Respiratory Chapter 31,42,43

Question 1

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.

Answer 1

the person is easy to awaken.

Question 2

Signs and symptoms associated with obstructive sleep apnea include:

1. insomnia.
2. excessive daytime sleepiness.
3. hypothyroidism.
4. metabolic alkalosis

Answer 2

1. insomnia.

2. excessive daytime sleepiness.

Question 3

Clinical disorders associated with central sleep apnea include:

1. Pickwickian syndrome.
2. depression.
3. encephalitis.
4. brain stem infarction.

Answer 3

3. encephalitis.

4. brain stem infarction.

Question 4

Sleep apnea would be diagnosed in a patient who has which of these findings?

1. More than 15 apnea episodes per hour of sleep
2. More than 5 apnea episodes per hour over an 8-hour period
3. More than 75% of the apneas are obstructive.
4. More than 75% of the apneas and hypopneas are obstructive

Answer 4

1, 3, 4

Question 5

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.

Answer 5

breath sounds

Question 6

Mixed sleep apnea has which of these traits?

1. Obstructive apnea traits
2. Central apnea traits
3. Usually begins as central apnea
4. Usually ends as central apnea

Answer 6

1. Obstructive apnea traits
2. Central apnea traits
3. Usually begins as central apnea

Question 7

Continuous positive airway pressure (CPAP) is useful in the management of the patient with obstructive sleep apnea because it:

Answer 7

prevents airway collapse

Question 8

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.

Answer 8

find the CPAP level to maintain an open airway.

Question 9

First-line treatment for the management of hyperventilation-related central sleep apnea includes:

Answer 9

CPAP.

Question 10

Which of the following may be used in the management of a patient with central sleep apnea?

1. Acetazolamide
2. Oxygen therapy
3. Inhaled bronchodilator medications
4. Adaptive servo-ventilation (VPAP)

Answer 10

1, 2, 4

Question 11

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)

Answer 11

Obstructive sleep apnea

Question 12

Sleep apnea is associated with:

1. increased SVR.
2. decreased SVR.
3. increased PVR.
4. decreased PVR.

Answer 12

a. 1, 3

Question 13

Which of the following cardiac dysrhythmias is life threatening?

a. Atrioventricular block
b. Sinus bradycardia
c. Ventricular tachycardia
d. Premature ventricular contraction

Answer 13

Ventricular tachycardia

Question 14

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.

Answer 14

hypoglycemia.

Question 15

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.

Answer 15

published standards for scoring or interpretation.

Question 16

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.

Answer 16

preoxygenate the airway prior to the apneic episodes.

Question 17

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?

Answer 17

Her glottis spasmed and prevented pool water from entering her lungs.

Question 18

What are complications associated with a near drowning in unclean, swampy water?

Answer 18

1. Pneumonia

2. Acute respiratory distress syndrome (ARDS)

Question 19

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.

Answer 19

Both cause identical pathologic changes.

Question 20

The effects of a near-drowning victim inhaling water into the lungs include:

1. alveolar consolidation.
2. bronchospasm.
3. production of frothy, white secretions.
4. pleural effusion.

Answer 20

1. alveolar consolidation.
2. bronchospasm.
3. production of frothy, white secretions.

Question 21

Favorable prognostic factors in clean water near-drowning include:

1. greater effort to reach the surface.
2. alcohol in the victim.
3. colder water.
4. younger age.

Answer 21

3. colder water.

4. younger age

Question 22

What water temperature has been shown to be a favorable prognostic factor in near drowning?

Answer 22

d. Between 27° F and 70° F

Question 23

A near-drowning victim in cardiac arrest has been placed in an ambulance. During transport, the goals of the paramedics should be to:

1. contact the victim’s insurance carrier.
2. perform high-quality CPR.
3. conserve the victim’s body heat.
4. administer FIO2 1.0.

Answer 23

2. perform high-quality CPR.

3. conserve the victim’s body heat.

Question 24

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.

Answer 24

measurement of venous blood gas values

Question 25

Which of the following would be routinely ordered for the majority of wet-drowning victims? 1. Positive end-expiratory pressure (PEEP) 2. Hemodialysis 3. Extracorporeal membrane oxygenation (ECMO) 4. Mechanical ventilation

Answer 25

1, 4

Question 26

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.

Answer 26

cooling the extremities and warming the body core.

Question 27

After an extended time underwater, a near-drowning victim will most likely have:

Answer 27

apnea

Question 28

Which of the following breath sounds would be expected during auscultation of a wet-drowning victim? 1. Bronchovesicular 2. Vesicular 3. Crackles 4. Friction rub

Answer 28

Crackles

Question 29

The pulmonary function findings for a wet drowning victim would reveal

Answer 29

decreased VC.

Question 30

The initial chest radiograph appearance of a near-drowning victim may include: 1. normal lung fields. 2. atelectasis. 3. pulmonary edema. 4. pencil point sign

Answer 30

1. normal lung fields. 2. atelectasis. 3. pulmonary edema

Question 31

In the United States, what percentage of pediatric drowning victims are male

Answer 31

80%

Question 32

According to the World Health Organization, where does drowning rank worldwide as a cause of unintentional death?

Answer 32

It’s the third leading cause of unintentional death.

Question 33

What is the upper time limit that a cold-water near-drowning victim can be submerged and survive?

Answer 33

60 minutes

Question 34

Clinical signs of an upper airway thermal injury include: 1. facial burns. 2. atelectasis. 3. mucosal edema. 4. epithelial sloughing.

Answer 34

1, 3, 4

Question 35

A patient has been brought to the emergency department after inhaling superheated steam. Pulmonary injuries unique to this situation include:

Answer 35

1. atelectasis. | 2. pulmonary edema.

Question 36

Which of the following conditions occurs in 20% to 30% of hospitalized fire victims with facial burns?

Answer 36

Upper airway obstruction

Question 37

Late-stage complications of extensive body surface burns include: 1. sepsis. 2. upper airway obstruction. 3. pneumonia. 4. pulmonary embolism.

Answer 37

1, 3, 4

Question 38

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?

Answer 38

It almost doubles the mortality rate.

Question 39

Which portion of the pulmonary system will be affected by the inhalation of low–water solubility gases such as hydrogen chloride and phosgene?

Answer 39

Distal airways and alveoli

Question 40

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.

Answer 40

steam

Question 41

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?

Answer 41

Perform endotracheal intubation.

Question 42

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?

Answer 42

10%

Question 43

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.

Answer 43

monoclonal antibody.

Question 44

Clinical signs associated with acute upper airway obstruction due to thermal injury include: 1. pleural friction rub. 2. inspiratory stridor. 3. pulmonary edema. 4. painful swallowing

Answer 44

2, 4

Question 45

The long-term effects of a smoke inhalation injury are:

Answer 45

obstructive and restrictive lung disorders.

Question 46

What COHb level is associated with a throbbing headache, nausea, vomiting, and impaired judgment?

Answer 46

20% to 30%

Question 47

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

Answer 47

Pulmonary edema/ARDS

Question 48

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?

Answer 48

4 mL/kg of body weight

Question 49

Which of the following would be recommended for the treatment of cyanide poisoning? a. Aztreonam b. Albuterol sulfate c. Amyl nitrate d. Aclidinium bromide

Answer 49

Amyl nitrate

Question 50

What level of carbon monoxide toxicity is associated with coma, convulsions, and Cheyne-Stokes respiration?

Answer 50

50% to 60% COHb

Question 51

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?

Answer 51

45% Approximately 45% of the patient’s BSA was burned: head and neck (9%), both arms (9%  2 = 18%), and anterior trunk (18%).