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WorksheetsRESP 172 Final Exam Review
Total questions: 108
Worksheet time: 54mins
The main goal of a bedside assessment is to:
Diagnose diseases
Evaluate the patient’s condition and response to therapy
Perform surgery
Measure oxygen saturation only
Normal respiratory rate for an adult at rest is:
8–12 breaths/min
12–20 breaths/min
20–30 breaths/min
30–40 breaths/min
Which breath sound is considered abnormal?
Vesicular
Bronchial
Crackles
Normal vesicular
Pulse oximetry measures:
PaO₂
Hemoglobin oxygen saturation
PaCO₂
Blood pressure
Which is an example of a trend monitoring tool?
One-time ABG
Continuous pulse oximetry
Patient history
Blood glucose spot check
A patient with low hemoglobin may have what?
Reduced oxygen-carrying capacity
Adequate oxygen delivery
High oxygen saturation
No effect on oxygen therapy
What does capnography show?
Oxygen saturation
Blood Pressure
Exhaled CO2
Hemoglobin
Which of the following is noninvasive monitoring?
Continuous pulse oximetry
Invasive blood pressure monitoring
Arterial blood gas analysis
Cardiac catheterization
Which vital sign change might indicate increased work of breathing?
Increased respiratory rate
Normal SpO2
Decreased heart rate
Slight temperature drop
Scenario: You enter a patient’s room for a bedside respiratory assessment. Task: Select two specific observations you would make and explain why each is clinically important.
Observe the patient’s respiratory rate and effort, as these can indicate respiratory distress or failure.
Check the patient’s temperature and pulse to assess for infection.
Inspect the patient’s skin for rashes and bruises to identify possible allergic reactions.
Assess the patient’s urine output and color to monitor kidney function.
Observation Check: A patient’s SpO₂ reads 88% while their heart rate is 110 bpm. Task: Explain why it’s important to check both SpO₂ and vital signs instead of relying on only one measurement.
Because checking both SpO₂ and vital signs provides a more complete picture of the patient’s condition.
Because SpO₂ alone always indicates all health problems.
Because heart rate alone is enough to assess oxygenation.
Because vital signs are not important when SpO₂ is measured.
Capnography Insight: During mechanical ventilation, you notice a rising end-tidal CO₂. Task: Describe how capnography helps identify respiratory problems in this situation.
Capnography helps detect hypoventilation and airway obstruction by showing changes in end-tidal CO₂.
Capnography is used to measure blood oxygen levels directly.
Capnography only monitors heart rate during ventilation.
Capnography is not useful for identifying respiratory problems during mechanical ventilation.
Lab Interpretation: A patient’s recent lab shows 7.5 g/dL in the component responsible for transporting oxygen in the blood. What is this component?
Hemoglobin
Platelets
Albumin
Leukocytes
Low levels of Hemoglobin (Hgb) or hematocrit (Hct) indicate reduced oxygen delivery to tissues. This is clinically significant because:
It can lead to tissue hypoxia and organ dysfunction.
It increases the risk of blood clots.
It improves oxygen delivery to tissues.
It causes excessive bleeding.
Prevention Focus: Monitoring a patient’s gas exchange on the floor can help prevent which two common problems?
Hypoxemia and hypercapnia
Hypertension and bradycardia
Dehydration and hypothermia
Arrhythmia and anemia
Identify two key observations from the assessment of a patient presenting with RR 28, anxious appearance, upright posture, use of accessory muscles, and crackles on auscultation.
Anxious appearance and use of accessory muscles
Normal respiratory rate and relaxed posture
No crackles and absence of accessory muscle use
Calm demeanor and supine posture
Case 1: A patient presents with RR 28, anxious appearance, upright posture, use of accessory muscles, and crackles on auscultation. 2. Which two immediate interventions should be taken?
Administer oxygen and position the patient upright
Give oral fluids and encourage deep breathing exercises
Start antibiotics and provide pain relief
Apply a warm compress and monitor temperature
Case 2: A patient on the floor has an SpO₂ of 85% while breathing room air. The patient appears lethargic, with rapid, shallow breathing, and dusky skin color. 1. Identify the main oxygenation problem in this patient and explain how the clinical signs support your conclusion.
The patient is experiencing hypoxemia, as indicated by low SpO₂, lethargy, rapid shallow breathing, and dusky skin.
The patient is experiencing hypercapnia, as indicated by low SpO₂ and lethargy.
The patient is experiencing metabolic acidosis, as indicated by rapid breathing and dusky skin.
The patient is experiencing dehydration, as indicated by lethargy and dusky skin.
Case 2: A patient on the floor has an SpO₂ of 85% while breathing room air. The patient appears lethargic, with rapid, shallow breathing, and dusky skin color. 2. Which two interventions are appropriate to improve oxygenation in this patient?
Administer supplemental oxygen and position the patient upright
Give oral fluids and encourage deep breathing exercises
Apply a warm blanket and reduce room lighting
Start intravenous antibiotics and restrict movement
Case 3: A mechanically ventilated patient shows rising end-tidal CO₂ and decreased perfusion. Identify two possible causes for these findings.
Hypoventilation and decreased cardiac output
Hyperventilation and increased cardiac output
Bronchospasm and hypertension
Metabolic alkalosis and tachycardia
Case 3: A mechanically ventilated patient shows rising end-tidal CO₂ and decreased perfusion. Which of the following are appropriate interventions or actions to take?
Increase ventilator rate and assess for causes of decreased perfusion
Decrease ventilator rate and ignore perfusion changes
Administer sedatives and reduce monitoring
Continue current settings and wait for improvement
True or False: Pulse oximetry can replace ABG analysis completely.
True
False
One advantage of noninvasive monitoring (e.g., SpO₂, ETCO₂) is:
Provides exact arterial oxygen content
Minimizes patient discomfort and risk of infection
Always replaces the need for ABGs
Measures hemoglobin directly
Fill in the blank: A sudden increase in heart rate from 88 to 120 bpm should prompt an RT to act immediately because ________________. Describe one intervention or assessment you would perform in response.
It may indicate acute distress, hypoxemia, pain, or other clinical deterioration. Assess the patient, check oxygenation, and intervene as needed.
It is a normal response to routine care and does not require intervention.
It always indicates the patient is experiencing anxiety and should be left alone.
It suggests the patient is ready for discharge and no further assessment is needed.
Fill in the blank: One simple way to prevent hypoxemia in a patient on supplemental oxygen is ____________ because it ______________. Explain how this intervention directly improves oxygenation.
to ensure proper device placement and flow rate; maintains adequate oxygenation and prevents desaturation.
to decrease the oxygen flow rate; increases carbon dioxide retention.
to remove the oxygen device periodically; allows for natural breathing cycles.
to use room air instead of supplemental oxygen; prevents oxygen toxicity.
A reduced DLCO most commonly indicates:
Asthma
Interstitial lung disease or emphysema
Obesity
Bronchitis
During a 6-minute walk test, a drop in SpO₂ from 96% to 87% suggests:
Need for oxygen during exercise
Poor effort
Improper sensor placement
Normal Response
ABG 7.31 / 52 / 25 → Interpretation?
Respiratory alkalosis
Metabolic alkalosis
Metabolic Acidosis
Respiratory Acidosis
Acute SOB and chest pain, clear CXR, respiratory alkalosis → likely cause?
Pneumonia
Pulmonary embolism
COPD exacerbation
ARDS
Elevated D-dimer and sudden dyspnea indicate:
Pneumothorax
CHF
Pulmonary embolism
Pleural effusion
Which hemodynamic finding differentiates pulmonary hypertension from left-heart failure?
Low right-ventricular pressure
Crackles and frothy sputum
Increased left-atrial pressure
Elevated pulmonary-artery pressure with normal wedge pressure
Which of the following patients is most at risk for developing a pulmonary embolism (PE)?
Young adult with mild asthma
Ambulatory patient after outpatient surgery
Post-operative orthopedic patient on bed rest
Patient with treated pneumonia
ABG 7.28 / 55 / 28 → Interpretation?
Respiratory alkalosis
Uncompensated respiratory acidosis
Compensated metabolic alkalosis
Metabolic acidosis
Immediate action for suspected pulmonary embolism?
Increase PEEP
Start IS therapy
Suction patient
Notify provider, initiate O₂, monitor closely
In pulmonary hypertension, expected finding:
Left-sided crackles only
Right-sided heart strain and jugular venous distension
Bradycardia
Bounding peripheral pulses
ABG 7.50 / 30 / 24 → Interpretation?
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Which spirometry finding is consistent with a restrictive disorder?
Decreased FEV₁ only
Normal values for all volumes
Normal FEV₁/FVC ratio and decreased FVC
Decreased FEV₁/FVC ratio and increased FVC
Which test is most useful for evaluating diffusion capacity?
DLCO
Spirometry
ABG
Plethysmography
Which diagnostic test confirms pulmonary hypertension?
Chest radiograph
Right-heart catheterization
Echocardiogram
ABG
Which patient should not receive vigorous chest physiotherapy (CPT)?
Bronchiectasis
Cystic fibrosis
Recent esophageal surgery
Chronic bronchitis
During spirometry, a patient’s FEV₁ is 1.8 L (50% predicted) and FVC is 3.8 L (75% predicted). The FEV₁/FVC ratio is 47%.
Restrictive pattern
Obstructive pattern
Normal
Poor effort
Which test measures total lung capacity and residual volume?
DLCO test
Spirometry
Body plethysmography
Pulse oximetry
A patient has a normal FEV₁/FVC ratio but both FVC and TLC are decreased. What type of defect is present?
Normal
Restrictive
Obstructive
Which value is calculated to evaluate diffusion capacity?
VT
FEV₁
DLCO
RV
Which step is most important to ensure accurate PFT results?
Testing in a noisy environment
Calibrating equipment before testing
Allowing patient to smoke beforehand
Having the patient seated only
Which of the following is most consistent with poor patient effort on spirometry?
Normal FEV₁/FVC ratio
Inconsistent flow–volume loops
High DLCO
Increased TLC
Which PFT finding is expected in emphysema?
Normal TLC with low FVC
Normal volumes with low DLCO
Increased TLC and RV
Decreased TLC and RV
In restrictive disease such as pulmonary fibrosis, which value is typically reduced?
Total lung capacity
Airway resistance
RV/TLC ratio
FEV₁/FVC ratio
A chest x-ray shows blunting of both costophrenic angles. What does this indicate?
Pneumothorax
Atelectasis
Pleural effusion
Hyperinflation
Which imaging study best detects pulmonary embolism?
CT pulmonary angiography
Standard PA chest x-ray
Bronchoscopy
Which of the following is the best initial test for suspected pulmonary embolism?
D-dimer
CT pulmonary angiography
Standard PA chest x-ray
Bronchoscopy
A right-sided pneumothorax will appear on chest x-ray as:
Dense opacity in right base
Flattened diaphragm bilaterally
Hyperlucency with absent vascular markings on right
Mediastinum shifted toward right
A portable AP chest x-ray shows diffuse patchy infiltrates and air bronchograms. Which diagnosis is most likely?
Pneumonia
Atelectasis
Pleural effusion
Pulmonary embolism
What finding indicates left-sided pleural effusion on chest x-ray?
Hyperinflation on left
Tracheal deviation to right and meniscus on left base
Right hemidiaphragm elevation
Collapsed left upper lobe
Which imaging technique provides real-time evaluation of pleural fluid movement?
MRI
Ultrasound
Bronchoscopy
CT
The hallmark symptom of interstitial lung disease is:
Hemoptysis with fever
Sudden chest pain
Productive cough with purulent sputum
Progressive dyspnea with dry cough
Which of the following is an expected finding in ILD?
Increased TLC
Decreased DLCO
Obstructive pattern on PFTs
Normal lung compliance
Which of the following is a radiographic finding in pulmonary fibrosis?
Apical hyperinflation
Reticulonodular pattern
Pleural meniscus sign
Lobar consolidation
Which therapy slows disease progression in idiopathic pulmonary fibrosis?
Bronchodilators only
No proven therapies
Long-term steroids alone
Antifibrotic medications
Which diagnostic procedure confirms a pleural effusion?
Bronchoscopy
Pulse oximetry
Thoracentesis
Sputum culture
After thoracentesis, the patient suddenly develops dyspnea and chest pain. CXR shows absent vascular markings on right.
Pneumothorax
Atelectasis
Hemothorax
Empyema
A pleural fluid sample that is cloudy and foul-smelling indicates:
Hemothorax
Empyema
Transudate
Chylothorax
Which pleural disease requires chest-tube drainage?
Small effusion
Trapped lung
Simple pleuritis
Large pneumothorax or empyema
A post-operative patient develops sudden dyspnea and pleuritic chest pain. ABG shows respiratory alkalosis and hypoxemia.
Pneumonia
Asthma attack
Atelectasis
Pulmonary embolism
Which bedside test can help rule out pulmonary embolism when negative?
Troponin
BNP
D-dimer
CRP
The most common source of pulmonary emboli is:
Right atrium
Pulmonary arteries
Coronary sinus
Deep veins of the legs
In pulmonary hypertension, which side of the heart is primarily affected?
Right atrium
Right ventricle
Left ventricle
Left atrium
Which imaging study best confirms pulmonary hypertension?
Chest x-ray
ABG
Echocardiogram
CT angiogram
Which ABG pattern is common in acute pulmonary embolism?
Respiratory alkalosis with hypoxemia
Normal ABG
Respiratory acidosis with hypercapnia
Metabolic alkalosis
What is the initial treatment priority for suspected PE?
Obtain sputum sample
Insert chest tube
Perform postural drainage
Administer oxygen and notify provider
Chronic pulmonary hypertension may progress to:
Left-sided heart failure
Pleural effusion
Pulmonary fibrosis
Cor pulmonale
A patient with a known DVT suddenly becomes short of breath. The most appropriate immediate test is:
EKG
Bronchoscopy
CT pulmonary angiogram
Sputum culture
A patient with pulmonary hypertension presents with ankle edema and hepatomegaly. These findings suggest:
Fluid overload only
Renal disease
Left-sided heart failure
Right-sided heart failure
Which preventive measure best reduces risk of pulmonary embolism in post-operative patients?
High-calorie diet
Routine antibiotics
Daily chest x-rays
Early ambulation and leg compression devices
Which ECG finding is sometimes associated with acute PE?
Bradycardia
Prolonged QT
Atrial flutter
Sinus tachycardia
Which imaging study best confirms the presence of a pleural effusion?
CT scan of the chest
Ultrasound of the thorax
Standard chest radiograph (CXR)
MRI of the chest
Which of the following best defines obstructive lung disease?
Restriction of lung expansion
Airflow limitation with difficulty exhaling
Decreased diffusion capacity only
Increased lung compliance without obstruction
Which PFT finding is most consistent with COPD?
FEV1/FVC ratio > 80%
FEV1/FVC ratio < 70%
Increased DLCO
Which condition is characterized by reversible airway obstruction?
Emphysema
Chronic bronchitis
Asthma
Bronchiectasis
A barrel chest is most commonly associated with:
Asthma
Chronic bronchitis
Emphysema
Pulmonary fibrosis
Which ABG pattern is typical in early COPD exacerbation?
Respiratory alkalosis
Compensated respiratory acidosis
Metabolic acidosis
Normal ABG values
Which chest x-ray finding is common in emphysema?
Bat-wing infiltrates
Flattened diaphragms and hyperinflation
Ground-glass opacities
Pleural effusion
Which intervention is most appropriate for mucus clearance in chronic bronchitis?
Bronchodilators only
Airway clearance techniques
High-flow oxygen therapy
Diuretics
Which of the following differentiates asthma from COPD?
Asthma is progressive and irreversible
COPD is reversible with bronchodilators
Asthma is reversible, COPD is progressive
Both are reversible with corticosteroids
Which patient education strategy is most critical in COPD management?
Smoking cessation
High-flow oxygen therapy
Daily chest x-rays
Which of the following is a risk of excessive oxygen therapy in COPD patients?
Hypoxemia
Suppression of hypoxic drive leading to hypercapnia
Increased elastic recoil
Reduced mucus production
Which of the following is NOT a direct cause of ARDS?
Pneumonia
Aspiration
Sepsis
Smoke inhalation
Which indirect cause is most common in ARDS?
Trauma
Sepsis
Pancreatitis
Massive transfusion
Which phase of ARDS occurs within the first 7 days?
Exudative phase
Proliferative phase
Fibrotic phase
Resolution phase
Which ABG pattern is typical in early ARDS?
Respiratory acidosis with hypoxemia
Respiratory alkalosis with hypoxemia
Metabolic acidosis with hypercapnia
Normal ABG values
Which imaging finding is characteristic of ARDS?
Bat-wing infiltrates
Diffuse bilateral opacities ("white-out")
Flattened diaphragms
Pleural effusion only
According to the Berlin Definition, severe ARDS is defined by:
P/F ratio 200-300
P/F ratio 100-200
P/F ratio < 100
Which ventilator strategy is recommended for ARDS?
High tidal volume ventilation
Low tidal volume ventilation (4–6 ml/kg IBW)
No PEEP
Plateau pressure > 35 cmH2O
What is the primary purpose of PEEP in ARDS management?
Reduce cardiac preload
Prevent alveolar collapse and recruit alveoli
Increase tidal volume
Reduce FiO2 requirements only
Which adjunct therapy improves oxygenation by redistributing perfusion?
Prone positioning
Supine positioning
Fluid overload
Bronchodilators
Which complication is most associated with ARDS and mechanical ventilation?
Barotrauma
Pleural effusion
COPD exacerbation
Pulmonary embolism
Which finding indicates early intubation in burn patients?
Productive cough
Hoarseness or facial burns
Crackles on auscultation
Hyperinflated lungs
Which imaging study best detects pulmonary embolism?
Ultrasound
CT pulmonary angiogram
Standard PA chest x-ray
Bronchoscopy
Which complication may develop 24–48 hours after chest contusion?
COPD
ARDS
Pneumonia only
Pleural effusion
Flail chest is defined as:
Single rib fracture
Multiple rib fractures causing paradoxical motion
Pleural effusion with rib fractures
Pneumothorax with rib fractures
Obesity hypoventilation syndrome is characterized by:
PaCO₂ < 35 mmHg
PaCO₂ > 45 mmHg with chronic hypoventilation
PaO₂ > 100 mmHg
Normal PaCO₂ with hypoxemia
Which ventilatory strategy is recommended for obese patients?
Low PEEP
Higher PEEP to counteract reduced FRC
Tidal volume based on actual body weight
Supine positioning
Near drowning primarily causes hypoxemia due to:
Surfactant washout and alveolar collapse
Increased cardiac preload
Excess mucus production
Bronchospasm only
Which complication is common after near drowning?
ARDS and pneumonia
COPD exacerbation
Pleural effusion only
Pulmonary embolism
Which airway concern is most urgent in burn victims?
Airway edema
Pleural effusion
Hyperinflation
Atelectasis only
Which gas is a major risk in smoke inhalation injury?
Nitrogen
Carbon monoxide
Oxygen
Helium
Which systemic effect of burns increases pulmonary edema risk?
Fluid shifts
Reduced metabolic demand
Decreased oxygen consumption
Increased compliance
Acute heart failure is defined as:
Gradual decline in ventricular function
Rapid decline in ventricular function causing pulmonary congestion
Restrictive lung disease
Chronic right-sided failure only
