive.

Question 20

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 20

B) Recent antitussive use

Question 21

All of the following factors would increase a person’s respiratory rate, EXCEPT:

A. narcotic analgesic use.
B. increased metabolism.
C. the use of amphetamines.
D. a rise in body temperature.

Answer 21

A. narcotic analgesic use.

Question 22

When a patient’s respirations are too rapid and too shallow:

A. the majority of inhaled air lingers in areas of physiologic dead space.
B. inhaled air may only reach the anatomic dead space before being exhaled.
C. the increase in tidal volume will compensate for a rapid respiratory rate.
D. minute volume increases because a larger amount of air reaches the lungs

Answer 22

B. inhaled air may only reach the anatomic dead space before being exhaled

Question 23

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 23

A) above 95%.

Question 24

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 5 g/dL of hemoglobin is desaturated.
C) his or her oxygen saturation falls below 50%.
D) 10% of his or her hemoglobin is desaturated.

Answer 24

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

Question 25

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 25

D) 50

Question 26

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 26

C) Fever and localized crackles

Question 27

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 27

B) pneumonia.

Question 28

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 28

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

Question 29

You respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the recent past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient’s daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically looking. You should:

A) apply a nonrebreathing mask, assess his oxygen saturation level, and prepare for immediate transport.
B) provide aggressive airway management unless the daughter can produce a valid DNR order.
C) intubate him at once, begin transport, and advise the daughter to notify the hospital when she finds the DNR order.
D) recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.

Answer 29

D) recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.

Question 30

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 30

C) air trapping in the lungs.

Question 31

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 31

C) thick secretions in the large airways.

Question 32

Digital clubbing is MOST indicative of:

A) acute hypoxemia.
B) chronic hypoxia.
C) right heart failure.
D) peripheral vascular disease.

Answer 32

B) chronic hypoxia.

Question 33

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 33

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

Question 34

Hepatomegaly and jugular venous distention are MOST suggestive of:

A) left heart failure.
B) right heart failure.
C) pulmonary edema.
D) severe pneumonia.

Answer 34

B) right heart failure.

Question 35

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 35

A) the epigastrium and thorax moving in opposite directions.

Question 36

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 36

A) extreme obesity.

Question 37

Pneumonitis is especially common in older patients with:

A) frequent infections.
B) a history of a stroke.
C) immunocompromised.
D) chronic food aspiration.

Answer 37

D) chronic food aspiration.

Question 38

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 38

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

Question 39

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 39

B) was previously intubated for his or her condition.

Question 40

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 40

D) physical exhaustion and inaudible breath sounds.

Question 41

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 41

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

Question 42

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 42

D) with poor peripheral perfusion.

Question 43

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 43

B) the faster he or she will desaturate.

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

Patients with obvious respiratory failure require immediate:

A) intubation.
B) ventilation support.
C) passive oxygenation.
D) bronchodilator therapy.

Answer 45

B) ventilation support.

Question 45

You have intubated a 70-year-old man with chronic bronchitis and are en route to the hospital. During transport, you note that ventilations are becoming increasingly difficult and the digital capnometry reading is falling. Your partner tells you that she can still hear bilaterally equal breath sounds, but they are faint. She further tells you that there are no sounds over the epigastrium. What intervention is MOST likely indicated for this patient?

A) Immediate extubation
B) Withdrawing the tube 2 cm
C) Tracheobronchial suctioning
D) Hyperventilation at 24 breaths/min

Answer 45

C) Tracheobronchial suctioning

Question 46

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 46

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

Question 47

The diaphragm of the stethoscope is designed to auscultate:

A) heart tones.
B) low-pitched sounds.
C) bowel sounds.
D) high-pitched sounds.

Answer 47

D) high-pitched sounds.

Question 48

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 48

D) prior intubation for the same problem.

Question 49

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 49

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

Question 50

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 50

C) does not equate to adequate ventilation.

Question 51

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

A) respiration.
B) inhalation.
C) ventilation.
D) exhalation.

Answer 51

C) ventilation.

Question 52

Following an optimal inspiration, the amount of air that can be forced from the lungs in a single exhalation is called the:

A) functional reserve capacity.
B) expiratory reserve volume.
C) residual expiratory volume.
D) fraction of inspired oxygen

Answer 52

A) functional reserve capacity.

Question 53

Difficulty with exhalation is MOST characteristic of:

A) supraglottic swelling.
B) upper airway obstruction.
C) a mild asthma attack.
D) obstructive lung disease.

Answer 53

D) obstructive lung disease.

Question 54

The by-product of cellular respiration is:

A) oxygen.
B) lactic acid.
C) pyruvic acid.
D) carbon dioxide.

Answer 54

D) carbon dioxide.

Question 55

The exchange of oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries is called:

A) internal respiration.
B) external respiration.
C) pulmonary ventilation.
D) intrapulmonary shunting

Answer 55

B) external respiration.

Question 56

You should insert the ET tube between the vocal cords until the:

A) centimeter marking reads 15 cm at the patient’s teeth.
B) distal end of the cuff is 1 to 2 cm past the vocal cords.
C) proximal end of the cuff is 1 to 2 cm past the vocal cords.
D) tube meets resistance as it makes contact with the carina.

Answer 56

C) proximal end of the cuff is 1 to 2 cm past the vocal cords.

Question 57

An increasing peak expiratory flow reading in a patient with respiratory distress suggests that the patient is:

A) experiencing worsened hypoxemia.
B) no longer experiencing bronchospasm.
C) responding to bronchodilator therapy.
D) in need of further bronchodilator therapy

Answer 57

C) responding to bronchodilator therapy.

Question 58

When obtaining a peak expiratory flow rate for a patient with acute bronchospasm, you should:

A) ask the patient to fully exhale before blowing into the mouthpiece.
B) perform the test three times and take the best rate of the three readings.
C) administer one bronchodilator treatment before obtaining the first reading.
D) ensure that the patient is in a supine position to obtain an accurate reading

Answer 58

B) perform the test three times and take the best rate of the three readings.

Question 59

When nasally intubating a patient, the ET tube is advanced:

A) as the patient exhales.
B) when the patient inhales.
C) when the patient swallows.
D) in between the patient’s breaths.

Answer 59

B) when the patient inhales.

Question 60

When looking inside a patient’s mouth, you cannot see the posterior pharynx and only the base of the uvula is exposed. This is indicative of a Mallampati Class:

A) I.
B) II.
C) III.
D) IV.

Answer 60

C) III.

Question 61

When inserting a stylet into an ET tube, you must ensure that:

A) the stylet rests at least ½ in back from the end of the tube.
B) you use a petroleum-based gel to facilitate easy removal.
C) the stylet is rigid and does not allow the ET tube to bend.
D) the tube is bent in the form of a U to facilitate placement

Answer 61

A) the stylet rests at least ½ in back from the end of the tube.

Question 62

When determining the correct-sized nasogastric tube for a patient, you should measure the tube:

A) from the nose to the ear and to the xiphoid process.
B) from the nose to the chin and to the epigastric region.
C) from the mouth to the chin and to the xiphoid process.
D) from the nose, around the ear, and to the xiphoid process.

Answer 62

A) from the nose to the ear and to the xiphoid process.

Question 63

Proper insertion of the LMA involves:
A) inserting the LMA into the patient’s mouth by following the curvature of the patient’s tongue.

B) lifting the patient’s jaw upward and blindly inserting the LMA until you meet resistance.
C) flexing the patient’s neck, depressing the tongue with a tongue blade, and blindly inserting the LMA.
D) inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate.

Answer 63

D) inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate.

Question 64

When checking the cuff of the LMA prior to insertion, you should:

A) stretch the cuff to check for tears or other damage.
B) inflate the cuff with 100 mL of air and then deflate.
C) gently pull on the cuff at the tube to ensure integrity.
D) inflate the cuff with 50% more air than is required

Answer 64

D) inflate the cuff with 50% more air than is required

Question 65

When administering oxygen via a nonrebreathing mask, you must ensure that the:

A) reservoir is half-filled first.
B) one-way valves are disabled.
C) patient has adequate tidal volume.
D) flow rate is set to at least 6 L/min.

Answer 65

C) patient has adequate tidal volume.

Question 66

A construction worker fell approximately 15 ft and landed on his head. He is semiconscious. His respiratory rate is 14 breaths/min with adequate depth. Further assessment reveals blood draining from his nose. You should:

A) administer oxygen via nonrebreathing mask and continue your assessment.
B) insert a nasopharyngeal airway and assist ventilations with a bag-mask device. C) suction his nasopharynx for up to 30 seconds and apply oxygen via nasal cannula.
D) insert a nasopharyngeal airway and administer oxygen via nonrebreathing mask

Answer 66

A) administer oxygen via nonrebreathing mask and continue your assessment.

Question 67

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 67

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

Question 68

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 68

A) ensuring an adequate mask seal with minimal leakage.

Question 69

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 69

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

Question 70

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 70

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

Question 71

Physiologic effects of CPAP include:

A) increased intrathoracic pressure.
B) forcing of fluid into the alveoli.
C) increased alveolar surface tension.
D) opening of collapsed alveoli

Answer 71

D) opening of collapsed alveoli

Question 72

Indications for CPAP include:

A) cardiopulmonary arrest.
B) acute pulmonary edema.
C) severe opiate toxicity.
D) acute bacterial pneumonia

Answer 72

B) acute pulmonary edema.

Question 73

When administering CPAP therapy to a patient, it is important to remember that:

A) acute symptomatic bradycardia has been directly linked to CPAP therapy.
B) SpO2 of 100% must be achieved as quickly as possible.
C) the increased intrathoracic pressure caused by CPAP can result in hypotension.
D) the head straps must be secured immediately in order to achieve an adequate seal

Answer 73

C) the increased intrathoracic pressure caused by CPAP can result in hypotension.

Question 74

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 74

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

Question 75

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 75

B) become hypercapneic and acidotic.

Question 76

When a patient is given a paralytic without sedation:

A) he or she is fully aware and can hear and feel.
B) you should only give one tenth of the standard dose.
C) placement of an ET tube is less traumatic.
D) paralysis is not achieved and intubation is not possible

Answer 76

A) he or she is fully aware and can hear and feel.

Question 77

What phase of the capnographic waveform is called the expiratory upslope?

A) A-B
B) B-C
C) C-D
D) D-E

Answer 77

B) B-C

Question 78

Most patients with an ST-elevation myocardial infarction:

A) will develop Q waves.
B) heal without treatment.
C) experience cardiac arrest.
D) present without chest pain.

Answer 78

A) will develop Q waves.

Question 79

A pathologic Q wave:

A) generally indicates that an acute myocardial infarction has occurred within the past hour.
B) is deeper than one quarter of the height of the R wave and indicates injury.
C) is wider than 0.04 seconds and indicates that a myocardial infarction occurred in the past.
D) can only be substantiated by viewing at least two previous 12-lead ECGs

Answer 79

C) is wider than 0.04 seconds and indicates that a myocardial infarction occurred in the past.

Question 80

Typically, ETCO2 is approximately:

A) 2 to 5 mm Hg higher than the arterial PaCO2.
B) 2 to 5 mm Hg lower than the arterial PaCO2.
C) 5 to 10 mm Hg higher than the arterial PaCO2.
D) 5 to 10 mm Hg lower than the arterial PaCO2

Answer 80

B) 2 to 5 mm Hg lower than the arterial PaCO2.

Question 81

A major complication associated with atrial fibrillation is:

A) clot formation in the fibrillating atria.
B) a significant reduction in atrial filling.
C) pulmonary congestion and hypoxemia.
D) a profound increase in the atrial kick.

Answer 81

A) clot formation in the fibrillating atria.

Question 82

The presence of dizziness in a patient with a suspected myocardial infarction is MOST likely the result of:

A) fear and anxiety.
B) the effects of nitroglycerin.
C) acute left-sided heart failure.
D) a reduction in cardiac output.

Answer 82

D) a reduction in cardiac output.

Question 83

A classic sign of atrial flutter is:

A) a constant 2:1 conduction ratio.
B) the presence of sawtooth F waves.
C) a ventricular rate less than 100 beats/min.
D) an irregular but consistent R-R interval.

Answer 83

B) the presence of sawtooth F waves.

Question 84

Patients who are experiencing an infarction of the right ventricle:

A) should not be given IV fluid boluses.
B) often require high doses of nitroglycerin.
C) are usually hypertensive and tachycardic.
D) may present with significant hypotension.

Answer 84

D) may present with significant hypotension.

Question 85

The procedure in which the vocal cords are visualized for placement of an ET tube is called direct:

A) bronchoscopy.
B) tracheostomy.
C) pharyngoscopy.
D) laryngoscopy.

Answer 85

D) laryngoscopy.

Question 86

A surgical opening into the trachea is called:

A) stoma.
B) laryngectomy.
C) Laryngectomee.
D) tracheostomy.

Answer 86

D) tracheostomy.

Question 87

A patient who is coughing up purulent sputum is MOST likely experiencing:

A) emphysema.
B) dehydration.
C) an infection.
D) pulmonary edema.

Answer 87

C) an infection.

Question 88

Which of the following abnormal respiratory patterns generally do NOT suggest brain injury or cerebral anoxia?

A) Biot respirations
B) Agonal respirations
C) Kussmaul respirations
D) Cheyne-Stokes respirations

Answer 88

C) Kussmaul respirations

Question 89

After using a corticosteroid inhaler, patients should rinse out the mouth with water or mouthwash. Residual corticosteroid in the pharynx can predispose patients to thrush, an annoying fungal infection of the pharynx.
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 89

B) takes a few hours to reduce bronchial edema.

Question 90

A “runaway” pacemaker is characterized by:

A) an absence of pacemaker spikes.
B) profound slowing of the heart rate.
C) a tachycardic pacemaker rhythm.
D) a narrowing of the QRS complexes.

Answer 90

C) a tachycardic pacemaker rhythm.

Question 91

A delta wave is identified on a cardiac rhythm strip as a(n):

A) apparent P wave that occurs at the end of the QRS complex.
B) acute widening of the QRS complex immediately after the R wave.
C) rapid upslope to the R wave immediately after the end of the P wave.
D) delay between the end of the P wave and the beginning of the R wave.

Answer 91

C) rapid upslope to the R wave immediately after the end of the P wave.

Question 92

A demand pacemaker:

A) generates pacing impulses only when it senses that the heart’s natural pacemaker has fallen below a preset rate.
B) sends out single electrical impulses when the patient’s inherent pacemaker rate exceeds 150 beats/min.
C) is easily identified on a cardiac rhythm strip by noting the presence of pacer spikes before all of the QRS complexes.
D) attaches to the atria and the ventricles and only generates an impulse if it senses that the patient is in ventricular fibrillation.

Answer 92

A) generates pacing impulses only when it senses that the heart’s natural pacemaker has fallen below a preset rate.

Question 93

Which of the following mechanisms causes hypertension?

A) Arteriosclerosis results in increased elasticity of the arteries, causing vasodilation and increased arteriolar capacity.
B) Atherosclerotic plaque narrows one or more of the coronary arteries, resulting in increased cardiac perfusion.
C) Increased afterload stimulates the Frank-Starling reflex, which raises the pressure behind the blood leaving the heart.
D) Heart rate that is persistently above 80 beats/min causes an increase in cardiac output and a resultant increase in blood pressure.

Answer 93

C) Increased afterload stimulates the Frank-Starling reflex, which raises the pressure behind the blood leaving the heart.

Question 94

A key to interpreting a Mobitz type II second-degree heart block is to remember that:

A) unlike a Mobitz type I second-degree heart block, a type II heart block is always regular.
B) in this type of heart block, the PR interval gets progressively longer until a P wave is not conducted.
C) the PR interval of all of the conducted P waves and their corresponding QRS complexes is constant.
D) most type II second degree AV blocks have more than two nonconducted P waves that occur in succession.

Answer 94

C) the PR interval of all of the conducted P waves and their corresponding QRS complexes is constant.

Question 95

A second-degree heart block, Mobitz type I, occurs when:

A) every other impulse generated by the SA node is blocked at the AV node and does not depolarize the ventricles.
B) each successive impulse is progressively delayed, until one impulse is blocked from entering the ventricles.
C) the PR interval progressively grows narrower, until there is a P wave that is not followed by a QRS complex.
D) more than one successive impulse from the SA node is blocked at the AV node and is not allowed to enter the ventricles.

Answer 95

B) each successive impulse is progressively delayed, until one impulse is blocked from entering the ventricles.