Chapter 15 – Respiratory Emergencies

What is dyspnea?
Shortness of breath
The most common form of COPD is ________.
– Asthma
– Bronchitis
– Emphysema
– Pneumonia
The most common form of COPD is ________.
– Asthma
– Bronchitis
*- Emphysema*
– Pneumonia
A ________ is a collection of fluid between the lung and chest wall that may compress the lung.
– Pleural effusion
– Pulmonary embolism
– Pneumothorax
– Pulmonary edema
A ________ is a collection of fluid between the lung and chest wall that may compress the lung.
*- Pleural effusion*
– Pulmonary embolism
– Pneumothorax
– Pulmonary edema
(T/F) Decreased, absent, or abnormal breath sounds are also called vesicular breath sounds.
False.

Decreased, absent, or abnormal breath sounds are also known as *adventitious* breath sounds.

(T/F) Adult patients breathing more than 20 breaths/min or fewer than 12 breaths/min should receive high-flow oxygen.
True.
(T/F) Snoring sounds are indicative of a partial lower airway obstruction, usually in the bronchioles.
False.

Snoring sounds are indicative of a partial *upper* airway obstruction, usually in the oropharynx.

Which of the following medications can be used for the treatment of an acute asthma attack?
– Cromolyn
– Albuterol
– Fluticasone
– Salmeterol
Which of the following medications can be used for the treatment of an acute asthma attack?
– Cromolyn
*- Albuterol*
– Fluticasone
– Salmeterol
What is the most appropriate method for oxygen delivery to an adult patient experiencing breathing difficulty?
– Nasal cannula at 2 to 6 L/min
– Nonrebreathing mask at 15 L/min
– Venturi mask at 8 L/min
– BVM at 15 L/min
What is the most appropriate method for oxygen delivery to an adult patient experiencing breathing difficulty?
– Nasal cannula at 2 to 6 L/min
*- Nonrebreathing mask at 15 L/min*
– Venturi mask at 8 L/min
– BVM at 15 L/min
When assisting an asthmatic patient with a small-volume nebulizer attached to oxygen, what is the appropriate flow rate for the oxygen?
– 2 L/min
– 4 L/min
– 6 L/min
– 10 L/min
When assisting an asthmatic patient with a small-volume nebulizer attached to oxygen, what is the appropriate flow rate for the oxygen?
– 2 L/min
– 4 L/min
*- 6 L/min*
– 10 L/min
In addition to asthma, which of the following conditions is associated with wheezing?
– Croup
– Epiglottitis
– Pulmonary embolism
– Bronchitis
In addition to asthma, which of the following conditions is associated with wheezing?
– Croup
– Epiglottitis
– Pulmonary embolism
*- Bronchitis*
What is atelectasis?
– Collapse of the alveolar air spaces of the lungs
– The buildup of excess acid in the blood or body tissues that results from a primary illness
– The buildup of excess base (lack of acids) in the body fluids
– An extreme, life-threatening, systemic allergic reaction that may include shock and respiratory failure
What is atelectasis?
*- Collapse of the alveolar air spaces of the lungs*
– The buildup of excess acid in the blood or body tissues that results from a primary illness
– The buildup of excess base (lack of acids) in the body fluids
– An extreme, life-threatening, systemic allergic reaction that may include shock and respiratory failure
Which type of breath sound are you more likely to hear in a person with congestive heart failure?
– Decreased/absent
– Rhonchi
– Crackles
– Stridor
Which type of breath sound are you more likely to hear in a person with congestive heart failure?
– Decreased/absent
– Rhonchi
*- Crackles*
– Stridor
You arrive at a residence where you find a woman in her early 60s. She is anxious, tachycardic, and her fingertips and lips are blue. As you assess her, she coughs up frothy sputum, and you hear crackles and some wheezing as you check for breath sounds. What condition do these findings indicate?
– Spontaneous pneumothorax
– Emphysema
– Bronchitis
– Congestive heart failure
You arrive at a residence where you find a woman in her early 60s. She is anxious, tachycardic, and her fingertips and lips are blue. As you assess her, she coughs up frothy sputum, and you hear crackles and some wheezing as you check for breath sounds. What condition do these findings indicate?
– Spontaneous pneumothorax
– Emphysema
– Bronchitis
*- Congestive heart failure*
In the mnemonic PASTE, what does the “S” stand for?
– Symptoms
– Severity
– Sputum
– Syncope
In the mnemonic PASTE, what does the “S” stand for?
– Symptoms
– Severity
*- Sputum*
– Syncope
CPAP is generally used for which condition?
– Acute pulmonary edema
– Hyperventilation
– Pleural effusion
– Spontaneous pneumothorax
CPAP is generally used for which condition?
*- Acute pulmonary edema*
– Hyperventilation
– Pleural effusion
– Spontaneous pneumothorax

*CPAP is a noninvasive means of providing ventilatory support for patients experiencing respiratory distress associated with obstructive pulmonary disease and acute pulmonary edema.*

Which of the following statements is true regarding asthma?
– Asthma involves accumulation of air in the pleural space.
– Asthma involves a collection of fluid in the pleural space.
– Asthma involves excessive mucus production.
– Asthma involves a collection of fluid in the alveoli.
Which of the following statements is true regarding asthma?
– Asthma involves accumulation of air in the pleural space.
– Asthma involves a collection of fluid in the pleural space.
*- Asthma involves excessive mucus production.*
– Asthma involves a collection of fluid in the alveoli.

*Asthma is an acute spasm of the smaller air passages, called bronchioles, associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages.*

Your patient has a chronic respiratory condition. His stimulus to breathe is triggered by low oxygen levels in the blood. This is known as the ___________.
– hypoxic drive
– CO2 drive
– COPD drive
– alternate drive
Your patient has a chronic respiratory condition. His stimulus to breathe is triggered by low oxygen levels in the blood. This is known as the ___________.
*- hypoxic drive*
– CO2 drive
– COPD drive
– alternate drive
Which of the following must be assessed in every respiratory patient?
– Orthostatic vital signs
– Distal pulse, motor, sensation
– Blood glucose levels
– Lung sounds
Which of the following must be assessed in every respiratory patient?
– Orthostatic vital signs
– Distal pulse, motor, sensation
– Blood glucose levels
*- Lung sounds*
Crackles (rales) are caused by _________.
– severe bronchoconstriction
– narrowing of the upper airways
– air passing through fluid
– mucus in the larger airways
Crackles (rales) are caused by _________.
– severe bronchoconstriction
– narrowing of the upper airways
*- air passing through fluid*
– mucus in the larger airways
“PASTE” is an alternate assessment tool for ___________.
– respiratory patients
– stroke patients
– seizure patients
– cardiac patients
“PASTE” is an alternate assessment tool for ___________.
*- respiratory patients*
– stroke patients
– seizure patients
– cardiac patients
Which of the following is a genetic disorder that predisposes the patient to repeated lung infections?
– Severe acute respiratory syndrome
– Multiple sclerosis
– Cystic fibrosis
– Celiac sprue
Which of the following is a genetic disorder that predisposes the patient to repeated lung infections?
– Severe acute respiratory syndrome
– Multiple sclerosis
*- Cystic fibrosis*
– Celiac sprue
In what area of the lungs does respiration occur?
– Alveoli
– Trachea
– Capillaries
– Bronchi
In what area of the lungs does respiration occur?
*- Alveoli*
– Trachea
– Capillaries
– Bronchi
In order for efficient pulmonary gas exchange to occur:
– oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane.
– there must be low quantities of pulmonary surfactant to allow for full alveolar expansion.
– the pulmonary capillaries must be completely constricted and the alveoli must be collapsed.
– the percentage of inhaled carbon dioxide must exceed the percentage of inhaled oxygen.
In order for efficient pulmonary gas exchange to occur:
*- oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane.*
– there must be low quantities of pulmonary surfactant to allow for full alveolar expansion.
– the pulmonary capillaries must be completely constricted and the alveoli must be collapsed.
– the percentage of inhaled carbon dioxide must exceed the percentage of inhaled oxygen.
Which of the following is MOST characteristic of adequate breathing?
– 24 breaths/min with bilaterally equal breath sounds and pink skin
– 30 breaths/min with supraclavicular retractions and clammy skin
– 20 breaths/min with shallow movement of the chest wall and pallor
– 22 breaths/min with an irregular pattern of breathing and cyanosis
Which of the following is MOST characteristic of adequate breathing?
*- 24 breaths/min with bilaterally equal breath sounds and pink skin*
– 30 breaths/min with supraclavicular retractions and clammy skin
– 20 breaths/min with shallow movement of the chest wall and pallor
– 22 breaths/min with an irregular pattern of breathing and cyanosis
Which of the following conditions would be LEAST likely to result in hypoxia?
– Severe anxiety
– Pleural effusion
– Pulmonary edema
– Narcotic overdose
Which of the following conditions would be LEAST likely to result in hypoxia?
*- Severe anxiety*
– Pleural effusion
– Pulmonary edema
– Narcotic overdose
A 59-year-old male with a history of emphysema complains of an acute worsening of his dyspnea and pleuritic chest pain following a forceful cough. Your assessment reveals that he has a barrel-shaped chest, unilaterally diminished breath sounds, and tachycardia. What is the MOST likely cause of this patient’s condition?
– Rupture of the diaphragm
– Spontaneous pneumothorax
– Exacerbation of his COPD
– Acute pulmonary embolism
A 59-year-old male with a history of emphysema complains of an acute worsening of his dyspnea and pleuritic chest pain following a forceful cough. Your assessment reveals that he has a barrel-shaped chest, unilaterally diminished breath sounds, and tachycardia. What is the MOST likely cause of this patient’s condition?
– Rupture of the diaphragm
*- Spontaneous pneumothorax*
– Exacerbation of his COPD
– Acute pulmonary embolism
Treatment with continuous positive airway pressure (CPAP) would MOST likely be contraindicated in which of the following situations?
– Pulmonary edema, history of hypertension, and anxiety
– Shortness of breath and a blood pressure of 76/56 mm Hg
– Difficulty breathing, two-word dyspnea, and tachycardia
– Conscious and alert patient with an oxygen saturation of 85%
Treatment with continuous positive airway pressure (CPAP) would MOST likely be contraindicated in which of the following situations?
– Pulmonary edema, history of hypertension, and anxiety
*- Shortness of breath and a blood pressure of 76/56 mm Hg*
– Difficulty breathing, two-word dyspnea, and tachycardia
– Conscious and alert patient with an oxygen saturation of 85%
Asthma is caused by a response of the:
– endocrine system.
– respiratory system.
– immune system.
– cardiovascular system.
Asthma is caused by a response of the:
– endocrine system.
– respiratory system.
*- immune system.*
– cardiovascular system.
A 30-year-old male presents with acute shortness of breath, widespread hives, and facial swelling. He denies any past medical history and takes no medications. During your assessment, you hear wheezing over all the lung fields. His blood pressure is 90/50 mm Hg and his heart rate is 110 beats/min. In addition to giving him high-flow oxygen, the MOST important treatment for this patient is:
– albuterol.
– a beta-antagonist.
– epinephrine.
– an antihistamine.
A 30-year-old male presents with acute shortness of breath, widespread hives, and facial swelling. He denies any past medical history and takes no medications. During your assessment, you hear wheezing over all the lung fields. His blood pressure is 90/50 mm Hg and his heart rate is 110 beats/min. In addition to giving him high-flow oxygen, the MOST important treatment for this patient is:
– albuterol.
– a beta-antagonist.
*- epinephrine.*
– an antihistamine.
When auscultating the lungs of a patient with respiratory distress, you hear adventitious sounds. This means that the patient has:
– normal breath sounds.
– an absence of breath sounds.
– abnormal breath sounds.
– diminished breath sounds.
When auscultating the lungs of a patient with respiratory distress, you hear adventitious sounds. This means that the patient has:
– normal breath sounds.
– an absence of breath sounds.
*- abnormal breath sounds.*
– diminished breath sounds.
While auscultating an elderly woman’s breath sounds, you hear low-pitched “rattling” sounds at the bases of both of her lungs. This finding is MOST consistent with which of the following conditions?
– Early pulmonary edema
– Aspiration pneumonia
– Acute asthma attack
– Widespread atelectasis
While auscultating an elderly woman’s breath sounds, you hear low-pitched “rattling” sounds at the bases of both of her lungs. This finding is MOST consistent with which of the following conditions?
– Early pulmonary edema
*- Aspiration pneumonia*
– Acute asthma attack
– Widespread atelectasis
You are assisting an asthma patient with his prescribed metered-dose inhaler. After the patient takes a deep breath and depresses the inhaler, you should:
– instruct him to hold his breath for as long as he comfortably can.
– allow him to breathe room air and assess his oxygen saturation.
– advise him to exhale forcefully to ensure medication absorption.
– immediately reapply the oxygen mask and reassess his condition.
You are assisting an asthma patient with his prescribed metered-dose inhaler. After the patient takes a deep breath and depresses the inhaler, you should:
*- instruct him to hold his breath for as long as he comfortably can.*
– allow him to breathe room air and assess his oxygen saturation.
– advise him to exhale forcefully to ensure medication absorption.
– immediately reapply the oxygen mask and reassess his condition.
A pleural effusion is MOST accurately defined as:
– a bacterial infection of the lung tissue.
– diffuse collapsing of the alveoli.
– fluid accumulation outside the lung.
– a unilaterally collapsed lung.
A pleural effusion is MOST accurately defined as:
– a bacterial infection of the lung tissue.
– diffuse collapsing of the alveoli.
*- fluid accumulation outside the lung.*
– a unilaterally collapsed lung.
You are attending to a 3-year-old male patient who is presenting with severe shortness of breath. His parents report that he has had a cough and cold with a low grade fever for the past two days. They became worried today, as his level of distress has increased dramatically. On assessment, the patient is sitting upright and making high-pitched noises with each breath. Based on this information, the patient is most likely suffering from:
– viral infection of the upper respiratory tract.
– inflammation of the bronchioles.
– inflammation of the lower respiratory tract and bronchospasm.
– bacterial infection of the epiglottis.
You are attending to a 3-year-old male patient who is presenting with severe shortness of breath. His parents report that he has had a cough and cold with a low grade fever for the past two days. They became worried today, as his level of distress has increased dramatically. On assessment, the patient is sitting upright and making high-pitched noises with each breath. Based on this information, the patient is most likely suffering from:
*- viral infection of the upper respiratory tract.*
– inflammation of the bronchioles.
– inflammation of the lower respiratory tract and bronchospasm.
– bacterial infection of the epiglottis.
His parents tell you that their son has had a chest infection for the past two days and when they took him to their family doctor, they were told it was likely due to the respiratory syncytial virus (RSV). They have kept him well hydrated, but the infection seems to have gotten worse. On auscultation, you hear decreased air entry bilaterally with fine expiratory wheezes and the occasional coarse wet crackle. Based on this information, your patient is most likely suffering from:
– pertussis.
– epiglottitis.
– bronchiolitis.
– croup.
His parents tell you that their son has had a chest infection for the past two days and when they took him to their family doctor, they were told it was likely due to the respiratory syncytial virus (RSV). They have kept him well hydrated, but the infection seems to have gotten worse. On auscultation, you hear decreased air entry bilaterally with fine expiratory wheezes and the occasional coarse wet crackle. Based on this information, your patient is most likely suffering from:
– pertussis.
– epiglottitis.
*- bronchiolitis.*
– croup.
You are attending to a 54-year-old female patient in a homeless shelter. The patient tells you that she had the flu a couple of weeks ago, and she has not gotten over it. She has been tired and keeps waking up at night, sweating. She has been coughing up green sputum occasionally and has been experiencing episodes of chest pain that get worse when she breathes. Based on this information, your patient is most likely suffering from:
– pneumonia.
– tuberculosis.
– influenza Type A.
– chronic obstructive pulmonary disease (COPD).
You are attending to a 54-year-old female patient in a homeless shelter. The patient tells you that she had the flu a couple of weeks ago, and she has not gotten over it. She has been tired and keeps waking up at night, sweating. She has been coughing up green sputum occasionally and has been experiencing episodes of chest pain that get worse when she breathes. Based on this information, your patient is most likely suffering from:
– pneumonia.
*- tuberculosis.*
– influenza Type A.
– chronic obstructive pulmonary disease (COPD).
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