Deck 16: Bedside Assessment of the Patient

Question 1

What term is used to describe difficult breathing in the reclining position?

A) Orthopnea
B) Platypnea
C) Eupnea
D) Apnea

Answer 1

A
Explanation: Dyspnea may be present only when the patient assumes the reclining position, in which case it is referred to as orthopnea.

Question 2

What term is used to describe shortness of breath in the upright position?

A) Orthopnea
B) Platypnea
C) Eupnea
D) Apnea

Answer 2

B
Explanation: Shortness of breath in the upright position is known as platypnea.

Question 3

Which of the following terms is used to describe coughing up blood-streaked sputum?

A) Hematemesis
B) Hemoptysis
C) Hemolysis
D) Hemostasis

Answer 3

B
Explanation: Coughing up blood or blood-streaked sputum from the lungs is referred to as hemoptysis.

Question 4

Which of the following are elements of a patient's social and environmental history?
1) Occupation and employment history
2) Drugs and medications
3) Recent travel
4) Living arrangements

A)1, 3, and 4 only
B)1 and 4 only
C)1, 2, and 3 only
D)1, 2, 3, and 4

Question 5

Which of the following characteristics are typical for pleuritic chest pain?
1) Located laterally.
2) Sharp and stabbing in nature.
3) Increases with breathing.
4) Radiates to the arm.

A)3 and 4 only
B)1 and 3 only
C)1, 2, and 3 only
D)1, 2, and 4 only

Question 6

What term is used to describe sputum that has pus in it?

A) Fetid
B) Mucoid
C) Purulent
D) Tenacious

Question 7

What change in the patient's respiratory breathing pattern is commonly seen with significant fever?

A) Slower rate
B) More rapid rate
C) More prolonged expiratory time
D) More prolonged inspiratory time

Question 8

Which of the following factors has minimal or no impact on the effectiveness of the patient's cough?

A) Lung recoil
B) Airways resistance
C) Lung volume
D) Pulmonary vascular resistance

Question 9

Your patient has an abnormal sensorium. Which of the following is most likely true?

A) The patient knows his or her name.
B) The patient is confused about where he or she is.
C) The patient is aware of the correct day.
D) The patient knows the name of the hospital he or she has been taken to.

Question 10

Which of the following is most commonly associated with tripodding?

A) Severe pulmonary hyperinflation
B) Congestive heart disease
C) Pneumonia
D) Pulmonary fibrosis

Question 11

Which of the following conditions is most likely to cause a dry, nonproductive cough?

A) Chronic bronchitis
B) Cystic fibrosis
C) Pulmonary fibrosis
D) Chronic obstructive pulmonary disease

Question 12

Which of the following are associated with diaphoresis?
1) Fever
2) Severe stress
3) Acute anxiety
4) Hemoptysis

A)2 and 3 only
B)1 and 4 only
C)1, 2, and 3 only
D)2, 3, and 4 only

Question 13

Which of the following can be considered a purpose of the interview the RT performs?
1) To collect diagnostic information
2) To establish a rapport with the patient
3) To identify plans for payment
4) To identify the effect of therapy

A)1 and 4 only
B)2 and 3 only
C)1, 2, and 4 only
D)1, 2, 3, and 4

Question 14

The patient interview conducted by the clinician is done in which space?

A) Social space
B) Personal space
C) Intimate space
D) Critical space

Question 15

What term is used to describe the chest pain associated with blockage of the coronary arteries?

A) Angina
B) Myocarditis
C) Myalgia
D) Infarction

Question 16

Which of the following are common causes of an increase in the drive to breathe, which would increase the sensation of dyspnea?
1) Hypoxemia
2) Acidosis
3) High fever
4) Hypocapnia

A)1 and 4 only
B)2 and 4 only
C)1, 2, and 3 only
D)2, 3, and 4 only

Question 17

What is the technical term for secretions from the tracheobronchial tree that have not been contaminated by the mouth?

A) Sputum
B) Phlegm
C) Mucus
D) Pus

Question 18

Which of the following are critical elements of a patient's past medical history?
1) Childhood diseases
2) Prior major illnesses or surgery
3) Marital status
4) Drugs and immunizations

A)1 and 2 only
B)1 and 3 only
C)1, 2, and 3 only
D)1, 2, and 4 only

Question 19

Which of the following is an example of a leading question?

A) Is your breathing better now?
B) How is your breathing now?
C) When did your breathing change?
D) Where is your pain located?

Question 20

What is the most common cause of pedal edema?

A) Liver failure
B) Kidney failure
C) Heart failure
D) Electrolyte imbalances

Question 21

Which of the following is/are advantages of the digital blood pressure measurement devices?

A) They reduce the risk of human error.
B) They reduce the cost.
C) They have an alarm.
D) They measure blood pressure and stroke volume.

Question 22

What is the most common cause of jugular venous distention (JVD)?

A) Right-sided heart failure
B) Arterial hypoxemia
C) Tension pneumothorax
D) Acute systemic hypertension

Question 23

Which of the following is the least likely cause of lymphadenopathy in the neck?

A) Lymphoma
B) Pulmonary infection
C) Congestive heart failure
D) Lung cancer

Question 24

What is the advantage of COPD patients breathing through pursed lips during exhalation?

A) Helps the patient focus on breathing.
B) Promotes more complete emptying of the lungs.
C) Reduces the patient's anxiety level.
D) Improves arterial pH levels.

Question 25

What is the normal range for pulse pressure?

A) 20 to 35 mm Hg
B) 30 to 60 mm Hg
C) 30 to 40 mm Hg
D) 30 to 60 mm Hg

Question 26

Which of the following sites is closest to core body temperature?

A) Axillary
B) Oral
C) Rectal
D) Forehead

Question 27

Which of the following is a true statement about the cause of systemic hypertension in adult patients?

A) The cause is often unknown.
B) The cause is often related to poor diet.
C) The cause is often related to a lack of exercise.
D) The cause is often related to sleep apnea.

Question 28

What artery is most often used to assess arterial blood pressure?

A) Femoral
B) Radial
C) Ulnar
D) Brachial

Question 29

Which of the following are causes of hypotension?
1) Heart failure
2) Hypovolemia
3) Mild tachycardia
4) Peripheral vasoconstriction

A)2 and 4 only
B)1, 2, and 4 only
C)3 and 4 only
D)1, 2, 3, and 4

Question 30

What structure in the body is responsible for regulating the body temperature?

A) Pituitary gland
B) Thyroid gland
C) Hypothalamus
D) Thymus gland

Question 31

What is the normal range for systolic blood pressure in the adult patient?

A) 90 to 140 mm Hg
B) 80 to 100 mm Hg
C) 75 to 100 mm Hg
D) 60 to 100 mm Hg

Question 32

Which of the following is a common cause of pulsus paradoxus?

A) Acute asthma attack
B) Severe pneumonia
C) Congestive heart failure
D) Myocardial infarction

Question 33

What is the most common cause of hypothermia?

A) Exposure to cold environment
B) Head injury
C) Stroke
D) Thyroid gland dysfunction

Question 34

Which of the following is least likely to cause tachycardia?

A) Fever
B) Severe pain
C) Hypotension
D) Hypothermia

Question 35

Why should the respiratory therapist perform a blood pressure assessment fairly quickly?

A) The procedure is expensive.
B) The procedure cuts off blood flow to the forearm temporarily.
C) The respiratory therapist has other procedures to do.
D) The procedure is billed by the time involved.

Question 36

What is indicated by the presence of central cyanosis?

A) Respiratory failure
B) Circulatory failure
C) Anemia
D) Hypotension

Question 37

What is the normal range for diastolic blood pressure in the adult patient?

A) 40 to 80 mm Hg
B) 60 to 90 mm Hg
C) 80 to 110 mm Hg
D) 60 to 110 mm Hg

Question 38

Which of the following are common causes of tachypnea?
1) Hypoxemia
2) Exercise
3) Narcotic overdose
4) Metabolic acidosis

A)2, 3, and 4 only
B)1, 2, and 4 only
C)2 and 3 only
D)1 and 4 only

Question 39

Which of the following may cause the trachea to shift to the right?

A) Right-sided tension pneumothorax
B) Right-sided large pleural effusion
C) Right upper lobe atelectasis
D) Left lower lobe pneumonia

Question 40

What two factors determine cardiac output?

A) Ventricular filling and heart rate
B) Stroke volume and heart rate
C) Stroke volume and respiratory rate
D) Heart rate and tidal volume

Question 41

What disease is associated with a barrel chest?

A) Emphysema
B) Heart failure
C) Pneumonia
D) Pleural effusions

Question 42

While percussing a patient's chest wall, you detect an abnormal increase in resonance. Which of the following are possible causes of this finding?
1) Asthma
2) Pneumothorax
3) Emphysema
4) Pneumonia

A)1, 2, and 3 only
B)2 and 4 only
C)1, 3, and 4 only
D)1, 2, 3, and 4

Question 43

Which of the following represent proper chest auscultation technique?
1) The practitioner should begin auscultation at the lung bases.
2) The patient should be instructed to breathe through an open mouth.
3) The patient should be placed in a comfortable upright position.
4) The patient should avoid deeply inhaling because it can mask certain lung sounds.

A)1 and 4 only
B)1, 2, and 3 only
C)3 only
D)1, 2, and 4 only

Question 44

While palpating the thorax of a patient who repeats the words "ninety-nine," you note a localized area of decreased tactile fremitus on the lower right side. Which of the following could explain this finding?
1) Atelectasis on the right
2) Right-sided lower pneumothorax
3) Right-sided lower pleural effusion
4) Obstruction of a bronchus in the right lung

A)2, 3, and 4 only
B)1 and 3 only
C)3 and 4 only
D)1, 3, and 4 only

Question 45

While percussing a patient's chest wall, you encounter an area that produces a decreased resonance to percussion. Which of the following are potential causes of this finding?
1) Pneumothorax
2) Pleural effusion
3) Pneumonia
4) Atelectasis

A)2 and 3 only
B)2 and 4 only
C)2, 3, and 4 only
D)1, 2, 3, and 4

Question 46

To minimize bony interference with percussion on the posterior chest wall, the practitioner should have the patient do which of the following?

A) Lean forward at a 45-degree angle.
B) Keep his or her arms at the sides of the body.
C) Raise his or her arms above the shoulders.
D) Place his or her hands on the hips.

Question 47

Which of the following would cause an increase in tactile fremitus?

A) Pleural effusion
B) Pneumonia
C) Emphysema
D) Pneumothorax

Question 48

What term is used to describe an abnormal anteroposterior curvature of the spine?

A) Scoliosis
B) Pectus excavatum
C) Kyphosis
D) Pectus carinatum

Question 49

What term is used to describe the breathing pattern seen in COPD patients in whom the lower costal margins of the chest wall draw inward with each inspiration?

A) Hoover's sign
B) Kussmaul's sign
C) Abdominal paradox sign
D) Respiratory alternans sign

Question 50

The vibration created by percussion penetrates the lung to approximately what depth?

A) 1 to 2 cm
B) 3 to 5 cm
C) 5 to 7 cm
D) 8 to 10 cm

Question 51

While observing a patient's breathing, you note that the depth and rate first increase, then decrease, followed by a period of apnea. Which of the following terms would you use in charting this observation?

A) Apneustic breathing
B) Cheyne-Stokes breathing
C) Biot's breathing
D) Paradoxical breathing

Question 52

On palpating the neck region of a patient on a mechanical ventilator, you notice a crackling sound and sensation. What is the most likely cause of this observation?

A) Subcutaneous emphysema
B) Upper bronchial obstruction
C) Pneumonia of the upper lobes
D) Atelectasis of the upper lobes

Question 53

You observe a patient's breathing pattern as very irregular and interspersed with long periods of apnea. Which of the following is the most likely cause of this problem?

A) Central nervous system disorder
B) Congestive heart failure
C) Metabolic acidosis
D) Increased intracranial pressure

Question 54

What breathing pattern is associated with severe atelectasis?

A) Rapid and deep
B) Rapid and shallow
C) Slow and shallow
D) Slow and deep

Question 55

What is indicated by retractions?

A) An increase in PaCO₂
B) An increase in the work of breathing
C) A decrease in blood flow to the lungs
D) Reduction in lung volumes

Question 56

What breathing pattern is associated with diabetic ketoacidosis?

A) Kussmaul breathing
B) Apneustic breathing
C) Biot's breathing
D) Apnea

Question 57

A patient with asthma would tend to exhibit which of the following?

A) Prolonged inhalation
B) Slow and shallow breathing
C) Prolonged exhalation
D) Deep and fast breathing

Question 58

While observing a patient's breathing, you note that the depth and rate first increase, then decrease, followed by a period of apnea. Which of the following are potential causes of this abnormality?
1) Central nervous system disorder
2) Congestive heart failure
3) Metabolic acidosis

A)1 and 2 only
B)2 and 3 only
C)1 and 3 only
D)1, 2, and 3

Question 59

While palpating the chest of a patient who repeats the words "ninety-nine," you note an area of increased tactile fremitus over the left lower lobe. Which of the following could explain this finding?
1) Pneumothorax
2) Emphysema
3) Pneumonia
4) Pleural effusions

A)2 only
B)1 and 4 only
C)1, 2, and 4
D)3 only

Question 60

What is indicated by the breathing pattern known as abdominal paradox?

A) Obstructive lung disease
B) Restrictive lung disease
C) Heart failure
D) Diaphragm fatigue

Question 61

Which of the following are true of early inspiratory crackles?
1) They most often occur in COPD patients.
2) They generally indicate severe airway obstruction.
3) They are affected by coughing or positional change.
4) They are usually scant (few in number).

A)2 and 4 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 2, and 4 only

Question 62

Loud, tubular breath sounds with an expiratory component equal to the inspiratory component best describes which of the following breath sounds?

A) Adventitious
B) Bronchial
C) Vesicular
D) Bronchovesicular

Question 63

An increase in intensity and clarity of vocal resonance because of enhanced transmission of sound is referred to as which of the following?

A) Bronchophony
B) Vesicularity
C) Pectoriloquy
D) Egophony

Question 64

The first heart sound (S₁) is created primarily by which of the following?

A) Closure of the semilunar valves
B) Opening of the semilunar valves
C) Opening of the atrioventricular valves
D) Closure of the atrioventricular valves

Question 65

Which of the following changes in the characteristics of wheezing indicate improvement in airway obstruction following bronchodilator therapy?

A) Lower pitch, shorter duration
B) Higher pitch, shorter duration
C) Lower pitch, longer duration
D) Higher pitch, longer duration

Question 66

What does the presence of stridor indicate?

A) Lower airway obstruction
B) Increased secretions in the large airways
C) Upper airway obstruction
D) Bronchial spasm

Question 67

Right ventricular hypertrophy often produces a systolic thrust that can be felt and seen near which of the following?

A) Lower left border of the sternum
B) Upper right border of the sternum
C) Left fifth intercostal space, midclavicular line
D) Lower right border of the sternum

Question 68

In which of the following patient categories would the intensity of the point of maximal impulse (PMI) be most difficult to palpate?

A) Chronic pulmonary hyperinflation
B) Mitral (bicuspid) stenosis
C) Left ventricular hypertrophy
D) Right ventricular hypertrophy

Question 69

During auscultation of a patient's chest, you hear coarse crackles throughout both inspiration and expiration. These sounds clear when the patient coughs. Which of the following is the most likely cause of these adventitious sounds?

A) Opening of closed smaller airways or alveoli
B) Opening of collapsed large, proximal airways
C) Variable obstruction to flow in the upper airway
D) Movement of excessive secretions in the airways

Question 70

A creaking or grating sound that increases in intensity with deep breathing and is similar to coarse crackles, but is not affected by coughing, best describes which of the following?

A) Rhonchi
B) Friction rub
C) Rales
D) Wheezing

Question 71

Soft, muffled sounds heard mainly during inspiration over the peripheral lung parenchyma best describe which of the following breath sounds?

A) Vesicular
B) Bronchovesicular
C) Bronchial
D) Tracheal

Question 72

What is the area of the anterior chest wall overlying the heart called?

A) Epigastrium
B) Precordium
C) Pericardium
D) Axillary

Question 73

Inspiratory crackles in patients without excess secretions are most commonly associated with which of the following?

A) Reduced chest-wall sound transmission
B) Airways popping open during inspiration
C) Complete obstruction of the upper airway
D) Mucosal edema or inflammation

Question 74

Normal heart sounds are created primarily by which of the following?

A) Opening of the heart valves
B) Rush of blood during systole
C) Closing of the heart valves
D) Electrical conduction in the heart

Question 75

What term best describes a loud, high-pitched continuous sound heard (often with the unaided ear) primarily over the larynx or trachea during inhalation in patients with upper airway obstruction?

A) Stridor
B) Rhonchi
C) Crackles
D) Wheeze

Question 76

During auscultation of a patient's chest, you hear abnormal discontinuous "bubbling" sounds at the lung bases. Which of the following chart entries best describes this finding?

A) "Bronchial sounds heard at lung bases."
B) "Wheezes heard at lung bases."
C) "Crackles heard at lung bases."
D) "Rhonchi heard at lung bases."

Question 77

In which of the following conditions would late-inspiratory crackles be most likely to occur?
1) Emphysema
2) Pulmonary fibrosis
3) Pneumonia
4) Pulmonary edema

A)2, 3, and 4 only
B)1, 3, and 4 only
C)3 and 4 only
D)1 and 2 only

Question 78

Which of the following can cause decreased breath sounds?
1) Air or fluid in the pleural space
2) Hyperinflation of lung tissue
3) Mucus plugging of the airways
4) Shallow or slow breathing

A)2 and 4 only
B)1, 2, and 3 only
C)1, 2, 3, and 4
D)2, 3, and 4 only

Question 79

Which of the following conditions would tend to shift the point of maximal impulse (PMI) farther to the left?
1) Pulmonary emphysema
2) Collapse of the left lower lobe
3) Collapse of the right lower lobe
4) Right-sided tension pneumothorax

A)1, 2, and 3 only
B)2 and 4 only
C)2, 3, and 4 only
D)1, 2, 3, and 4

Question 80

Where is the normal apical impulse (point of maximal impulse [PMI]) usually identified?

A) Third right intercostal space, left sternal border
B) Fifth left intercostal space, midclavicular line
C) Third left intercostal space, anterior axillary line
D) Fifth right intercostal space, midclavicular line