1. Within one second after initiating a forced vital capacity (FVC) maneuver, a patient with normal lungs should be able exhale what percent of the FVC?
A. 35-50% of the FVC
B. 50-70% of the FVC
C. 70-83% of the FVC
D. 84-93% of the FVC
The normal range for the FEV1 as a percent of the FVC (FEV1%) is 70-83%. Patients with obstructive pulmonary disease will show a reduction in timed FEV% values, while patients with restrictive disorders will generally exhibit normal (or sometimes high) FEV% values.
The correct answer is: 70-83% of the FVC
2. Simple spirometry CANNOT be used to measure the
A. vital capacity
B. residual volume
C. tidal volume
D. inspiratory reserve volume
Residual volume (RV) is defined as the amount of air left in the lungs after a maximal exhalation. Because the RV cannot be exhaled, it cannot be measured by simple spirometry. And because the RV is a component of the FRC and TLC, simple spirometry also cannot measure these capacities.
The correct answer is: residual volume
3. Which of the following approaches can be used to obtain a medication history from a patient with a depressed level of consciousness or who is severely agitated?
A. obtain and review the patient’s past medical history
B. ask the patient’s nurse about the patient’s prescriptions
C. request that the lab run a comprehensive blood drug screen
D. obtain the patient’s current prescription vials from the family
In patients with a depressed level of consciousness or severe agitation, the medication history may need to be obtained from the family members. In these cases, it also may be useful to either obtain information on the pharmacies where the patient has prescriptions filled, or request that a family member provide the hospital pharmacy with all the patient’s current prescription vials for review.
The correct answer is: obtain the patient’s current prescription vials from the family
4. Which of the following thoracic ultrasound findings is consistent with the presence of a pneumothorax?
A. presence of gliding sign
B. absence of A-lines
C. presence of barcode sign
D. presence of seashore sign
Ultrasound findings consistent with the presence of an underlying pneumothorax include: absence of the gliding sign and B-lines, and the presence of A-lines and (on M-mode) the barcode sign. A lung point sign (or lead point) also may be present in patients with a pneumothorax, representing the transition between an area where pleural gliding is visible and where it stops (demarcating the beginning of air in the pleural space). The presence of the seashore sign on M-mode rules out pneumothorax.
The correct answer is: presence of barcode sign
5. Which of the following would tend to increase insensible water loss?
B. bypassed upper airway
D. diuretic administration
The (invisible) evaporative loss through the skin and respiratory tract is called insensible water loss. Normally about 2/3rd of this is lost via the skin, with only about 1/3rd lost via the respiratory tract. Insensible water loss is increased by fever, hypermetabolism and hyperventilation. Insensible water also increases when the upper airway is bypassed and no supplemental humidification is provided.
The correct answer is: bypassed upper airway
6. Which of the following would tend to decrease a patient’s energy expenditure?
C. major trauma
Common factors decreasing metabolic rate and thus energy expenditure include sedation/ analgesics, muscle paralysis, shock/hypovolemia, hypothermia/cooling, hypothyroidism, antipyretics, starvation, and properly applied ventilatory support. Conversely, fever, Inflammation (including SIRS), sepsis, major trauma (including burns), shivering, seizures, agitation/anxiety/ pain, hyperthyroidism, adrenergic drugs and ventilator weaning all tend to increase energy expenditure.
The correct answer is: hypothermia
7. A patient has acute respiratory acidosis. You would expect the base excess (BE) to range between:
A. + 6 mEq/L
B. – 6 mEq/L
C. +/- 2 mEq/L
D. +/- 8 mEq/L
In acute or uncompensated respiratory acidosis, the base excess (BE) should always fall within the normal range. On the other hand, when renal compensation is occurring in response to a chronic respiratory acidosis, the BE should rise above the normal range (due to the increased levels of plasma HCO3).
The correct answer is: +/- 2 mEq/L
8. Which of the following arterial blood gas results would most likely be reported for a patient who is having a mild asthma attack?
A. pH = 7.31 PCO2 = 50 torr PO2 = 60 torr
B. pH = 7.40 PCO2 = 50 torr PO2 = 50 torr
C. pH = 7.47 PCO2 = 32 torr PO2 = 60 torr
D. pH = 7.47 PCO2 = 40 torr PO2 = 50 torr
A mild asthma attack usually results in a respiratory alkalosis with hypoxemia. The only answer that matches this is the pH of 7.47, PaCO2 of 32 torr and the PaO2 of 60 torr.
The correct answer is: pH = 7.47 PCO2 = 32 torr PO2 = 60 torr
9. The Apgar score for a normal newborn infant ranges between
At birth, an Apgar score of 7-10 is considered normal. Scores of 4-6 are intermediate and usually dictate the need for more intensive support. Infants with Apgar scores of 0-3 usually undergo aggressive resuscitation. Needed interventions should never be delayed in order to obtain the Apgar score, nor should these scores dictate resuscitation procedures.
The correct answer is: 7-10
10. On inspection of a patient’s ECG strip, you note no identifiable P waves; rapid irregular undulations of the isoelectric line; and an irregular ventricular rhythm. In addition, the precordial cardiac rate is greater than the peripheral pulse rate. The most likely problem is:
A. 2nd degree (Wenckebach) heart block
B. ventricular fibrillation
C. atrial fibrillation
D. ventricular tachycardia
The most likely problem is atrial fibrillation, in which ectopic foci in the atria fire irregularly at rates greater than 350/min. P waves are replaced by irregular undulations of the isoelectric line. Since AV node transmission varies, the ventricular response is also irregular. With some contractions too weak to palpate peripherally, a pulse deficit (difference between the precordial and peripheral pulse rates) is often observed
The correct answer is: atrial fibrillation
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