RESPIRATORY CARE: PRINCIPLES AND PRACTICE
4TH EDITION TEST BANK – HESS 2021 –
COMPREHENSIVE CHAPTERS 1-62 EXAM
SECTION 1: RESPIRATORY ASSESSMENT (Chapters 1-12)
Chapter 1: History and Physical Examination
1. During a patient interview, which question is most appropriate to assess for
orthopnea?
A) "Do you wake up at night feeling short of breath?"
B) "How many pillows do you use to sleep comfortably?"
C) "Do you become short of breath during daily activities?"
D) "Have you noticed any swelling in your feet or ankles?"
Answer: B
Rationale: Orthopnea is dyspnea that occurs when lying flat and is relieved by sitting up or
using pillows to elevate the head. The number of pillows needed directly correlates with the
severity of orthopnea (e.g., two-pillow orthopnea, three-pillow orthopnea). This symptom is
classic for left-sided heart failure and severe respiratory disease.
2. Clubbing of the digits is most commonly associated with:
A) Acute asthma exacerbation
B) Chronic hypoxemic conditions
C) Pulmonary embolism
D) Pneumonia
Answer: B
Rationale: Digital clubbing results from chronic hypoxemia and is associated with
,conditions such as cystic fibrosis, bronchiectasis, interstitial lung disease, and cyanotic
congenital heart disease. The mechanism involves megakaryocyte fragmentation and
platelet-derived growth factor release in the distal phalanges.
3. Which breath sound is characterized by high-pitched, continuous musical sounds
heard during expiration?
A) Crackles
B) Rhonchi
C) Wheezes
D) Stridor
Answer: C
Rationale: Wheezes are continuous, high-pitched musical sounds typically heard during
expiration. They indicate narrowed airways, commonly seen in asthma, COPD, and
bronchospasm. Stridor is a high-pitched inspiratory sound indicating upper airway
obstruction.
4. During inspection of a patient's thorax, you note an increased anteroposterior (AP)
diameter with a barrel chest appearance. This finding is most characteristic of:
A) Kyphoscoliosis
B) Pectus excavatum
C) Chronic obstructive pulmonary disease
D) Pneumothorax
Answer: C
Rationale: A barrel chest with increased AP diameter results from air trapping and
hyperinflation, classic findings in COPD. The normal AP-to-transverse diameter ratio of 1:2
increases to 1:1 in COPD patients due to loss of elastic recoil and chronic hyperinflation.
5. A patient presents with decreased tactile fremitus, hyperresonance on percussion,
and decreased breath sounds. This clinical picture is most consistent with:
A) Lobar pneumonia
B) Pleural effusion
C) Pneumothorax
D) Atelectasis
Answer: C
Rationale: Pneumothorax causes decreased tactile fremitus (air blocks sound
transmission), hyperresonance (increased air in pleural space), and decreased breath
sounds. Pleural effusion would cause dullness to percussion, while pneumonia would
show increased fremitus and bronchial breath sounds.
,6. Which of the following is considered a normal finding on chest palpation?
A) Symmetrical chest expansion
B) Increased tactile fremitus over consolidation
C) Subcutaneous emphysema
D) Tracheal deviation
Answer: A
Rationale: Symmetrical chest expansion is normal. Increased tactile fremitus indicates
consolidation (pneumonia). Subcutaneous emphysema suggests air in tissue
(pneumothorax, tracheal injury). Tracheal deviation indicates mediastinal shift (tension
pneumothorax, massive pleural effusion).
Chapter 2: Respiratory Monitoring
7. Capnography monitoring of a mechanically ventilated patient shows a sudden
decrease in end-tidal CO2 (EtCO2) to zero. The most likely cause is:
A) Bronchospasm
B) Disconnection from the ventilator
C) Hyperventilation
D) Pulmonary embolism
Answer: B
Rationale: A sudden decrease in EtCO2 to zero indicates no CO2 reaching the capnograph,
most commonly due to disconnection, esophageal intubation, or complete airway
obstruction. A sudden drop but not zero suggests pulmonary embolism or cardiac arrest
with reduced blood flow.
8. The normal EtCO2 value in a healthy adult is approximately:
A) 25-30 mmHg
B) 35-45 mmHg
C) 45-55 mmHg
D) 55-65 mmHg
Answer: B
Rationale: Normal EtCO2 ranges from 35-45 mmHg, approximately 2-5 mmHg less than
PaCO2 due to alveolar dead space. The gradient (PaCO2 - EtCO2) normally 2-5 mmHg
widens in conditions with increased dead space such as pulmonary embolism or ARDS.
9. Which of the following pulse oximetry readings indicates the need for immediate
intervention?
A) 92% on room air
B) 94% on 2 L/min nasal cannula
C) 88% on 4 L/min nasal cannula
, D) 96% on 2 L/min nasal cannula
Answer: C
Rationale: SpO2 below 90% (88% on oxygen) indicates significant hypoxemia requiring
immediate intervention. Target SpO2 is typically ≥92% for most patients, except COPD
where 88-92% may be appropriate to avoid suppressing hypoxic drive.
10. A limitation of pulse oximetry includes:
A) Inability to detect hyperoxemia
B) Inability to detect hypoxemia
C) Inability to detect changes in oxygenation
D) Inability to be used continuously
Answer: A
Rationale: Pulse oximetry cannot detect hyperoxemia because hemoglobin is fully
saturated above PaO2 of approximately 100 mmHg. This is why ABG analysis remains
essential for patients receiving high FiO2 or at risk for oxygen toxicity.
11. Transcutaneous monitoring (TcPO2) is most useful in which patient population?
A) Adult ICU patients
B) Neonates and infants
C) Geriatric patients
D) Outpatient pulmonary rehabilitation
Answer: B
Rationale: TcPO2 is particularly valuable in neonates because it provides continuous, non-
invasive oxygenation monitoring without frequent blood sampling. The thin skin of
neonates allows better oxygen diffusion to the sensor. It is also used in wound healing
assessment.
12. In a patient with carbon monoxide poisoning, pulse oximetry will likely show:
A) Falsely elevated SpO2
B) Falsely decreased SpO2
C) Accurate SpO2 readings
D) No reading
Answer: A
Rationale: Pulse oximetry cannot distinguish between oxyhemoglobin and
carboxyhemoglobin. The SpO2 reading will be falsely elevated because
carboxyhemoglobin absorbs light similarly to oxyhemoglobin. Co-oximetry is required for
accurate assessment in CO poisoning.
Chapter 3: Hemodynamic Monitoring
4TH EDITION TEST BANK – HESS 2021 –
COMPREHENSIVE CHAPTERS 1-62 EXAM
SECTION 1: RESPIRATORY ASSESSMENT (Chapters 1-12)
Chapter 1: History and Physical Examination
1. During a patient interview, which question is most appropriate to assess for
orthopnea?
A) "Do you wake up at night feeling short of breath?"
B) "How many pillows do you use to sleep comfortably?"
C) "Do you become short of breath during daily activities?"
D) "Have you noticed any swelling in your feet or ankles?"
Answer: B
Rationale: Orthopnea is dyspnea that occurs when lying flat and is relieved by sitting up or
using pillows to elevate the head. The number of pillows needed directly correlates with the
severity of orthopnea (e.g., two-pillow orthopnea, three-pillow orthopnea). This symptom is
classic for left-sided heart failure and severe respiratory disease.
2. Clubbing of the digits is most commonly associated with:
A) Acute asthma exacerbation
B) Chronic hypoxemic conditions
C) Pulmonary embolism
D) Pneumonia
Answer: B
Rationale: Digital clubbing results from chronic hypoxemia and is associated with
,conditions such as cystic fibrosis, bronchiectasis, interstitial lung disease, and cyanotic
congenital heart disease. The mechanism involves megakaryocyte fragmentation and
platelet-derived growth factor release in the distal phalanges.
3. Which breath sound is characterized by high-pitched, continuous musical sounds
heard during expiration?
A) Crackles
B) Rhonchi
C) Wheezes
D) Stridor
Answer: C
Rationale: Wheezes are continuous, high-pitched musical sounds typically heard during
expiration. They indicate narrowed airways, commonly seen in asthma, COPD, and
bronchospasm. Stridor is a high-pitched inspiratory sound indicating upper airway
obstruction.
4. During inspection of a patient's thorax, you note an increased anteroposterior (AP)
diameter with a barrel chest appearance. This finding is most characteristic of:
A) Kyphoscoliosis
B) Pectus excavatum
C) Chronic obstructive pulmonary disease
D) Pneumothorax
Answer: C
Rationale: A barrel chest with increased AP diameter results from air trapping and
hyperinflation, classic findings in COPD. The normal AP-to-transverse diameter ratio of 1:2
increases to 1:1 in COPD patients due to loss of elastic recoil and chronic hyperinflation.
5. A patient presents with decreased tactile fremitus, hyperresonance on percussion,
and decreased breath sounds. This clinical picture is most consistent with:
A) Lobar pneumonia
B) Pleural effusion
C) Pneumothorax
D) Atelectasis
Answer: C
Rationale: Pneumothorax causes decreased tactile fremitus (air blocks sound
transmission), hyperresonance (increased air in pleural space), and decreased breath
sounds. Pleural effusion would cause dullness to percussion, while pneumonia would
show increased fremitus and bronchial breath sounds.
,6. Which of the following is considered a normal finding on chest palpation?
A) Symmetrical chest expansion
B) Increased tactile fremitus over consolidation
C) Subcutaneous emphysema
D) Tracheal deviation
Answer: A
Rationale: Symmetrical chest expansion is normal. Increased tactile fremitus indicates
consolidation (pneumonia). Subcutaneous emphysema suggests air in tissue
(pneumothorax, tracheal injury). Tracheal deviation indicates mediastinal shift (tension
pneumothorax, massive pleural effusion).
Chapter 2: Respiratory Monitoring
7. Capnography monitoring of a mechanically ventilated patient shows a sudden
decrease in end-tidal CO2 (EtCO2) to zero. The most likely cause is:
A) Bronchospasm
B) Disconnection from the ventilator
C) Hyperventilation
D) Pulmonary embolism
Answer: B
Rationale: A sudden decrease in EtCO2 to zero indicates no CO2 reaching the capnograph,
most commonly due to disconnection, esophageal intubation, or complete airway
obstruction. A sudden drop but not zero suggests pulmonary embolism or cardiac arrest
with reduced blood flow.
8. The normal EtCO2 value in a healthy adult is approximately:
A) 25-30 mmHg
B) 35-45 mmHg
C) 45-55 mmHg
D) 55-65 mmHg
Answer: B
Rationale: Normal EtCO2 ranges from 35-45 mmHg, approximately 2-5 mmHg less than
PaCO2 due to alveolar dead space. The gradient (PaCO2 - EtCO2) normally 2-5 mmHg
widens in conditions with increased dead space such as pulmonary embolism or ARDS.
9. Which of the following pulse oximetry readings indicates the need for immediate
intervention?
A) 92% on room air
B) 94% on 2 L/min nasal cannula
C) 88% on 4 L/min nasal cannula
, D) 96% on 2 L/min nasal cannula
Answer: C
Rationale: SpO2 below 90% (88% on oxygen) indicates significant hypoxemia requiring
immediate intervention. Target SpO2 is typically ≥92% for most patients, except COPD
where 88-92% may be appropriate to avoid suppressing hypoxic drive.
10. A limitation of pulse oximetry includes:
A) Inability to detect hyperoxemia
B) Inability to detect hypoxemia
C) Inability to detect changes in oxygenation
D) Inability to be used continuously
Answer: A
Rationale: Pulse oximetry cannot detect hyperoxemia because hemoglobin is fully
saturated above PaO2 of approximately 100 mmHg. This is why ABG analysis remains
essential for patients receiving high FiO2 or at risk for oxygen toxicity.
11. Transcutaneous monitoring (TcPO2) is most useful in which patient population?
A) Adult ICU patients
B) Neonates and infants
C) Geriatric patients
D) Outpatient pulmonary rehabilitation
Answer: B
Rationale: TcPO2 is particularly valuable in neonates because it provides continuous, non-
invasive oxygenation monitoring without frequent blood sampling. The thin skin of
neonates allows better oxygen diffusion to the sensor. It is also used in wound healing
assessment.
12. In a patient with carbon monoxide poisoning, pulse oximetry will likely show:
A) Falsely elevated SpO2
B) Falsely decreased SpO2
C) Accurate SpO2 readings
D) No reading
Answer: A
Rationale: Pulse oximetry cannot distinguish between oxyhemoglobin and
carboxyhemoglobin. The SpO2 reading will be falsely elevated because
carboxyhemoglobin absorbs light similarly to oxyhemoglobin. Co-oximetry is required for
accurate assessment in CO poisoning.
Chapter 3: Hemodynamic Monitoring
