Test 3 Flashcards
win
Wheezing is resolved with medications that:
A) dry up secretions in the lower airway.
B) reduce soft tissue swelling in the larynx.
C) relax the smooth muscle of the bronchioles.
D) cause bronchoconstriction and improved airflow
C
Unlike bronchodilator therapy, corticosteroid therapy:
A) causes immediate improvement in breathing.
B) takes a few hours to reduce bronchial edema.
C) is administered exclusively in a hospital setting.
D) is the primary treatment for acute bronchospasm.
B
A 76-year-old woman with emphysema presents with respiratory distress that has worsened progressively over the past 2 days. She is breathing through pursed lips and has a prolonged expiratory phase and an oxygen saturation of 76%. She is on home oxygen at 2 L/min. Your initial action should be to:
A) increase her oxygen flow rate to 6 L/min.
B) administer a beta-2 agonist via nebulizer.
C) place her in a position that facilitates breathing.
D) auscultate her lungs for adventitious breath sounds.
C
You are transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should:
A) remove the nonrebreathing mask and apply a nasal cannula.
B) administer a sedative and a paralytic and then intubate his trachea.
C) begin assisting his ventilations with a bag-mask and 100% oxygen.
D) insert a nasal airway, apply a CPAP unit, and notify medical control.
C
Emphysema is caused by:
A) an abundance of pulmonary surfactant.
B) chronic destruction of the alveolar walls.
C) excessive mucus production in the bronchi.
D) progressive weakening of the lung parenchyma.
B
Know dose(s) of albuterol
5 mg nebulized
2.5 mg when mixed with Atrovent
Cor pulmonale is defined as:
A) increased preload caused by severe hypertension.
B) left heart failure secondary to mitral valve damage.
C) rupture of the alveoli due to increased surface tension.
D) right heart failure secondary to chronic lung disease.
D
You are transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should:
A) continue the CPAP treatment and administer a diuretic to remove fluids from his lungs quickly.
B) remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.
C) suspect that he has developed a pneumothorax and prepare to perform a needle chest decompression.
D) decrease the amount of positive-end expiratory pressure that you are delivering and reassess.
B
What function do the nasal turbinates serve?
A) Separating the left and right nostrils
B) Warming and humidifying inhaled air
C) Decreasing the surface area of the nasopharynx
D) Secreting mucus that traps viruses and bacteria
B
COPD is characterized by:
A) narrowing of the smaller airways that is often reversible with prompt treatment.
B) changes in pulmonary structure and function that are progressive and irreversible.
C) small airway spasms during the inhalation phase, resulting in progressive hypoxia.
D) widespread alveolar collapse due to increased pressure during the exhalation phase.
B
You respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the recent past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient’s daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically looking. You should:
A) apply a nonrebreathing mask, assess his oxygen saturation level, and prepare for immediate transport.
B) provide aggressive airway management unless the daughter can produce a valid DNR order.
C) intubate him at once, begin transport, and advise the daughter to notify the hospital when she finds the DNR order.
D) recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.
D
Bedridden patients with excessive pulmonary secretions are MOST prone to developing: A) pneumonia. B) bronchospasm. C) a pneumothorax. D) a pulmonary embolism.
A
A patient with orthopnea:
A) seeks a sitting position when short of breath.
B) is awakened from sleep with severe dyspnea.
C) prefers to lie flat in order to facilitate breathing.
D) generally has a slow, shallow respiratory pattern.
A
Which of the following medications is a parasympathetic bronchodilator? A) Alupent B) Albuterol C) Bronkosol D) Ipratropium
D
Abnormal breath sounds associated with pneumonia and congestive heart failure are MOST often heard in the: A) right middle lobe. B) bases of the lungs. C) apices of the lungs. D) midaxillary line.
B
Patients with pneumonia often experience a coughing fit when they roll from one side to the other because:
A) movement loosens pulmonary secretions and stimulates coughing.
B) most cases of pneumonia occur in conjunction with bronchospasm.
C) the secretions in their lungs suddenly disperse and impair breathing.
D) pneumonia often occurs in the lung bases, typically on only one side.
D
A 29-year-old woman is experiencing a severe asthma attack. Her husband reports that she was admitted to an intensive care unit about 6 months ago, and had a breathing tube in place. Prior to your arrival, the patient took 3 puffs of her rescue inhaler without effect. She is anxious and restless, is tachypneic, and has audible wheezing. You should:
A) apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.
B) begin assisting her ventilations with a bag-mask device and 100% oxygen and prepare to intubate her trachea.
C) start an IV of normal saline, administer methylprednisolone via IV push, and transport as soon as possible.
D) attempt to slow her breathing with respiratory coaching, administer a nebulized bronchodilator, and transport.
A
A 36-year-old man with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta-2 agonist, but his poor respiratory effort is inhibiting effective drug delivery via the nebulizer and his mental status is deteriorating. You should:
A) assist his ventilations and establish vascular access.
B) start an IV of normal saline and administer a steroid.
C) apply high-flow oxygen via a nonrebreathing mask.
D) assist him with a metered-dose inhaler bronchodilator.
A
Review Solumedrol and its effects
Classification: Glucocorticoid Description Naturally occurring steroid that suppresses acute and chronic inflammation. Potentiates vascular smooth muscle relaxation by beta adrenergic agonists, and may alter air- way hyperactivity. Indications Anaphylaxis / Allergic states Inhalation of Hot Smoke and Gases Bronchodilator unresponsive asthma COPD Shock / (controversial) Acute spinal cord injury / (controversial Onset 1 - 2 hours Contraindications Use with caution in patients with GI bleeding Adverse Reactions Few short term Headache Hypertension Sodium and water retention Dose 125 mg IV Spinal Cord injury initial dose is 30 mg/kg IV bolus followed by an infusion of 5.4 mg/kg/hr for 23 hours
Retractions of the sternum or ribs during inhalation:
A) are common in patients with emphysema.
B) are signs of acute respiratory failure in adults.
C) occur when soft tissue is pulled in around the bones.
D) are especially common in infants and small children.
D
One of the hallmarks of a pulmonary embolism is:
A) the disappearance of radial pulses during inhalation.
B) pleuritic chest pain that occurs after a strong cough.
C) cyanosis that does not resolve with oxygen therapy.
D) jugular venous distention while in a supine position
C
You are dispatched to a residence for a young woman with difficulty breathing. When you arrive, you find the patient sitting in a tripod position, noticeably dyspneic and tachypneic. She tells you that she experienced a sudden sharp pain to the left side of her chest and then started having trouble breathing. She denies any past medical history and states that she only takes birth control pills. Based on this patient's clinical presentation, you should be MOST suspicious for: A) a pleural effusion. B) spontaneous pneumothorax. C) acute pulmonary embolism D) hyperventilation syndrome.
C
The presence of diffuse rhonchi (low-pitched crackles) in the lungs indicates:
A) right-sided congestive heart failure.
B) isolated consolidation of secretions.
C) thick secretions in the large airways.
D) air being forced through narrowed airways.
C
\_\_\_\_\_\_\_\_\_\_\_ respirations are characterized by a grossly irregular pattern of breathing that may be accompanied by lengthy periods of apnea. A) Biot B) Agonal C) Eupneic D) Cheyne-Stokes
A
An unresponsive patient who overdosed on a central nervous system depressant drug would be expected to have \_\_\_\_\_\_\_\_\_\_ respirations. A) eupneic B) hyperpneic C) bradypneic D) Kussmaul
C
A known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. You should:
A) suction his oropharynx, perform intubation, and then administer naloxone via slow IV push.
B) preoxygenate him with a bag-mask device for 2 to 3 minutes and then intubate his trachea.
C) apply oxygen via nonrebreathing mask, administer naloxone, and be prepared to assist ventilations.
D) assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.
D
The barrel-chest appearance classically seen in emphysemic patients is secondary to: A) widespread atelectasis. B) chest wall hypertrophy. C) air trapping in the lungs. D) carbon dioxide retention.
C
Which of the following clinical findings is MOST suggestive of pneumonia in a patient with COPD? A) Nonproductive cough B) White sputum and rales C) Fever and localized crackles D) Dyspnea and diffuse wheezing
C
In a person who is not bedridden, most pulmonary infections occur in the: A) middle lobes of the lungs. B) bases of the lungs. C) apices of the lungs. D) upper portion of the lungs.
B
Hypoventilating patients: A) eliminate too much carbon dioxide. B) become hypercapneic and acidotic. C) experience an increase in blood pH. D) typically do not have an open airway.
B
Respiratory alkalosis is the result of: A) carbon dioxide retention. B) slow and shallow respirations. C) increased hydrogen ion production. D) excess carbon dioxide elimination.
D
When auscultating the lungs of a patient with early pulmonary edema, you will MOST likely hear:
A) inspiratory rhonchi to the bilateral apices of the lungs.
B) crackles in the bases of the lungs at the end of inspiration.
C) faint rhonchi to all lung fields on inspiration and expiration.
D) coarse crackles to the bases of the lungs during inspiration.
B
The most obvious external landmark of the larynx is the: A) cricoid cartilage. B) hyoid bone. C) arytenoid cartilage. D) thyroid cartilage.
D
Stretch receptors in the lungs are responsible for the \_\_\_\_\_\_\_\_\_\_\_\_ reflex, which causes you to cough if you take too deep a breath. A) Cushing B) Hering-Breuer C) pneumotaxic D) yawning
B
With regard to pulse oximetry, the more hypoxic a patient becomes:
A) the slower his or her PaO2 will fall.
B) the faster he or she will desaturate.
C) the slower he or she will desaturate.
D) the less reliable the pulse oximeter is.
B
Reactive airway disease is characterized by:
A) bronchospasm, edema, and mucus production.
B) chronic bronchoconstriction of varying severity.
C) acute, reversible swelling of the laryngeal muscles.
D) excessive mucus production and a chronic cough.
A
The hypoxic drive is a phenomenon in which:
A) a chronically hypoxic patient’s primary respiratory drive is stimulated by increased levels of carbon dioxide in the arterial blood.
B) a relatively large percentage of patients with COPD become acutely apneic after receiving high-flow oxygen.
C) high levels of oxygen rapidly depress a COPD patient’s respiratory rate and depth, leading to worsened hypoxia and severe acidosis.
D) bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance.
D
• What patients should not receive diuretics
Do not give diuretics to patients with pneumonia or to those who are already dehydrated; reserve them for pts who clearly have pulmonary edema
Condition with reversible narrowing of the airways
asthma
clinches jaws also known as
tristas
flank bruising indicates retroperitoneal hemorrhage
grey turner sign
persons ability to perform coordinated functions
ataxia
wave like muscular contraction moves food inferiorly toward the stomach
peristalsis
starting flowing rate when administering cpap
5cm H20
reabsorption of water and sodium occur in the kidneys
Loop of henley
term of right sided heart failure due to COPD
corpulmonale
term used for large amounts of uring output
polyurea
during this period of neurologic distress you will notice patient has an arched back and becomes rigid?
hypertonic
what is the dose of nalbuphine?
10 mg
