CLINICAL MANIFESTATIONS & ASSESSMENT OF
RESPIRATORY DISEASE 8TH EDITION BY TERRY
DES JARDINS
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,Table of content
Chapter l The Patient Interview
Chapter 2 The Physical Examination
Chapter 3 The Pathophysiologic Basis for Common Clinical Manifestations
Chapter 4 Pulmonary Function Testing
Chapter 5 Blood Gas Assessment
Chapter 6 Assessment of Oxygenation
Chapter 7 Assessment of the Cardiovascular System
Chapter 8 Radiologic Examination of the Chest
Chapter 9 Other Important Tests and Procedures
Chapter l O The Therapist-Driven Protocol Program
Chapter II Respiratory Insufficiency, Respiratory Failure, and Ventilatory Management Protocols
Chapter 12 Recording Skills and Intraprofessional Communication
Chapter 13 Chronic Obstructive Pulmonary Disease, Chronic Bronchitis, and Emphysema
Chapter 14 Asthma
Chapter 15 Cystic Fibrosis
Chapter 16 Bronchiectasis
Chapter 17 Atelectasis
Chapter 18 Pneumonia, Lung Abscess Formation, and Important Fungal Diseases
Chapter I9 Tuberculosis
Chapter 20 Pulmonary Edema
Chapter 21 Pulmonary Vascular Disease
Chapter 22 Flail Chest
Chapter 23 Pneumothorax
Chapter 24 Pleural Effusion and Empyema
Chapter 25 Kyphoscoliosis
Chapter 26 Cancer of the Lung
Chapter 27 Interstitial Lung Diseases
Chapter 28 Acute Respiratory Distress Syndrome
Chapter 29 Guillain-Barr~ Syndrome
Chapter 30 Myasthenia Gravis
Chapter 31 Cardiopulmonary Assessment and Care of Patients with Neuromuscular Disease
Chapter 32 Sleep Apnea
Chapter 33 Newborn Assessment and Management
Chapter 34 Pediatric Assessment and Management
Chapter 35 Meconium Aspiration Syndrome
Chapter 36 Transient Tachypnea of the Newborn
Chapter 37 Respiratory Distress Syndrome
Chapter 38 Pulmonary Air Leak Syndromes
Chapter 39 Respiratory Syncytial Virus Infection (Bronchiolitis)
Chapter 40 Chronic Lung Disease of Infancy
Chapter 41 Congenital Diaphragmatic Hernia
Chapter 42 Congenital Heart Diseases
Chapter 43 Croup and Croup-Like Syndromes
Chapter 44 Near Drowning/Wet Drowning
Chapter 45 Smoke Inhalation. Thermal Lung Iniuries. and Carbon Mono
,Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th
Edition
Chapter 01: The Patient Interview
MULTIPLE CHOICE
1. 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 isnot the primary purpose of the interview.
2. For there to be a successful interview, the respiratory therapist must:
a. provide leading questions to guide the patient.
b. reassure the patient.
c. be an active listener.
d. use medical terminology to show knowledge of the subject matter.
ANS: C
The personal qualities that a respUiratoSry tNh er aTp is t muO
s t 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 providera. 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 forbilling purposes, would not be found on the history form.
, 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 NURSINGTB.COM
b. 1, 3
c. 1, 2, 3
d. 2, 3, 4
ANS: C
An open-ended question should be used to start the interview, introduce a new section of questions,
and gather more information from a patient’s topic. Closed or direct questions are used to gather
specific information.
6. The direct question interview format is used to:
1. speed up the interview.
2. let the patient fully explain his/her situation.
3. help the respiratory therapist show empathy.
4. gather specific information.
a. 1, 4
b. 2, 3
c. 3, 4
d. 1, 2, 3
ANS: A
Direct or closed questions are best to gather specific information and speed up the interview. Open-
ended questions are best suited to let the patient fully explain his/her situation and possibly help the
respiratory therapist show empathy.
, 7. During the interview the patient states, “Every time I climb the stairs I have to stop to catch
my breath.” Hearing this, the respiratory therapist replies, “So, it sounds like you get short
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
N URld tI
to assist in the interview shou SheGrNB. Tiratory tOherapist avoid?
esp
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 fend fthe finterview fon fa fpositive fnote, fthe frespiratory ftherapist fshould fthank fthe fpatient
fand f ask f if fthe fpatient fhas fany fquestions. fIf fthere fis fno fneed f for fthe fvital fsigns fto fbe
fchecked, fthey fshould fnot fbe. fThe fdoor fmay f be f left fopen for fclosed, fdepending fon fthe
fsituation.
11. The frespiratory ftherapist fshould fbe faware fof fa fpatient’s fculture fand freligious
fbeliefs ffor fwhich fof fthe f following freasons?
a. To fbe fable fto fengage fin fa fmeaningful fconversation
b. To fchange fany fmisguided fnotions fthe fpatient fhas fthat fmay fimpact fhis/her fhealth
c. To fexplain fto fthe fpatient fhow fthese fbeliefs fwill flead fto
fdiscrimination fand fstereotyping
d. To fbetter funderstand fhow fthe fpatient’s fbeliefs fmay fimpact fhow fthe fpatient
fthinks fand f behaves
ANS: f D
Culture fand freligious fbeliefs fmay fhave fa fprofound feffect fon fhow fpatients fthink fand fbehave,
fand fthis f may f impact ftheir f health for fhealth fcare fdecisions. fThe frole fof fthe frespiratory
therapist fis fnot fto fchange fthe fpatient’s fbeliefs, fengage fin fsensitive fconversations, for fdiscuss
fdiscrimination. fRather, fthe frespiratory ftherapist fneeds fto funderstand f how fthese fbeliefs f may
f impact fthe fpatient’s fhealth fcare fdecisions.
12. Which fof fthe ffollowing fare fthe fmost fimportant fcomponents fof fa fsuccessful finterview?
a. Communication fand funderstanding
b. Authority fand fthe fuse fof fmedical fterminology
c. Providing fassurance fand fgiving fadvice
d. Asking fleading fquestions fand fanticipating fpatient fresponses fto fquestions
ANS: f A
NUfR fI f
G fB.C fM
Communication fand funderstanding far e t he bas iN
S s ff o T
r fa fgoodOpatient finterview. fAuthority, fthe fuse fof
medical fjargon, fproviding fassurance, fgiving fadvice, fasking fleading fquestions, fand fanticipating
fare fall ftypes fof f nonproductive fcommunication f forms f and fcreate f barriers fto fpatient
fcommunication.
13. The frespiratory ftherapist fis fconducting fa fpatient finterview fand frecording fresponses
fin fthe fpatient’s felectronic f health frecord. fThe frespiratory ftherapist fshould ftake
fwhich fof fthe f following f into faccount fregarding fthe fuse fof fthe fcomputer fto frecord
fresponses?
a. The ftherapist’s fattention fmay fbe fshifted ffrom fthe fpatient fto fthe fcomputer.
b. The fpatient fwill ffeel fmore fimportant fthan fif fthe finformation fis frecorded fon fpaper.
c. The ftherapist fwill fbe fless flikely fto fmake fspelling ferrors fif fusing fa
fspell-check fprogram.
d. The fenvironment fwill fbe fmore fprofessional fand fthe fpatient fwill fbe fmore
flikely fto fopen fup f if fthe f interview f is f conducted fwith fpaper.
ANS: f A
The ftherapist’s fuse fof fthe fcomputer fcan fbe fthreatening fand fmay, fin fsome fcases, fbe fa
fpotential fhazard fto fgood fpatient fcommunication. fThe fpatient fcan fbe f intimidated fto fthe fpoint
fof f “shutting fdown.” fIn faddition, fthe ftherapist fwho fhas fto fshift f focus f from fthe fpatient fto
fthe fcomputer fcan f miss f important fverbal fand f nonverbal f messages.
, Chapter f02: fThe fPhysical fExamination
Des fJardins: fClinical fManifestations fand fAssessment fof fRespiratory fDisease, f8th
fEdition
MULTIPLE fCHOICE
1. When fwould finduced fhypothermia fbe findicated?
a. During fbrain fsurgery
b. During fbowel fsurgery
c. To fbreak fa ffever
d. To ftreat fcarbon fmonoxide fpoisoning
ANS: f A
Induced fhypothermia fmay finvolve fonly fa fportion fof fthe fbody for fthe fwhole fbody. fInduced
fhypothermia f is foften f indicated f before fcertain f surgeries, f such fas f heart for fbrain f surgery, for
fafter freturn fof fspontaneous fcirculation fafter fa f cardiac f arrest.
2. A f50-year-old fpatient fhas fa fheart frate fby fpalpation fof f120 fbpm. fHow fshould
fthis fbe f interpreted?
a. Within fthe fnormal frange ffor fan fadult
b. An ferror fsince fa fstethoscope fwas fnot fused
c. Bradycardia
d. Tachycardia
ANS: f D
In fan fadult, fa fheart frate fof fgNfreaRter ftU
IhaS
n fG
10N0 f /B
m f. i f Cnute fM T i s fconsidered fto fbe
ftachycardia. fA f heart frate fof f less fthan f60/minute f in fan fadult f is fconsidered fto fbe
fbradycardia. fPalpation f and
auscultation fare fboth facceptable fto fcheck fheart frate.
3. Tachypnea fmay fbe fthe fresult fof:
1. hypoxemia.
2. hypothermia.
3. fever.
4. sedation.
a. 2, f 4
b. 1, f3
c. 2, f3, f 4
d. 1, f2, f3
ANS: f B
Tachypnea fmay fbe fthe fresult fof fhypoxemia, ffever, fand fother fcauses. fHypothermia fand
fsedation f will fusually fresult f in f bradycardia.
4. A f50-year-old fpatient fwould fbe fsaid fto fhave fhypotension fwhen fher:
a. blood fpressure fis f130/90 fmm fHg.
b. blood fpressure fis f85/55 fmm fHg.
c. heart frate fis f55 fbpm.
d. pulse fpressure fis f40 fmm
fHg. fANS: f B