TEST BANK Des Jardins Clinical Manifestations and Assessment of Respiratory Disease, 8th Edition

TEST BANK Des Jardins Clinical Manifestations and Assessment of Respiratory Disease, 8th EditionTable of Contents Chapter 01: The Patient Interview ................................ ............................. 3 Chapter 02: The Physical Examination ................................ .......................... 7 Chapter 03: The Pathophysiologic Basis for Common Clinical Manifestations ........................ 11 Chapter 04: Pulmonary Function Testing ................................ ...................... 15 Chapter 05: Blood Gas Assessment ................................ ........................... 19 Chapter 06: Assessment of Oxygenation ................................ ....................... 23 Chapter 07: Assessment of the Cardiovascular System ................................ ........... 27 Chapter 08: Radiologic Examination of the Chest ................................ ............... 31 Chapter 09: Other Important Tests and Procedures ................................ ............. 35 Chapter 10: The Therapist-Driven Protocol Program ................................ ............ 39 Chapter 11: Respiratory Insufficiency, Respiratory Failure and VentilatoryManagement Protocols ...... 42 Chapter 12: Recording Skills and Intra-professional Communication ............................... 46 Chapter 13: Chronic Obstructive Pulmonary Disease, Chronic Bronchitis and Emphysema ............. 49 Chapter 14: Asthma ................................ ................................ ........ 54 Chapter 15: Cystic Fibrosis ................................ ................................ .. 58 Chapter 16: Bronchiectasis ................................ ................................ .. 64 Chapter 17: Atelectasis ................................ ................................ ..... 70 Chapter 18: Pneumonia, Lung Abscess Formation, and Important Fungal Diseases ................... 75 Chapter 19: Tuberculosis ................................ ................................ ... 84 Chapter 20: Pulmonary Edema ................................ .............................. 89 Chapter 21: Pulmonary Vascular Disease: Pulmonary Embolism and PulmonaryHypertension ......... 94 Chapter 22: Flail Chest ................................ ................................ .... 100 Chapter 23: Pneumothorax................................ ................................ . 104 Chapter 24: Pleural Effusion and Empyema ................................ ................... 109 Chapter 25: Kyphoscoliosis ................................ ................................ 113 Chapter 26: Cancer of the Lung, Prevention and Palliation ................................ ...... 117 Chapter 27: Interstitial Lung Diseases ................................ ....................... 121 Chapter 28: Acute Respiratory Distress Syndrome ................................ ............. 125 Chapter 29: Guillain-Barré Syndrome ................................ ........................ 130 Chapter 30: Myasthenia Gravis ................................ ............................. 135 Chapter 31: Cardiopulmonary Assessment and Care of Patients With NeuromuscularDisease ......... 140 Chapter 32: Sleep Apnea ................................ ................................ ... 146 Chapter 33: Newborn Assessment and Management ................................ ........... 151 Chapter 34: Pediatric Assessment, Protocols, and PALS Management ............................. 156 Chapter 35: Meconium Aspiration Syndrome ................................ .................. 159 1 | P a g eChapter 36: Transient Tachypnea of the Newborn ................................ .............. 164 Chapter 37: Respiratory Distress Syndrome ................................ ................... 168 Chapter 38: Pulmonary Air Leak Syndrome ................................ ................... 173 Chapter 39: Respiratory Syncytial Virus Infection (Bronchiolitis) ................................ . 178 Chapter 40: Chronic Lung Disease of Infancy ................................ .................. 182 Chapter 41: Congenital Diaphragmatic Hernia ................................ ................. 186 Chapter 42: Congenital Heart Disease ................................ ........................ 191 Chapter 43: Croup and Croup-like Syndromes: Laryngotracheobronchitis, BacterialTracheitis, and Acute Epiglottitis ................................ ................................ .............. 194 Chapter 44: Near Drowning/Wet Drowning ................................ ................... 198 Chapter 45: Smoke Inhalation, Thermal Injuries, and Carbon Monoxide Intoxication ................ 203 2 | P a g eChapter 01: The Patient Interview MULTIPLE CHOICE 1. The respiratory care practitioner is conducting a patient interview. The main purpose of thisinterview is to: a. review data with the patient. b. gather subjective data from the patient. c. gather objective data from the patient. d. fill out the history form or checklist. ANS: B The interview is a meeting between the respiratory care practitioner and the patient. It allows thecollection of subjective data about the patient’s feelings regarding his/her condition. The history should be done before the interview. Although data can be reviewed,that is not the primary purpose of the interview. 2. For there to be a successful interview, the respiratory therapist must: a. provide leading questions to guide the patient. b. reassure the patient. c. be an active listener. d. use medical terminology to show knowledge of the subject matter. ANS: C The personal qualities that a respiratory therapist must have to conduct a successful interview include being an active listener, having a genuine concern for the patient, and having empathy. Leading questions must be avoided. Reassurance may provide a false sense of comfort to the patient. Medicaljargon can sound exclusionary and paternalistic to a patient. 3. Which of the following would be found on a history form? 1. Age 2. Chief complaint 3. Present health 4. Family history 5. Health insurance provider a. 1, 4 b. 2, 3 c. 3, 4, 5 d. 1, 2, 3, 4 ANS: D Age, chief complaint, present health, and family history are typically found on a health history form because each can impact the patient’s health. Health insurance provider information, whileneeded for billing purposes, would not be found on the history form. 4. External factors the respiratory care practitioner should make efforts to provide during aninterview include which of the following? 3 | P a g e1. Minimize or prevent interruptions. 2. Ensure privacy during discussions. 3. Interviewer is the same sex as the patient to prevent bias. 4. Be comfortable for the patient and interviewer. a. 1, 4 b. 2, 3 c. 1, 2, 4 d. 2, 3, 4 ANS: C External factors, such as a good physical setting, enhance the interviewing process. Regardless of the interview setting (the patient’s bedside, a crowded emergency room, an office in the hospital or clinic,or the patient’s home), efforts should be made to (1) ensure privacy, (2) prevent interruptions, and (3)secure a comfortable physical environment (e.g., comfortable room temperature, sufficient lighting, absence of noise). An interviewer of either gender, who acts professionally, should be able to interview a patient of either gender. 5. The respiratory therapist is conducting a patient interview. The therapist chooses to useopen-ended questions. Open-ended questions allow the therapist to do which of the following? 1. Gather information when a patient introduces a new topic. 2. Introduce a new subject area. 3. Begin the interview process. 4. Gather specific information. a. 4 b. 1, 3 c. 1, 2, 3 d. 2, 3, 4 ANS: C An open-ended question should be used to start the interview, introduce a new section of questions,and gather more information from a patient’s topic. Closed or direct questions are used to gather specific information. 6. The direct question interview format is used to: 1. speed up the interview. 2. let the patient fully explain his/her situation. 3. help the respiratory therapist show empathy. 4. gather specific information. a. 1, 4 b. 2, 3 c. 3, 4 d. 1, 2, 3 ANS: A Direct or closed questions are best to gather specific information and speed up the interview. Open- ended questions are best suited to let the patient fully explain his/her situation and possibly help therespiratory therapist show empathy. 7. During the interview the patient states, “Every time I climb the stairs I have to stop to catch my breath.” Hearing this, the respiratory therapist replies, “So, it sounds like you get short 4 | P a g eof breath climbing stairs.” This interviewing technique is called: a. clarification. b. modeling. c. empathy. d. reflection. ANS: D With reflection, part of the patient’s statement is repeated. This lets the patient know that whathe/she said was heard. It also encourages the patient to elaborate on the topic. Clarification, modeling, and empathy are other communication techniques. 8. The respiratory therapist may choose to use the patient interview technique of silencein which of the following situations? a. To prompt the patient to ask a question b. After a direct question c. After an open-ended question d. To allow the patient to review his/her history ANS: C After a patient has answered an open-ended question, the respiratory therapist should pause (use silence) before asking the next question. This pause allows the patient to add something else beforemoving on. The patient may also choose to ask a question. 9. To have the most productive interviewing session, which of the following types of responses to assist in the interview should the respiratory therapist avoid? a. Confrontation b. Reflection c. Facilitation d. Distancing ANS: D With confrontation, the respiratory therapist focuses the patient’s attention on an action, feeling, orstatement made by the patient. This may prompt a further discussion. Reflection helps the patient focus on specific areas and continues in his/her own way. Facilitation encourages patients to say more, to continue with the story. The respiratory therapist should avoid giving advice, using avoidance language, and using distancing language. 10. When closing the interview, the respiratory therapist should do which of the following? 1. Recheck the patient’s vital signs. 2. Thank the patient. 3. Ask if the patient has any questions. 4. Close the door behind himself/herself for patient privacy. a. 2 b. 2, 3 c. 1, 3, 4 d. 1, 2, 4 ANS: B To end the interview on a positive note, the respiratory therapist should thank the patient and ask if the patient has any questions. If there is no need for the vital signs to be checked, they should not be.The door may be left open or closed, depending on the situation. 11. The respiratory therapist should be aware of a patient’s culture and religious beliefs forwhich of the following reasons? 5 | P a g ea. To be able to engage in a meaningful conversation b. To change any misguided notions the patient has that may impact his/her health c. To explain to the patient how these beliefs will lead to discrimination and stereotyping d. To better understand how the patient’s beliefs may impact how the patient thinksand behaves ANS: D Culture and religious beliefs may have a profound effect on how patients think and behave, and this may impact their health or health care decisions. The role of the respiratory therapist is not to change the patient’s beliefs, engage in sensitive conversations, or discuss discrimination. Rather, the respiratory therapist needs to understand how these beliefs may impact the patient’s health care decisions. 12. Which of the following are the most important components of a successful interview? a. Communication and understanding b. Authority and the use of medical terminology c. Providing assurance and giving advice d. Asking leading questions and anticipating patient responses to questions ANS: A Communication and understanding are thebasis for a good interview. Authority, the use of medical jargon, providing assurance, giving advice, asking leading questions, and anticipating are alltypes of nonproductive communication forms and create barriers to patient communication. 13. The respiratory therapist is conducting a patient interview and recording responses in thepatient’s electronic health record. The respiratory therapist should take which of the following into account regarding the use of the computer to record responses? a. The therapist’s attention may be shifted from the patient to the computer. b. The patient will feel more important than if the information is recorded on paper. c. The therapist will be less likely to make spelling errors if using a spell-check program. d. The environment will be more professional and the patient will be more likely to open up if the interview is conducted with paper. ANS: A The therapist’s use of the computer can be threatening and may, in some cases, be a potential hazardto good patient communication. The patient can be intimidated to the point of “shutting down.” In addition, the therapist who has to shift focus from the patient to the computer can miss important verbal and nonverbal messages. 6 | P a g eChapter 02: The Physical Examination MULTIPLE CHOICE 1. When would induced hypothermia be indicated? a. During brain surgery b. During bowel surgery c. To break a fever d. To treat carbon monoxide poisoning ANS: A Induced hypothermia may involve only a portion of the body or the whole body. Induced hypothermia is often indicated before certain surgeries, such as heart or brain surgery, or after return of spontaneous circulation after a cardiac arrest. 2. A 50-year-old patient has a heart rate by palpation of 120 bpm. How should this beinterpreted? a. Within the normal range for an adult b. An error since a stethoscope was not used c. Bradycardia d. Tachycardia ANS: D In an adult, a heart rate of greater than 100 bpm is considered to be tachycardia. A heart rate of less than 60 bpm in an adult is considered to be bradycardia. Palpation and auscultation are both acceptable to check heart rate. 3. Tachypnea may be the result of: 1. hypoxemia. 2. hypothermia. 3. fever. 4. sedation .a. 2, 4 b. 1, 3 c. 2, 3, 4 d. 1, 2, 3 ANS: B Tachypnea may be the result of hypoxemia, fever, and other causes. Hypothermia and sedationwill usually result in bradycardia. 4. A 50-year-old patient would be said to have hypotension when her: a. blood pressure is 130/90 mm Hg. b. blood pressure is 85/55 mm Hg. c. heart rate is 55 bpm. d. pulse pressure is 40 mm Hg.ANS: B Hypotension is said to be present when the patient’s blood pressure falls below 90/60 mm Hg. Aheart rate of 55 bpm would be bradycardia. Pulse pressure is normally about 40 mm Hg. 7 | P a g e5. A dull percussion note would be heard in which of the following situations? 1. Atelectasis 2. Pleural thickening 3. Chronic obstructive pulmonary disease (COPD) 4. Consolidation a. 1, 2 b. 3, 4 c. 2, 3, 4 d. 1, 2, 4 ANS: D Because of hyperinflation, a patient with COPD would have a hyperresonant percussion note. Allof the other listed options would result in a dull percussion note. 6. Coarse crackles are associated with: 1. inspiration typically. 2. air passing through an airway intermittently occluded by mucus. 3. bronchial asthma. 4. expiration typically. a. 2, 4 b. 3, 4 c. 2, 3, 4 d. 1, 2, 3 ANS: A Coarse crackles are associated with air passing through an airway intermittently occluded by mucus; they are more typically heard during inspiration, not expiration. Wheezes are an expiratory sound associated with bronchial asthma. 7. While assessing an unconscious patient, the respiratory therapist observes that the patient’sbreathing becomes progressively faster and deeper and then progressively becomes slowerand shallower. After that, there is a period of apnea before the cycle begins again. This breathing pattern would be identified as: a. Cheyne-Stokes. b. Tachypnea. c. Kussmaul. d. Hyperventilation. ANS: A The abnormal breathing pattern called Cheyne-Stokes is identified by progressively faster and deeperbreathing that then progressively becomes slower and shallower. After that there is a period of apneabefore the cycle begins again. Tachypnea is rapid breathing. Kussmaul breathing is consistently fast and deep breathing. Hyperventilation is confirmed by a low carbon dioxide level. 8. Benefits of pursed-lip breathing include that it: 1. stabilizes airways. 2. offsets air trapping on exhalation. 3. generates a better gas mixing breathing pattern. 4. increases the respiratory rate. a. 1 b. 2, 3 c. 1, 2, 3 8 | P a g ed. 2, 3, 4 ANS: C All of the listed options are benefits of pursed-lip breathing in a patient with an airwayobstruction problem such as asthma or COPD. 9. A patient comes into the emergency department with a complaint of centrally located,constant chest pain. What is his most likely problem? a. Pleurisy b. Myocardial ischemia c. Pneumothorax d. Fractured rib ANS: B Often a patient with myocardial ischemia will complain of centrally located, constant chest pain. The pain may also radiate down an arm or up the neck. 10. A patient with bronchiectasis has a productive cough. Which of the following should the respiratory therapist be evaluating about the patient’s sputum? 1. Color 2. Odor 3. Frequency of cough 4. Consistency a. 3 b. 1, 2 c. 3, 4 d. 1, 2, 4 ANS: D The respiratory therapist should evaluate a patient’s sputum for color, odor, amount, consistency, and any other significant factors. This could include time of greater or smaller amounts or a change in consistency after inhaling a mucolytic medication. 11. The respiratory therapist is monitoring the blood pressure of a patient in the emergencydepartment and notes that the blood pressure is 15 mm Hg less on inspiration than on expiration. Which of the following would most likely result in this finding? a. The patient is hypovolemic. b. The patient has a pulmonary embolism. c. The patient is having a myocardial infarction. d. The patient is having a severe exacerbation ofasthma. ANS: D A change in blood pressure that is more than 10 mm Hg lower on inspiration than on expiration is known as pulsus paradoxus. This exaggerated waxing and waning of arterial blood pressure can be detected with a sphygmomanometer or, in severe cases, by palpating the pulse at the wrist or neck. Commonly associated with severe asthmatic episodes, pulsus paradoxus is believed to be caused bythe major intrapleural pressure swings that occur during inspiration and expiration. 12. The respiratory therapist is examining a patient in the medical ward and notes that thetrachea is deviated to the right. Which of the following may be causing the tracheal deviation to the right? a. A right-sided tension pneumothorax. 9 | P a g eb. A right-sided pleural effusion. c. A tumor mass on the right. d. Atelectasis of the right upper lobe. ANS: D A number of abnormal pulmonary conditions can cause the trachea to deviate from its normal position. For example, a tension pneumothorax, pleural effusion, or tumor mass may push the tracheato the unaffected side (in this case to the left), whereas atelectasis pulls the trachea to the affected side(in this case to the right). 13. The respiratory therapist is performing palpation on a patient recently admitted to the medical ward. The therapist notes decreased tactile fremitus over the right lung. Which ofthe following could most likely be the cause for this physical examination finding? a. Right-sided atelectasis b. Right-sided pneumothorax c. Right-sided pleural effusion d. Right-sided pleural tumor ANS: A Tactile fremitus decreases when anything obstructs the transmission of vibration. Suchconditions include tumors or thickening of the pleural cavity, pleural effusion, and pneumothorax. Tactile fremitus increases in patients with atelectasis. 14. Moderate hypoxemia is indicated with an SpO2 value between a. 95%; 99% b. 91%; 94% c. 86%; 90% d. 80%; 85% ANS: C In the adult, normal SpO2 values range from 95% to 99%. SpO2 values of 91% to 94% indicate mild hypoxemia. Mild hypoxemia warrants additional evaluation by the respiratory practitioner but does not usually require supplemental oxygen. SpO2 readings of 86% to 90% indicate moderate hypoxemia. These patients often require supplemental oxygen. SpO2 values of 85% or lower indicatesevere hypoxemia and warrant immediate medical intervention, including the administration of oxygen, ventilatory support, or both. and . 10 | P a g eChapter 03: The Pathophysiologic Basis for Common Clinical Manifestations MULTIPLE CHOICE 1. Which of the following is considered a normal tidal volume for a normal adult? a. 4 to 6 mL/kg b. 7 to 9 mL/kg c. 9 to 11 mL/kg d. 10 to 12 mL/kg ANS: B In normal adults, the VT is about 500 mL (7 to 9 mL/kg), the ventilatory rate is about 15 (with a range of 12 to 18) breaths per minute, and the I:E ratio is about 1:2. In patients with respiratory disorders, however, an abnormal ventilatory pattern is often present. 2. Which of the following is considered a symptom a patient with pulmonary disease may complain of when in distress? a. Dyspnea b. Tachypnea c. Retractions of intercostal spaces d. Distressed facial expressions ANS: A Dyspnea is defined as the “breathlessness” or “shortness of breath,” or the “labored or difficult breathing” felt and described only by the patient. The symptoms of dyspnea (“subjective information”) are sensations that can only be experienced by the patient who is having breathing difficulties—not by the observation of the hospital care staff. Signs of dyspnea (“objectiveinformation”) include audibly labored breathing, hyperventilation, and/or tachypnea, retractions of intercostal spaces, use of accessory muscles, a distressed facial expression, flaring of the nostrils, paradoxical movements of the chest and abdomen, and gasping. 3. Which of the following terms is used to describe shortness of breath in thereclining position? a. Orthopnea b. Eupnea c. Exertional dyspnea d. Cardiac dyspneaANS: A Common types of dyspnea include (1) positional dyspnea, which occurs only when the patient is inthe reclining position—and is also known as orthopnea, (2) cardiac dyspnea, which is labored breathing caused by heart disease (e.g., congestive heart failure), (3) exertional dyspnea, which is provoked by physical exercise or exertion, (4) paroxysmal nocturnal dyspnea, which is a form of respiratory distress related to posture (especially reclining while sleeping) and is usually associatedwith congestive heart failure with pulmonary edema, and (5) renal dyspnea, which is difficulty in breathing due to kidney disease. Eupnea is defined as the normal breathing rate (between 12 and 20breaths/min) and regular rhythm and moderate depth for an adult. 4. What ventilatory pattern occurs when the compliance of the lungs decreases? a. No noticeable change. b. Rate generally increases while the tidal volume simultaneously decreases. c. Rate and tidal volume generally increase. d. Rate generally decreases while the tidal volume simultaneously decreases. 11 | P a g eANS: B Although the precise mechanism is not clear, the fact that certain ventilatory patterns occur when lung compliance is altered is well documented. For example, when CL decreases, the patient’s breathing rate generally increases while the tidal volume simultaneously decreases. 5. How can work of breathing be quantified? a. Work = resistance × volume b. Work = pressure volume c. Work = flow volume d. Work = pressure × volume ANS: D In physics, work is defined as the force multiplied by the distance moved (work = force × distance). In respiratory physiology, the change in pulmonary pressure (force) multiplied by the change in lung volume (distance) may be used to quantify the work of breathing (WOB) (work = pressure × volume). 6. In patients with chronically high PaCO2 and low PaO2 which of the following is the primary receptor site for the control of ventilation? a. Central chemoreceptors b. Peripheral chemoreceptors c. Juxtapulmonary-capillary receptors d. Aortic and carotid sinus baroreceptors ANS: B When the peripheral chemoreceptors are activated, an afferent (sensory) signal is sent to the respiratory centers of the medulla by way of the glossopharyngeal nerve (cranial nerve IX) from thecarotid bodies and by way of the vagus nerve (cranial nerve X) from the aortic bodies. Efferent (motor) signals are then sent to the respiratory muscles, which results in an increased rate of breathing. It should be noted that in patients who have a chronically high PaCO2 and low PaO2, the peripheral chemoreceptors are the primary receptor sites for the control of ventilation. 7. Which of the following are considered accessory muscles of inspiration? 1. Sternocleidomastoids 2. Scalenes 3. Internal obliques 4. Transversus abdominis a. 1, 2 b. 2, 3 c. 1, 2, 4 d. 2, 3, 4 ANS: A The major accessory muscles of inspiration are the scalenes, sternocleidomastoids, pectoralismajor muscle groups, and the trapezius muscle groups. The major accessory muscles of expiration are the rectus abdominis, external and internal obliques, and the transversus abdominis. 8. Which of the following are considered accessory muscles of expiration? 1. Trapezius 2. Scalenes 3. External obliques 4. Transversus 12 | P a g eabdominis a. 1, 3 b. 2, 4 c. 2, 3 d. 1, 3, 4 ANS: D The major accessory muscles of inspiration are the scalenes, sternocleidomastoids, pectoralismajor muscle groups, and the trapezia muscle groups. The major accessory muscles of expiration are the rectus abdominis, external and internal obliques, and thetransversus abdominis. 9. Which of the following terms describes a patient’s severe resistant to taking a deep breath? a. Splinting b. Pursed-lip breathing c. Retractions d. Pleurisy ANS: A Chest pain is one of the most common complaints among patients with cardiopulmonary problems. It can be divided into two categories: pleuritic and nonpleuritic. Unlike cough, dyspnea, and sputum production, it is not subtle. Obviously severe resistance to taking a deep breath is a symptom of pleuritic chest pain and is called splinting. 10. A patient is complaining of a constant chest pain that is centrally located, does not worsen with deep inspiration, but does radiate? Which of the following disorders is associated with these complaints? a. Pneumonia b. Lung cancer c. Pulmonary hypertension d. Tuberculosis ANS: C Nonpleuritic chest pain is described as a constant pain that is usually located centrally. It is not generally worsened by deep inspiration. The pain may also radiate. Nonpleuritic chest pain is associated with the following disorders: • Myocardial ischemia • Pericardial inflammation • Pulmonary hypertension • Esophagitis • Local trauma or inflammation of the chest cage, muscles, bones, or cartilage 11. As you assess the respiratory status of a patient you notice they have jugular venous distention. Which of the following conditions is the most likely cause of this finding? a. Congestive heart failure b. Pneumonia c. Lung cancer d. Pulmonary infarction ANS: A In patients with left heart failure (congestive heart failure), right heart failure (cor pulmonale), severe flail chest, pneumothorax, or pleural effusion, flow from the major veins of the chest that return blood to the right side of the heart may be compromised. When this happens, cardiac venous return decreases and central venous pressure increases. This condition is manifested by distended neck 13 | P a g eveinsalso called jugular venous distention. 12. The majority of the mucous blanket consists of: a. glycoproteins. b. carbohydrates. c. lipids. d. water. ANS: D A mucous layer, commonly referred to as the mucous blanket, covers the epithelial lining of the tracheobronchial tree. The mucous blanket is 95% water. The remaining 5% consists of glycoproteins,carbohydrates, lipids, DNA, some cellular debris, and foreign particles. 14 | P a g eChapter 04: Pulmonary Function Testing MULTIPLE CHOICE 1. Pulmonary function studies are done for which of the following measurements? 1. The patient’s carbon monoxide level 2. Lung volumes and capacities 3. Pulmonary diffusion capacity 4. Forced expiratory flowrates a. 1 b. 2, 3 c. 2, 3, 4 d. 1, 2, 3 ANS: C A blood sample must be analyzed by a cooximeter to determine a patient’s carbon monoxide level. All of the other listed options can be measured on a pulmonary function test. 2. In response to a restrictive lung disorder, which of the following is typically found? 1. Decreased lung compliance 2. Increased ventilatory rate 3. Decreased tidal volume 4. Decreased lung rigidity a. 1 b. 2, 3 c. 2, 3, 4 d. 1, 2, 3 ANS: D With a restrictive lung disorder, there will be increased lung rigidity. This causes decreased lung compliance. As a result, the patient breathes faster and with a smaller tidal volume. 3. A special indirect measurement procedure must be done to find which of the following? a. Inspiratory reserve volume b. Residual volume c. Expiratory reserve volume d. Inspiratory capacity ANS: B Because the residual volume cannot be measured by spirometry, special procedures and equipment must be used to indirectly measure it. The other listed options can be directly measured by spirometry. 4. In a healthy individual, which of the following is considered a normal expiratory time necessary to perform a forced vital capacity? a. Less than 4 seconds b. 4 to 6 seconds c. 6 to 8 seconds d. 8 to 10 seconds ANS: B A normal adult will exhale a forced vital capacity (FVC) within 4 to 6 seconds. 15 | P a g e5. Overall characteristics of pulmonary function testing results on a patient with obstructive lung disease include that the FEV1: a. is reduced and FEV1% is normal. b. and FEV1% are both increased. c. and FEV1% are both reduced. d. is increased and FEV1% is decreased. ANS: C Because of airway narrowing problems, a patient with obstructive lung disease will have a reduced FEV1 volume and FEV1% flow. A patient with restrictive lung problems may haveFEV1 reduced and FEV1% normal. The other combinations are not seen. 6. The FEF25%-75% is used to evaluate: a. flow in large airways. b. lung volumes. c. maximum breathing effort. d. flow in medium-size to small airways. ANS: D The forced expiratory flow 25%-75% (FEF25%-75%) is the average flowrate generated by the patient during the middle 50% of an FVC measurement. This expiratory maneuver is used to evaluate the status of medium to small airways in obstructive lung disorders. Other tests would be needed to assess the other listed options. 7. Which of the following are true of the peak expiratory flowrate test? 1. It is effort dependent. 2. It is taken from the FVC test results. 3. It is taken from the MVV test results. 4. It assesses large upper airways.a. 1, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 2, 3 ANS: B The maximum voluntary ventilation (MVV) test is used to measure the maximum amount of air that can be breathed in a minute. The peak flow requires maximum effort from the patient, is taken fromthe FVC test, and assesses flow through the large upper airways. 8. A patient has restrictive lung disease. In response to this, which of the following aretypically found? 1. Decreased lung compliance 2. Increased ventilatory rate 3. Increased tidal volume 4. Decreased ventilatory rate a. 3, 4 b. 2, 3 c. 1, 2 d. 1, 3, 4 ANS: C Restrictive lung disorders result in an increase in lung rigidity, which in turn decreases lung compliance. When lung compliance decreases, the ventilatory rate increases and the tidal volume decreases. 16 | P a g e9. The pulmonary diffusion capacity of the carbon monoxide test is used to: a. assess the patient’s blood carbon monoxide level. b. remove carbon monoxide from the patient’s blood. c. measure the residual volume. d. assess the alveolar-capillary membrane. ANS: D Alveolar-capillary membrane function is measured by the pulmonary diffusion capacity of the carbon monoxide test. A very small amount of carbon monoxide (CO) is inhaled by the patient toperform the test. But the CO level is not measured in the blood, and CO is not removed from the blood. 10. Total lung capacity is composed of which of the following? 1. IRV 2. IC 3. ERV 4. RVa. 3, 4 b. 2, 3 c. 1, 2 d. 2, 3, 4 ANS: D Total lung capacity (TLC) can be calculated by adding IC, ERV, and RV. 11. A respiratory therapist has just performed a pulmonary function study and notes that the results show obstructive lung disease with a decreased DLCO value. Which of the following is the best interpretation of these results? a. The patient has pulmonary fibrosis. b. The patient has asthma. c. The patient has cystic fibrosis. d. The patient has emphysema. ANS: D A decreased DLCO is a hallmark clinical manifestation in emphysema because of the destruction ofthe alveolar pulmonary capillaries and decreased surface area for gas diffusion associated with the disease. The DLCO is usually normal in all other obstructive lung disorders. Pulmonary fibrosis is arestrictive disease, not an obstructive disease. 12. The respiratory therapist is called to the neurologic care unit to assess the muscle strength ofa patient diagnosed with myasthenia gravis. Which of the following tests should the therapist recommend to assess the patient’s respiratory muscle strength? a. Maximum inspiratory pressure (MIP) b. Maximum inspiratory flowrate (MIFR) c. Maximum expiratory flowrate (MEFR) d. Vital capacity (VC) ANS: A The most commonly used tests to evaluate the patient’s respiratory muscle strength at the bedside aremaximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), forced vital capacity(FVC), and maximum voluntary ventilation (MVV). 13. The respiratory therapist is performing a pulmonary function study on a patient who has periodic symptoms of asthma. The pulmonary function results are within normal limits. What further testing can the therapist recommend to aid in either confirming or negating 17 | P a g ethe possible diagnosis? a. Inhaled methacholine challenge testing b. Body plethysmography c. Inhaled digitalis d. Warm, humid air challenge ANS: A Because some patients have clinical manifestations associated with asthma, but otherwise normal lungfunction between asthma episodes, measurements of airway responsiveness to inhaled methacholine or histamine, or an indirect challenge test to inhaled mannitol, or to an exercise or cold air challenge may be confirming a diagnosis of asthma. 18 | P a g eChapter 05: Blood Gas Assessment MULTIPLE CHOICE 1. Which of the following would be a normal person’s arterial carbon dioxide pressure (PaCO2)? a. 25 to 35 mm Hg b. 35 to 45 mm Hg c. 45 to 60 mm Hg d. 60 to 80 mm Hg ANS: B The normal PaCO2 range is 35 to 45 mm Hg; below this is hypocapnia, and above this ishypercapnia. 2. Which of the following would be a normal person’s venous oxygen pressure (PaO2)? a. 35 to 45 mm Hg b. 45 to 80 mm Hg c. 80 to 100 mm Hg d. 100 to 120 mm Hg ANS: A A normal person’s PaO2 is 35 to 45 mm Hg. Higher values could only be achieved by giving the person supplemental oxygen. 3. Which of the following will likely be seen in the arterial blood gas values of a patient with acute ventilatory failure? 1. Acidic pH 2. Near-normal bicarbonate level 3. Alkaline pH 4. High carbon dioxide level a. 1, 4 b. 2, 3 c. 2, 3, 4 d. 1, 2, 4 ANS: D An alkaline pH could be caused by hyperventilation. Ventilatory failure with a high CO2 level would cause an acidotic pH, with a near-normal bicarbonate level. 4. What causes stimulation of the peripheral chemoreceptors to increase the ventilatory rate? a. Pain or anxiety b. PaCO2 of about 40 mm Hg c. PaO2 of about 60 mm Hg or less d. Venous pH of 7.30 to 7.40 ANS: C A lower than normal PaO2 of about 60 mm Hg or less will stimulate the peripheral chemoreceptors. These chemoreceptors will not be stimulated by pain or anxiety, normal PaCO2, or normal venous pH. 5. A patient has had chronic ventilatory failure for several years. What is the primary factor that determines her breathing pattern? 19 | P a g ea. Muscle efficiency b. Ventilatory efficiency c. Heart function d. Work efficiency ANS: D Although the exact mechanism is unclear, the patient slowly develops a breathing pattern that uses theleast amount of oxygen for the energy expended. In essence, the patient selects a breathing pattern based on work efficiency rather than ventilatory efficiency. 6. An anion gap of 17 would indicate: a. metabolic acidosis. b. respiratory alkalosis. c. respiratory acidosis. d. metabolic alkalosis. ANS: A An anion gap of 15 or higher would indicate a metabolic acidosis. The normal gap is 9 to 14 mEq/L. 7. Common causes of metabolic acidosis include: 1. diabetic ketoacidosis. 2. shallow breathing from a sedative overdose. 3. lactic acidosis. 4. renal failure. a. 1 b. 2, 3 c. 2, 3, 4 d. 1, 3, 4 ANS: D Shallow breathing from a sedative overdose would cause a respiratory acidosis. All of the other options would cause a metabolic acidosis. 8. Which of the following would be found in a stable patient with long-standing obstructive lung disease? a. Low bicarbonate level and low carbon dioxide level b. Low bicarbonate level and high carbon dioxide level c. High bicarbonate level and low carbon dioxide level d. High bicarbonate level and high carbon dioxide level ANS: D A high bicarbonate level and high carbon dioxide level are found in a stable patient with long-standing obstructive lung disease. The other options are associated with other acid-base disorders. 9. Common causes of metabolic alkalosis include: 1. renal failure. 2. vomiting. 3. excessive sodium bicarbonate administration. 4. gastric suctioning. a. 1, 3 b. 2, 4 c. 2, 3, 4 d. 1, 2, 3 20 | P a g eANS: C Renal failure does not cause metabolic alkalosis. 10. The most common cause of acute alveolar hyperventilation is: a. hypoxemia. b. metabolic alkalosis. c. tachycardia. d. supplemental oxygen administration. ANS: A The most common cause of acute alveolar hyperventilation is hypoxemia. The decreased PaO2 seenduring acute alveolar hyperventilation usually develops from a decreased ventilation-perfusion ratio, capillary shunting, or venous admixture associated with a pulmonary disorder. The PaO2 continues to drop as the pathologic effects of the disease intensify. Eventually the PaO2 may decline to a point low enough (a PaO2 of about 60 mm Hg) to significantly stimulate the peripheralchemoreceptors, which in turn causes the ventilatory rate to increase. The increased ventilatory response in turn causes the PaCO2 to decrease and the pH to increase. 11. Mechanical ventilation is indicated for which of the following ABG results?a. pH 7.56; PaCO2 27; HCO3 23; PaO2 63 b. pH 7.21; PaCO2 68; HCO3 26; PaO2 51 c. pH 7.36; PaCO2 79; HCO3 43; PaO2 63 d. pH 7.52; PaCO2 51; HCO3 40; PaO2 46 ANS: B When an increased PaCO2 is accompanied by acidemia (decreased pH), acute ventilatory failure, or respiratory acidosis, is said to exist. Clinically, this is a medical emergency that may require mechanical ventilation. 12. A respiratory therapist is questioning the accuracy of the ABG results obtained on a patientin the ICU. The results show a pH and PaO2 that seem unreasonably high, while the PaCO2seems unreasonably low. Which of the following would most likely cause these erroneous results? a. A venous sample was obtained. b. There was excessive heparin in the blood gas syringe. c. The sample was excessively delayed in analysis. d. There was an air bubble in the sample.ANS: D An air bubble in the sample would cause an increase in the pH and PaO2 while causing adecrease in PaCO2. 13. The respiratory therapist is assessing a patient with end-stage COPD who was admitted to the medical ward for an exacerbation of COPD due to increasing sputum purulence. The therapist notes the following ABG results in the patient’s electronic medical record: pH 7.52, PaCO2 51; HCO3 40; PaO2 46. Which of the following is the best interpretation of these ABG results? a. Chronic ventilatory failure with hypoxemia b. Acute ventilatory failure with hypoxemia c. Partially compensated metabolic alkalosis with hypoxemia d. Acute alveolar hyperventilation superimposed on chronic ventilatory failure 21 | P a g eANS: D An end-stage COPD patient would be expected to have chronic ventilatory failure for baseline ABG results. During an exacerbation, he/she may also experience acute periods of hyperventilation. If able, these patients have the mechanical reserve to increase their alveolar ventilation significantly inan attempt to maintain their baseline PaO2, which has decreased in relation to an acute pulmonary problem, in this case an increase in sputum purulence. When excessive alveolar ventilation occurs, this action causes the patient’s PaCO2 to decrease from its normally “high baseline” level. As the PaCO2 decreases, the arterial pH increases. As this condition intensifies, the patient’s baseline ABG values can quickly change from chronic ventilatory failure to acute alveolar hyperventilation superimposed on chronic ventilatory failure. If the therapist does not know the past history of the patient with acute alveolar hyperventilation superimposed on chronic ventilatory failure, he/she might initially interpret the ABG values as signifying partially compensated metabolic alkalosis with severe hypoxemia. However, the clinical situation that offsets this interpretation is the presence of marked hypoxemia. A low oxygen level is not normally seen in patients with pure metabolic alkalosis. Thus whenever the ABG values appear to reflect partially compensated metabolic alkalosis but the condition is accompanied by significant hypoxemia, the respiratory therapist should be alert to the possibility of acutealveolar hyperventilation superimposed on chronic ventilatory failure. 14. Calculate the anion gap using the following data:Na+: 140 mEq/L K+ 4.1 mEq/L Cl-: 105 mEq/L HCO -: 24 mEq/L a. 31 mEq/L. b. 21 mEq/L. c. 11 mEq/L. d. More information is needed to calculate. 3 ANS: C - - The anion gap is the calculated difference between the Na+ ions and the sum of the HCO3 and Cl ions. The potassium is not needed in this calculation. Anion gap 22 | P a g eChapter 06: Assessment of Oxygenation MULTIPLE CHOICE 1. When a sample of arterial blood is analyzed for the pressure of oxygen (PaO2), the valuecomes from the: a. blood plasma. b. leukocytes. c. hemoglobin. d. erythrocytes. ANS: A A small amount of oxygen that diffuses from the alveoli to the pulmonary capillary blood remains in the dissolved form. The term dissolved means that the gas molecule (in this case oxygen) maintains itsexact molecular structure and freely moves throughout the plasma of the blood in its normal gaseous state. Clinically, it is the dissolved oxygen that is measured to assess the patient’s partial pressure of oxygen (PO2). Oxygen is chemically bound to the hemoglobin in the erythrocytes and is measured by an oximeter as the saturation, not as a partial pressure. Leukocytes do not carry oxygen. 2. Oxygen consumption: 1. increases with exercise. 2. is the amount of oxygen used by the body. 3. is inversely related to carbon dioxide production. 4. is about 250 mL per minute in the resting adult. a. 1, 2 b. 3, 4 c. 2, 4 d. 1, 2, 4 ANS: D Oxygen consumption is the amount of oxygen used by the body and increases with exercise.At rest, an adult consumes about 250 mL per minute. Oxygen use is not inversely related to carbon dioxide production. 3. A patient has been exposed to smoke during a house fire. An ABG result shows a normalPaO2. How should the patient’s PaO2 value be interpreted? a. The PaO2 is being falsely elevated by the carbon monoxide. b. The PaO2 is being falsely decreased by the carbon monoxide. c. The PaO2 is accurate. d. The PaO2 is a false measurement because the presence of carbon monoxide makesthe analyzer unable to determine the PaO2. ANS: C The patient’s plasma PaO2 value may be normal or high. This can mislead the respiratorytherapist because the patient’s total oxygen value (CaO2) is low. Remember that carbon monoxide will prevent hemoglobin from carrying oxygen. 4. A person’s C(a-v)O2 increases in which of the following? 1. Seizures 2. Peripheral shunting 3. Hyperthermia 4. Exercise a. 1 23 | P a g eb. 2, 3 c. 2, 3, 4 d. 1, 3, 4 ANS: D Peripheral shunting decreases the C(a-v)O2 because less oxygen is extracted by the tissues. All of theother listed options increase oxygen extraction and so will increase the C(a-v)O2. 5. A sample of blood has been taken from a patient’s pulmonary artery. What mixed venousoxygen saturation value (SvO2) would indicate that the patient is normal? a. 40 mm Hg b. 95 mm Hg c. 75% d. 97% ANS: C A normal SvO2 is 75%. Normal PvO2 is 40 mm Hg. Normal arterial blood values for oxygen are SaO2 of 97% and PaO2 of 95 mm Hg. 6. Polycythemia is: 1. a condition of too many red blood cells. 2. a condition of too few red blood cells. 3. caused by lack of iron in the diet. 4. the body’s response to chronic hypoxemia.a. 1, 2 b. 2, 3 c. 1, 4 d. 2, 4 ANS: C The body’s response to chronic hypoxemia is to produce too many red blood cells; this ispolycythemia. Lack of iron in the diet could lead to anemia. 7. A patient has a chronic respiratory disorder and vasoconstriction of her pulmonary vascularsystem. What is the chief control over this vasoconstriction? a. Low PAO2 b. Low PaO2 c. High PaCO2 d. High pH ANS: A A low PAO2 (pressure of alveolar oxygen) is primarily responsible for pulmonary vasoconstriction. Arterial oxygen and carbon dioxide values and pH are not causes. 8. An increased cardiac output causes the: 1. C(a-v)O2 to decrease. 2. SvO2 to increase. 3. total O2 delivery to decrease. 4. O2ER to increase. a. 1 b. 2, 3 c. 3, 4 d. 1, 2 ANS: D 24 | P a g eAs cardiac output increases, less oxygen is extracted from the blood. Because of this, the C(a- v)O2 decreases and SvO2 increases. Increased cardiac output would also increase total oxygen delivery and decrease the oxygen extraction ratio. 9. A condition that will cause hypoxic hypoxia is: a. cyanosis. b. decreased cardiac output or heart failure. c. hypoventilation from an overdose of a sedative medication. d. carbon monoxide poisoning. ANS: C Hypoventilation from any cause will cause hypoxic hypoxia because an inadequate amount of oxygenis breathed in. Cyanide poisoning will cause histotoxic hypoxia because the tissue cells will not be able to metabolize oxygen. Decreased cardiac output or heart failure will cause circulatory hypoxia because the heart will not deliver enough blood and oxygen to the tissues. Carbon monoxide poisoning will cause anemic hypoxia because the hemoglobincannot carry oxygen. 10. A condition that will cause anemic hypoxia is: a. cyanide poisoning. b. decreased cardiac output or heart failure. c. polycythemia. d. carbon monoxide poisoning. ANS: D Carbon monoxide poisoning will cause anemic hypoxia because the hemoglobin cannot carry oxygen.Cyanide poisoning will cause histotoxic hypoxia because the tissue cells will not be able to metabolize oxygen. Decreased cardiac output or heart failure will cause circulatory hypoxia because the heart will not deliver enough blood and oxygen to the tissues. Polycythemia does not cause hypoxia. 11. The respiratory therapist is evaluating a patient in the intensive care unit who shows signs oftissue hypoxia. Laboratory results reveal the following: HgB 14.8 grams, CaO2 19.6 vol.%, PaO2 102 mm Hg, a-v difference 9.8 vol.%, PvO2 24 mm Hg. Based on these results, which of the following types of hypoxia does this patient have? a. Hypoxic hypoxia b. Anemic hypoxia c. Circulatory hypoxia d. Histotoxic hypoxia ANS: C An increase in the a-v difference is due to a decrease in cardiac output (circulatory hypoxia). The cardiac output and a-v difference are inversely related, and an a-v difference of 9.9 vol.% is evidence of the inadequacy of the cardiac output. 12. The respiratory therapist is reviewing a patient’s electronic medical record to try to verify if the patient has tissue hypoxia. Which of the following laboratory values is most likely to correlate with tissue hypoxia? a. Metabolic acidosis b. Thrombocytopenia c. Hypokalemia d. Bilirubinemia ANS: A When hypoxia exists, alternate anaerobic mechanisms are activated in the tissues that produce dangerous metabolites—such as lactic acid—as waste products. Lactic acid is a nonvolatile 25 | P a g eacidand causes the pH to decrease, resulting in metabolic acidosis. 13. A patient is mildly hypoxemic. Which of the following signs would the respiratory therapist expect to find in this patient? a. An increase in the patient’s breathing rate and heart rate b. A decrease in systemic blood pressure c. Cardiac dysrhythmias on an EKG d. Anemia ANS: A Clinically, the presence of mild hypoxemia generally stimulates the oxygen peripheral chemoreceptors to increase the patient’s breathing rate and heart rate; consequently blood pressure may slightly increase, not decrease. Cardiac dysrhythmias would not be expected withmild hypoxemia. Anemia is unrelated to mild hypoxemia. 14. Which of the following values is considered a normal hemoglobin level in a healthy adult? a. 0.003–1.34 mEq/L b. 12 to 16 g/dL c. 96% to 100% d. 14 to 20 g/dL. ANS: B Clinically, the weight measurement of hemoglobin, in reference to 100 mL of blood, is known as the grams per deciliter (g/dL). The normal hemoglobin value for men is 14 to 16 g/dL. The normal hemoglobin value for women is 12 to 15 g/dL. The normal hemoglobin value for infants is 14 to 20 g/dL. 26 | P a g eChapter 07: Assessment of the Cardiovascular System MULTIPLE CHOICE 1. The T wave represents: a. depolarization of the ventricles. b. repolarization of the ventricles. c. depolarization of the atria. d. repolarization of the atria. ANS: B The T wave represents the repolarization of the ventricles. The QRS complex represents the depolarization of the ventricles. The P wave represents the depolarization of the atria. The repolarization of the atria cannot be seen. 2. When reviewing a cardiac rhythm strip, the respiratory therapist notices that there are threelarge boxes between two QRS complexes. Approximately what is this patient’s heart rate? a. 60 b. 75 c. 100 d. 150 ANS: C Approximate heart rate can be determined by dividing the number of large boxes between QRS complexes on the rhythm strip into 300. Therefore 300 divided by 3 =100 bpm for a heart rate. 3. Which of the following is found when a patient has sinus arrhythmia? 1. Rate decreases during expiration. 2. Rate decreases during inspiration. 3. Rate varies by more than 10% from beat to beat. 4. Rate increases during inspiration. a. 3 b. 2, 3 c. 1, 4 d. 1, 3, 4 ANS: D Sinus arrhythmia has the following identifying traits: rate decreases during expiration, rate varies bymore than 10% from beat to beat, and rate increases during inspiration. 4. A premature ventricular contraction (PVC) can be identified by which of the following? 1. There is no P wave. 2. The QRS is wide. 3. The QRS looks normal. 4. The heart rate is altered. a. 1 b. 3, 4 c. 1, 2, 4 d. 1, 3, 4 ANS: C A PVC would have the following traits: there is no P wave, the QRS is wide and bizarre looking, and the heart rate is altered. 27 | P a g e5. A premature ventricular contraction (PVC) can be caused by: 1. sleep. 2. intrinsic myocardial disease. 3. hypoxemia. 4. acidemia. a. 1 b. 3, 4 c. 1, 2, 4 d. 2, 3, 4 ANS: D Sleep does not cause PVCs. 6. In which of the following is the atrial rate faster than the ventricular rate? 1. Atrial fibrillation 2. Sinus bradycardia 3. Atrial flutter 4. Sinus tachycardia a. 1, 3 b. 2, 4 c. 3, 4 d. 1, 2, 3 ANS: A Atrial fibrillation and atrial flutter both involve an abnormally fast atrial depolarization rate, while the ventricular rate is less than the atrial rate. Sinus bradycardia is a heart rate of less than 60 bpm. Sinus tachycardia is a very fast ventricular rate that matches the atrial rate. 7. Which of the following will be found in a patient with asystole? 1. Increased ventricular activity 2. Absence of electrical activity 3. No blood pressure 4. Highly variable heart rate a. 2 b. 1, 4 c. 2, 3 d. 1, 3, 4 ANS: C Asystole is the complete absence of electrical and mechanical activity in the heart. Because of that, there is no blood pressure. Death is imminent. 8. A pulmonary artery (Swan-Ganz) catheter can be used for which of the following? 1. Measuring cardiac output 2. Arterial blood sampling 3. Measuring left atrial pressure 4. Measuring pulmonary artery pressure a. 1 b. 2, 3 c. 2, 3, 4 d. 1, 3, 4 28 | P a g eANS: D A pulmonary artery (Swan-Ganz) catheter can be used to sample mixed venous blood. Arterial bloodsampling requires an arterial (radial) catheter. The other listed options can be performed with a pulmonary artery catheter. 9. A central venous pressure (CVP) catheter is used to: a. measure left atrial pressure. b. measure left ventricular work. c. monitor right ventricular function. d. monitor left ventricular function. ANS: C A central venous pressure (CVP) catheter is used to monitor right ventricular function and measure right atrial pressure and the right ventricular filling pressure. Left ventricular function cannot be measured with a CVP catheter; a pulmonary artery catheter is needed. 10. Which of the following hemodynamic changes are commonly seen in a patient with cardiogenic pulmonary edema? 1. Increased pulmonary capillary wedge pressure (PCWP) 2. Increased pulmonary vascular resistance (PVR) 3. Decreased mean pulmonary artery pressure (PA) 4. Decreased cardiac output (CO) a. 1, 4 b. 2, 3 c. 1, 2, 3 d. 2, 3, 4 ANS: A Patients with pulmonary edema (hypervolemia) will have an increased pulmonary capillary wedge pressure (PCWP) and decreased cardiac output (CO). The lung damage caused by COPD leads to increased pulmonary vascular resistance (PVR). The PA pressure will be increased with pulmonary edema. 11. The respiratory therapist is assessing a patient with sinus tachycardia. Which of thefollowing would least likely be a cause of the sinus tachycardia? a. Hypoxemia b. Severe anemia c. Hyperthermia d. Beta-blocker medicationsANS: D Common abnormal causes of sinus tachycardia include hypoxemia, severe anemia, hyperthermia, massive hemorrhage, pain, fear, anxiety, hyperthyroidism, and sympathomimetic or parasympatholytic drug administration. Beta-blocker medication may lead to sinus bradycardia, notsinus tachycardia. 12. The respiratory therapist is monitoring a patient in the medical ICU and notes multiple premature ventricular complexes (PVCs) on the cardiac monitor. The respiratory therapistelects to review the patient’s medication administration record (MAR) for medications thepatient is receiving to rule out medication toxicity as a cause of the PVCs. Which of the following medications should the therapist evaluate as a possibility 29 | P a g eof inducing PVCs? a. Theophylline b. Beta-blockers c. Vitamin D d. Acetaminophen ANS: A PVCs may be a sign of theophylline or alpha-stimulate or beta-agonist toxicity. Beta-blockers may lead to sinus bradycardia. Vitamin D and acetaminophen would not cause PVCs. 13. The respiratory therapist is called to a patient’s room as part of the rapid response team(RRT). The patient is unconscious and pulseless. The EKG monitor displays asystole. Which of the following actions would be indicated at this time? 1. Call a code. 2. Begin CPR. 3. Defibrillate the patient. 4. Administer ACLS medications. a. 1, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 2, 3 ANS: B Electric shock (defibrillation) is not effective for this rhythm—CPR and ACLS medications are required. The therapist should call a code, begin CPR, and administer ACLS medications that areused to stimulate electrical activity of the heart. Defibrillation is only effective if the heart has noelectrical activity. 30 | P a g eChapter 08: Radiologic Examination of the Chest MULTIPLE CHOICE 1. Which of the following is true of a chest radiograph? a. Lateral films are shot through one side of an upright patient. b. AP films are typically taken in the x-ray department. c. PA films artificially increase the size of the heart shadow. d. Lateral decubitus films are shot with the patient lying supine. ANS: A A lateral radiograph is filmed with the patient standing upright with either the left (preferred) or right side of the chest against the film plate. AP films are taken by a portable machine at the patient’s bedside. PA films show the heart at its correct size. A lateral decubitus film is taken with the patient lying on either side. 2. Which of the following are evaluated on a chest radiograph? 1. Examination of baby in pregnant women 2. Exposure quality 3. The heart shadow 4. The tracheobronchial tree a. 4 b. 1, 4 c. 1, 2, 4 d. 2, 3, 4 ANS: D An ultrasound, not a chest radiograph, is most associated with the test used to examine a baby inpregnant women. All of the other listed options are evaluated on a chest radiograph. 3. For most chest x-ray studies, what is usually done? a. There is a full exhalation. b. There is a full inspiration. c. Separate inspiratory and expiratory films are taken. d. The patient is told to pant to provide a middle lung volume. ANS: B The vast majority of chest radiographs are taken at full inspiration when the breath is held. A patient with obstructive lung disease may also have an expiratory film taken to compare the position of the hemidiaphragms. Panting should not be done because the movement would blur the image on the film. 4. The heart shadow on a chest radiograph will show up larger than normal on a(n): a. AP film. b. PA film. c. left lateral film. d. computed tomography (CT) scan. ANS: A With an AP projection, the heart is enlarged because the x-rays enter from the front and exit from the back to the film. A PA and left lateral film will show the heart at the correct size. The same is true of a CT scan. 31 | P a g e5. Which of the following would be normal findings of the heart and its surrounding area? 1. The left hilum is about 2 cm higher than the right hilum. 2. Most of the heart shadow is to the right of the sternum. 3. Calcified lymph nodes indicate an adult patient. 4. The cardiothoracic ratio is less than 1:2.a. 1, 4 b. 2, 3 c. 1, 2, 4 d. 2, 3, 4 ANS: A Normally, the left hilum is about 2 cm higher than the right hilum and the cardiothoracic ratio is less than 1:2. Most of the heart’s shadow should be on the left side of the sternum. Calcified lymphnodes could be a sign of histoplasmosis or tuberculosis. 6. The chest radiograph shows blunting of the patient’s costophrenic angles. What does thissuggest? a. The patient did not take a deep enough breath. b. Lung cancer. c. Pleural fluid. d. Underpenetrated exposure on the film. ANS: C When the patient is standing upright for the chest x-ray, any pleural fluid will go to the bases of the lungs and blunt the costophrenic angles. None of the other listed options will affect the costophrenic angles. 7. A patient has a long smoking history and has recently coughed up blood. The physiciansuspects that there may be lung cancer, but no lesions can be seen on a standard chest radiograph. A CT scan offers which of the following advantages? 1. Bronchial tumors can be seen. 2. Lung tumors as small as 0.4 cm can be seen. 3. A tumor’s metabolism can be identified. 4. A mediastinal mass can be seen.a. 1, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 2, 3 ANS: B Only a PET scan can identify a tumor by its metabolic activity. A CT scan can offer the other listed advantages. 8. A PET/CT scan can provide which of the following? 1. Early detection of cancer metastasis 2. Accurate staging of cancer 3. Radiation treatment of the cancer 4. Activation of chemotherapy drugs within the tumor a. 1, 2 b. 3, 4 c. 1, 2, 4 d. 1, 2, 3 ANS: A 32 | P a g eA PET/CT scan is helpful because it provides early detection of cancer metastasis and accurate staging of cancer. Radiation treatment of the cancer and activation of chemotherapy drugs within the tumor areentirely separate from a PET/CT scan. 9. Which of the following can be identified by pulmonary angiography? 1. Pulmonary emboli 2. Coronary artery occlusions 3. Arteriovenous malformations 4. Cause of hemoptysis a. 4 b. 1, 3 c. 2, 3, 4 d. 1, 2, 3 ANS: B Pulmonary angiography can identify pulmonary emboli and arteriovenous malformations. A coronaryangiogram is needed to find coronary artery occlusions. A bronchoscopy may be needed to find the source of B.C M hemoptysis. 10. A patient has had a ventilation-perfusion scan. What would be identified from the ventilation scan? a. Location of a lung abscess b. Alveolar consolidation c. Location of a pulmonary embolism d. Location of an airway obstruction ANS: B A ventilation scan can identify the location of an airway obstruction. A perfusion scan can identify the other listed problems. 11. The respiratory therapist is called to evaluate a patient with a suspected pleural effusion. Therespiratory therapist would most likely recommend which of the following chest radiographic views to help determine if the patient has a pleural effusion? a. An AP film b. A PA film c. A left lateral film d. A lateral decubitus film ANS: D The lateral decubitus radiograph is useful in the diagnosis of a suspected or known fluid accumulation in the pleural space (i.e., a pleural effusion) that is not easily seen in the PA radiograph. A pleural effusion, which is usually more thinly spread out over the diaphragm in the upright position, collects in the gravity-dependent areas while the patient is in the lateral decubitus position, allowing the fluid to be more readily seen. 12. The respiratory therapist is called to evaluate a patient with a suspected pulmonary embolus.The respiratory therapist would most likely recommend which of the following diagnostic procedures to help determine if the patient has a pulmonary embolus? a. CTPA b. Fluoroscopy c. PET scan d. MRI scan ANS: A 33 | P a g eComputed tomography pulmonary angiogram (CTPA) (also called a CT pulmonary angiography) with intravenous contrast has largely replaced pulmonary angiography and is fast becoming the first-line test for diagnosing suspected pulmonary embolism. The CTPA is now a preferred choice of imaging in the diagnosis of a pulmonary embolism because the only invasive requirement for the scan is an intravenous line. 13. The respiratory therapist is reviewing the electronic medical record of a patient in the medical ICU. In reading the most recent chest radiograph interpretation, the therapist notesthat the cardiothoracic ratio is stated to be less than 1:2 on the PA view. How should the therapist interpret this information? a. This is a normal cardiothoracic ratio. b. This is a decreased cardiothoracic ratio c. This ratio shows hyperinflation of the lung fields with subsequent air trapping. d. This interpretation should be ignored because it is inaccurate in the PA view. ANS: A On the PA projection the ratio of the width of the heart to the thorax (the cardiothoracic ratio) is normally less than 1:2. In other words, normally the width of the heart should be less than 50% ofthe width of the thorax. 14. The respiratory therapist is reviewing the transthoracic echocardiogram of a patient. The images are very poor. What other type of imaging study can they suggest to the physician toimprove the image quality? a. A transesophageal echocardiogram b. A stress echocardiogram c. A color Doppler d. Fluoroscopy ANS: A Transesophageal echocardiogram (TEE) is commonly used when the quality of the transthoracic echocardiogram images is poor. A flexible tube containing a transducer is passed down the esophagus and positioned close to the heart. The TEE provides a cleaner and sharper image of the heart, since thevarious structures between the outside of the chest and heart are not between the transducer and the heart. 34 | P a g eChapter 09: Other Important Tests and Procedures MULTIPLE CHOICE 1. Culture and sensitivity tests: