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Chapters 19-20
Chapters 19-20
72
Medical
Professional
04/07/2013
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Term
The process of moving air into or out of the lungs is called:
 Definition
ventilation.
Term
Which of the following physiologic processes occurs during pulmonary respiration?
 Definition
Carbon dioxide diffuses into the alveoli.
Term
More carbon dioxide diffuses out of the bloodstream when:
 Definition
fresh oxygen diffuses into the alveoli.
Term
Characteristics of adequate breathing in an adult include all of the following, EXCEPT:
 Definition
asymmetrical chest movement.
Term
Chronic carbon dioxide retention, as seen in patients with certain lung diseases, may cause the patient to:
 Definition
breathe on the basis of decreased oxygen.
Term
You are dispatched for an elderly male with dyspnea. When you arrive, you find the patient lying on the couch. He is semiconscious and unable to effectively communicate with you. As you perform an initial assessment, your partner applies 100% oxygen and a pulse oximeter, which reads 90%. The MOST reliable indicator of cerebral hypoxia in this patient is his:
 Definition
mental status alteration.
Term
In contrast to bronchitis, pneumonia typically presents with:
 Definition
fever and chills.
Term
You are dispatched to a residence for a 69-year-old female with “breathing problems.” When you arrive, the patient's husband directs you to his wife, who is sitting on the couch in obvious respiratory distress. She is semiconscious and has labored, shallow respirations. You auscultate her lungs and hear diffuse rhonchi in all lung fields. Which of the following would benefit her LEAST?
 Definition
100% supplemental oxygen via nonrebreathing mask
Term
Which of the following physiologic processes does NOT occur in patients with chronic obstructive pulmonary disease (COPD)?
 Definition
Increased surfactant production
Term
Which of the following is the MOST accurate clinical definition of chronic bronchitis?
 Definition
Productive cough for 3 months per year for 3 consecutive years
Term
Patients with COPD are highly susceptible to respiratory infections because:
 Definition
they cannot effectively expel infected pulmonary secretions.
Term
IV therapy is often needed in patients with COPD in order to:
 Definition
improve hydration and loosen pulmonary secretions.
Term
Which of the following statements MOST accurately describes asthma?
 Definition
Reversible airway disease caused by an exaggerated immune response.
Term
An anaphylactic reaction impairs effective breathing secondary to:
 Definition
upper airway swelling.
Term
You are dispatched to the home of a 64-year-old male patient with lung cancer. The patient complains of acute dyspnea; however, as long as he is sitting upright, his breathing is easier. He denies fever and his breath sounds are decreased over the base of the left lung. What is the MOST likely cause of this patient's symptoms?
 Definition
Collection of fluid outside of the lung
Term
Approximately 2 weeks following a total hip replacement, a 70-year-old female complains of a sudden onset of dyspnea and pleuritic chest pain. Your assessment reveals perioral cyanosis, blood-tinged sputum, and wheezing to the base of the right lung. As your partner applies a nonrebreathing mask, the patient states that she has a history of hypertension. You should be MOST suspicious of:
 Definition
a pulmonary embolism.
Term
You are assessing a young male with an acute onset of tachypnea. He is conscious and alert with respirations of 40 breaths/min and shallow, and complains of numbness and tingling to his face and hands. The patient's girlfriend tells you that he has been very worried about his mother, who was recently diagnosed with cancer. Appropriate treatment for this patient includes:
 Definition
coached breathing and oxygen as needed.
Term
You are transporting a 60-year-old male to the hospital for a suspected exacerbation of his COPD. He is receiving 100% oxygen via nonrebreathing mask. As you reassess him, you note that his respirations have decreased and have become shallow. You should:
 Definition
assist ventilations with a BVM.
Term
Common side effects of medications used to treat bronchoconstriction include all of the following, EXCEPT:
 Definition
somnolence.
Term
The exchange of oxygen and carbon dioxide, at the cellular level or in the lungs, is called:
 Definition
respiration.
Term
The two processes that occur during respiration are:
 Definition
inspiration and expiration.
Term
The movement and utilization of oxygen in the body is dependent on all of the following, EXCEPT:
 Definition
effective alveolar-capillary osmosis.
Term
If the level of arterial carbon dioxide drops too low:
 Definition
tidal volume decreases.
Term
Which of the following clinical findings is MOST consistent with inadequate breathing?
 Definition
Respirations of 16 breaths/min and reduced tidal volume
Term
In cases of pulmonary edema, diffusion is impaired primarily because of:
 Definition
fluid-filled alveoli.
Term
Emphysema, a degenerative disease, is caused by:
 Definition
surfactant destruction and increased alveolar surface tension.
Term
Patients with emphysema are commonly referred to as “pink puffers” because they:
 Definition
breathe through pursed lips and may develop polycythemia.
Term
When assessing the severity of nocturnal dyspnea in a patient with a chronic respiratory disease, you should ask:
 Definition
how many pillows he or she sleeps with at night.
Term
A 20-year-old female presents with acute respiratory distress. Auscultation of her lungs reveals diffuse expiratory wheezing. She is in moderate distress and tells you that she has a prescribed inhaler that she uses when this happens. You should suspect:
 Definition
an acute asthma attack.
Term
When assessing a patient using a pulse oximeter, it is important to remember that:
 Definition
pulse oximetry detects gross abnormalities and not subtle changes.
Term
Approximately 20 minutes after receiving a penicillin injection at the doctor's office, a 41-year-old female presents with acute respiratory distress, facial swelling, and intense itching to her entire body. Her level of consciousness is decreased and her breathing is labored with minimal chest rise. The MOST appropriate treatment for this patient should include:
 Definition
assisted ventilations, IV of normal saline, epinephrine, and an antihistamine.
Term
What acid-base derangement initially occurs in a tachypneic patient without a physiologic demand for increased oxygen?
 Definition
Respiratory alkalosis
Term
The MOST significant risk associated with hyperventilating an apneic adult patient is:
 Definition
gastric distention and regurgitation.
Term
The middle, muscular layer of the heart is called the:
 Definition
myocardium.
Term
The tricuspid and mitral valves of the heart are referred to as:
 Definition
atrioventricular valves.
Term
The aortic valve:
 Definition
regulates the flow of blood from the left ventricle to the systemic circulation.
Term
Which of the following is NOT a component of the cardiac electrical conduction system?
 Definition
Interventricular septum
Term
Pacemakers in the heart function by:
 Definition
dictating the rate at which the heart will cycle.
Term
The ability of the cardiac cells to generate an electrical impulse, even when there is no external nerve stimulus, is called:
 Definition
automaticity.
Term
Which of the following represents the correct sequence of electrical conduction through the myocardium?
 Definition
SA node, AV node, Bundle of His, bundle branches, Purkinje fibers
Term
Stimulation of the sympathetic nervous system results in:
 Definition
increased blood pressure and heart rate.
Term
The three key electrolytes responsible for initiating and conducting electrical impulses in the heart are:
 Definition
sodium, potassium, and calcium.
Term
Afterload is defined as the:
 Definition
pressure against which the left ventricle must pump.
Term
The _____________ arteries arise from the aorta shortly after they leave the left ventricle.
 Definition
coronary
Term
The coronary arteries of a person with arteriosclerotic heart disease:
 Definition
are thickened and hardened and lose their elasticity.
Term
Which of the following MOST accurately describes the pathophysiology of angina pectoris?
 Definition
Reversible process in which myocardial oxygen demand exceeds the supply of available oxygen.
Term
Unstable angina pectoris is characterized by:
 Definition
chest pain or discomfort that may not be relieved by rest or nitroglycerin, and that occurs without a fixed frequency.
Term
An acute myocardial infarction is more apt to occur in the left ventricle because:
 Definition
it is large and thick and demands more oxygen than the right ventricle.
Term
Damage to the myocardium following infarction can be minimized if fibrinolytic therapy is administered no later than _____ hours following the onset of symptoms.
 Definition
12
Term
As with angina, the pain associated with acute myocardial infarction is MOST commonly described as:
 Definition
pressure.
Term
Which of the following cardiac dysrhythmias requires immediate defibrillation?
 Definition
Nonperfusing ventricular fibrillation
Term
When treating a patient with a blood pressure of 80/40 mm Hg due to “pump failure,” you should:
 Definition
give a 20 mL/kg crystalloid fluid bolus to improve perfusion.
Term
Treatment for a patient experiencing a cardiovascular emergency begins by:
 Definition
ensuring airway patency and adequate breathing.
Term
A 49-year-old male complains of acute chest discomfort. He is conscious but restless, and he is noticeably diaphoretic. As your partner is applying 100% oxygen, the patient hands you a bottle of nitroglycerin that was prescribed to him by his family physician. Prior to assisting the patient with his medication, you should:
 Definition
assess his systolic BP to ensure that it is at least 90 mm Hg.
Term
What are the physiologic effects of nitroglycerin when given to a patient with suspected cardiac-related chest pain?
 Definition
Vascular smooth muscle relaxation and coronary artery dilation
Term
When assessing a middle-aged male patient with chest pain, you note a large vertical scar in the center of his chest. This indicates that he has MOST likely had:
 Definition
a coronary artery bypass graft.
Term
When applying the AED pads to a patient with a surgically-implanted pacemaker, you should:
 Definition
apply the pads at least 1” away from the pacemaker.
Term
You are dispatched to a residence for a 4-year-old male who is not breathing. When you and your partner arrive at the scene, you find the child's father is performing mouth-to-mouth rescue breathing on him. The father tells you that his son stuck a pin in an electrical socket. After assessing the child and determining that he is pulseless and apneic, you should:
 Definition
apply the AED using pediatric defibrillation pads.
Term
A 50-year-old female is in cardiac arrest. You attach the AED and receive a “no shock advised” message. You should:
 Definition
perform immediate CPR and reanalyze her cardiac rhythm after 2 minutes.
Term
Effectively performed CPR is a crucial treatment for a patient in cardiac arrest because it:
 Definition
maintains myocardial and cerebral perfusion.
Term
During your initial assessment of an unresponsive 47-year-old male, you find that he has slow, gasping breaths. You should:
 Definition
give two rescue breaths with a BVM and assess his pulse.
Term
After defibrillating an adult patient in cardiac arrest with the AED, you should:
 Definition
begin or resume CPR starting with chest compressions.
Term
Blood enters the right atrium via the:
 Definition
vena cavae and coronary sinus.
Term
Which of the following valves of the heart are semilunar valves?
 Definition
Aortic and pulmonic
Term
The primary function of the atrioventricular (AV) node is to:
 Definition
slow conduction from the atria to the ventricles to allow for ventricular filling.
Term
A 56-year-old male with a history of coronary artery disease complains of an acute onset of substernal chest discomfort and diaphoresis while moving a heavy box. After sitting down and taking one nitroglycerin tablet, the discomfort promptly subsides. This episode is MOST consistent with:
 Definition
stable angina pectoris.
Term
The MOST common cardiac dysrhythmia associated with sudden cardiac death following an acute myocardial infarction is:
 Definition
ventricular fibrillation.
Term
You receive a call for a 40-year-old female with nausea, dizziness, and a headache. During your assessment, you note that her blood pressure is 170/100 mm Hg. The patient, who is conscious and alert, states that she has a history of hypertension, but admits to being noncompliant with her medications. In addition to IV therapy, appropriate treatment for this patient includes:
 Definition
100% oxygen and transport to the closest appropriate facility.
Term
When treating a 56-year-old female with chest pain, you have administered two doses of sublingual nitroglycerin; however, the patient's pain has not improved. You reassess her blood pressure and note that it is 104/66 mm Hg. You should start an IV and then:
 Definition
administer one more dose of nitroglycerin.
Term
You receive a call to a local grocery store for a possible heart attack. Upon arrival at the scene, you find two employees performing CPR on the patient, a 49-year-old male. You should:
 Definition
confirm that the patient is pulseless and apneic.
Term
Following defibrillation of a pulseless and apneic adult in ventricular fibrillation, you should:
 Definition
immediately perform CPR.
Term
You are dispatched to a nightclub where the manager, a 45-year-old male, is complaining of crushing chest pain that he rates as a “10” on a 0 – 10 scale. He is conscious and alert with a BP of 160/94 mm Hg. The cardiac monitor reveals sinus tachycardia at 140 beats/min. After administering 100% oxygen, you should:
 Definition
administer up to 325 mg of aspirin.
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