You can find the answers to these questions in the TMC Test Bank.

1. A 67-year-old patient with COPD complains that she becomes breathless after brushing her hair and must sit down to catch her breath. This complaint is most closely related to which of the following?

A. increased work of breathing
B. cardiac tamponade
C. increased pulmonary reserve
D. orthopnea

2. Which of the following respiratory signs noted on inspection of an adult patient would be considered ABNORMAL?

A. ribs higher posteriorly than anteriorly at end-expiration
B. sternocleidomastoid muscles used at rest
C. costal angle of 90 degrees increases with inspiration
D. respiratory rate of 18 breaths per minute

3. You are reviewing the chest X-ray of a 32 year-old female receiving ventilatory support via an oral endotracheal (ET) tube. To assure proper placement of the tube, you would look for its tip to be positioned

A. at the same level as the carina
B. not more than 2 cm above the carina
C. between the 2nd and 4th thoracic vertebra
D. level with the fifth cervical vertebra

4. Which of the following would be the most likely cause of stridor in a child?

A. asthma
B. pneumonia
C. croup
D. cystic fibrosis

5. Upon reviewing the patient’s chart, results of a chest x-ray indicate: “Complete opacification of the left chest with a shift of the trachea and mediastinum to the left.” These findings are consistent with which of the following?

A. pneumothorax of the right lung
B. atelectasis of the left lung
C. diffuse pulmonary emphysema
D. right-sided pleural effusion

6. A 55 year old patient has been smoking 1-1/2 packs of cigarettes per day for 30 years. You would quantify and record his smoking history as:

A. 15 pack-years
B. 30 pack-years
C. 45 pack-years
D. 60 pack-years

7. When inspecting a chest radiograph, you note that the heart is shifted to the patient’s right. Which of the following is the most likely cause of this finding?

A. right sided tension pneumothorax
B. right sided pleural effusion
C. left sided atelectasis/lung collapse
D. left sided tension pneumothorax

8. You are evaluating a patient in the recovery room following an exploratory laparotomy. The patient appears to be asleep. His respiratory rate is 14/min and heart rate is 84/min. To determine the patient’s level of consciousness, you speak to the patient, who does not respond. Which of the following should you do FIRST?

A. wait 1 hour and then repeat the attempt
B. shake the patient’s arm gently
C. call for help
D. administer a sternal rub

9. In observing a patient, you note that her breathing is extremely deep and fast. Which of the following terms would you use in charting this observation?

A. Kussmaul’s breathing
B. Biot’s breathing
C. Cheyne-Stokes breathing
D. apneustic breathing

10. Which of the following findings would you expect to observe on the AP chest radiograph of a patient suffering from advanced stages of pulmonary emphysema?

A. increased vascular markings
B. flattening of the diaphragms
C. decreased radiolucency
D. increased C/T ratio

11. Which of the following procedures require active patient cooperation to be effective?

A. ventilator weaning
B. breathing exercises
C. mask CPAP
D. mechanical cough assist

12. During auscultation, you hear a creaking or grating sound which increases in intensity with deep breathing, but is not affected by coughing. Which of the following conditions best ‘fits’ this finding?

A. pleurisy
B. chronic bronchitis
C. pulmonary edema
D. atelectasis

13. A patient in ICU develops a supraventricular tachycardia at a rate of 165/min. Which of the following effects would this have on cardiac function?

A. increased end-diastolic volume
B. mitral valve regurgitation
C. increased stroke volume
D. decreased end-diastolic volume

14. The first heart sound (S1) is created primarily by:

A. closure of the semilunar valves
B. closure of the atrioventricular valves
C. opening of the semilunar valves
D. opening of the atrioventricular valves

15. Prior to initiating chest physiotherapy, the patient tell you that “I seem to breathe fast and lift my shoulders a lot, but l feel like I am getting enough air. I sleep through the night and use only one pillow.” You can conclude that the patient likely has:

A. dyspnea
B. orthopnea
C. increased work of breathing
D. a decreased level of consciousness

16. A patient with paradoxical chest wall movement most likely has:

A. atopic asthma
B. chronic bronchitis
C. flail chest
D. tension pneumothorax

17. The development of paradoxical pulse in a patient following trauma or cardiothoracic surgery, especially in connection with increasing venous pressure and heart rate, suggests:

A. severe COPD
B. pericarditis
C. myocardial infarction
D. cardiac tamponade

18. When performing posterior thoracic palpation of an adult, you note minimal right-side diaphragmatic movement as the patient takes a full, deep breath. Left-sided movement is normal. Which of the following conditions would best explain this finding?

A. right-sided pleural effusion
B. left lower lobe atelectasis
C. pulmonary emphysema
D. left phrenic nerve paralysis

19. A patient with asthma is in acute respiratory distress and presents to the emergency department with markedly diminished breath sounds. Following bronchodilator therapy, auscultation of the chest reveals rhonchi and wheezing. This change suggests which of the following?

A. development of a pneumothorax
B. improvement of the air flow
C. onset of pneumonia
D. development of pulmonary edema

20. While inspecting a spontaneously breathing adult patient’s thorax, you note paradoxical movement of the right chest wall. This observation is most consistent with which of the following conditions?

A. pulmonary emphysema
B. phrenic nerve dysfunction
C. pulmonary embolism
D. pulmonary fibrosis

21. An AP X-ray of a 3 year-old child with wheezing and stridor shows an area of prominent subglottic edema, but the lateral neck X-ray appears normal. What is the most likely problem?

A. croup
B. foreign body
C. epiglottitis
D. cystic fibrosis



22. Upon exam of an acutely dyspneic and hypotensive patient, you note the following (all limited to the left hemithorax): reduced chest expansion, hyperresonance to percussion, absent of breath sounds and tactile fremitus, and a tracheal shift to the right. These findings suggest:

A. left-sided pleural effusion
B. left-sided consolidation
C. left lobar obstruction/atelectasis
D. left-sided pneumothorax

23. When you make a return visit to a postoperative patient to assess her progress with incentive spirometry, she indicates that compared to yesterday her pain is preventing her from carry out the treatment. On a 10-point scale, she rates the effect of her pain on her activities as an ‘8.’ You should

A. coach her to go ahead with the incentive spirometry anyway
B. tell the nurse to up the dosage of the patient’s pain medication
C. switch the patient to intermittent positive pressure breathing therapy
D. report this finding to the patient’s attending physician

24. While assessing a patient receiving artificial ventilatory support, you note significant weakening of the pulse during the inspiratory phase of machine breaths. Which of the following is the most likely cause of this finding?

A. fluid retention due to acute renal failure
B. decrease stroke volume during positive pressure
C. increased metabolic rate due to diet restrictions
D. the development of a large tension pneumothorax

25. While interviewing a patient, you note obvious use of the neck muscles during regular inspiration, especially the scalenes. This finding is consistent with which of the following?

A. COPD
B. orthopnea
C. pulmonary embolism
D. myasthenia gravis

26. The attending physician of a patient who is experiencing pain asks that you evaluate the intensity of her pain. The most objective way to do so would be to:

A. Ask the patient “How much pain are you having”
B. Observe the patient for facial expressions indicative of pain
C. Measure the patient’s pulse and respiratory rate
D. Have the patient rate her pain on a numeric rating scale

27. Which of the following is relevant information regarding a patient’s occupational exposure history?

A. cleaning agents used at home
B. patient’s residential water supply
C. protective equipment worn on job
D. patient’s hobbies/avocational pursuits

28. Which of the following findings would you expect to observe on the AP chest radiograph of a patient suffering from advanced stages of pulmonary emphysema?

A. decreased vascular markings
B. elevated hemidiaphragms
C. decreased radiolucency
D. increased C/T ratio

29. Which of the characteristics of a patient’s sputum should be assessed at the bedside and documented in the chart?

A. density
B. DNA content
C. surface tension
D. viscosity

30. You hear bronchial breath sound over the patient’s right middle lobe. What condition is probably present?

A. emphysema
B. asthma
C. pneumonia
D. pleural effusion

31. When inspecting a normal chest radiograph, you would expect the heart to be positioned

A. entirely to the left side of the patient’s midline/spine
B. primarily to the left side of the patient’s midline/spine
C. entirely to the right side of the patient’s midline/spine
D. primarily to the right side of the patient’s midline/spine

32. After determining that an alert patient is experiencing pain and after quantifying its intensity as being relatively mild (3 on a scale of 10), you should:

A. Immediately report your findings to the patient’s physician
B. Record your findings in the chart, i.e., respiratory care progress notes
C. Repeat the intensity assessment to see if the results are reproducible
D. Assess how much the pain is interfering with the patient’s activities

33. During an education session with a 34 year old patient with asthma, you review with her how to recognize and respond to episodes of worsening symptoms. To confirm her understanding of this information you should ask:

A. “Can you explain to me what you would do if your symptoms worsen?”
B. “Do you know what to do if you experience an acute exacerbation of your disease?”
C. “You know that you should take the beta-agonist if your FEV1 decreases, correct?
D. “Do you understand all the information I have just reviewed with you?”

34. When interviewing a patient to obtain information about sputum production, he states that after coughing he typically produces about a “tablespoon full of spit’. You would record this in your assessment as equivalent to about what volume of sputum production?

A. 2 mL
B. 5 mL
C. 15 mL
D. 30 mL

35. A patient properly utilizing diaphragmatic breathing can be recognized by observing which of the following?

A. the abdomen rising on inspiration
B. the abdomen rising on exhalation
C. the use of pursed-lip breathing
D. the use of intercostal muscles during inspiration

36. During the assessment of a mechanically ventilated patient in the ICU you notice the following vital signs:

Heart rate:
118/min
BP:
135/90
Set resp rate:
8/min
Total resp rate:
35/min
Temp:
99.3 °F

A surgical resident has just inserted a right pleural chest tube to drain a significant pleural effusion. At this point you should recommend that the resident:

A. paralyze the patient
B. reposition the chest tube
C. ask the patient to relax
D. assess for pain

37. Which of the following patients most likely has a health literacy limitation?

A. a patient who asks a lot of care-related questions
B. a patient whose first language is not English
C. a patient who has difficulty correctly filling out a form
D. a patient who prefers watching television to reading

38. To assess for normal diaphragm activity, you should look for which of the following during inspiration?

A. outward motion of the abdomen
B. supraclavicular retractions
C. intercostal retractions
D. inward motion of the abdomen

39. Which of the following would be the most likely cause of stridor in an adult?

A. asthma
B. croup
C. epiglottitis
D. post-extubation edema

40. Incentive spirometry is to be initiated on a post-op cholecystectomy patient. Which of the following would be the best way to determine the patient’s ability to understand your instructions?

A. ask him to hold his breath for 3 sec
B. ask him to count backwards from 10
C. determine his orientation to person, place and time
D. ask him to repeat the instructions

41. A patient with an acute upper airway obstruction would have which of the following physical signs?

A. inspiratory crackles
B. unilateral lung expansion
C. dullness to percussion
D. inspiratory stridor

42. Upon palpating a patient’s radial artery for 1 minute, you note 90 unevenly spaced beats with decreased pulse strength during inspiration. Which of the following describes the patient’s pulse?

A. thready pulse
B. bounding pulse
C. pulsus alternans
D. pulsus paradoxus

43. The best way to assess a patient’s level of consciousness is to

A. ask the patient to follow simple commands
B. check vital signs
C. check for reflex activity
D. check pupil size and reactivity

44. The chest X-ray of a patient admitted to ICU exhibits a large area of consolidation in the left lung. Which of the following is a potential cause of this finding?

A. lobar pneumonia
B. pulmonary barotrauma
C. tension pneumothorax
D. interstitial emphysema

45. Auscultation of a patient’s chest revealing wheezes would indicate the presence of which of the following:

A. pleural effusion
B. pneumothorax
C. laryngospasm
D. aspirated foreign body

You can find the answers to these questions in the TMC Test Bank.