Random Study Questions Flashcards
While inspecting an elderly female patient, you note that she has an abnormal anterposterior (AP) curvature of the spine. This best describes which of the following?
A. kyphosis
B. scoliosis
C. kyphoscoliosis
D. pectus excavatum
A. kyphosis
An abnormal AP curvature of the spine is called kyphosis. Other common deformities are 1) pectus carinatum (abnormal anterior protrusion of the sternum); 2) pectus excavatum (depression of part or all of the sternum); 3) scoliosis (abnormal lateral curvature of the spinal); and 4) kyphoscoliosis (a combination of kyphosis and scoliosis which may produce a severe restrictive lung defect).
While auscultating a patient’s chest, you hear intermittent “bubbling” sounds at the lung bases. Which of the following best describes this finding?
A. “bronchial sounds heard at lung bases”
B. “wheezes heard at lung bases”
C. “rhonchi heard at lung bases”
D. “crackles (rales) heard at lung bases”
D. “crackles (rales) heard at lung bases”
The preferred term for short, discontinuous adventitious lung sounds that are crackling or bubbling in nature is crackles. Many clinicians still use the term rales for these sounds. Crackles are caused either by movement of excessive secretions in the airways (course crackles), or by collapsed airways opening during inspiration (fine crackles).
While feeling a patient’s radial pulse, you note that the pulse feels bounding and full. Which of the following conditions would likely be the cause of this finding?
A. hypovolemia
B. hypertension
C. cardiovascular shock
D. low cardiac output
B. hypertension
A ‘bounding’ pulse is characterized by forceful pulsations that quickly disappear, indicating a high systolic pressure without a rise in diastolic pressure (increased pulse pressure). A bounding pulse is normal during exercise or as a result of a ‘fight or flight’ release of epinephrine. A bounding pulse also can signal an abnormal condition, most commonly hypertension due to atherosclerosis or disorders causing increased stroke volume. Hypovolemia, shock, and low cardiac output usually result in decreased systolic and pulse pressures.
A patient is cachexic, exhibits generalized edema and dry skin, and appears to be lacking energy. The most likely problem in this scenario is:
A. heart failure
B. Addison’s disease
C. renal failure
D. malnutrition
D. malnutrition
A weak or emaciated appearance (cachexia); generalized edema (anasarca); cracked lips (cheilosis); dry, scaly skin; and listlessness are all physical signs associated with severe malnutrition
Before giving an aerosol treatment, you see a note in the chart that states your patient had pink frothy secretions on admission to the emergency department. This is most likely indicates which of the following:
A. cor pulmonale
B. left ventricular failure
C. an electrolyte imbalance
D. ARDS
B. left ventricular failure
Frothy pink-tinged secretions are a hallmark sign of cardiogenic pulmonary edema, which is the result of left ventricular failure or CHF.
After feeling chest pain and shortness of breath, a 38-year-old female drove herself to the emergency room. After starting oxygen therapy on the patient, the RRT performed a physical exam and noted: a hyperresonant percussion note on the right side and a tracheal shift to the left. What is most likely the cause of these findings?
A. broken ribs on the right side
B. right-sided pneumothorax
C. broken clavicle on the right side
D. acute myocardial infarction
B. right-sided pneumothorax
The patient’s signs and symptoms best fit those of a right-sided pneumothorax. Although it is possible for a patient to have a broken bone, this would not produce shortness of breath, a hyperresonant percussion note on the right side, and a tracheal shift to the left side. An acute MI could cause sudden chest pain and shortness of breath, but would not cause a hyperresonant percussion note or tracheal shift.
You have a patient who walks slower than people of the same age because of breathlessness. How would you characterize their degree of dyspnea?
A. slight
B. moderate
C. severe
D. very severe
B. moderate
You can assess a patient’s exercise tolerance via interview using the American Thoracic Society Breathlessness Scale. By inquiring as to when breathlessness is first noticed by the patient, you can assign a rating to the symptom, with a descriptive term for each level. In this case, a patient who walks slower than people of the same age on level ground because of breathlessness or has to stop for breath when walking at own pace on level ground would be characterized as having moderate dyspnea.
fter assessing an acutely dyspneic and hypotensive patient, you note the following, all on the left side of the chest: reduced chest expansion,
hyperresonance to percussion, absent of breath sounds and tactile fremitus, and a
tracheal shift to the right. These findings most likely suggest:
A. left-sided pneumothorax
B. left-sided consolidation
C. left lobar obstruction/atelectasis
D. left-sided pleural effusion
A. left-sided pneumothorax
An acutely ill patient with dyspnea, hypotension, unilateral findings of reduced chest expansion, a hyperresonant percussion note, absent of breath sounds and tactile fremitus, and a tracheal shift to the right has most likely suffered a large pneumothorax on the affected side. If the pneumothorax is severe enough to disrupt cardiac function, blood pressure will also fall.
While assessing a patient, you notice that her responses to your questions are unclear. Which of the following would be your most appropriate response?
A. “Please go on”
B. “You seem to be anxious”
C. “I see why you are so upset”
D. “Please explain that to me again”
D. “Please explain that to me again”
You’ve asked your patient to inhale as deeply as possible and blow out all of the air as hard as they can until empty. Which test is being performed?
A. FVC
B. IC
C. TLC
D. MVV
A. FVC
When a patient performs a maximal exhalation after a maximal inhalation, he is performing the forced vital capacity (FVC) maneuver.
how to identify an ET tube on a chest radiograph.
The distal tip of the tube should be seen in the middle of the trachea. An ET tube that is too deep will be in the right mainstem bronchi. They love to ask questions about this on the exam.
There is always at least one question regarding knowing the proper placement of an ET tube. Do this by: palpation of the larynx and neck, check for bilateral breath sounds, look for moisture condensation of the inside of the tube, detect exhaled CO2, look for symmetric chest expansion on exhalation, check the tip of the tube placement on chest x-ray, observe that the 24 cm mark of the tube is at the patient’s teeth.
MIP or maximum inspiratory pressure
It’s a quick and noninvasive procedure for measuring inspiratory muscle strength.
The NBRC likes to ask questions about it in regards to mechanical ventilation. Basically, be sure to remember that in order to wean the patient from mechanical ventilation, they need to have an MIP of at least -20 cmH2O.
placement of the CVP stop-clock or arterial pressure transducer.
Just remember that it should be placed at the mid-chest for accurate pressure measurements. If it’s placed above the mid-chest, the measurement will be falsely low. If it’s placed below the mid-chest, the measurement will be falselyhigh
PEEP and Cardiac Output
A decreased cardiac output is caused by hypovolemia or heart failure. Cardiac output may also be decreased on a ventilator dependent with high peak pressures or a high PEEP.
They may ask you a question in regards to a patient with a decreased cardiac output. So in that case, you should know to “decrease the PEEP.”
Nebs and Water Condensate
Remember, with a nebulizer system, if there is water condensate inside the aerosol tubing, the inspired oxygen percentage will increase.
This is because the back pressure on the jet and air entrainment ports prevents room air from being drawn into the system.
