Respiratory Chapter 31,42,43 Flashcards
All of the following are found during rapid eye movement sleep EXCEPT:
a. the diaphragm functions normally.
b. the person is easy to awaken.
c. dreaming occurs.
d. skeletal muscles are paralyzed.
the person is easy to awaken.
Signs and symptoms associated with obstructive sleep apnea include:
- insomnia.
- excessive daytime sleepiness.
- hypothyroidism.
- metabolic alkalosis
- insomnia.
2. excessive daytime sleepiness.
Clinical disorders associated with central sleep apnea include:
- Pickwickian syndrome.
- depression.
- encephalitis.
- brain stem infarction.
- encephalitis.
4. brain stem infarction.
Sleep apnea would be diagnosed in a patient who has which of these findings?
- More than 15 apnea episodes per hour of sleep
- More than 5 apnea episodes per hour over an 8-hour period
- More than 75% of the apneas are obstructive.
- More than 75% of the apneas and hypopneas are obstructive
1, 3, 4
All of the following are evaluated during a polysomnographic sleep study EXCEPT:
a. breath sounds.
b. chest and/or abdominal movement.
c. electro-oculogram (EOG).
d. nasal and oral air flow.
breath sounds
Mixed sleep apnea has which of these traits?
- Obstructive apnea traits
- Central apnea traits
- Usually begins as central apnea
- Usually ends as central apnea
- Obstructive apnea traits
- Central apnea traits
- Usually begins as central apnea
Continuous positive airway pressure (CPAP) is useful in the management of the patient with obstructive sleep apnea because it:
prevents airway collapse
A CPAP titration polysomnogram is performed to:
a. find the maximum CPAP level for the functional residual capacity.
b. determine the lowest possible CPAP level.
c. find the CPAP level to maintain an open airway.
d. determine the pressure needed for negative-pressure ventilation.
find the CPAP level to maintain an open airway.
First-line treatment for the management of hyperventilation-related central sleep apnea includes:
CPAP.
Which of the following may be used in the management of a patient with central sleep apnea?
- Acetazolamide
- Oxygen therapy
- Inhaled bronchodilator medications
- Adaptive servo-ventilation (VPAP)
1, 2, 4
During a pulmonary function study, it was found that a patient has a sawtooth pattern on his flow-volume loop. What is this finding associated with?
a. Central sleep apnea
b. COPD
c. Obstructive sleep apnea
d. Laryngeal edema (epiglottitis)
Obstructive sleep apnea
Sleep apnea is associated with:
- increased SVR.
- decreased SVR.
- increased PVR.
- decreased PVR.
a. 1, 3
Which of the following cardiac dysrhythmias is life threatening?
a. Atrioventricular block
b. Sinus bradycardia
c. Ventricular tachycardia
d. Premature ventricular contraction
Ventricular tachycardia
The respiratory therapist is evaluating a patient for risk of obstructive sleep apnea. All of the following are risk factors for obstructive sleep apnea EXCEPT:
a. excess weight.
b. neck size.
c. hypertension.
d. hypoglycemia.
e. chronic nasal congestion.
hypoglycemia.
All of the following may be an advantage of in-home portable sleep testing EXCEPT:
a. convenience.
b. patient acceptance.
c. can be easily performed over multiple nights.
d. decreased cost.
e. published standards for scoring or interpretation.
published standards for scoring or interpretation.
The rationale behind the use of supplemental oxygen in the treatment of sleep apnea is to:
a. preoxygenate the airway prior to the apneic episodes.
b. stimulate the central chemoreceptors and prevent apneic episodes.
c. increase the respiratory drive in the medulla.
d. blow off carbon dioxide in the alveolus.
preoxygenate the airway prior to the apneic episodes.
A 10-year-old girl was rescued from a school swimming pool, where she was found unconscious, and transported to a nearby hospital, where her lungs were discovered to be dry. What could cause dry lungs in this near drowning?
Her glottis spasmed and prevented pool water from entering her lungs.
What are complications associated with a near drowning in unclean, swampy water?
- Pneumonia
2. Acute respiratory distress syndrome (ARDS)
In comparing the pathologic changes to the lungs caused by fresh water versus salt water, which of the following can be stated?
a. Salt water causes more damage.
b. Fresh water causes more damage.
c. Both cause identical pathologic changes.
d. Cold water of either type causes more damage than warm water of either type.
Both cause identical pathologic changes.
The effects of a near-drowning victim inhaling water into the lungs include:
- alveolar consolidation.
- bronchospasm.
- production of frothy, white secretions.
- pleural effusion.
- alveolar consolidation.
- bronchospasm.
- production of frothy, white secretions.
Favorable prognostic factors in clean water near-drowning include:
- greater effort to reach the surface.
- alcohol in the victim.
- colder water.
- younger age.
- colder water.
4. younger age
What water temperature has been shown to be a favorable prognostic factor in near drowning?
d. Between 27° F and 70° F
A near-drowning victim in cardiac arrest has been placed in an ambulance. During transport, the goals of the paramedics should be to:
- contact the victim’s insurance carrier.
- perform high-quality CPR.
- conserve the victim’s body heat.
- administer FIO2 1.0.
- perform high-quality CPR.
3. conserve the victim’s body heat.
Hospital management of near-drowning victims includes all of the following EXCEPT:
a. measurement of arterial blood gas values.
b. rewarming if the patient is hypothermic.
c. measurement of venous blood gas values.
d. chest radiography.
measurement of venous blood gas values
Which of the following would be routinely ordered for the majority of wet-drowning victims?
- Positive end-expiratory pressure (PEEP)
- Hemodialysis
- Extracorporeal membrane oxygenation (ECMO)
- Mechanical ventilation
1, 4
Warming techniques for a cold-water near-drowning victim include all of the following EXCEPT:
a. cooling the extremities and warming the body core.
b. warming the inspired oxygen.
c. heated intravenous solutions.
d. heated lavage of the pericardial space.
cooling the extremities and warming the body core.
After an extended time underwater, a near-drowning victim will most likely have:
apnea
Which of the following breath sounds would be expected during auscultation of a wet-drowning victim?
- Bronchovesicular
- Vesicular
- Crackles
- Friction rub
Crackles
The pulmonary function findings for a wet drowning victim would reveal
decreased VC.
The initial chest radiograph appearance of a near-drowning victim may include:
- normal lung fields.
- atelectasis.
- pulmonary edema.
- pencil point sign
- normal lung fields.
- atelectasis.
- pulmonary edema
In the United States, what percentage of pediatric drowning victims are male
80%
According to the World Health Organization, where does drowning rank worldwide as a cause of unintentional death?
It’s the third leading cause of unintentional death.
What is the upper time limit that a cold-water near-drowning victim can be submerged and survive?
60 minutes
Clinical signs of an upper airway thermal injury include:
- facial burns.
- atelectasis.
- mucosal edema.
- epithelial sloughing.
1, 3, 4
A patient has been brought to the emergency department after inhaling superheated steam. Pulmonary injuries unique to this situation include:
- atelectasis.
2. pulmonary edema.
Which of the following conditions occurs in 20% to 30% of hospitalized fire victims with facial burns?
Upper airway obstruction
Late-stage complications of extensive body surface burns include:
- sepsis.
- upper airway obstruction.
- pneumonia.
- pulmonary embolism.
1, 3, 4
A 65-year-old patient has third-degree skin burns over 30% of his body and a smoke inhalation injury. How does the combination of skin burns and smoke inhalation affect his prognosis?
It almost doubles the mortality rate.
Which portion of the pulmonary system will be affected by the inhalation of low–water solubility gases such as hydrogen chloride and phosgene?
Distal airways and alveoli
All of the following will be typically found in the air of an enclosed house fire EXCEPT:
a. steam.
b. carbon monoxide.
c. hydrogen cyanide.
d. hydrogen chloride.
steam
A 10-year-old patient has inhaled hot gases, and an inspection of her mouth shows edema and blisters. What should the respiratory therapist recommend?
Perform endotracheal intubation.
A patient with carbon monoxide poisoning has a COHb level of 20%. If the patient is given 100% oxygen, what will the approximate COHb level be in 1 hour?
10%
All of the following classes of medications are commonly used in the care of patients with smoke inhalation injury EXCEPT:
a. parasympatholytics.
b. mucolytics.
c. sympathomimetics.
d. monoclonal antibody.
monoclonal antibody.
Clinical signs associated with acute upper airway obstruction due to thermal injury include:
- pleural friction rub.
- inspiratory stridor.
- pulmonary edema.
- painful swallowing
2, 4
The long-term effects of a smoke inhalation injury are:
obstructive and restrictive lung disorders.
What COHb level is associated with a throbbing headache, nausea, vomiting, and impaired judgment?
20% to 30%
Which of the following radiographic findings would be associated with the intermediate stage of recovery from a serious smoke inhalation injury?
a. Pulmonary edema/ARDS
b. Patchy or segmental infiltrates
c. Empyema
d. Normal/full recovery
Pulmonary edema/ARDS
According to the Parkland Formula, what is the recommended volume of fluid that should be infused over a 24-hour period for each percent of body surface burned?
4 mL/kg of body weight
Which of the following would be recommended for the treatment of cyanide poisoning?
a. Aztreonam
b. Albuterol sulfate
c. Amyl nitrate
d. Aclidinium bromide
Amyl nitrate
What level of carbon monoxide toxicity is associated with coma, convulsions, and Cheyne-Stokes respiration?
50% to 60% COHb
In an industrial accident, an adult incurred burns over his head and neck, both arms, and his anterior trunk. What percent of his BSA was burned?
45%
Approximately 45% of the patient’s BSA was burned: head and neck (9%), both arms (9% 2 = 18%), and anterior trunk (18%).
