Deck 16: Respiratory Emergencies

Question 1

When assessing a 3-year-old male in respiratory distress, the EMT should recognize "see-saw" breathing when he observes:

A) alternate breathing through the nose and mouth.
B) movement of the chest and abdomen in opposite directions.
C) retraction of the muscles between the ribs.
D) up-and-down motion of the head as the patient breathes.

Answer 1

B

Question 2

How many breaths per minute is normal for a child who is breathing adequately?

A) 5 to 10
B) 15 to 30
C) 30 to 40
D) 40 to 45

Answer 2

B

Question 3

While you are getting a medical history for a patient with generalized weakness and fatigue, she hands you a list of all the medications she is currently taking. Which one of the following medications should the EMT recognize as a bronchodilator?

A) Metaproterenol
B) Mucomyst
C) Prednisone
D) Metformin

Answer 3

A

Question 4

A patient requires several doses of medication from her metered-dose inhaler. At a minimum, how long should the EMT wait between administrations?

A) 30 seconds
B) 2 minutes
C) 5 minutes
D) 10 minutes

Question 5

Which one of the following is considered an early sign of inadequate breathing in children?

A) Blue-gray skin
B) Barrel chest
C) Nasal flaring
D) Crying

Question 6

You are administering a medication through a metered-dose inhaler (MDI) using a spacer. Which one of the following actions would be most appropriate?

A) Administer the medication into the spacer and then have the patient inhale.
B) Instruct the patient to inhale slowly just prior to the medication being placed in the spacer.
C) Administer the medication into the spacer and then have the patient exhale.
D) Instruct the patient to exhale slowly as you place the medication into the spacer.

Question 7

Within minutes of administering Proventil (albuterol) to a patient through her metered-dose inhaler (MDI), she is breathing easier and states that she feels much better. An Emergency Medical Responder on scene asks you how the medication in the MDI helped the patient. Which one of the following responses would be most appropriate?

A) "The medication travels to the brain and forces the respiratory rate to increase."
B) "The medication in the MDI relaxes the throat, allowing more oxygen to enter."
C) "The medication is an anti-inflammatory and decreases swelling in the lung tissue."
D) "The medication in the inhaler relaxes and opens up the small airways in the lungs."

Question 8

How many breaths per minute is normal for an infant?

A) 8 to 10
B) 12 to 20
C) 25 to 50
D) 45 to 60

Question 9

At a health fair, a patient informs you that she has just been prescribed a metered-dose inhaler (MDI) for her asthma. She states that she is confused about how to take the medication when needed. Which one of the following statements about the MDI would be most appropriate for you to make?

A) "Take it every 4 hours around the clock, even if you feel fine."
B) "Make sure to store the metered-dose inhaler in your refrigerator."
C) "You should only take the medication after calling your doctor."
D) "It is important to shake the inhaler vigorously before taking the medication."

Question 10

Medical direction has ordered you to assist a patient in taking his metered-dose inhaler (MDI). After placing his lips on the mouthpiece, which one of the following instructions would be most appropriate?

A) "Please hold your breath and I will administer the medication."
B) "Please inhale, then hold your breath, and I will give you the medication."
C) "Please inhale slowly and I will administer the medication."
D) "Please exhale, hold your breath, and I will administer the medication."

Question 11

You are assisting a patient in taking her metered-dose inhaler for the first time. Which one of the following statements about the side effects of the medication would be most appropriate?

A) "You will probably not even remember taking the medication."
B) "You may feel anxious and your heart rate may increase."
C) "You may experience a runny nose and increase in saliva."
D) "The medication may cause you to become very tired and fatigued."

Question 12

What is the most common cause of cardiac arrest in infants and children?

A) Heart birth defect
B) Accidental overdose
C) Respiratory compromise
D) Abuse and neglect

Question 13

Family directs you to a bedroom where a 62-year-old male is in respiratory distress. During the scene size-up, which of the following most strongly suggests that the patient suffers from a chronic respiratory disease?

A) Furnace turned on high with humidifier running
B) Bottles of aspirin and nitroglycerin on nightstand
C) Patient in chair in tripod position
D) Smell of cigarettes in house

Question 14

A 67-year-old male patient is complaining of shortness of breath. The patient cannot remember how many times he used his inhaler prior to your arrival. Which of the following should be your next action?

A) Call medical direction for advisement.
B) Assist the patient in the self-administration of his inhaler.
C) Transport the patient to the hospital.
D) Auscultate the lung sounds and administer the inhaler if you hear wheezing.

Question 15

A confused, lethargic, and nonverbal 50-year-old female has altered mental status. You are told she has a history of chronic obstructive pulmonary disease (COPD). The primary assessment reveals a breathing rate of 6 per minute and cool, clammy skin with cyanosis around the lips. Which of the following should be your next action?

A) Administer oxygen by nasal cannula at 15 lpm.
B) Assist respirations with positive pressure ventilation.
C) Administer oxygen by nonrebreather mask at 15 lpm.
D) Sit the patient up, assess lung sounds, and obtain a blood pressure.

Question 16

It is important for the EMT to remember that when an infant or child starts to become hypoxic, the pulse will initially:

A) decrease.
B) not change.
C) become irregular.
D) increase.

Question 17

The mother of a 5-year-old female states that her daughter has been "sick" with a sore throat and fever for several days. The mother became concerned tonight and called 911 because the child was "making funny noises" and could not breathe. Your assessment reveals a lethargic, well-developed child sitting upright and with high-pitched tracheal noises when she breathes. Of the following, what is the priority action?

A) Placing an oropharyngeal airway
B) Administering supplemental oxygen
C) Inspecting the airway with a tongue depressor
D) Performing abdominal thrusts

Question 18

After you administer a medication through a metered-dose inhaler (MDI), it is important that the patient:

A) immediately inhale deeply.
B) pant for 10 seconds.
C) exhale as forcefully as possible.
D) hold her breath for several seconds.

Question 19

An alert and oriented 45-year-old female patient is complaining of shortness of breath. Although her respiratory volume and rate are satisfactory, you note cyanosis in her fingertips. Which one of the following should be your next action?

A) Administer supplemental oxygen.
B) Assist respirations with the bag-valve mask.
C) Place a nasopharyngeal airway and assist respirations.
D) Move to the stretcher for immediate and rapid transport.

Question 20

The medication contained within a metered-dose inhaler is in what form?

A) Aerosolized
B) Compressed tablet
C) Pressurized liquid
D) Viscous gel

Question 21

You are treating a patient who states that he has been short of breath for the past month. Tonight, his breathing just "got too bad" and he decided to call 911. The 67-year-old male is alert and oriented and has a patent airway. He is breathing 24 times per minute but appears to have an adequate tidal volume. His pulse is strong and regular, and his skin is warm. Vital signs are: pulse 92 beats per minute, respirations 22, blood pressure 128/66 mmHg, and SpO₂ 93% while on home oxygen at 2 lpm. What instruction would you give to your partner regarding this patient's care?

A) "Let's try 3 liters of oxygen through a nasal cannula."
B) "He seems pretty stable; we can refer him to his family doctor."
C) "Why don't we see how he tolerates a nasal airway?"
D) "Let's go ahead and put him on 15 lpm of oxygen."

Question 22

A 4-year-old female is having great difficulty breathing. She is responsive to verbal stimuli and has an open airway. Her respiratory rate is 40 breaths per minute, and she has an SpO₂ reading of 88% while receiving high-concentration oxygen through a pediatric nonrebreather mask. Her pulse is rapid, and her skin cool to the touch. As a knowledgeable EMT, you would recognize what condition?

A) Respiratory distress
B) Cardiopulmonary arrest
C) Respiratory arrest
D) Respiratory failure

Question 23

On scene, you find a 2-year-old male in significant respiratory distress. He is responsive to verbal stimuli and exhibits noisy respirations through an open airway. His breathing is shallow at a rate of 44 breaths per minute. His pulse is rapid. Assessment of the skin shows it to be cool and diaphoretic with cyanosis to the extremities and around the mouth. What is the immediate priority for this patient?

A) Start positive pressure ventilation.
B) Insert an oropharyngeal airway.
C) Apply oxygen through a pediatric nonrebreather mask.
D) Move to the ambulance for immediate transport.

Question 24

A son has called 911 for his father, who is having difficulty breathing. On scene the 81-year-old patient is lethargic and lying on a couch in the living room and is in obvious respiratory distress. He is confused, but has an open airway. His respirations are 30 per minute and his skin is extremely diaphoretic with cyanosis in the fingertips. At this time, the EMT should:

A) suction the airway of secretion.
B) start positive pressure ventilation.
C) assess the patient's breath sounds.
D) determine the patient's past medical history.

Question 25

You have been called for a patient who is complaining of shortness of breath. On scene you find the 41-year-old woman sitting upright in bed with nasal flaring and wheezing. A metered-dose inhaler (MDI) is lying on the nightstand next to her. To assist her with the MDI, which of the following criteria must be met?

A) The MDI must be prescribed for the patient.
B) The pulse oximeter reading must be less than 90%.
C) High-concentration oxygen must be administered first for 5 minutes.
D) The patient must display altered mental status.

Question 26

Your medical director's written protocol instructs you to obtain on-line medical direction prior to assisting a patient with a metered-dose inhaler (MDI). Given this protocol, you must contact:

A) the patient's family doctor before assisting with the MDI.
B) the medical director after assisting with the MDI.
C) an emergency physician prior to assisting with the MDI.
D) no one; physician direction is not required when assisting with the MDI.

Question 27

When assessing an adult patient with difficulty breathing, what sign or symptom would be of most concern?

A) Temperature of 101.3°F
B) Blue coloration to the lips
C) Rate between 20 and 24 breaths per minute
D) Cyanosis to the fingernails

Question 28

A 4-year-old boy in respiratory distress is sitting upright in bed and drooling. His mother states that he has been complaining of a sore throat throughout the day and tonight became severely short of breath and started drooling. He is alert with adequate breathing. His skin is hot to the touch. Vital signs are pulse 132, respirations 28, and SpO₂ 90% on room air. Which one of the following is your first action in caring for this child?

A) Insert an oral airway and start ventilations.
B) Suction the airway of secretions.
C) Apply supplemental oxygen.
D) Use a tongue depressor to inspect for a foreign body obstruction.

Question 29

A 6-year-old female is in respiratory distress and will not keep the nonrebreather face mask on her face. In this situation, the EMT should:

A) secure the mask with tape to her face.
B) have the mother hold it near her face.
C) start positive pressure ventilation.
D) immediately transport without oxygen therapy.

Question 30

You have been dispatched for a young child with difficulty breathing. As you enter the apartment, which one of the following scene clues would best indicate that the patient is experiencing a problem in her upper airway?

A) Grunting with exhalation
B) Stridorous noises with inspiration
C) Low-pitched sobbing and crying
D) Audible wheezing on expiration

Question 31

A 36-year-old patient has overdosed on an unknown drug and is unresponsive. He is breathing shallowly at 6 times per minute. He has cyanosis around his lips and to his fingertips. His skin is cool to the touch, and his radial pulse is rapid. His breath sounds are diminished but clear. The EMT should recognize which one of the following respiratory conditions?

A) Hypoxia
B) Tachypnea
C) Bronchospasm
D) Apnea

Question 32

As you enter the living room of an adult patient who called 911 for shortness of breath, you observe the patient sitting upright in a chair with a panicked look on her face, struggling to breathe. Her breathing rate appears to be fast and tidal volume poor. You can hear rhonchi from her lungs without the aid of a stethoscope. Once at her side, you initial care should be to:

A) apply oxygen immediately.
B) auscultate lung sounds.
C) establish her rate of breathing.
D) assess her airway.

Question 33

A 48-year-old male is short of breath and confused. His airway is open, and his breathing accelerated. A radial pulse is easily palpated. His skin is warm to cool and dry. Your partner reports the following vital signs: pulse 124 beats per minute, respirations 24, blood pressure 158/86 mmHg, and an SpO₂ at 89% on room air. His lung sounds indicate slight wheezing. Based on this information, the immediate threat to this patient's well-being is which one of the following conditions?

A) Hypoxia
B) Elevated blood pressure
C) Infection
D) Increased heart rate

Question 34

You are called to a motor vehicle collision. A 26-year-old female states that she was unrestrained and struck the steering column with her chest after the car she was driving struck another from behind. She is somewhat confused, and complaining of chest pain and difficult and painful breathing when she inhales. Her airway is patent and her breathing is adequate. Assessment of the radial pulse reveals it to be rapid and very irregular and weak. She has cyanosis in her nose and finger tips. Her breath sounds are clear and equal and skin moist and pale. She informs you that she suffers from asthma and has a metered-dose inhaler (MDI). What is your best action in treating this patient?

A) Assist the patient with her MDI.
B) Apply supplemental oxygen.
C) Apply CPAP and transport.
D) Transport in a position of comfort.

Question 35

You have been called for a 2-year-old male who is sick and having a difficult time breathing. On scene, you find the patient in his mother's arms. He appears to have labored breathing and skin that is warm to the touch. What additional assessment finding would you recognize as the most serious?

A) Continual crying accompanied by a fever of 99.4°F
B) Respiratory rate of 28 breaths per minute
C) Grunting noise heard as the child exhales
D) Slight abdominal movement with breathing

Question 36

A confused and cyanotic patient is breathing 8 times per minute with poor chest rise and fall. What instruction would you give your partner about the respiratory care of this patient?

A) "Only deliver a ventilation with the bag-valve mask when he breathes."
B) "Ventilate him at 10 to 12 times per minute and superimpose your ventilations over his."
C) "Be sure to deliver your ventilations with the bag-valve mask in between his breaths."
D) "Since he is breathing, let's go ahead and put him on a nonrebreather mask with 15 lpm of oxygen."

Question 37

Auscultation of breath sounds in a patient complaining of shortness of breath reveals wheezing. Which one of the following conditions is responsible for this finding?

A) Bronchiole constriction
B) Significant hypoxia
C) Swelling in the throat
D) Mucus in the lungs

Question 38

A 911 call was placed for a 3-year-old child with difficulty breathing. On scene you note that the child is upright with slight stridor upon inspiration. He is alert and breathing at a rate of 30 breaths per minute. His skin is warm and dry, and his radial pulse strong and regular. His breath sounds are clear and equal. His mother states that he has been fine all day until 15 minutes ago when he was playing with friends in the playroom and suddenly started having difficulty breathing. As an EMT, you should suspect which of the following conditions?

A) Foreign body airway obstruction
B) Epiglottitis
C) Croup (laryngotracheobronchitis)
D) Bronchial asthma

Question 39

Following a call in which you treated a pediatric patient suffering from croup, a new EMT who is in orientation asks you how you can differentiate croup from epiglottitis. Which one of the following responses would be most appropriate?

A) "The swelling associated with epiglottitis typically decreases with exposure to cool air; the swelling with croup does not."
B) "Epiglottitis is accompanied by a cough; croup is not associated with a cough."
C) "Croup is typically associated with wheezing; epiglottitis is typically associated with crackles in the lungs."
D) "The child with epiglottitis typically drools; the child with croup rarely, if ever, drools."

Question 40

When assessing a patient complaining of shortness of breath, which of the following actions should the EMT perform first?

A) Ascertain whether the patient has used an MDI.
B) Assess the adequacy of a patient's breathing.
C) Get the patient's SpO₂ to 100%.
D) Determine the cause of the shortness of breath.

Question 41

The EMT is correctly assessing a patient for subcutaneous emphysema when he:

A) palpates the anterior and posterior chest.
B) listens posteriorly for breath sounds.
C) observes the chest for abnormalities.
D) examines the neck veins for distention.

Question 42

A 4-year-old female with a decreased level of consciousness is in respiratory distress. Her airway is patent and respirations are 12 per minute. Breath sounds are diminished bilaterally and there is noted accessory muscle use with inspiration and expiration. Her pulse is 84 and SpO₂ 88%. Which of the following should be your immediate action?

A) Recheck the SpO₂ on another finger.
B) Start positive pressure ventilation.
C) Apply CPAP.
D) Initiate immediate transport to the hospital.

Question 43

As you enter a room for an unknown medical emergency, you find an unresponsive male with snoring respirations lying supine in bed. Which one of the following actions should you take immediately?

A) Take in-line manual spinal stabilization.
B) Perform a head-tilt, chin-lift maneuver.
C) Start positive pressure ventilation.
D) Suction the airway of fluids.

Question 44

Which of the following statements regarding ventilation in a healthy patient is true?

A) Inspiration requires little energy; expiration requires much energy.
B) Both inspiration and expiration require the same amount of energy.
C) Inspiration is an active process that requires energy; expiration requires little to no energy.
D) Inspiration and expiration require no energy in a healthy person.

Question 45

The EMT is properly using a small-volume nebulizer when she:

A) places a spacer on the small-volume nebulizer.
B) attaches the nebulizer to oxygen at 8 to 10 lpm.
C) shakes the medication canister for 30 seconds prior to administration.
D) instructs the patient to breathe deeply through his nose.

Question 46

You have been called to a residence for a patient with altered mental status and shortness of breath. On scene an Emergency Medical Responder meets you and states that he believes the patient had a stroke and is unresponsive. As you enter the room, you see the patient lying in bed with snoring respirations. Oxygen at 15 liters per minute has been applied. Your immediate action when you reach the patient's side would be to:

A) place a nasal airway and suction.
B) start positive pressure ventilation.
C) perform the head-tilt, chin-lift.
D) determine if the patient has a pulse.

Question 47

A 71-year-old female is complaining of the sudden onset of shortness of breath and rapid breathing. She also states that she is experiencing some chest pain that seems to worsen when she takes a deep breath. The primary assessment shows her to be alert and oriented with a patent airway and rapid breathing that is adequate. Her pulse rate is 92 per minute and her blood pressure is 116/68 mmHg. When obtaining a history, which statement made by the patient should raise your suspicion that the patient may be experiencing a pulmonary embolism?

A) "I think that I may also have a fever."
B) "I had foot surgery five days ago."
C) "I just started a new blood pressure medication today."
D) "I had a headache earlier and took an aspirin."

Question 48

You are by the side of a 77-year-old male with the complaint of shortness of breath. Auscultation of his lungs indicates crackles in the bases. In addition, both of his feet are swollen. His SpO₂ on room air is 82% and the remainder of his vitals are: pulse 144 , respirations 26, and blood pressure 168/90 mmHg. He is complaining of lower-back pain with a history of a "pinched nerve" in that area. He continues to state that he always has this pain. He has difficulty finishing his sentences without gasping for air. Which of the following is the most appropriate care for this patient?

A) Oxygen at 2 lpm by nasal cannula
B) Bronchodilator through a small-volume nebulizer
C) Transport in an upright position
D) Immobilize to a backboard for the back pain

Question 49

When administering albuterol to a patient with shortness of breath, the EMT realizes that the therapeutic effect of this medication is achieved by:

A) decreasing mucus production.
B) opening the large airways.
C) decreasing inflammation.
D) dilating the small airways.

Question 50

When auscultating breath sounds, the EMT should recognize rhonchi when he hears which of the following sounds?

A) Rattling-like noises that decrease when the patient coughs
B) Crowing-like sounds that are accompanied by a high-pitched cough
C) High-pitched whistling-like noises heard more on expiration
D) Crackling-like noises that are heard in the upper portion of the lung

Question 51

You have arrived on scene to find a 32-year-old male patient complaining of rapid breathing, light-headedness, tachycardia, and numbness and tingling to his lips and hands. Family on scene reports that he received bad advice from his attorney about a pending divorce when the symptoms started. The patient denies chest pain as well as any other past medical history. His pulse is 124, respirations are 52, and his blood pressure is 158/68 mmHg. What is your first course of action in treating this patient?

A) Apply a nonrebreather face mask with 8-10 liters of oxygen.
B) Monitor for spasms of the hand muscles and administer nitroglycerin.
C) Instruct the patient to close his mouth and breathe through his nose.
D) Have the patient breathe into a paper bag for approximately 5 minutes.

Question 52

You are administering positive pressure ventilation to an elderly male with a history of advanced chronic obstructive pulmonary disease (COPD). Which of the following must you keep in mind as you care for this patient?

A) Too forceful ventilations may rupture the lung tissue and cause a pneumothorax.
B) High concentrations of oxygen will damage the lungs and must be avoided.
C) Ventilations must be given with greater force to overcome natural stiffening of the rib cage.
D) Positive pressure ventilation with high-concentration oxygen is contraindicated for this patient.

Question 53

When instructing a patient on how to use a small-volume nebulizer, which one of the following statements would be correct?

A) "Breathe about 20-30 times per minute so the medication gets into your lungs."
B) "As I depress the trigger on the canister, take in a deep breath."
C) "Take nice slow and deep breaths, and try not to cough the medicine out."
D) "It is really important to occasionally cough during the treatment."

Question 54

You have been called to a home for an 18-year-old male who informs you that he experienced a sudden onset of shortness of breath and back pain while watching television. He also informs you that he has a history of spontaneous pneumothorax, and the current symptoms he is experiencing are identical to those he felt with a previous pneumothorax. Assessment reveals the patient to be slightly dyspneic with breath sounds clear and intact bilaterally. During transport, what is most critical to continually monitor on this patient?

A) Blood pressure
B) Mental status
C) Spasms to the hands
D) Breath sounds

Question 55

When auscultating the lungs of an elderly patient, you note rhonchi-like noises to the upper lobes of both lungs. As a knowledgeable EMT, you would recognize that this is caused by:

A) fluid accumulation in the alveoli.
B) accumulation of mucus in the bronchi.
C) narrowing of the larger airways.
D) edema to the bronchioles.

Question 56

You are having a hard time getting the past medical history of a patient who is short of breath. Which one of the following pieces of information would lead the EMT to believe that the patient has a history of chronic lung disease, such as emphysema or chronic bronchitis?

A) She takes a daily aspirin.
B) Her chest is "barrel" shaped.
C) Her respirations are tachypneic.
D) She continually coughs.

Question 57

A patient who is nonverbal from a previous stroke is in severe respiratory distress. Family states that she has multiple medical problems including high blood pressure, diabetes, heart failure, and chronic obstructive pulmonary disease (emphysema and chronic bronchitis). When assessing the patient, which one of the following signs or symptoms should raise your suspicion that the patient is suffering from heart failure, as opposed to COPD or asthma?

A) Pulmonary crackles
B) Diaphoresis
C) Edema to left foot
D) Pursed lip breathing

Question 58

After administering a bronchodilator to a patient through a small-volume nebulizer, which one of the following statements made by the patient should be of most concern to an EMT?

A) "I feel shaky."
B) "My mouth is really dry."
C) "I suddenly feel nervous."
D) "My chest feels heavy."

Question 59

You have been called for a 3-year-old male who is "not breathing right." Aside from a notable expiratory wheeze, which one of the following would be cause for most concern?

A) Respiratory rate of 24 breaths per minute
B) Clinging to his mother and crying
C) Prolonged and forced expiration
D) Abdominal wall movement with inspiration

Question 60

You realize the EMT is properly ventilating an unresponsive adult male patient when he:

A) ventilates smoothly at a rate of 24 breaths a minute.
B) flexes the patient's head as ventilations are administered.
C) allows 2 seconds between each ventilation.
D) delivers each breath over a 1-second period.

Question 61

Which of the following respiratory sounds would make you suspicious of an upper airway problem?

A) Wheezing
B) Crackles
C) Rhonchi
D) Stridor

Question 62

Which of the following pieces of information would heighten the EMT's suspicion that a child with a persistent cough may have pertussis (whooping cough)?

A) Chest pain while coughing
B) Cough for the past six months
C) Never had childhood immunizations
D) Cough worse during the day

Question 63

A patient in respiratory distress is exhibiting pursed lip breathing. You realize that he is doing this to:

A) exhale increased amounts of CO₂.
B) inhale additional amounts of oxygen.
C) keep the small airways open.
D) prevent the loss of vapor with exhalation.

Question 64

A patient, with a history of COPD, is breathing 32 times a minute. Her vital signs are: pulse 140, blood pressure 168/102, and SpO₂ 98% on room air. You would classify this as:

A) apnea.
B) dyspnea.
C) bradypnea.
D) hypoxia.

Question 65

A 26-year-old male has summoned EMS after lifting a heavy box and suddenly experiencing shortness of breath and sharp pain to the left side of his chest that worsens with deep inspiration. Given this description, you immediately become suspicious of a pneumothorax. Which of the following should you perform next to help confirm this suspicion?

A) Inquire about past lung problems.
B) Obtain an SpO₂ reading.
C) Palpate the chest for subcutaneous emphysema.
D) Auscultate breath sounds.

Question 66

The EMT is correctly accessing for accessory muscle use when he examines what part of the body?

A) Nares
B) Chest
C) Back
D) Inner mouth

Question 67

Assessment of a 67-year-old male reveals absent lung sounds to the right lung, accompanied by sharp chest pain to the same side. When obtaining a history, which one of the following statements made by the patient's wife would the EMT recognize as most important?

A) "He did not take his medications today."
B) "He had a fever last night."
C) "He has emphysema."
D) "He has been in bed for 12 hours."

Question 68

On scene you suspect that a young female patient is suffering from hyperventilation syndrome. Which one of the following signs would best assist you in confirming this suspicion?

A) Heart rate of 64 beats per minute
B) Urinary incontinence
C) Breathing through the mouth
D) Spasm of the hands

Question 69

You have been called to a residence for an 18-year-old female with shortness of breath and a history of cystic fibrosis. On scene you find the patient to be very thin and sick looking. Her airway is patent and breathing adequate, although slightly labored. Her radial pulse is strong, and she has a constant cough, which produces green- and yellow-colored mucus. Auscultation of the lungs reveals rhonchi to the upper portion of both lungs. Vital signs are pulse 108, respirations 20, blood pressure 98/56 mmHg, and SpO₂ 92%. Based on these findings, appropriate care should include:

A) suctioning of the lower airway to remove mucus.
B) gentle abdominal thrusts to help the patient expectorate the mucus.
C) bronchodilator administered via small-volume nebulizer.
D) humidified oxygen via nasal cannula at 2 liters per minute.

Question 70

You are delivering positive pressure ventilations to a patient who is breathing poorly with absent breath sounds to the right lung. Which of the following instructions would you provide to those who are ventilating the patient?

A) "Make sure to really get those ventilations into his good lung. He needs the oxygen."
B) "Use the minimal tidal volume possible, just enough to make the chest rise and fall."
C) "If his SpO₂ is 85% or above, let's stop the ventilations and put him on high-concentration oxygen with a face mask."
D) "Let's use just room air for the ventilations. We don't want to cause a tension pneumothorax by giving pure oxygen."

Question 71

You have been called for a 6-year-old male with shortness of breath. On scene you find the patient with a runny nose and mucus coming from the right nare. Breath sounds are clear and his SpO₂ is 99% on room air. When asked, he states that his throat is very sore. His vital signs are: pulse 124, respirations 20, and temperature 98.9∘F. There is no medical history, according to the mother. Which one of the following statements or instructions would be most appropriate for this situation?

A) "Why don't we give him an aspirin for his fever and then you can follow up at your pediatrician's office."
B) "I am very concerned he may have epiglottitis, so we are going to take him to the hospital with lights and siren."
C) "Let's give him some oxygen since the heart rate is most likely elevated because his oxygen is low."
D) "He is very stable, but we will take him to the hospital. The danger lies in the infection spreading to the lungs."

Question 72

You are transporting a 4-year-old female who you found sitting in a chair with labored respirations, inspiratory stridor, and drooling. Which one of the following signs would warrant immediate reassessment?

A) The stridor disappears.
B) The drooling continues.
C) The SpO₂ drops from 96% to 95%.
D) The patient remains dyspneic.

Question 73

You have a patient that you suspect of being infected with pertussis (whooping cough). While performing the primary assessment, you note a deep cough with clear breath sounds. Her vital signs are: pulse 108, respirations 16, and SpO₂ at 96% on room air. Given this scenario, which one of the following would be most appropriate?

A) Assist with a metered-dose inhaler.
B) Administer oxygen via nasal cannula.
C) Encourage the patient not to cough.
D) Monitor the patient and transport.

Question 74

You have been dispatched to a home for a 16-year-old female with shortness of breath. On scene you find the patient in bed with her mother at her side. Her mother states that her daughter has a fever with a past medical history of cystic fibrosis and would like to have her transported to the hospital for evaluation of possible pneumonia. As a knowledgeable EMT, you know that the underlying pathophysiology of cystic fibrosis is a:

A) contagious disease in which the lungs are damaged by bacteria and excessive coughing.
B) condition in which excessive and thick mucus often plugs the airways.
C) disease in which lifelong antibiotic medications are needed for survival.
D) hereditary disease in which the lungs are malformed and smaller than normal.

Question 75

The EMT indicates that he is properly assessing the patient's breath sounds when he gives which one of the following instructions to the patient?

A) "Please take a deep breath and gently cough as I listen to your lungs."
B) "Please sit upright and take a deep breath through your nose as I listen to your lungs."
C) "Please breathe slowly through your mouth as I listen to your lungs."
D) "I need to listen to your right lung first and then compare it to your left."

Question 76

The EMT understands adequate breathing when he states:

A) "If the respiratory rate is between 10 and 20, the breathing is most likely adequate."
B) "If the patient is breathing faster than 22 times a minute, it is inadequate."
C) "Normal and adequate breathing is specific to the patient and is determined by assessment."
D) "If the rate is between 10 and 20, with an intact airway and clear breath sounds, it is adequate."

Question 77

You have been called to an industrial warehouse for a young adult male who was exposed to an unknown chemical gas. The patient was immediately removed from the environment and presents to you with a patent airway, burning to the throat with inspiration, and complaint of shortness of breath. His vital signs are: pulse 120, respirations 28, blood pressure 164/60, and SpO₂ of 90%. In addition, you note bilateral wheezing to the lungs. What should be your first action in caring for this patient?

A) Apply in-line manual spinal stabilization.
B) Administer high-concentration oxygen.
C) Identify the chemical to which he was exposed.
D) Administer a saline mist through a small-volume nebulizer.

Question 78

You arrive on scene for a 9-year-old female with a severe cough. Her mother states that she has spoken to her pediatrician who believes that the child may have whooping cough and should be taken to the hospital for evaluation. Her mother states that she is unsure if her daughter has had all her immunizations. Which one of the following statements would be most appropriate in the care of this patient?

A) "She is possibly contagious, so let's put a surgical mask on her."
B) "Since this is caused by a virus, she is not contagious and we just need to transport her."
C) "She is probably contagious, so we need to each put on a gown and goggles to protect ourselves."
D) "Let's get a full set of vital signs, since this disease can cause heart problems, especially in the young."

Question 79

The best way to gauge the effectiveness of oxygen therapy would be to monitor the:

A) pulse oximetry.
B) respiratory rate.
C) heart rate.
D) mental status.

Question 80

You are starting to assess a patient's breath sounds and have just listened to the upper right back. You would next listen to the:

A) left upper back.
B) left anterior chest.
C) right lower back.
D) left lateral chest.