Question 1

You are working at the triage desk in the ED when a young man on crutches approaches the desk. He appears moderately short of breath. He states he had a cast put on his left leg seven days ago after surgery for a ruptured Achilles tendon. This morning, while he was watching television, he suddenly became short of breath. He has a history of asthma, for which he takes Xopenex as needed, and is taking Tylenol with codeine for pain related to his surgery. The patient's lung sounds are clear and equal, SpO₂ is 90 percent on room air, heart rate is 100 and regular, respirations are 24 and slightly labored, blood pressure is 128/88 mmHg, and the patient is afebrile. These findings are most consistent with: A) allergic reaction to codeine. B) COPD exacerbated by recent anesthesia. C) pneumonia secondary to recent anesthesia. D) pulmonary embolism associated with immobilization of the lower extremity.

Accepted Answer

The patient's recent surgery and immobilization of his lower extremity increase his risk for developing a pulmonary embolism (PE), which is a potentially life-threatening condition. Additionally, his sudden onset of shortness of breath and slightly labored respirations are consistent with a PE. The absence of wheezing and clear lung sounds make an allergic reaction or COPD exacerbation less likely, and the absence of fever and normal blood pressure make pneumonia less likely. Urgent diagnostic testing, such as a CT angiogram, is needed to confirm the diagnosis of PE and guide treatment.

Question 2

In which of the following situations is a significant amount of carboxyhemoglobin most likely to be present? A) A patient who is being treated with nitrites for cyanide poisoning B) A patient with COPD who is short of breath with an SpO₂ of 90 percent C) A patient found unresponsive in an apartment in which there is a gas furnace D) A patient who inhaled anhydrous ammonia fumes

Accepted Answer

Carbon monoxide, a byproduct of incomplete combustion, binds to hemoglobin in the blood to form carboxyhemoglobin, reducing the amount of oxygen that can be transported in the blood. In scenario C, the patient was found in an apartment with a gas furnace, which suggests the possibility of carbon monoxide poisoning. Therefore, a significant amount of carboxyhemoglobin is most likely to be present in this scenario. Option A is incorrect because nitrites are used to treat cyanide poisoning, not carbon monoxide poisoning. Option B is incorrect because while patients with COPD may have reduced oxygen levels, carboxyhemoglobin is not a likely factor in this scenario. Option D is incorrect because anhydrous ammonia is not known to form carboxyhemoglobin.

Question 3

The valve between the right atrium and right ventricle is the ________ valve.
A) bicuspid
B) pulmonic
C) tricuspid
D) aortic

Accepted Answer

The valve between the right atrium and right ventricle is called the tricuspid valve, as it has three cusps. The bicuspid valve is located between the left atrium and left ventricle, while the pulmonic and aortic valves are located in the arteries leaving the heart.

Question 4

Conditions that can cause an inaccurate pule oximetry ready include all EXCEPT?
A) The presence of methemoglobinemia
B) Hyperfusion
C) Anemia
D) Shivering

Accepted Answer

Hyperfusion does not cause inaccurate pulse oximetry readings. Conditions like methemoglobinemia, anemia, and shivering can affect the accuracy of the readings.

Question 5

A male patient with an acute exacerbation of his emphysema presents in severe distress with decreased air movement and diffuse inspiratory wheezes in all fields. HR = 132, BP = 142/88, RR =30, SaO₂ = 88%. Which of the following blood gas values is most likely? A) pH of 7.6 B) PO₂ of 100 mmHg C) PCO₂ of 70 mmHg D) PCO₂ of 35 mmHg

Accepted Answer

Given the patient's severe distress, decreased air movement, and decreased SaO2, it is likely that the patient has respiratory acidosis. Therefore, the most likely blood gas value is an increased PCO2 (option C). A pH of 7.6 (option A) and a PO2 of 100 mmHg (option B) are not typical findings in a patient with an acute exacerbation of emphysema. A PCO2 of 35 mmHg (option D) would actually be a normal value and not consistent with the patient's clinical presentation.

Question 6

ETCO₂ is recorded during phase ________ of the capnogram. A) I B) II C) III D) IV

Accepted Answer

ETCO₂ represents the end-tidal CO2, which is recorded during phase III of the capnogram. This phase reflects the plateau of exhaled CO2 concentration, indicating alveolar gas.

Question 7

Lung perfusion depends on all of the following EXCEPT:
A) efficient pumping of blood by the heart.
B) intact pulmonary capillaries.
C) an intact alveolar membrane.
D) adequate blood volume.

Accepted Answer

Lung perfusion depends on efficient pumping of blood by the heart, intact pulmonary capillaries, and adequate blood volume. An intact alveolar membrane is not necessary for lung perfusion, as oxygen and carbon dioxide exchange between the alveoli and the blood occurs via diffusion and is dependent on gas pressure gradients.

Question 8

You are working in the ED, caring for a 55-year-old female patient with a long history of COPD. She is more short of breath today than usual, and states that she has an increased cough. She has a tympanic temperature of 99.8°F. You have drawn arterial blood gases with the patient on room air; when the report comes back, it shows that the patient has a PaO₂ of 92 mmHg. Which of the following is most likely? A) You have inadvertently drawn a venous sample. B) The patient is critically hypoxic and requires assisted ventilation. C) This is the typical value for this patient. D) The lab performed the test incorrectly.

Accepted Answer

In a patient with COPD, a PaO2 of 92 mmHg on room air is typical, as they often have chronic hypoxemia. This value does not necessarily indicate a need for assisted ventilation or an error in the lab test. However, the patient should still be closely monitored and treated for exacerbation of COPD.

Question 9

Which of the following is the most important determinant of ventilatory rate? A) Arterial PO₂ B) Venous PCO₂ C) Venous PO₂ D) Arterial PCO₂

Accepted Answer

Arterial PCO2 is the most important determinant of ventilatory rate, as it is the primary factor that drives respiration by stimulating the chemoreceptors in the medulla oblongata to increase or decrease respiratory rate. The other options (arterial PO2, venous PCO2, and venous PO2) do not have as direct or significant an impact on ventilatory rate.

Question 10

Your patient is a 16-year-old male who attempted suicide. He is unconscious and apneic, lying supine on a garage floor. The family states that they found the patient unconscious in the front seat of a car that was running in an enclosed garage. HR = 70, BP = 100/60, RR = 0. In addition to an IV of normal saline, which of the following is the most appropriate action?
A) Intubate, remove the patient from the garage, and transport to a hospital with a hyperbaric chamber.
B) Remove the patient from the garage, initiate BVM ventilations with 100 percent oxygen, intubate, and transport to a hospital with a hyperbaric chamber.
C) Remove the patient from the garage, initiate BVM ventilations with 100 percent oxygen, intubate, and transport to the nearest facility.
D) Remove the patient from the garage, intubate, and transport to the nearest hospital.

Accepted Answer

The patient is unconscious and apneic, indicating respiratory failure. Additionally, the patient was found in an enclosed garage with a running car, suggesting carbon monoxide poisoning as a possibility. Therefore, the most appropriate action is to remove the patient from the garage and initiate BVM ventilations with 100 percent oxygen. Intubation is then necessary to secure the airway and provide adequate ventilation during transport. Transport should be to a hospital with a hyperbaric chamber to manage potential carbon monoxide poisoning.

Question 11

Capnometry measures the partial pressure of CO₂ in: A) venous blood. B) arterial blood. C) expired air. D) inspired air.

Accepted Answer

Capnometry measures the partial pressure of CO2 in expired air.

Question 12

You have applied a CO-oximeter to your patient, and it is displaying an SpCO of 15 percent. Which of the following is the most appropriate interpretation of this finding?
A) This is consistent with a fatal level of carbon monoxide poisoning.
B) This is a normal reading for a smoker and nothing to worry about.
C) This is a normal reading for a nonsmoker and nothing to worry about.
D) This is consistent with mild carbon monoxide poisoning.

Accepted Answer

An SpCO of 15 percent is consistent with mild carbon monoxide poisoning, as levels above 10 percent are considered abnormal. However, the severity of symptoms can vary among individuals, and further evaluation and treatment may be necessary depending on the patient's clinical presentation.

Question 13

The greater the concentration of hydrogen ions in arterial blood, the ________ the pH.
A) more erratic
B) higher
C) more dangerous
D) lower

Accepted Answer

The greater the concentration of hydrogen ions in arterial blood, the lower the pH. This is because hydrogen ions are acidic, and as their concentration increases, the acidity of the blood increases, leading to a lower pH.

Question 14

Which of the following is NOT analyzed in arterial blood gas tests? A) SaO₂ B) PaO₂ C) pCO₂ D) O₂

Accepted Answer

None of the provided units (O₂) are measured or analyzed in arterial blood gas tests. The correct units measured in arterial blood gas tests are pH (pCO2), partial pressure of carbon dioxide (PaCO2), and the partial pressure of oxygen (PaO2).

Question 15

An arterial blood gas analysis includes all of the following EXCEPT:
A) perfusion.
B) ventilation.
C) electrolyte balance.
D) acid-base balance.

Accepted Answer

An arterial blood gas analysis measures the pH, carbon dioxide levels, oxygen levels, and bicarbonate levels in the blood. It assesses the acid-base balance (pH), ventilation (carbon dioxide levels), and oxygenation (oxygen levels). It does not directly measure electrolyte balance.

Question 16

Your patient is a 62-year-old woman with a history of COPD. She is slightly more short of breath than usual today. She is alert and speaks three to four words between breaths. Her SpO₂ is 93 percent on room air. Which of the following devices should be used for the administration of oxygen to this patient? A) Nonrebreather mask B) Nasal cannula C) CPAP D) BVM

Accepted Answer

The patient's oxygen saturation is only slightly decreased and she is able to speak between breaths, indicating that she may not require a high concentration of oxygen. A nasal cannula delivers a lower concentration of oxygen than a nonrebreather mask and allows the patient to continue speaking and eating. CPAP and BVM are not appropriate for this patient as she is only slightly short of breath and not in respiratory distress.

Question 17

Your patient is a 44-year-old woman, alert and oriented, in moderate distress and complaining of difficulty breathing. She gives a one-week history of fever and malaise, with shortness of breath developing three days ago. She also has left-sided chest pain with deep inspiration and a "phlegmy" cough. Physical examination reveals hot, pale, dry skin, and rhonchi and crackles throughout the left lung. The right lung sounds are clear. HR = 134, BP = 88/64, RR = 24, SaO₂ = 92%. She has a history of two previous myocardial infarctions and takes nitroglycerin as needed. Which of the following is the best course of prehospital management? A) Endotracheal intubation, ventilation with supplemental oxygen, nebulized albuterol and Atrovent, and corticosteroids IV B) Albuterol via nebulizer with 100 percent oxygen C) Oxygen via nonrebreather mask D) Oxygen via CPAP

Accepted Answer

Given the patient's symptoms of difficulty breathing, fever, malaise, and the presence of rhonchi and crackles in the left lung, the best prehospital management is to provide supplemental oxygen to improve her oxygen saturation. The patient's condition suggests a possible pneumonia or other pulmonary issue rather than a condition that would immediately benefit from interventions like endotracheal intubation or nebulized medications. The use of a nonrebreather mask is appropriate to increase her oxygen levels and address her hypoxia.

Question 18

Your patient is a 15-year-old asthmatic who has been having difficulty breathing for 45 minutes, but does not have his Xopenex inhaler with him. Capnography shows an ETCO₂ of 45 mmHg. What is the best way to interpret this finding? A) This is a normal ETCO₂, indicating that this is a mild asthma attack. B) The patient's ETCO₂ first dropped as he began to hyperventilate but now is rising again and may continue to rise to dangerous levels. C) This is a high ETCO_2, and the patient requires immediate ventilatory assistance to prevent respiratory arrest. D) This is a low ETCO₂, indicating that the patient is hyperventilating, and thus in the early stages of an asthma attack.

Accepted Answer

The answer of Your patient is a 15-year-old asthmatic who...

Question 19

Which of the following statements about pulse oximetry is FALSE?
A) Oxygen saturation is the percentage of hemoglobin that is bound with some molecular structure.
B) Pulse oximetry values can be expected to decrease within seconds in cases of developing hypoxia.
C) Pulse oximetry should be used on all patients with respiratory complaints.
D) It may be difficult to obtain a reading in patients experiencing peripheral vasoconstriction.

Accepted Answer

Pulse oximetry values may not decrease immediately in cases of developing hypoxia due to the time it takes for changes in blood oxygen levels to be reflected in peripheral circulation.

Question 20

Most carbon dioxide from cellular metabolism reaches the alveoli by being transported:
A) bound to hemoglobin.
B) as bicarbonate ion.
C) dissolved in plasma.
D) as carbonic anhydrase.

Accepted Answer

Most carbon dioxide from cellular metabolism is transported as bicarbonate ion in the blood. Carbon dioxide diffuses into red blood cells, where it combines with water to form carbonic acid. Carbonic acid then dissociates into bicarbonate ion and hydrogen ion. The bicarbonate ion then leaves the red blood cell and enters the plasma, where it can be transported to the alveoli.

Quiz 6: Patient Monitoring Technology

In which of the following situations is a significant amount of carboxyhemoglobin most likely to be present?

The valve between the right atrium and right ventricle is the ________ valve.

Conditions that can cause an inaccurate pule oximetry ready include all EXCEPT?

A male patient with an acute exacerbation of his emphysema presents in severe distress with decreased air movement and diffuse inspiratory wheezes in all fields. HR = 132, BP = 142/88, RR =30, SaO2 = 88%. Which of the following blood gas values is most likely?

ETCO2 is recorded during phase ________ of the capnogram.

Lung perfusion depends on all of the following EXCEPT:

Which of the following is the most important determinant of ventilatory rate?

Capnometry measures the partial pressure of CO2 in:

You have applied a CO-oximeter to your patient, and it is displaying an SpCO of 15 percent. Which of the following is the most appropriate interpretation of this finding?

The greater the concentration of hydrogen ions in arterial blood, the ________ the pH.

Which of the following is NOT analyzed in arterial blood gas tests?

An arterial blood gas analysis includes all of the following EXCEPT:

Your patient is a 15-year-old asthmatic who has been having difficulty breathing for 45 minutes, but does not have his Xopenex inhaler with him. Capnography shows an ETCO2 of 45 mmHg. What is the best way to interpret this finding?

Which of the following statements about pulse oximetry is FALSE?

Most carbon dioxide from cellular metabolism reaches the alveoli by being transported:

A male patient with an acute exacerbation of his emphysema presents in severe distress with decreased air movement and diffuse inspiratory wheezes in all fields. HR = 132, BP = 142/88, RR =30, SaO₂ = 88%. Which of the following blood gas values is most likely?

ETCO₂ is recorded during phase ________ of the capnogram.

Capnometry measures the partial pressure of CO₂ in:

Your patient is a 15-year-old asthmatic who has been having difficulty breathing for 45 minutes, but does not have his Xopenex inhaler with him. Capnography shows an ETCO₂ of 45 mmHg. What is the best way to interpret this finding?