Shadow Health Respiratory System - Yuki
Morimoto | Complete Focused Exam,
Asthma Exacerbation, Subjective &
1. Which set of findings best distinguishes subjective data from objective data during a
focused respiratory assessment for asthma?
A. Subjective: 'I feel short of breath'; Objective: expiratory wheezing on auscultation
B. Subjective: respiratory rate 28/min; Objective: patient reports chest tightness
C. Subjective: oxygen saturation 90%; Objective: use of accessory muscles
D. Subjective: peak expiratory flow 55% of best; Objective: patient states 'my chest feels
tight'
Answer: A. Subjective: 'I feel short of breath'; Objective: expiratory wheezing on
auscultation
Rationale: Subjective data are what the patient reports (e.g., dyspnea, chest tightness),
while objective data are measurable or observable findings (e.g., wheezing, respiratory
rate, oxygen saturation). Options B, C, and D misclassify measurable findings as subjective
or patient reports as objective.
2. A patient with asthma reports nighttime awakenings twice weekly and uses a
short-acting beta-2 agonist three times per week but has no limitation of activity.
According to current asthma control assessment, how should this be classified?
A. Well controlled
B. Not well controlled
C. Very poorly controlled
D. Uncontrolled requiring urgent care
Answer: B. Not well controlled
Rationale: Nighttime awakenings more than once per month and SABA use more than twice
per week indicate not well controlled asthma; well controlled requires symptoms 2
days/week and nighttime awakenings 1 time/month. Very poorly controlled requires
symptoms throughout the day, nightly awakenings, and significant activity limitation, which
are absent here.
Page 1 of 73
,3. During auscultation of a patient with an asthma exacerbation, which finding most
directly reflects small airway obstruction and air trapping?
A. Inspiratory crackles at the bases
B. Prolonged expiratory phase with end-expiratory wheezing
C. Pleural friction rub
D. Bronchial breath sounds over the periphery
Answer: B. Prolonged expiratory phase with end-expiratory wheezing
Rationale: Asthma obstruction produces expiratory airflow limitation with air trapping,
classically heard as a prolonged expiratory phase and end-expiratory wheezing. Crackles
suggest fluid or inflammation in alveoli, friction rub suggests pleural inflammation, and
bronchial breath sounds peripherally suggest consolidation.
4. Which spirometry pattern is most consistent with asthma in a symptomatic patient?
A. Reduced FEV1/FVC ratio with significant improvement after bronchodilator
B. Normal FEV1/FVC ratio with reduced diffusing capacity
C. Increased FEV1/FVC ratio with reduced total lung capacity
D. Restrictive pattern with decreased residual volume
Answer: A. Reduced FEV1/FVC ratio with significant improvement after
bronchodilator
Rationale: Asthma is characterized by variable expiratory airflow obstruction, reflected as
a reduced FEV1/FVC ratio that improves meaningfully after a bronchodilator. Restrictive
patterns, reduced diffusing capacity, and reduced lung volumes are more typical of other
pulmonary or interstitial processes.
Page 2 of 73
,5. A patient is prescribed a daily inhaled corticosteroid for persistent asthma. Which
statement indicates correct understanding of the medication's purpose?
A. 'I will use this inhaler only when I feel short of breath.'
B. 'This medication reduces airway inflammation and prevents exacerbations.'
C. 'This medication will immediately open my airways during an attack.'
D. 'I can stop this medication once my wheezing resolves.'
Answer: B. 'This medication reduces airway inflammation and prevents
exacerbations.'
Rationale: Inhaled corticosteroids are controller medications that reduce airway
inflammation and decrease exacerbation frequency; they are not rapid relievers. Using
them only for symptoms, expecting immediate bronchodilation, or stopping when symptoms
resolve reflects misunderstanding of controller therapy.
6. Which documentation entry most accurately reflects a focused respiratory
assessment finding in a patient with asthma exacerbation?
A. 'Patient appears uncomfortable; lungs sound bad.'
B. 'Patient speaking in full sentences; lungs clear to auscultation.'
C. 'Patient speaking in 2-3 word phrases; bilateral expiratory wheezing; RR 28/min;
SpO2 91% on room air.'
D. 'Patient denies shortness of breath; no respiratory distress noted.'
Answer: C. 'Patient speaking in 2-3 word phrases; bilateral expiratory wheezing; RR
28/min; SpO2 91% on room air.'
Rationale: High-quality documentation is specific, objective, and quantifiable, including
work of breathing, auscultation findings, respiratory rate, and oxygen saturation. Vague
descriptors, normal findings inconsistent with exacerbation, or denials that contradict
observed distress are inaccurate or incomplete.
Page 3 of 73
, 7. A patient's peak expiratory flow is 55% of personal best during an exacerbation.
Which action is most appropriate based on a written asthma action plan?
A. Continue routine controller inhaler only and reassess in 24 hours
B. Use the reliever inhaler and initiate the action plan's yellow-zone steps with prompt
clinical follow-up
C. Withhold all medications until seen in clinic
D. Begin oral corticosteroids only if symptoms persist beyond one week
Answer: B. Use the reliever inhaler and initiate the action plan's yellow-zone steps
with prompt clinical follow-up
Rationale: A peak flow of 50-79% of personal best falls in the yellow (caution) zone, which
typically directs use of a reliever inhaler, possible corticosteroid initiation per plan, and
close follow-up. Withholding treatment, delaying steroids for a week, or continuing only
controller therapy risks deterioration.
8. Which instruction is most important when teaching a patient to use a metered-dose
inhaler with a spacer for asthma?
A. Inhale rapidly and forcefully during actuation
B. Actuate the inhaler before beginning a slow, deep inhalation and hold breath
C. Use the spacer only with controller medications, never with relievers
D. Rinse the spacer weekly and store it wet
Answer: B. Actuate the inhaler before beginning a slow, deep inhalation and hold
breath
Rationale: Correct inhaler technique involves actuating the device at the start of a slow,
deep inhalation followed by a breath hold to maximize lung deposition. Rapid forceful
inhalation, restricting spacers to controller medications, or storing spacers wet are
incorrect and reduce drug delivery.
Page 4 of 73
Morimoto | Complete Focused Exam,
Asthma Exacerbation, Subjective &
1. Which set of findings best distinguishes subjective data from objective data during a
focused respiratory assessment for asthma?
A. Subjective: 'I feel short of breath'; Objective: expiratory wheezing on auscultation
B. Subjective: respiratory rate 28/min; Objective: patient reports chest tightness
C. Subjective: oxygen saturation 90%; Objective: use of accessory muscles
D. Subjective: peak expiratory flow 55% of best; Objective: patient states 'my chest feels
tight'
Answer: A. Subjective: 'I feel short of breath'; Objective: expiratory wheezing on
auscultation
Rationale: Subjective data are what the patient reports (e.g., dyspnea, chest tightness),
while objective data are measurable or observable findings (e.g., wheezing, respiratory
rate, oxygen saturation). Options B, C, and D misclassify measurable findings as subjective
or patient reports as objective.
2. A patient with asthma reports nighttime awakenings twice weekly and uses a
short-acting beta-2 agonist three times per week but has no limitation of activity.
According to current asthma control assessment, how should this be classified?
A. Well controlled
B. Not well controlled
C. Very poorly controlled
D. Uncontrolled requiring urgent care
Answer: B. Not well controlled
Rationale: Nighttime awakenings more than once per month and SABA use more than twice
per week indicate not well controlled asthma; well controlled requires symptoms 2
days/week and nighttime awakenings 1 time/month. Very poorly controlled requires
symptoms throughout the day, nightly awakenings, and significant activity limitation, which
are absent here.
Page 1 of 73
,3. During auscultation of a patient with an asthma exacerbation, which finding most
directly reflects small airway obstruction and air trapping?
A. Inspiratory crackles at the bases
B. Prolonged expiratory phase with end-expiratory wheezing
C. Pleural friction rub
D. Bronchial breath sounds over the periphery
Answer: B. Prolonged expiratory phase with end-expiratory wheezing
Rationale: Asthma obstruction produces expiratory airflow limitation with air trapping,
classically heard as a prolonged expiratory phase and end-expiratory wheezing. Crackles
suggest fluid or inflammation in alveoli, friction rub suggests pleural inflammation, and
bronchial breath sounds peripherally suggest consolidation.
4. Which spirometry pattern is most consistent with asthma in a symptomatic patient?
A. Reduced FEV1/FVC ratio with significant improvement after bronchodilator
B. Normal FEV1/FVC ratio with reduced diffusing capacity
C. Increased FEV1/FVC ratio with reduced total lung capacity
D. Restrictive pattern with decreased residual volume
Answer: A. Reduced FEV1/FVC ratio with significant improvement after
bronchodilator
Rationale: Asthma is characterized by variable expiratory airflow obstruction, reflected as
a reduced FEV1/FVC ratio that improves meaningfully after a bronchodilator. Restrictive
patterns, reduced diffusing capacity, and reduced lung volumes are more typical of other
pulmonary or interstitial processes.
Page 2 of 73
,5. A patient is prescribed a daily inhaled corticosteroid for persistent asthma. Which
statement indicates correct understanding of the medication's purpose?
A. 'I will use this inhaler only when I feel short of breath.'
B. 'This medication reduces airway inflammation and prevents exacerbations.'
C. 'This medication will immediately open my airways during an attack.'
D. 'I can stop this medication once my wheezing resolves.'
Answer: B. 'This medication reduces airway inflammation and prevents
exacerbations.'
Rationale: Inhaled corticosteroids are controller medications that reduce airway
inflammation and decrease exacerbation frequency; they are not rapid relievers. Using
them only for symptoms, expecting immediate bronchodilation, or stopping when symptoms
resolve reflects misunderstanding of controller therapy.
6. Which documentation entry most accurately reflects a focused respiratory
assessment finding in a patient with asthma exacerbation?
A. 'Patient appears uncomfortable; lungs sound bad.'
B. 'Patient speaking in full sentences; lungs clear to auscultation.'
C. 'Patient speaking in 2-3 word phrases; bilateral expiratory wheezing; RR 28/min;
SpO2 91% on room air.'
D. 'Patient denies shortness of breath; no respiratory distress noted.'
Answer: C. 'Patient speaking in 2-3 word phrases; bilateral expiratory wheezing; RR
28/min; SpO2 91% on room air.'
Rationale: High-quality documentation is specific, objective, and quantifiable, including
work of breathing, auscultation findings, respiratory rate, and oxygen saturation. Vague
descriptors, normal findings inconsistent with exacerbation, or denials that contradict
observed distress are inaccurate or incomplete.
Page 3 of 73
, 7. A patient's peak expiratory flow is 55% of personal best during an exacerbation.
Which action is most appropriate based on a written asthma action plan?
A. Continue routine controller inhaler only and reassess in 24 hours
B. Use the reliever inhaler and initiate the action plan's yellow-zone steps with prompt
clinical follow-up
C. Withhold all medications until seen in clinic
D. Begin oral corticosteroids only if symptoms persist beyond one week
Answer: B. Use the reliever inhaler and initiate the action plan's yellow-zone steps
with prompt clinical follow-up
Rationale: A peak flow of 50-79% of personal best falls in the yellow (caution) zone, which
typically directs use of a reliever inhaler, possible corticosteroid initiation per plan, and
close follow-up. Withholding treatment, delaying steroids for a week, or continuing only
controller therapy risks deterioration.
8. Which instruction is most important when teaching a patient to use a metered-dose
inhaler with a spacer for asthma?
A. Inhale rapidly and forcefully during actuation
B. Actuate the inhaler before beginning a slow, deep inhalation and hold breath
C. Use the spacer only with controller medications, never with relievers
D. Rinse the spacer weekly and store it wet
Answer: B. Actuate the inhaler before beginning a slow, deep inhalation and hold
breath
Rationale: Correct inhaler technique involves actuating the device at the start of a slow,
deep inhalation followed by a breath hold to maximize lung deposition. Rapid forceful
inhalation, restricting spacers to controller medications, or storing spacers wet are
incorrect and reduce drug delivery.
Page 4 of 73
