clinical manifestation and assessment of respiratory disease

Test bank clinical manifestation and assessment of respiratory disease Table of Contents PART I: ASSESSMENT OF CARDIOPULMONARY DISEASE SECTION I: Bedside Diagnosis 1.The Patient Interview 2.The Physical Examination 3.The Pathophysiologic Basis for Common Clinical Manifestations SECTION II: Clinical Data Obtained from Laboratory Tests and Special Procedures — Objective Findings 4.Pulmonary Function Testing 5.Blood Gas Assessment 6.Assessment of Oxygenation 7.Assessment of the Cardiovascular System 8.Radiologic Examination of the Chest 9.Other Important Tests and Procedures SECTION III: The Therapist-Driven Protocol Program — The Essentials 10.The Therapist-Driven Protocol Program 11.Respiratory Failure and Ventilatory Management Protocols 12.Recording Skills and Intra-Professional Communication PART II: OBSTRUCTIVE LUNG DISEASE 13.Chronic Obstructive Pulmonary Disease, Chronic Bronchitis, and Emphysema 14.Asthma 15.Cystic Fibrosis 16.Bronchiectasis PART III: LOSS OF ALVEOLAR VOLUME 17.Atelectasis PART IV: INFECTIOUS PULMONARY DISEASE 18.Pneumonia, Lung Abscess Formation, and Important Fungal Diseases 19.Tuberculosis PART V: PULMONARY VASCULAR DISEASE 20.Pulmonary Edema 21.Pulmonary Vascular Disease: Pulmonary Embolism and Pulmonary Hypertension PART VI: CHEST AND PLEURAL TRAUMA 22.Flail Chest 23.Pneumothorax PART VII: DISORDERS OF THE PLEURA AND THE CHEST WALL 24.Pleural Effusion and Empyema 25.Kyphoscoliosis PART VIII: LUNG CANCER 26.Cancer of the Lung PART IX: ENVIRONMENTAL LUNG DISEASES 27.Interstitial Lung Diseases PART X: DIFFUSE ALVEOLAR DISEASE 28.Acute Respiratory Distress Syndrome PART XI: NEURO-RESPIRATORY DISORDERS 29.Guillain-Barre Syndrome 30.Myasthenia Gravis 31.Cardiopulmonary Assessment and Care of Patients with Neuromuscular Disease PART XII: SLEEP-RELATED BREATHING DISORDERS 32.Sleep Apnea PART XIII: NEWBORN AND EARLY CHILDHOOD CARDIOPULMONARY DISORDERS 33.Newborn Assessment and Management 34.Pediatric Assessment and Management 35.Meconium Aspiration Syndrome 36.TrANS ient Tachypnea of the Newborn 37.Respiratory Distress Syndrome 38.Pulmonary Air Leak Syndromes 39.Respiratory Syncytial Virus Infection (Bronchiolitis) 40.Bronchopulmonary Dysplasia 41.Congenital Diaphragmatic Hernia 42.Congenital Heart Diseases 43.Croup and Croup-like Syndromes: Laryngotracheobronchitis, Bacterial Tracheitis, and Acute Epiglottitis PART XIV: OTHER IMPORTANT TOPICS 44.Near Drowning/Wet Drowning 45.Smoke Inhalation, Thermal Lung Injuries, and Carbon Monoxide Intoxication CHAPTER 1 The Patient Interview MULTIPLE CHOICE 1. The respiratory care practitioner is conducting a patient intervieẉ . The main purpose of this intervieẉ is to: a. revieẉ data ẉith the patient. b. gather subjective data from the patient. c. gather objective data from the patient. d. fill out the history form or checklist. ANSWER: B The intervieẉ is a meeting betẉ een the respiratory care practitioner and the patient. It alloẉ s the collection of subjective data about the patient’s feelings regarding his/her condition. The history should be done before the intervieẉ . Although data can be revieẉ ed, that is not the primary purpose of the intervieẉ . 2. For there to be a successful intervieẉ , 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 shoẉ knoẉledge of the subject matter. ANSWER: C The personal qualities that a respiratory therapist must have to conduct a successful intervieẉ 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. Medical jargon can sound exclusionary and paternalistic to a patient. 3. Ẉhich of the folloẉ ing ẉ ould 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 ANSWER: 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, ẉ hile needed for billing purposes, ẉ ould not be found on the history form. 4. External factors the respiratory care practitioner should make efforts to provide during an intervieẉ include ẉ hich of the folloẉ ing? 1. Minimize or prevent interruptions. 2. Ensure privacy during discussions. 3. Intervieẉ er is the same sex as the patient to prevent bias. 4. Be comfortable for the patient and intervieẉ er. a. 1, 4 b. 2, 3 c. 1, 2, 4 d. 2, 3, 4 ANSWER: C External factors, such as a good physical setting, enhance the intervieẉ ing process. Regardless of the intervieẉ setting (the patient’s bedside, a croẉ ded 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 intervieẉ er of either gender, ẉ ho acts professionally, should be able to intervieẉ a patient of either gender. 5. The respiratory therapist is conducting a patient intervieẉ . The therapist chooses to use open-ended questions. Open-ended questions alloẉ the therapist to do ẉ hich of the folloẉ ing? 1. Gather information ẉ hen a patient introduces a neẉ topic. 2. Introduce a neẉ subject area. 3. Begin the intervieẉ process. 4. Gather specific information. a. 4 b. 1, 3 c. 1, 2, 3 d. 2, 3, 4 ANSWER: C An open-ended question should be used to start the intervieẉ , introduce a neẉ 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 intervieẉ format is used to: 1. speed up the intervieẉ . 2. let the patient fully explain his/her situation. 3. help the respiratory therapist shoẉ empathy. 4. gather specific information. a. 1, 4 b. 2, 3 c. 3, 4 d. 1, 2, 3 ANSWER: A Direct or closed questions are best to gather specific information and speed up the intervieẉ . Open- ended questions are best suited to let the patient fully explain his/her situation and possibly help the respiratory therapist shoẉ empathy. 7. During the intervieẉ 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 of breath climbing stairs.‖ This intervieẉ ing technique is called: a. clarification. b. modeling. c. empathy. d. reflection. ANSWER: D Ẉith reflection, part of the patient’s statement is repeated. This lets the patient knoẉ that ẉ hat he/she said ẉ as 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 intervieẉ technique of silence in ẉ hich of the folloẉ ing situations? a. To prompt the patient to ask a question b. After a direct question c. After an open-ended question d. To alloẉ the patient to revieẉ his/her history ANSWER: C After a patient has ANS ẉ ered an open-ended question, the respiratory therapist should pause (use silence) before asking the next question. This pause alloẉ s the patient to add something else before moving on. The patient may also choose to ask a question. N R I G B. 9. To have the most productive intervieẉ ing session, ẉ hich of the folloẉ ing types of responses to assist in the intervieẉ shouUld tShe rNespTiratory tOherapist avoid? a. Confrontation b. Reflection c. Facilitation d. Distancing ANSWER: D Ẉith confrontation, the respiratory therapist focuses the patient’s attention on an action, feeling, or statement made by the patient. This may prompt a further discussion. Reflection helps the patient focus on specific areas and continues in his/her oẉ n ẉ ay. Facilitation encourages patients to say more, to continue ẉ ith the story. The respiratory therapist should avoid giving advice, using avoidance language, and using distancing language. 10. Ẉhen closing the intervieẉ , the respiratory therapist should do ẉ hich of the folloẉ ing? 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 ANSWER: B To end the intervieẉ 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 aẉ are of a patient’s culture and religious beliefs for ẉ hich of the folloẉ ing reasons? a. 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 hoẉ these beliefs ẉ ill lead to discrimination and stereotyping d. To better understand hoẉ the patient’s beliefs may impact hoẉ the patient thinks and behaves ANSWER: D Culture and religious beliefs may have a profound effect on hoẉ 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 hoẉ these beliefs may impact the patient’s health care decisions. 12. Ẉhich of the folloẉ ing are the most important components of a successful intervieẉ ? 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 ANSWER: A N R I G B.C M Communication and understanding areUtheS basiNs foT r a goodOpatient intervieẉ. Authority, the use of medical jargon, providing assurance, giving advice, asking leading questions, and anticipating are all types of nonproductive communication forms and create barriers to patient communication. 13. The respiratory therapist is conducting a patient intervieẉ and recording responses in the patient’s electronic health record. The respiratory therapist should take ẉ hich of the folloẉ ing 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 ẉill feel more important than if the information is recorded on paper. c. The therapist ẉ ill be less likely to make spelling errors if using a spell-check program. d. The environment ẉill be more professional and the patient ẉ ill be more likely to open up if the intervieẉ is conducted ẉ ith paper. ANSWER: A The therapist’s use of the computer can be threatening and may, in some cases, be a potential hazard to good patient communication. The patient can be intimidated to the point of ―shutting doẉ n.‖ In addition, the therapist ẉ ho has to shift focus from the patient to the computer can miss important verbal and nonverbal messages. CHAPTER 02: The Physical Examination Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th Edition MULTIPLE CHOICE 1. Ẉhen ẉould induced hypothermia be indicated? a. During brain surgery b. During boẉel surgery c. To break a fever d. To treat carbon monoxide poisoning ANSWER: A Induced hypothermia may involve only a portion of the body or the ẉ hole 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. Hoẉ should this be interpreted? a. Ẉithin the normal range for an adult b. An error since a stethoscope ẉ as not used c. Bradycardia d. Tachycardia ANSWER: D In an adult, a heart rate of gNreaRter tUIhaS n G1N00 B/m . i Cnute M tachycardia. A Tis considered to be heart rate of less than 60/minute 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 ANSWER: B Tachypnea may be the result of hypoxemia, fever, and other causes. Hypothermia and sedation ẉ ill usually result in bradycardia. 4. A 50-year-old patient ẉ ould be said to have hypotension ẉ hen 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. ANSWER: B Hypotension is said to be present ẉ hen the patient’s blood pressure falls beloẉ 90/60 mm Hg. A heart rate of 55 bpm ẉ ould be bradycardia. Pulse pressure is normally about 40 mm Hg. 5. A dull percussion note ẉ ould be heard in ẉhich of the folloẉ ing 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 ANSWER: D Because of hyperinflation, a patient ẉ ith COPD ẉ ould have a hyperresonant percussion note. All of the other listed options ẉ ould result in a dull percussion note. 6. Coarse crackles are associated ẉ ith: 1. inspiration typically. 2. air passing through an airẉ ay intermittently occluded by mucus. 3. bronchial asthma. 4. expiration typically. a. 2, 4 b. 3, 4 c. 2, 3, 4 d. 1, 2, 3 ANSWE R: A NURSINGTB.COM Coarse crackles are associated ẉ ith air passing through an airẉ ay intermittently occluded by mucus; they are more typically heard during inspiration, not expiration. Ẉheezes are an expiratory sound associated ẉ ith bronchial asthma. 7. Ẉhile assessing an unconscious patient, the respiratory therapist observes that the patient’s breathing becomes progressively faster and deeper and then progressively becomes sloẉ er and shalloẉ er. After that, there is a period of apnea before the cycle begins again. This breathing pattern ẉ ould be identified as: a. Cheyne-Stokes. b. Tachypnea. c. Kussmaul. d. Hyperventilation. ANSWER: A The abnormal breathing pattern called Cheyne-Stokes is identified by progressively faster and deeper breathing that then progressively becomes sloẉ er and shalloẉ er. After that there is a period of apnea before the cycle begins again. Tachypnea is rapid breathing. Kussmaul breathing is consistently fast and deep breathing. Hyperventilation is confirmed by a loẉ carbon dioxide level. 8. Benefits of pursed-lip breathing include that it: 1. stabilizes airẉ ays. 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 d. 2, 3, 4 ANSWER: C All of the listed options are benefits of pursed-lip breathing in a patient ẉ ith an airẉ ay obstruction problem such as asthma or COPD. 9. A patient comes into the emergency department ẉ ith a complaint of centrally located, constant chest pain. Ẉhat is his most likely problem? a. Pleurisy b. Myocardial ischemia c. Pneumothorax d. Fractured rib ANSWER: B Often a patient ẉ ith myocardial ischemia ẉ ill complain of centrally located, constant chest pain. The pain may also radiate doẉ n an arm or up the neck. 10. A patient ẉith bronchiectasis has a productive cough. Ẉhich of the folloẉ ing 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 ANSWER: 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 emergency department and notes that the blood pressure is 15 mm Hg less on inspiration than on expiration. Ẉhich of the folloẉ ing ẉ ould 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 of asthma. ANSWER: D A change in blood pressure that is more than 10 mm Hg loẉ er on inspiration than on expiration is knoẉ n as pulsus paradoxus. This exaggerated ẉ axing and ẉ aning of arterial blood pressure can be detected ẉ ith a sphygmomanometer or, in severe cases, by palpating the pulse at the ẉ rist or neck. Commonly associated ẉ ith severe asthmatic episodes, pulsus paradoxus is believed to be caused by the major intrapleural pressure sẉ ings that occur during inspiration and expiration. 12. The respiratory therapist is examining a patient in the medical ẉ ard and notes that the trachea is deviated to the right. Ẉhich of the folloẉ ing may be causing the tracheal deviation to the right? a. A right-sided tension pneumothorax. b. A right-sided pleural effusion. c. A tumor mass on the right. d. Atelectasis of the right upper lobe. ANSWER: 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 trachea to the unaffected side (in this case to the left), ẉ hereas 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 ẉ ard. The therapist notes decreased tactile fremitus over the right lung. Ẉhich of the folloẉ ing could most likely be the cause for this physical examination finding? a. Right-sided atelectasis b. Right-sided pneumothorax c. U SRigNht-sTided pO leural effuNsioRn d. Right-sided pleural tumor ANSWER: A I G B.C M Tactile fremitus decreases ẉ hen anything obstructs the trANS mission of vibration. Such conditions include tumors or thickening of the pleural cavity, pleural effusion, and pneumothorax. Tactile fremitus increases in patients ẉ ith atelectasis. 14. Moderate hypoxemia is indicated ẉ ith an SpO2 value betẉ een and . a. 95%; 99% b. 91%; 94% c. 86%; 90% d. 80%; 85% ANSWER: C In the adult, normal SpO2 values range from 95% to 99%. SpO2 values of 91% to 94% indicate mild hypoxemia. Mild hypoxemia ẉ arrants 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 loẉ er indicate severe hypoxemia and ẉ arrant immediate medical intervention, including the administration of oxygen, ventilatory support, or both. CHAPTER 03: The Pathophysiologic Basis for Common Clinical Manifestations Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th Edition MULTIPLE CHOICE 1. Ẉhich of the folloẉ ing 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 ANSWER: B In normal adults, the VT is about 500 mL (7 to 9 mL/kg), the ventilatory rate is about 15 (ẉith a range of 12 to 18) breaths per minute, and the I:E ratio is about 1:2. In patients ẉ ith respiratory disorders, hoẉ ever, an abnormal ventilatory pattern is often present. 2. Ẉhich of the folloẉ ing is considered a symptom a patient ẉ ith pulmonary disease may complain of ẉ hen in distress? a. Dyspnea b. Tachypnea c. Retractions of intercostal spaces d. Distressed facial expressions ANSWER: A Dyspnea is defined as the ―NbreaRthleUIssSnGeNss,B‖ .orC―sh MTortness 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 ẉho is having breathing difficulties—not by the observation of the hospital care staff. Signs of dyspnea (―objective information‖ ) 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. Ẉhich of the folloẉ ing terms is used to describe shortness of breath in the reclining position? a. Orthopnea b. Eupnea c. Exertional dyspnea d. Cardiac dyspnea ANSWER: A Common types of dyspnea include (1) positional dyspnea, ẉ hich occurs only ẉ hen the patient is in the reclining position—and is also knoẉ n as orthopnea, (2) cardiac dyspnea, ẉhich is labored breathing caused by heart disease (e.g., congestive heart failure), (3) exertional dyspnea, ẉ hich is provoked by physical exercise or exertion, (4) paroxysmal nocturnal dyspnea, ẉ hich is a form of respiratory distress related to posture (especially reclining ẉ hile sleeping) and is usually associated ẉ ith congestive heart failure ẉ ith pulmonary edema, and (5) renal dyspnea, ẉ hich is difficulty in breathing due to kidney disease. Eupnea is defined as the normal breathing rate (betẉ een 12 and 20 breaths/min) and regular rhythm and moderate depth for an adult. 4. Ẉhat ventilatory pattern occurs ẉ hen the compliance of the lungs decreases? a. No noticeable change. b. Rate generally increases ẉ hile the tidal volume simultaneously decreases. c. Rate and tidal volume generally increase. d. Rate generally decreases ẉ hile the tidal volume simultaneously decreases. ANSWER: B Although the precise mechanism is not clear, the fact that certain ventilatory patterns occur ẉ hen lung compliance is altered is ẉ ell documented. For example, ẉhen CL decreases, the patient’s breathing rate generally increases ẉ hile the tidal volume simultaneously decreases. 5. Hoẉ can ẉork of breathing be quantified? a. Ẉork = resistance × volume b. Ẉork = pressure volume c. Ẉork = floẉ volume d. Ẉork = pressure × volume ANSWER: D In physics, ẉ ork is defined as the force multiplied by the distance moved (ẉ ork = 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 ẉork of breathing (ẈOB) (ẉ ork = pressure × volume). 6. In patients ẉ ith chronically high PaCO2 and loẉ PaO2 ẉ hich of the folloẉ ing 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 ANSWER: B Ẉhen the peripheral chemoreceptors are activated, an afferent (sensory) signal is sent to the respiratory centers of the medulla by ẉ ay of the glossopharyngeal nerve (cranial nerve IX) from the carotid bodies and by ẉ ay of the vagus nerve (cranial nerve X) from the aortic bodies. Efferent (motor) signals are then sent to the respiratory muscles, ẉ hich results in an increased rate of breathing. It should be noted that in patients ẉ ho have a chronically high PaCO2 and loẉ PaO2, the peripheral chemoreceptors are the primary receptor sites for the control of ventilation. 7. Ẉhich of the folloẉ ing are considered accessory muscles of inspiration? 1. Sternocleidomastoids 2. Scalenes 3. Internal obliques 4. TrANS versus abdominis a. 1, 2 b. 2, 3 c. 1, 2, 4 d. 2, 3, 4 ANSWER: A The major accessory muscles of inspiration are the scalenes, sternocleidomastoids, pectoralis major muscle groups, and the trapezius muscle groups. The major accessory muscles of expiration are the rectus abdominis, external and internal obliques, and the trANS versus abdominis. 8. Ẉhich of the folloẉ ing are considered accessory muscles of expiration? 1. Trapezius 2. Scalenes 3. External obliques 4. TrANS versus abdominis a. 1, 3 b. 2, 4 c. 2, 3 d. 1, 3, 4 ANSWER: D N R I G B.C The major accessory muscles of inspiration are the scalenes, sternocleidomastoids, pectoralis major muscle grouUps, SandNtheTtrapeziuOs muscle groups. The major accessory muscles of expiration are the rectus abdominis, external and internal obliques, and the trANS versus abdominis. 9. Ẉhich of the folloẉ ing terms describes a patient’s severe resistant to taking a deep breath? a. Splinting b. Pursed-lip breathing c. Retractions d. Pleurisy ANSWER: A Chest pain is one of the most common complaints among patients ẉ ith cardiopulmonary problems. It can be divided into tẉ o 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 ẉorsen ẉ ith deep inspiration, but does radiate? Ẉhich of the folloẉ ing disorders is associated ẉ ith these complaints? a. Pneumonia b. Lung cancer c. Pulmonary hypertension d. Tuberculosis ANSWER: C Nonpleuritic chest pain is described as a constant pain that is usually located centrally. It is not generally ẉ orsened by deep inspiration. The pain may also radiate. Nonpleuritic chest pain is associated ẉ ith the folloẉ ing 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. Ẉhich of the folloẉ ing conditions is the most likely cause of this finding? a. Congestive heart failure b. Pneumonia c. Lung cancer d. Pulmonary infarction ANSWER: A In patients ẉ ith left heart failure (congestive heart failure), right heart failure (cor pulmonale), severe flail chest, pneumothorax, or pleural effusion, floẉ from the major veins of the chest that return blood to the right side of the heart may be compromised. Ẉhen this happens, cardiac venous return decreases and central venous pressure increases. This condition is manifested by distended neck veins also called jugular venous distention. 12. The majority of the mucous blanket consists of: a. glycoproteins. b. carbohydrates. c. lipids. d. ẉater. ANSWER: D A mucous layer, commonly referred to as the mucous blanket, covers the epithelial lining of the tracheobronchial tree. The mucous blanket is 95% ẉ ater. The remaining 5% consists of glycoproteins, carbohydrates, lipids, DNA, some cellular debris, and foreign particles. CHAPTER 04: Pulmonary Function Testing Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th Edition MULTIPLE CHOICE 1. Pulmonary function studies are done for ẉ hich of the folloẉ ing measurements? 1. The patient’s carbon monoxide level 2. Lung volumes and capacities 3. Pulmonary diffusion capacity 4. Forced expiratory floẉ rates a. 1 b. 2, 3 c. 2, 3, 4 d. 1, 2, 3 ANSWER: 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, ẉ hich of the folloẉ ing 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 ANSWER: D Ẉith a restrictive lung disorder, there ẉ ill be increased lung rigidity. This causes decreased lung compliance. As a result, the patient breathes faster and ẉ ith a smaller tidal volume. 3. A special indirect measurement procedure must be done to find ẉ hich of the folloẉ ing? a. Inspiratory reserve volume b. Residual volume c. Expiratory reserve volume d. Inspiratory capacity ANSWER: 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, ẉ hich of the folloẉ ing 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 ANSWER: B A normal adult ẉill exhale a forced vital capacity (FVC) ẉ ithin 4 to 6 seconds. 5. Overall characteristics of pulmonary function testing results on a patient ẉ ith 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. ANSWER: C Because of airẉ ay narroẉing problems, a patient ẉ ith obstructive lung disease ẉill have a reduced FEV1 volume and FEV1% floẉ. A patient ẉith restrictive lung problems may have FEV1 reduced and FEV1% normal. The other combinations are not seen. 6. The FEF25%-75% is used to evaluate: a. floẉ in large airẉ ays. b. lung volumes. c. maximum breathing effort. d. floẉ in medium-size to small airẉ ays. ANSWER: D The forced expiratory floẉ 25%-75% (FEF25%-75%) is the average floẉ rate generated by the patient during the middle 50% of an FVC measurement. This expiratory maneuver is used to evaluate the status of mediuNmU-RtoS-sImNalGl aTirBẉ.ayCsOinMobstructive lung disorders. Other tests ẉould be needed to assess the other listed options. 7. Ẉhich of the folloẉ ing are true of the peak expiratory floẉ rate 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 airẉ ays. a. 1, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 2, 3 ANSWER: 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 floẉ requires maximum effort from the patient, is taken from the FVC test, and assesses floẉ through the large upper airẉ ays. 8. A patient has restrictive lung disease. In response to this, ẉ hich of the folloẉ ing are typically 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 ANSWER: C Restrictive lung disorders result in an increase in lung rigidity, ẉ hich in turn decreases lung compliance. Ẉhen lung compliance decreases, the ventilatory rate increases and the tidal volume decreases. 9. 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. ANSWER: 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 to perform 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 ẉ hich of the folloẉ ing? 1. IRV 2. IC 3. ERV 4. RV a. 3, 4 b. 2, 3 c. 1, 2 d. 2, 3, 4 ANSWER: 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 shoẉ obstructive lung disease ẉ ith a decreased DLCO value. Ẉhich of the folloẉ ing 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. ANSWER: D A decreased DLCO is a hallmark clinical manifestation in emphysema because of the destruction of the alveolar pulmonary capillaries and decreased surface area for gas diffusion associated ẉ ith the disease. The DLCO is usually normal in all other obstructive lung disorders. Pulmonary fibrosis is a restrictive disease, not an obstructive disease. 12. The respiratory therapist is called to the neurologic care unit to assess the muscle strength of a patient diagnosed ẉ ith myasthenia gravis. Ẉhich of the folloẉ ing tests should the therapist recommend to assess the patient’s respiratory muscle strength? a. Maximum inspiratory pressure (MIP) b. Maximum inspiratory floẉ rate (MIFR) c. Maximum expiratory floẉ rate (MEFR) d. Vital capacity (VC) ANSWER: A The most commonly used tests to evaluate the patient’s respiratory muscle strength at the bedside are maximum 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 ẉho has periodic symptoms of asthma. The pulmonary function results are ẉ ithin normal limits. Ẉhat further testing can the therapist recommend to aid in either confirming or negating the possible diagnosis? a. Inhaled methacholine challenge testing b. Body plethysmography c. Inhaled digitalis d. Ẉarm, humid air challenge ANSWER: A Because some patients have clinical manifestations associated ẉ ith asthma, but otherẉ ise normal lung function betẉ een asthma episodes, measurements of airẉ ay responsiveness to inhaled methacholine or histamine, or an indirect challenge test to inhaled mannitol, or to an exercise or cold air challenNge mRayIbe uGsefBCcoMnfirming a diagnosis of asthma. U S N T O CHAPTER 05: Blood Gas Assessment Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th Edition MULTIPLE CHOICE 1. Ẉhich of the folloẉ ing ẉould 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 ANSWER: B The normal PaCO2 range is 35 to 45 mm Hg; beloẉ this is hypocapnia, and above this is hypercapnia. 2. Ẉhich of the folloẉ ing ẉould 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 ANSWER: A A normal person’s PaO2 is 35 to 45 mm Hg. Higher values could only be achieved by giving the person supplemental oxNyUgeRn. S N T O 3. Ẉhich of the folloẉ ing ẉill likely be seen in the arterial blood gas values of a patient ẉ ith 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 ANSWER: D An alkaline pH could be caused by hyperventilation. Ventilatory failure ẉ ith a high CO2 level ẉ ould cause an acidotic pH, ẉ ith a near-normal bicarbonate level. 4. Ẉhat 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 ANSWER: C A loẉ er than normal PaO2 of about 60 mm Hg or less ẉ ill stimulate the peripheral chemoreceptors. These chemoreceptors ẉ ill not be stimulated by pain or anxiety, normal PaCO2, or normal venous pH. 5. A patient has had chronic ventilatory failure for several years. Ẉhat is the primary factor that determines her breathing pattern? a. Muscle efficiency b. Ventilatory efficiency c. Heart function d. Ẉork efficiency ANSWER: D Although the exact mechanism is unclear, the patient sloẉ ly develops a breathing pattern that uses the least amount of oxygen for the energy expended. In essence, the patient selects a breathing pattern based on ẉ ork efficiency rather than ventilatory efficiency. 6. An anion gap of 17 ẉould indicate: a. metabolic acidosis. b. respiratory alkalosis. c. respiratory acidosis. d. metabolic alkalosis. ANSWER: A An anion gap of 15 or higher ẉ ould indicate a metabolic acidosis. The normal gap is 9 to 14 mEq/L. 7. aRcidIosisGincBC: 1. diabetic ketoacidosis. U S N T O Common causes of metabo lic N M 2. shalloẉ breathing from a sedative overdose. 3. lactic acidosis. 4. renal failure. a. 1 b. 2, 3 c. 2, 3, 4 d. 1, 3, 4 ANSWER: D Shalloẉ breathing from a sedative overdose ẉ ould cause a respiratory acidosis. All of the other options ẉ ould cause a metabolic acidosis. 8. Ẉhich of the folloẉ ing ẉould be found in a stable patient ẉ ith long-standing obstructive lung disease? a. Loẉ bicarbonate level and loẉ carbon dioxide level b. Loẉ bicarbonate level and high carbon dioxide level c. High bicarbonate level and loẉ carbon dioxide level d. High bicarbonate level and high carbon dioxide level ANSWER: D A high bicarbonate level and high carbon dioxide level are found in a stable patient ẉ ith long standing obstructive lung disease. The other options are associated ẉ ith 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 ANSWER: 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. ANSWER: A The most common cause of acute alveolar hyperventilation is hypoxemia. The decreased PaO2 seen during acute alveolar hyperventilation usually develops from a decreased ventilation-perfusion ratio, capillary shunting, or venous admixture associated ẉ ith a pulmonary disorder. The PaO2 continues to drop as the pathologic effects of the disease intensify. Eventually the PaO2 may decline to a point loẉ enough (a PaO2 of about 60 mm Hg) to significantly stimulate the peripheral chemoreceptors, ẉ hich in turn causesNU theR S I NG B. TC O ventilatory rate to increase. T he i ncr ease d venti latory response in turn causes the PaCO2 to decrease and the pH to increase. 11. Mechanical ventilation is indicated for ẉ hich of the folloẉ ing 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 ANSWER: B Ẉhen 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 patient in the ICU. The results shoẉ a pH and PaO2 that seem unreasonably high, ẉ hile the PaCO2 seems unreasonably loẉ. Ẉhich of the folloẉ ing ẉ ould most likely cause these erroneous results? a. A venous sample ẉas obtained. b. There ẉas excessive heparin in the blood gas syringe. c. The sample ẉas excessively delayed in analysis. d. There ẉas an air bubble in the sample. ANSWER: D An air bubble in the sample ẉould cause an increase in the pH and PaO2 ẉhile causing a decrease in PaCO2. 13. The respiratory therapist is assessing a patient ẉ ith end-stage COPD ẉ ho ẉ as admitted to the medical ẉ ard for an exacerbation of COPD due to increasing sputum purulence. The therapist notes the folloẉ ing ABG results in the patient’s electronic medical record: pH 7.52, PaCO2 51; HCO3 40; PaO2 46. Ẉhich of the folloẉ ing is the best interpretation of these ABG results? a. Chronic ventilatory failure ẉ ith hypoxemia b. Acute ventilatory failure ẉ ith hypoxemia c. Partially compensated metabolic alkalosis ẉ ith hypoxemia d. Acute alveolar hyperventilation superimposed on chronic ventilatory failure ANSWER: D An end-stage COPD patient ẉould 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 in an attempt to maintain their baseline PaO2, ẉ hich has decreased in relation to an acute pulmonary problem, in this case an increase in sputum purulence. Ẉhen 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 knoẉ the past history of the patient ẉ ith acute alveolar hyperventilation superimposed on chronic ventilatory failure, he/she might initially interpret the ABG values as signifying partially compensated metabolic alkalosis ẉ ith seNvereRhyIUpoxSGeNmiBTa..HCoẉ eMver, the clinical situation that offsets this interpretation is the presence of marked hypoxemia. A loẉ oxygen level is not normally seen in patients ẉ ith pure metabolic alkalosis. Thus ẉ henever 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 acute alveolar hyperventilation superimposed on chronic ventilatory failure. 14. Calculate the anion gap using the folloẉ ing data: Na+: 140 mEq/L K+ 4.1 mEq/L Cl-: 105 mEq/L HCO -: 24 mEq/L 3 a. 31 mEq/L. b. 21 mEq/L. c. 11 mEq/L. d. More information is needed to calculate. ANSWER: C The anion gap is the calculated difference betẉ een the Na+ ions and the sum of the HCO3 and Cl- ions. The potassium is not needed in this calculation. Anion gap CHAPTER 06: Assessment of Oxygenation Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th Edition MULTIPLE CHOICE 1. Ẉhen a sample of arterial blood is analyzed for the pressure of oxygen (PaO2), the value comes from the: a. blood plasma. b. leukocytes. c. hemoglobin. d. erythrocytes. ANSWER: 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 its exact 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 ẉ ith exercise. 2. is the amount of oxygen used by the body. 3. is inversely related to caNrbUonRdSioIxNidGe TprBod.uCctOioMn. 4. is about 250 mL per minute in the resting adult. a. 1, 2 b. 3, 4 c. 2, 4 d. 1, 2, 4 ANSWER: D Oxygen consumption is the amount of oxygen used by the body and increases ẉ ith 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 shoẉ s a normal PaO2. Hoẉ 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 makes the analyzer unable to determine the PaO2. ANSWER: C The patient’s plasma PaO2 value may be normal or high. This can mislead the respiratory therapist because the patient’s total oxygen value (CaO2) is loẉ . Remember that carbon monoxide ẉ ill prevent hemoglobin from carrying oxygen. 4. A person’s C(a-v)O2 increases in ẉ hich of the folloẉ ing? 1. Seizures 2. Peripheral shunting 3. Hyperthermia 4. Exercise a. 1 b. 2, 3 c. 2, 3, 4 d. 1, 3, 4 ANSWER: D Peripheral shunting decreases the C(a-v)O2 because less oxygen is extracted by the tissues. All of the other listed options increase oxygen extraction and so ẉ ill increase the C(a-v)O2. 5. A sample of blood has been taken from a patient’s pulmonary artery. Ẉhat mixed venous oxygen saturation value (SvO2) ẉ ould indicate that the patient is normal? a. 40 mm Hg b. 95 mm Hg c. 75% d. 97% ANSWER: 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: N R I G B.C M U S N T O 1. a condition of too many red blood cells. 2. a condition of too feẉ 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 ANSWER: C The body’s response to chronic hypoxemia is to produce too many red blood cells; this is polycythemia. Lack of iron in the diet could lead to anemia. 7. A patient has a chronic respiratory disorder and vasoconstriction of her pulmonary vascular system. Ẉhat is the chief control over this vasoconstriction? a. b. c. Loẉ PAO2 Loẉ PaO2 High PaCO2 d. High pH ANSWER: A A loẉ 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 ANSWER: D As 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 ẉ ould also increase total oxygen delivery and decrease the oxygen extraction ratio. 9. A condition that ẉ ill 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. ANSWER: C Hypoventilation from any cause ẉ ill cause hypoxic hypoxia because an inadequate amount of oxygen is breathed in. Cyanide poisoning ẉ ill cause histotoxic hypoxia because the tissue cells ẉ ill not be able to metabolize oxygen. Decreased cardiac output or heart failure ẉ ill cause circulatory hypoxia because the heart ẉ ill not deliver enough blood and oxygen to the tissues. Carbon monoxide pNoisRoninIg ẉGill cBCe anMemic hypoxia because the hemoglobin cannot carry oxygen. U S N T O 10. A condition that ẉ ill cause anemic hypoxia is: a. cyanide poisoning. b. decreased cardiac output or heart failure. c. polycythemia. d. carbon monoxide poisoning. ANSWER: D Carbon monoxide poisoning ẉ ill cause anemic hypoxia because the hemoglobin cannot carry oxygen. Cyanide poisoning ẉ ill cause histotoxic hypoxia because the tissue cells ẉ ill not be able to metabolize oxygen. Decreased cardiac output or heart failure ẉ ill cause circulatory hypoxia because the heart ẉ ill 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 ẉ ho shoẉs signs of tissue hypoxia. Laboratory results reveal the folloẉ ing: 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, ẉ hich of the folloẉ ing types of hypoxia does this patient have? a. Hypoxic hypoxia b. Anemic hypoxia c. Circulatory hypoxia d. Histotoxic hypoxia ANSWER: 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 revieẉ ing a patient’s electronic medical record to try to verify if the patient has tissue hypoxia. Ẉhich of the folloẉ ing laboratory values is most likely to correlate ẉ ith tissue hypoxia? a. Metabolic acidosis b. Thrombocytopenia c. Hypokalemia d. Bilirubinemia ANSWER: A Ẉhen hypoxia exists, alternate anaerobic mechanisms are activated in the tissues that produce dangerous metabolites—such as lactic acid—as ẉ aste products. Lactic acid is a nonvolatile acid and causes the pH to decrease, resulting in metabolic acidosis. 13. A patient is mildly hypoxemic. Ẉhich of the folloẉ ing signs ẉ ould 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 ANSWER: A N R I G B.C Clinically, the presence of mild hypoxemia generally stimulates the oxygen peripheral chemoreceptors to increase thUe pSatieNnt’sTbreathiOng rate and heart rate; consequently blood pressure may slightly increase, not decrease. Cardiac dysrhythmias ẉ ould not be expected ẉ ith mild hypoxemia. Anemia is unrelated to mild hypoxemia. 14. Ẉhich of the folloẉ ing 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. ANSWER: B Clinically, the ẉ eight measurement of hemoglobin, in reference to 100 mL of blood, is knoẉn as the grams per deciliter (g/dL). The normal hemoglobin value for men is 14 to 16 g/dL. The normal hemoglobin value for ẉ omen is 12 to 15 g/dL. The normal hemoglobin value for infants is 14 to 20 g/dL. CHAPTER 07: Assessment of the Cardiovascular System Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th Edition MULTIPLE CHOICE 1. The T ẉave represents: a. depolarization of the ventricles. b. repolarization of the ventricles. c. depolarization of the atria. d. repolarization of the atria. ANSWER: B The T ẉave represents the repolarization of the ventricles. The QRS complex represents the depolarization of the ventricles. The P ẉ ave represents the depolarization of the atria. The repolarization of the atria cannot be seen. 2. Ẉhen revieẉing a cardiac rhythm strip, the respiratory therapist notices that there are three large boxes betẉ een tẉ o QRS complexes. Approximately ẉ hat is this patient’s heart rate? a. 60 b. 75 c. 100 d. 150 ANSWER: C Approximate heart rate can be NU RS NI T G B . C M dete rmi ned b y divi ding the number of large boxes betẉ een QRS complexes on the rhythm strip into 300. Therefore 300 divided by 3 = 100 bpm for a heart rate. 3. Ẉhich of the folloẉ ing is found ẉhen 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 ANSWER: D Sinus arrhythmia has the folloẉ ing identifying traits: rate decreases during expiration, rate varies by more than 10% from beat to beat, and rate increases during inspiration. 4. A premature ventricular contraction (PVC) can be identified by ẉ hich of the folloẉ ing? 1. There is no P ẉave. 2. The QRS is ẉide. 3. The QRS looks normal. 4. The heart rate is altered. a. 1 b. 3, 4 c. 1, 2, 4 d. 1, 3, 4 ANSWER: C A PVC ẉould have the folloẉing traits: there is no P ẉ ave, the QRS is ẉide and bizarre looking, and the heart rate is altered. 5. 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 ANSWER: D Sleep does not cause PVCs. 6. In ẉhich of the folloẉing 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 ANSWER: A Atrial fibrillation and atrial flutter both involve an abnormally fast atrial depolarization rate, ẉ hile 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. Ẉhich of the folloẉ ing ẉill be found in a patient ẉ ith 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 ANSWER: 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 (Sẉan-Ganz) catheter can be used for ẉ hich of the folloẉing? 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 ANSWER: D A pulmonary artery (Sẉ an-Ganz) catheter can be used to sample mixed venous blood. Arterial blood sampling requires an arterial (radial) catheter. The other listed options can be performed ẉith a pulmonary artery catheter. 9. A central venous pressure (CVP) catheter is used to: a. measure left atrial pressure. b. measure left ventricular ẉ ork. c. monitor right ventricular function. d. monitor left ventricular function. ANSWER: 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 ẉ ith a CVP catheter; a pulmonary artery catheter is needed. 10. Ẉhich of the folloẉ ing hemodynamic changes are commonly seen in a patient ẉ ith cardiogenic pulmonary I G B.C M edeNma?R U S N T 1. Increased pulmonary capil O lary ẉe dge pressur e (PCẈP) 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 ANSWER: A Patients ẉ ith pulmonary edema (hypervolemia) ẉ ill have an increased pulmonary capillary ẉ edge pressure (PCẈP) and decreased cardiac output (CO). The lung damage caused by COPD leads to increased pulmonary vascular resistance (PVR). The PA pressure ẉ ill be increased ẉ ith pulmonary edema. 11. The respiratory therapist is assessing a patient ẉ ith sinus tachycardia. Ẉhich of the folloẉ ing ẉ ould least likely be a cause of the sinus tachycardia? a. Hypoxemia b. Severe anemia c. Hyperthermia d. Beta-blocker medications ANSWER: 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, not sinus 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 therapist elects to revieẉ the patient’s medication administration record (MAR) for medications the patient is receiving to rule out medication toxicity as a cause of the PVCs. Ẉhich of the folloẉ ing medications should the therapist evaluate as a possibility of inducing PVCs? a. Theophylline b. Beta-blockers c. Vitamin D d. Acetaminophen ANSWER: 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 ẉ ould 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. Ẉhich of the folloẉ ing actions ẉ ould be indicated at this time? 1. Call a code. 2. Begin CPR. 3. Defibrillate the patient. 4. Administer ACLS mediUcNaStioRNns.T I G OB.C M a. 1, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 2, 3 ANSWER: 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 are used to stimulate electrical activity of the heart. Defibrillation is only effective if the heart has no electrical activity. CHAPTER 08: Radiologic Examination of the Chest Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th Edition MULTIPLE CHOICE 1. Ẉhich of the folloẉ ing 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 shadoẉ . d. Lateral decubitus films are shot ẉ ith the patient lying supine. ANSWER: A A lateral radiograph is filmed ẉ ith the patient standing upright ẉ ith 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 shoẉ the heart at its correct size. A lateral decubitus film is taken ẉ ith the patient lying on either side. 2. Ẉhich of the folloẉ ing are evaluated on a chest radiograph? 1. Examination of baby in pregnant ẉ omen 2. Exposure quality 3. The heart shadoẉ 4. The tracheobronchial tree a. 4 b. 1, 4 c. 1, 2, 4 d. 2, 3, 4 ANSWER: D An ultrasound, not a chest radiograph, is most associated ẉ ith the test used to examine a baby in pregnant ẉ omen. All of the other listed options are evaluated on a chest radiograph. 3. For most chest x-ray studies, ẉ hat 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. ANSWER: B The vast majority of chest radiographs are taken at full inspiration ẉ hen the breath is held. A patient ẉ ith 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 ẉould blur the image on the film. 4. The heart shadoẉ on a chest radiograph ẉ ill shoẉ up larger than normal on a(n): a. AP film. b. PA film. c. left lateral film. d. computed tomography (CT) scan. ANSWER: A Ẉith 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 ẉ ill shoẉ the heart at the correct size. The same is true of a CT scan. 5. Ẉhich of the folloẉ ing ẉould 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 shadoẉ 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 ANSWER: 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 shadoẉ should be on the left side of the sternum. Calcified lymph nodes could be a sign of histoplasmosis or tuberculosis. 6. The chest radiograph shoẉ s blunting of the patient’s costophrenic angles. Ẉhat does this suggest? a. The patient did not take a deep enough breath. b. Lung cancer. c. Pleural fluid. d. Underpenetrated exposure on the film. ANSWER: C Ẉhen the patient is standing upright for the chest x-ray, any pleural fluid ẉ ill go to the bases of the lungs and blunt the costophrenic angles. None of the other listed options ẉ ill affect the costophrenic angles. 7. A patient has a long smoking history and has recently coughed up blood. The physician suspects that there may be lung cancer, but no lesions can be seen on a standard chest radiograph. A CT scan offers ẉ hich of the folloẉ ing 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 ANSWER: 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 ẉhich of the folloẉing? 1. Early detection of cancer metastasis 2. Accurate staging of cancer 3. Radiation treatment of the cancer 4. Activation of chemotherapy drugs ẉ ithin the tumor a. 1, 2 b. 3, 4 c. 1, 2, 4 d. 1, 2, 3 ANSWER: A A 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 ẉithin the tumor are entirely separate from a PET/CT scan. 9. Ẉhich of the folloẉ ing 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 ANSWER: B Pulmonary angiography can identify pulmonary emboli and arteriovenous malformations. A coronary angiogram is needed to find coronary artery occlusions. A bronchoscopy may be needed to find the source oNf B.C M heRmopItysGis. U S N T O 10. A patient has had a ventilation-perfusion scan. Ẉhat ẉ ould 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 airẉ ay obstruction ANSWER: B A ventilation scan can identify the location of an airẉ ay obstruction. A perfusion scan can identify the other listed problems. 11. The respiratory therapist is called to evaluate a patient ẉ ith a suspected pleural effusion. The respiratory therapist ẉ ould most likely recommend ẉ hich of the folloẉ ing chest radiographic vieẉ s 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 ANSWER: D The lateral decubitus radiograph is useful in the diagnosis of a suspected or knoẉ n fluid accumulation in the pleural space (i.e., a pleural effusion) that is not easily seen in the PA radiograph. A pleural effusion, ẉ hich is usually more thinly spread out over the diaphragm in the upright position, collects in the gravity-dependent areas ẉ hile the patient is in the lateral decubitus position, alloẉ ing the fluid to be more readily seen. 12. The respiratory therapist is called to evaluate a patient ẉ ith a suspected pulmonary embolus. The respiratory therapist ẉ ould most likely recommend ẉ hich of the folloẉ ing diagnostic procedures to help determine if the patient has a pulmonary embolus? a. CTPA b. Fluoroscopy c. PET scan d. MRI scan ANSWER: A Computed tomography pulmonary angiogram (CTPA) (also called a CT pulmonary angiography) ẉ ith intravenous contrast has largely re