1. Maximum inspiratory pressure (MIP; NIF) measurement provides information about which of the following?
A. airway resistance
B. functional residual capacity
C. inspiratory capacity
D. respiratory muscle strength
Inspiratory pressures (MIP/NIF) most accurately measure respiratory muscle strength. Normal values vary by age and gender but for all groups generally exceed 70 cm H2O (negative). When a patient’s MIP/NIF is less than 20 to 30 cm H2O (negative), muscle strength may not be sufficient to support adequate spontaneous ventilation. Although MIP/NIF has been used as a weaning measure, it is best applied to follow the progress of patients with neuromuscular disorders that impair respiratory muscle function.
The correct answer is: respiratory muscle strength
2. Which of the following laboratory values is most consistent with a diagnosis of fluid depletion (dehydration)?
A. increased hematocrit
B. decreased BUN
C. decreased serum osmolality
D. decreased urine specific gravity
Fluid depletion (dehydration) is indicated by an increase in one of more of the following lab
measures: hematocrit, BUN, serum osmolarlity and/or urine specific gravity.
The correct answer is: increased hematocrit
3. Which of the following would represent an abnormal V/Q scan suggesting pulmonary embolism?
A. large segmental areas with normal ventilation and normal perfusion
B. large segmental areas with no ventilation and no perfusion
C. large segmental areas with normal ventilation but no perfusion
D. large segmental areas with no ventilation but normal perfusion
A V/Q scan is considered abnormal if there is a mismatch of ventilation and perfusion. Pulmonary embolism is indicated when a perfusion defect exists in an area with normal ventilation. The degree of mismatch determines the probability of PE as the diagnosis.
The correct answer is: large segmental areas with normal ventilation but no perfusion
4. During the administration of an aerosol treatment, the patient’s respiratory rate drops from 15 breaths/min to 6 breaths/min. Identify this breathing pattern.
B. Biot’s breathing
Bradypnea is a less than normal rate of breathing; narcotic drug overdose is a common cause. Hypercapnia and hypoxemia are potential problems.
The correct answer is: bradypnea
5. You measure the blood pressure of an adult patient as 88/53 mm Hg. Which of the following chart entries would you use in describing this finding?
A. patient is hypertensive
B. patient is hypotensive
C. patient has low pulse pressure
D. patient has high pulse pressure
An adult blood pressure of 88/53 mm Hg is less than the lower limits of normal (95/60 mm Hg), and would be considered hypotension. Hypotension may result from peripheral vasodilation, left ventricular failure, or low blood volume. In any case, hypotension can cause a decrease in perfusion of vital body and thereby impair oxygen delivery to the tissues. On the other hand, the pulse pressure (systolic-diastolic) is 35 mm Hg (88-53), which is in the normal adult range of 30-40 mm Hg.
The correct answer is: patient is hypotensive
6. While assisting a physician with a transthoracic ultrasound exam, you observe gliding or shimmering of the pleural layer during breathing. This observation
A. is consistent with the interstitial syndrome
B. rules out an underlying pneumothorax
C. indicates the presence of pleural adhesions
D. confirms an underlying pneumothorax
As viewed during real-time ultrasonic imaging, gliding or shimmering of the visceral pleural layer during breathing (the gliding sign) is a normal finding. Lung gliding tends to be most prominent in lower thorax, when the greatest lung expansion occurs. Generally, the presence of lung gliding rules out pneumothorax in the area under the ultrasound probe. Lung gliding will be absent in patients who are apneic or who have a pneumothorax in the area under the probe. Gliding also will be absent in patients with pleural adhesions and when a lung is not ventilated, e.g., with mainstem intubation or occlusion.
The correct answer is: rules out an underlying pneumothorax
7. Your review of a patient’s chart notes an admission diagnosis of fluid depletion/ dehydration. Which of the following findings would be most likely on bedside assessment of the patient?
A. inspissated secretions
B. pitting edema
C. venous distension
D. crackle on auscultation
Common signs of fluid depletion (dehydration) include CNS disturbances (sleepiness, apathy, stupor, coma); tachycardia; collapsed veins; hypotension; thick, inspissated secretions; decreased skin turgor; sunken eyes and dry, coated tongue; and weight loss. Venous distension, pitting edema, and crackles are signs of fluid overload (overhydration).
The correct answer is: inspissated secretions
8. 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
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
Kussmaul’s breathing is an abnormal pattern characterized by deep and fast respirations. Kussmaul’s breathing is usually associated with the body’s attempt to compensate for a metabolic acidosis, as in diabetic ketoacidosis.
The correct answer is: Kussmaul’s breathing
10. Gross observation of a patient’s sputum specimen reveals purulent green sputum that has separated into layers and has a foul odor. Which of the following is most likely causing the patient to produce this type of sputum?
The presence of green, layered sputum which has a foul odor suggests the presence of pseudomonas aeruginosa, which is a common finding in patients with bronchiectasis.
The correct answer is: bronchiectasis
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