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APA chapter questions
Terms in this set (243)
the type of CXR most helpful in identifying a pneumothorax is:
a 5 y.o patient is admitted to the ED with suspected smoke inhalation. to assess the oxygenation status you would recommend:
arterial sample & CO-oximetry
which of the following are key elements in the provision of patient-centered care?
2. individualized care
3. Provider collaboration
after a postoperative patient you are interviewing grimaces while holding her abdomen, you note some confusion about her responses. which of the following factors likely is affecting communication?
pain and anxiety
active listening is most essential during what stage of the clinical encounter?
initial assessment stage
After several attempts to instruct a patient with COPD on the proper use of a metered-dose inhaler, the patient complains of the inability to master the correct technique. Applying patient-centered principles, you should:
request permission from the patients doctor to find a more acceptable delivery system.
in which of the following spaces is a patient rapport best established?
which of the following violates HIPPA-re4lated privacy and security rules?
Leaving a computer unattended without logging off.
which of the following cultural beliefs should be explored with your patients during the initial assessment stage with your patients during the initial assessment stage of the clinical encounter?
1. concepts of health and disease
2. responses to authority
3. gender and family roles
4. religious values
For most respiratory care to succeed, patients need to:
actively participate in treatment regimen
during an initial patient encounter, you note that her acute anxiety appears to be affecting your ability to help her learn more about her disease process. to overcome this problem, you would not consider:
recommending that the doctor prescribe an analgesic
a good patient action plan should include which of the following elements?
1. actions needed to achieve the goal
2. barriers to goal achievement
3. a specific, measurable goal
4. a follow-up mechanism
While supervising a respiratory therapy student, you observe that an anxious patient asks her if the aerosol bronchodilator she is about to deliver has any bad effects. The student replies "none to worry about." After the treatment session is over, you should explain to the student that:
patients should be encouraged to ask questions about their medications
For a clinical encounter with a patient on airborne precautions, you should:
wear a properly fitting N95 respirator
a patient responds poorly to a treatment you have given. After assuring that the patient is stable, you should:
speak with the patient's nurse, chart the response and whom you notified
in setting up a postural drainage treatment schedule for a postoperative patient, which of the following information would you try to obtain from the patient's nurse?
1. patients medication schedule
2. patients ideal body weight
3. patients meal schedule
all of the following are appropriate roles for a respiratory therapist serving on a team managing a patient with COPD, except:
recommending changes in diet and nutrition
proper diagnosis and treatment are determined to a great extent by the accuracy and detail of the patients history.
during the interview, if the therapist responds to the information provided by the patient with appropriate comments, this is evidence of which of the following?
1. active listening
Proper introduction of yourself to the patient before the interview is useful for all the following except:
identifying diagnostic information
which of the following would be examples of techniques used in conversational interviewing's?
1.using questions such as "what happened next?"
2. asking for clarification of a symptom
a patient cannot provide a medical history, and it is obtained from a close relative. this is an example of what?
In what section of the patient history can a detailed description of the patient's current symptoms be found?
history of present illness
information that is evident only to the patient and cannot be perceived by the observer is known as which of the following?
in what section of the patient history would you find information about a possible history of exposure to asbestos?
your patient has a 50-pack-year smoking history. How can this be written?
2 packs/day for 25 years
1 pack/day for 50 years
5 packs/day for 10 years
subjective manifestations of disease are termed:
your patient has pneumonia and complain of chest pain and cough but denies fever. How would you classify the lack of fever in this case?
which of the following is not considered a constitutional symptom?
chills and fever
the family history may be helpful in diagnosing a patient with which problem?
which of the following illnesses may be related to visiting or living in a certain geographic locations?
your patient has a DNR label on his hart and at the head of his bed. This indicates:
the patient should not be resuscitated if cardiac arrest occurs
which of the following factors may lead to a weak cough?
reduced lung recoil
weak inspiratory muscles
A cough described as being persistent for more than 3 weeks would be called which of the following?
which of the following problems is associated with hemoptysis?
a patients complaint of breathlessness or air hunger would be defined as which of the following?
what term is used to describe shortness of breath in the upright position?
which of the following is least associated with causing dyspnea?
an increase in lung compliance
what term is used to describe difficult breathing in the reclining position?
which of the following characteristics is least associated with pleuritic chest pain?
radiates to the neck
which of the following may cause syncope?
which of the following is true regarding dependent edema caused by lung disease?
accompanying hepatomegaly may be present
chronic pulmonary hypertension may lead to what clinical findings?
which of the following is associated with night sweats?
In what decade of life is snoring and OSA most likely to be present in adult males?
which of the following symptoms is least likely to be associated with GERD?
what is not included in measurement of vital signs?
what change is consistent with a fever?
increased pulse rate
what method of temperature measurement is recommended for neonates?
what is the normal value of resting pulse rates in adults?
what is the normal range of the respiratory rate for adults?
which of the following causes tachycardia in the adult?
which of the following arterial sites is most common for evaluating the pulse in adult patients?
which of the following causes tachypnea in the adult?
which of the following causes an erroneously low blood pressure measurement?
not enough pressure used in the cuff during measurement
hypotension may often be associated with all of the following except:
excessive salt intake
the peak pressure in the arteries is known as which of the following?
a decrease in the intensity of palpated pulse during inhalation is a definition of which of the following?
what is the normal range for pulse pressure?
35-40 mm Hg
which of the following is not a typical component to physical examination?
pursed lip breathing is often seen in which patient?
which of the following is an unlikely cause of diaphoresis
in which of the following is lymphadenopathy of the neck seen?
infection of the upper airway
in which of the following may cause an increased jugular venous distention?
right-sided heart failure secondary to left-sided heart failure
right-sided heart failure alone
what spinous process is most prominent with the patient sitting and with the head bent forward?
at which if the topographic locations is the bifurcation of the trachea located on the anterior chest?
beneath the sternal angle
the minor (horizontal) fissure begins at which of the following locations on the anterior chest?
fourth rib at the sternal border
"An inward depression of the sternum" describes which of the following thoracic configurations?
what type of lung problem is associated with kyphoscoliosis?
restrictive lung disease
which of the following best describes an apneustic breathing pattern
what Is indicated by the presence of retractions?
an increase on the work of breathing
What I:E ratio is consistent with a severe asthma attack?
which of the following breathing patterns is associated with narrowing intrathoracic airways?
prolonged expiratory time
which of the following indicate diaphragmatic fatigue?
which of the following causes an increased tactile fremitus?
atelectasis with a patent bronchiole
which of the following causes bilateral decrease in chest expansion?
which of the following causes an increased resonance to percussion of the chest?
what clinical condition would cause the range of diaphragm movement to be reduced bilaterally?
Normal tracheal breathe sounds are produced by what mechanism?
turbulent airflow through the large airways
which of the following terms is used to describe discontinuous adventitious lung sounds?
the findings of late inspiratory crackles on auscultation of a patient might indicate what?
what clinical condition is most closely associated with polyphonic wheezing?
what lung sounds is commonly heard in the patient with upper airway obstruction?
what is the normal topographic location of the PMI?
fifth intercostal space at the midclavicular line
what is the best location for auscultating the mitral valve?
fifth intercostal space at the midclavicular line
what produces the sound associated with the first heart sound?
closure of the atrioventricular (AV) valves
what clinical condition is most closely associated with a gallop heart rhythm?
congestive heart failure
what may cause an increased P2 component of the second heart sound?
what is associated with right heart failure?
jugular venous distention
what is the common reference range for arterial pH?
what is the common reference range for PaO2 breathing air at sea level?
80-100 mm Hg
what is the common reference for CaO2?
to evaluate a patient's acid-base status, you would recommend which of the following?
arterial blood gas
to measure actual blood O2 saturation, you would recommend:
what would you use to assess the adequacy of ventilation in an intubated child receiving mechanical ventilation?
arterial blood gas
continuous noninvasive assessment of a patient oxygenation can be provided by which of the following methods?
a patient receiving mechanical ventilation requires frequent assessment of oxygenation, ventilation, and acid-base balance. what would you recommend?
arterial blood gas sampling through an A-line
before an arterial blood gas sampling is obtained, the patient's clotting parameters should be evaluated because:
bleeding time may be prolonged if they are abnormal
preferred site for arterial puncture:
radial artery after performing the modified allens test
if allens test fails on one wrist what action should be taken?
repeat the test on the opposite wrist
what infection control precaution should be applied when obtaining an arterial blood sample?
standard precaution plus a face shield
a patient has a measured SaO2 of 82%. what is their approximate PaO2?
50 mm Hg
what is true regarding standard pulse oximetry?
in patients with good perfusion their accuracy is in the 2-4% range
a 5 y.o. patient is admitted to the ED with suspected smoke inhalation. What would you recommend to assess the oxygenation status?
arterial samples & CO-oximetry
which of the following represents a normal P(A-a)O2 for a 50 year old woman breathing room air?
15 mm Hg
an 80year old patient with has a PaO2 of 71 mm Hg. how would you describe this findings?
normal for their age
a patient is breathing 40% O2 has a markedly higher than normal P(A-a)O2, which does not improved when the O2 concentration is increased to 50%. what is the most likely cause of their hypoxemia?
what parameter represents the respiratory component of acid-base status?
what is the best indicator of metabolic acid-base status?
what ratio of HCO-3/PaCO2 would result in a ph of 7.40?
what arterial blood gas acid-base represents an error?
pH = 7.5, PaCO2= 50 mm Hg, HCO-3= 20 mmol/L
In the respiratory alkalosis the PaCO2 will be:
less than 35 mm Hg
determine the following ABG:
pH = 7.33
PaCO2 = 35 mm Hg
HCO-3 = 18 mmol/L
BE = -7 mmol/L
uncompensated metabolic acidosis
determine the following ABG:
PaCO2 = 30 mm Hg
HCO-3 = 23mmol/L
BE = +1 mmol/L
uncompensated respiratory alkalosis
determine the following ABG:
PaCO2 = 25 mm Hg
HCO-3 = 17 mmol/L
BE = -6 mmol/L
compensated respiratory alkalosis
determine the following ABG:
pH = 7.24
PaCO2 = 68 mm Hg
HCO-3 = 28 mmol/L
BE = +1 mmol/L
partially compensated respiratory acidosis
an acute increase in PaCO2 of 10-15 mm Hg causes a corresponding increase in plasma HCO-3 of how much?
what can cause metabolic acidosis?
a mixed metabolic acidosis and respiratory alkalosis is likely when the pH and the HCO-3 are low and the PaCO2:
higher than predicted
the best way to minimize the impact of cell metabolism on analysis of an ABG sample is to:
analyze the sample within 30 minutes
the procedure whereby blood-measuring instrument is exposed to samples at two or more known levels to ensure accuracy is determined:
the blood gas results from a patient breathing a confirmed O2 consentration of 30% indicates a PaO2 of 250 mm Hg. based on this data, it can be concluded that:
PaO2 is error and should be re-measured.
What does the following ABG show?
PaCO2 67 mm Hg
HCO-3 26 mmol/L
BE +2 mmol/L
PaO2 49 mm Hg
Hb 10.1 g/dL
CaO2 10.4 mL/dL
RR 25v breathes/min
1) shows severe hypoxemia
2) O2 carrying capacity is decreased
3) uncompensated respiratory acidosis
4) acute airway obstruction
what tissue is normally the most radiolucent?
what is true regarding the distance between the x-ray source, image, and patient when taking a CXR?
as the distance between the source and the patient decreased, magnification increases.
what is the standard distance between the x-ray source and the image for a posterior CXR
A CXR is used to confirm what?
ETT placement during cardiopulmonary resuscitation
what is true regarding a posteroanterior CXR?
heart size is subject to less magnification (1/3)
which view helps to evaluate for the presence of small amounts of free pleural fluid?
A Portable CXR (anteroposterior)
the heart is seen as 1/2 & patient is often not centered on the image
CXR most helpful in identifying a pneumothorax is:
in a properly intubated adult patient, an Et tube tip should be this far from the carina:
after insertion of a CVP line, a CXR is obtained to:
Evaluate the position of the line in relation to other thoracic structures
in which clinical scenario is a CT scan most useful?
interstitial lung disease
MRI of the chest is most helpful for the detection of
interstitial lung disease
in which of the following clinical scenarios is gallium lung most useful?
Best method for evaluating for the presence of pulmonary embolism
The depth of inspiration on an x-ray is considered adequate if the lung shadows span the posterior shadows of this many ribs
the significance of the silhouette sign is that:
it can help determine the location of a pulmonary opacity
the CXR findings most consistent with tension Pneumothorax is:
increased radiolucency on the affected side
the radiographic sign of atelectasis is:
CXR finding most suggestive of heart failure is:
increased cardiothoracic ratio
CXR finding most suggestive of pneumonia
CXR finding consistent with hyperinflation
large lung volumes
CXR findings consistent with a small pleural effusion
blunted costophrenic angles
what is true about communication with older adult patients
it is a time consuming task if done appropriately
what statement reflects an ageist attitude?
most older adults are sick and frail
what medications may cause ototoxicity?
asprin and amnoglycocides
the major risk factor associated with development of cataracts is?
normal age-related restructuring of the heart results in an enlargement of what structure?
typical symptoms of right sided heart failure all of the following except which one?
what is not an age related pulmonary change?
increase in total lung compliance
blunted cell-mediated immunity in older adults is one factor in the increased incidence of:
based on your knowledge of pneumonia in older adults, the clinical presentation would most likely include:
an increased respiratory rate
which of the following is the definition of pulse pressure:
the difference between systolic and diastolic pressure
syncope associated with standing up quickly may result from what?
what is an abnormal heart sound heard sound in older adults that may be an early sign of CHF?
which serum value may decrease as a result of the normal aging process?
which of the following activities is classified as an IADL?
talking on the telephone
based on current data, which of the following is the projected PaO2 of a healthy 74 year old person?
87.2 mm Hg
approximately what percentage of adults older than 65 years of age in the US live in nursing homes?
a normal SpO2 percent of a healthy active older adult should be no lower than what?
lower systolic pressure in an adult will cause what?
decreased risk of stroke
ageism is defined as what?
a discriminatory attitude against older adults
what gas is required for the optimal production of ATP?
what is an indicator of the energy requirements of the patient?
VO2 per minute
What is true about the REE?
it requires a VO2 measurement to calculate
measuring the patients energy expenditure using oxygen consumption is referred to as what?
what is a pulmonary affect of starvation?
increased risk for pneumonia
what in excess quantities contributes to the most CO2 production?
what element must be stored in sufficient quanitites to meet the metabolic demands of the diaphragm?
what is true about anaerobic metabolism?
it can cause metabolic acidosis
what is the RQ value of a patient on pure carbohydrate diet?
in feeding the patient with pulmonary disease, how many grams of protein per kilogram of body weight are initially required?
what may be more difficult to achieve with a high carbohydrate diet?
weaning from mechanical ventilation
nitrogen balance is useful in determining:
the adequacy of protein intake
what is associated with a low protein diet?
what is associated with a high fat diet?
increased risk for heart disease
decreased tissue oxygenation
what mineral plays a very important role in oxygen transport?
what route of nutritional feeding is considered as the first choice in feeding patients?
what is associated with an increased metabolism?
which of the following might indicate poor nutritional status?
negative nitrogen balance
what factor may contribute to decreased colloid osmotic pressure and pulmonary edema?
how does the cachetic patient appear physically?
very thin and malnourished
what is true about the resting energy expenditure?
i1) it requires a VO2 measurement in order to calculate
2) it gives an estimation of the patients nutritional needs
3) if it is not met, use of the bodies stored energy is required
what is the RQ value of a patient on a pure fat diet?
Measures of REE in malnourished emphysema patients will consistently be:
what is normal BMI?
what blood values quickly reflect nutritional deprivation?
prealbumin (TBPA) and retinol-binding protein (RBP)
what mightv indicate poor nutritional status?
negative nitrogen balance
what dietary component should most of your caloric intake com from?
essential amino acids are readily synthesized by the body:
false; it aids in the balance of nitrogen
what is the RQ value of a patient on a pure protein diet?
what is the most accurate test to determine the protein nutrition status?
what is the importance of potassium?
regulates cell excitability & maintains intracellular fluid
what are the three formed elements of the blood?
what is the medical name for platelets?
what is the primary role for white blood cells?
to fight infection
what is the normal reference range for WBCs?
4,500 - 10,000/ mm3
what white cell type normally represents the largest percent in the WBC differential?
a left shifted white cell differential is evidence by what finding?
an increase in the number of bands (immature neutrophils)
what is a common finding in patients with bacterial pneumonia?
what is a common finding in patients with an allergic reaction?
viral infections typically produce which abnormality?
your patient had AIDS. the most useful test to identify the prognosis of AIDS is:
Chemotherapy used to treat cancer can cause a suppression of blood counts for which cells?
your patient may have active TB. What laboratory finding is most consistent with this suspicion?
What statements are true regarding Hb?
1) it functions in oxygen transport
2) it is the main component in RBCs
3) it functions in CO2 transport
What is the most common cause of anemia?
1) defined as an increase in RBC, Hb, and Hct
2) can be caused by chronic hypoxemia
3) increases the oxygen-carrying capacity of the blood
which test is used to assess the patients blood clotting ability?
which electrolytes closely affects the muscle function?
Which electrolyte is mainly responsible for extracellular water balance?
anion gap is useful in assessing the cause of:
an increase in the sweat chloride electrolyte concentration is seen in:
which tests are a measure of the kidney function?
BUN & Creatinine
The recommended test for early detection of myocardial infarction is:
what bacteriologic test is used to determine the effectiveness of antibiotics on a particular organism?
A Ziehl-Neelson stain is used to identify what organism?
what items are evaluated during a macroscopic (gross) sputum examination?
color, consistency, and volume
What is the most common cause of bacterial pneumonia?
what finding is consistent with pleural infection?
Opaque or turbid pleural fluid
what test performed during a urine analysis could be helpful in diagnosing diabetes mellitus?
Proteinuria usually is indictive of what?
what may cause a patient to have a negative reaction to a skin test?
1) He/She does not have the disease
2) He/She is anergic
what is true regarding a PPD?
It is often positive if the patient has previously had a BCG vaccination.
what percent of the WBCs are Eosinophils?
what percent of WBCs are lymphocytes?
20-40% (two types: T-cells and B-cells)
what percent of WBCs are monocytes?
what makes up the complete WBC?
Granulucytes (Neutrophils, Eosinophils, and Basophils)
What is the common reference range for CaO2?
To measure ACTUAL blood O2 saturation, you would recommend?
pseudoneutrophilia can be caused by what?
Stress or trauma; no banded cells
increase in the number of white blood cells
Abnormally low white blood cell count
Elevated associated with allergic reaction (asthmatic)
Elevated, responds with eosinophils
Elevation associated with viral infections
What happens with lidocaine OD?
Two problems with lidocaine with a bronchoscopy
Seizures(OD) and masks arythmia's (pvc = hypoxia)
Anion gap range
Hyperkalemia (high potassium)
High T waves, bradycardia-cardiac arrest
What electrolytes cAuse muscle weakness?
Hypokalemia and hypo magnesia
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