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MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.
1) Your patient is a 16-year-old male who attempted suicide. He is unconscious and apneic, lying supine on a garage floor. The family states they found the patient unconscious in the front seat of acar that was running in an enclosed garage. HR = 70, BP = 100/60, RR = 0. Which of the following isthe most appropriate? A) Remove the patient from the garage, initiate BVM ventilations with 100% oxygen, intubate, and transport to nearest the facility.
B) Remove the patient from the garage, initiate BVM ventilations with 100% oxygen, intubate, and transport to a hospital with a hyperbaric chamber.
C) Remove the patient from the garage, intubate, and transport to the nearest hospital.
D) Intubate, remove the patient from the garage, and transport to a hospital with a hyperbaric 2) Your patient is a 72-year-old female, alert and oriented, sitting up in bed at a nursing home. She is in mild respiratory distress. Staff describe a 4-day history of fever, malaise, and productive cough.
The patient also states that she has been experiencing chills and chest pain with deep inspiration.
Physical examination reveals rales and rhonchi in the right upper lobe and warm, moist skin. HR =116, BP = 104/76, RR = 20, SaO2 = 93%. Based on the clinical exam findings, the most appropriatediagnosis would be: 3) Your patient is a 52-year-old male complaining of shortness of breath. He is sitting up, alert, and oriented and appears to be in moderate respiratory distress. He states that he "always gets a chestcold in the winter" and describes a 3-week history of productive cough and increasing shortness ofbreath. Physical examination reveals coarse rhonchi to the upper lobes bilaterally, air movement isdecreased in the bases, and his skin is cool with peripheral cyanosis. You note that he is overweightand describes an 18-pack-a-year smoking history. Based on these clinical exam findings, youmight also expect to find: A) barrel chest and increased anterior/posterior chest diameter.
B) JVD, pedal edema, hepatic congestion.
4) Your patient is a 24-year-old male who has been an in-patient in a rehabilitation hospital following surgical reduction of a fractured pelvis. Staff reports sudden development ofhypotension and severe respiratory distress about 30 minutes ago. There is no other significanthistory. Physical exam findings include cold, diaphoretic skin with peripheral cyanosis; jugularvenous distension; clear breath sounds bilaterally; and vitals as follows: HR = 134, BP = 74/50, RR =28, SaO2 = 84%. Which of the following is most likely? 5) Which of the following statements about pulse oximetry is FALSE? A) It may be difficult to obtain a reading in patients experiencing peripheral vasoconstriction.
B) Pulse oximetry should be used on all patients with respiratory complaints.
C) Pulse oximetry values can be expected to decrease within seconds in cases of developing D) Oxygen saturation is the percentage of hemoglobin that is bound with some molecular 6) All of the following are acceptable methods of clearing a foreign body airway obstruction in an A) using Magill forceps to remove the obstruction.
B) pushing the obstruction into the right main stem bronchus.
C) intubating around the foreign body.
D) alternating back blows and abdominal thrusts.
7) The carpopedal spasms that occur due to hyperventilation syndrome are a result of a relative C) hypocalcemia, increase in bound calcium D) hypocalcemia, decrease in unbound calcium 8) Improving ________ is a primary treatment goal in a patient with bronchospasm.
B) diffusion across the alveolar membrane 9) Which of the following is NOT an intrinsic risk factor associated with respiratory disease? 10) Which of the following statements comparing pulse oximetry and end-tidal CO2 detection is A) Pulse oximeters and capnometers can both give erroneously high readings in cases of carbon B) Pulse oximetry gives the care provider feedback on the effectiveness of ventilation, while capnography provides feedback on the effectiveness of oxygenation.
C) Pulse oximetry gives the care provider feedback on the effectiveness of oxygenation, while capnography provides feedback on the effectiveness of ventilation.
D) Both pulse oximetry and colormetric CO2 detection provide numerical feedback.
11) Your patient is 24-year-old male Chinese citizen on vacation in the United States. He is in moderate distress complaining of difficulty breathing and gives a 4-day history of runny nose, sorethroat, and general malaise with a productive cough. His sputum production was significantlyworse when he woke this morning, and he developed difficulty breathing this afternoon. You notecool, pale, and diaphoretic extremities and lung sounds with rhonchi bilaterally. He gives amedical history of asthma treated with an albuterol inhaler as needed. HR = 134, BP = 132/84, RR =26, SaO2 = 90%. Which of the following is the best course of prehospital treatment for this patient? A) Provider use of PPE, albuterol via nebulizer, IV of NS KVO, cardiac monitor, transport B) Provider use of PPE, oxygen via nasal cannula 4 lpm, notify receiving hospital, transport C) Provider use of PPE, oxygen via nonrebreathing mask 15 lpm, IV of NS KVO, cardiac monitor, notify receiving hospital, transport D) Oxygen via nonrebreathing mask 15 lpm, IV of NS with 250 fluid challenge, cardiac monitor, 12) Which of the following statements about severe acute respiratory syndrome (SARS) is FALSE? A) SARS is caused by the SARS-CoV bacteria.
B) SARS is considered contagious as long as the patient exhibits symptoms.
C) SARS is transmitted via respiratory secretions and droplets.
D) Patients with underlying respiratory disease have a higher risk of SARs-related problems.
13) You have intubated a 66-year-old female who was experiencing an acute exacerbation of her emphysema. What special consideration does this patient, with her specific pathology, require? A) She requires frequent, deep suctioning.
B) While ventilating, you must allow for a prolonged expiratory phase.
C) She requires hyperventilation to blow off excess CO2.
D) Oxygen flow should be limited to 4 lpm because of the hypoxic drive common in COPD 14) Your patient is a 68-year-old male complaining of difficulty breathing for the past 2 days. He is sitting up, conscious, alert, and oriented and appears to be in mild respiratory distress. Physicalexamination reveals cool, dry, pink skin; he is thin with well-defined accessory muscles, and younote diffuse wheezing to all lung fields. HR = 102, BP = 136/96, RR = 20, SaO2 = 92%. The patientgives a 20-pack-a-year history of smoking. Based on these clinical exam findings, which of thefollowing is most likely? A) a technique for creating back pressure in the airway in order to maintain patency of the alveoli and ensuring adequate ventilation and oxygenation.
B) positive pressure provided by a BVM that increases back pressure in the airway in order to maintain patency of the alveoli and ensure adequate ventilation and oxygenation.
C) positive pressure provided by a BVM that increases expiratory pressure by keeping the D) a positive effort encouraged in patients with difficulty breathing.
16) A 61-year-old male with a 24-pack-a-year history of smoking presents with pursed-lipped breathing and shortness of breath. You note that he is thin and has florid skin and a barrel chest.
Auscultation of his lungs reveals diffuse expiratory wheezing to all fields. Based on this clinicalcondition, what additional complication is he most likely to develop? 17) Your patient is a 23-year-old female in moderate respiratory distress, complaining of difficulty breathing. She describes an acute onset of shortness of breath 15 minutes ago that has been gettingprogressively worse and has not responded to her Atrovent inhaler. Physical examination revealscool, pale, and diaphoretic skin and clear lung sounds bilaterally. She has a history of asthma, is asmoker, and had breast-reduction surgery yesterday. Medications include Atrovent and albuterolinhalers and birth control pills. HR = 129, BP = 110/60, RR = 26, SaO2 = 91%. In addition to 100%oxygen, which of the following is the most appropriate treatment? A) Albuterol and atrovent via nebulizer, IV of NS KVO D) Albuterol and atrovent via nebulizer, epinephrine 1:1000 SQ, IV of NS with 250 cc fluid 18) To which of the following medications does the late phase of an asthma attack best respond? 19) Lung perfusion depends on all of the following EXCEPT: D) efficient pumping of blood by the heart.
20) Why is the oxygen-hemoglobin dissociation curve curved and not linear? A) It's impossible to achieve 100 percent hemoglobin saturation.
B) As the PO2 increases above 70 mmHg, there are only small changes in the curve.
C) Hemoglobin and oxygen undergo cooperative binding, making it easier for each additional oxygen molecule to bind to hemoglobin.
D) Hemoglobin levels in individual red blood cells vary, making oxygen binding in the blood a Answer KeyTestname: EPC, CH 27 QUIZ W-KEY 1)2)3)4)5)6)7)8)9)10)11)12)13)14)15)16)17)18)19)20)

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