Test Bank For Clinical Manifestations and Assessment of Respiratory Diseases 8th Edition By Jardins | Complete 2023/2024 | 100% VERIFIED

The respiratory care practitioner is conducting a patient interview. The main purpose of this interview 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 the collection 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 N R I G B.C M 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. Medical jargon 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, while needed for billing purposes, would not be found on the history form. NURSINGTB.COM 4. External factors the respiratory care practitioner should make efforts to provide during an interview include which of the following? 1. 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 use open-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 NU RS IN GT B.CO M 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. gatherspecific 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. Openended questions are best suited to let the patient fully explain his/her situation and possibly help the respiratory therapist show empathy. N R I G B.C 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 of 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 what he/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 silence in 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 before moving 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 shouUld tShe rNespTiratory tOherapist 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, 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 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 for which of the following 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 how these beliefs will lead to discrimination and stereotyping d. To better understand how the patient’s beliefs may impact how the patient thinks and 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 N R I G B.C M Communication and understanding are UtheSbasi Ns fo T r a good O patient interview. 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 interview and recording responses in the patient’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 hazard to 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. N R UI SGN B . C MT Chapter 02: The Physical Examination Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th Edition 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 be interpreted? 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 g rea ter t han 100 /m i nute is considered to be tachycardia. A 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 ANS: B Tachypnea may be the result of hypoxemia, fever, and other causes. Hypothermia and sedation will 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. A heart rate of 55 bpm would be bradycardia. Pulse pressure is normally about 40 mm Hg. 5. 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. All of 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 NU RS IN GT B.CO M 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’s breathing becomes progressively faster and deeper and then progressively becomes slower and 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 deeper breathing that then progressively becomes slower and shallower. 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 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 d. 2, 3, 4 ANS: C All of the listed options are benefits of pursed-lip breathing in a patient with an airway obstruction 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 NU RS IN GT B.CO M 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. 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 of asthma. 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 by the 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 the trachea is deviated to the right. Which of the following 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. 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 trachea to 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 of the following could most likely be the cause for this physical examination finding? a. Right-sided atelectasis b. Right-sided pneumothorax c. U S RigN ht-T sided pO leural effuNsioRn I G B.C M d. Right-sided pleural tumor ANS: A Tactile fremitus decreases when anything obstructs the transmission of vibration. Such conditions 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 and . 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 indicate severe hypoxemia and warrant immediate medical intervention, including the administration of oxygen, ventilatory support, or both. N R UI SGN B . C MT Chapter 03: The Pathophysiologic Basis for Common Clinical Manifestations Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th Edition 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 “ brea thle ssn ess, ” or “sh ortness 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 (“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. Which of the following terms is used to describe shortness of breath in the reclining position? a. Orthopnea b. Eupnea c. Exertional dyspnea d. Cardiac dyspnea ANS: A Common types of dyspnea include (1) positional dyspnea, which occurs only when the patient is in the 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 associated with 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 20 breaths/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. ANS: 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 NU RS IN GT B.CO M 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 the carotid 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? N R I G B.C 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, 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 transversus abdominis. 8. Which of the following are considered accessory muscles of expiration? 1. Trapezius 2. Scalenes 3. External obliques 4. Transversus abdominis 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, pectoralis major muscle grouUps, SandNtheTtrapeziuOs muscle groups. The major accessory muscles of expiration are the rectus abdominis, external and internal obliques, and the transversus 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 veins also called jugular venous distention. 12. The majority of the mucous blanket consists of: a. glycoproteins. b. carbohydrates. c. lipids. d. water. ANS: D NU RS IN GT B.CO M 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. 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 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 NU RS IN GT B.CO M 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. 5. 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 have FEV1 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 mediuNmU-RtoS-sImNalGl aTirBCsOinMobstructive 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 from the 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 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 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. 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. 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 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 which of the following? 1. IRV 2. IC 3. ERV 4. RV a. 3, 4 b. 2, 3 c. 1, 2 d. 2, 3, 4 ANS: D NU RS IN GT B.CO M 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 of the 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 a restrictive disease, not an obstructive disease. U S N T O 12. The respiratory therapist is called to the neurologic care unit to assess the muscle strength of a 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 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 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 the 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 lung function 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 challenN ge mR ayI be uG sefB ul. inC coM nfirming 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. 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 is hypercapnia. 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 oxNy geRn. I G B.C M