(Test Bank) Wilkins’ Clinical Assessment in Respiratory Care

Heuer, 8

Nursing

Test Bank

8th Edition

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Test Bank for Wilkins’ Clinical Assessment in Respiratory Care, The downloadable file consists of 194 pages, and the total size of the file is 1.71 MB. Purchase now only for highly discounted price.

Author(s): Heuer

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PRIMEXAM.COM Wilkins’ Clinical Assessment in Respiratory Care 8th Edition Heuer Test Bank Chapter 1: Preparing for the Patient Encounter Test Bank MULTIPLE CHOICE 1. Which of the following activities is not part of the role of respiratory therapists (RTs) in patient assessment? a. Assist the physician with diagnostic reasoning skills. b. Help the physician select appropriate pulmonary function tests. c. Interpret arterial blood gas values and suggest mechanical ventilation changes. d. Document the patient diagnosis in the patient’s chart. ANS: D RTs are not qualified to make an official diagnosis. This is the role of the attending physician. REF: Table 1-1, pg. 4 OBJ: 9 2. In which of the following stages of patient –clinician interaction is the review of physician orders carried out? a. Treatment stage b. Introductory stage c. Preinteraction stage d. Initial assessment stage ANS: C Physician orders should be reviewed in the patient’s chart before the physician sees the patient. REF: Table 1-1, pg. 4 OBJ: 9 3. In which stage of patient –clinician interaction is the patient identification bracelet checked? a. Introductory stage b. Preinterac tion stage c. Initial assessment stage d. Treatment stage ANS: A The patient ID bracelet must be checked before moving forward with assessment and treatment. REF: Table 1-1, pg. 4 OBJ: 9 4. What should be done just before the patient’s ID bracelet is checked? a. Check the patient’s SpO 2. b. Ask the patient for permission. c. Check the chart for vital signs. d. Listen to breath sounds. ANS: B It is considered polite to ask the patient for permission before touching and reading his or her ID bracelet. PRIMEXAM.COM REF: pg. 3 OBJ: 3 | 5 5. What is the goal of the introductory phase? a. Assess the patient’s apparent age. b. Identify the patient’s family history. c. Determine the patient’s diagnosis. d. Establish a rapport with the patient. ANS: D The introductory phase is all about getting to know the patient and establishing a rapport with him or her. REF: Table 1-1, pg. 4 OBJ: 3 6. Which of the following behaviors is not consistent with resistive behavior of a patient? a. Crossed arms b. Minimal eye contact c. Brief answers to questions d. Asking the purpose of the treatment ANS: D If a patient asks about the purpose of the treatment you are about to give, this generally indicates that he or she is not upset. REF: Table 1-1, pg. 4 OBJ: 3 7. What is the main purpose of the initial assessment stage? a. To identify any allergies to medications b. To document the patient’s smoking history c. To personally get to know the patient better d. To verify that the prescribed treatment is still needed and appropriate ANS: D When you first see the patient, you are encouraged to perform a brief assessment to make sure the treatment order by the physician is still appropriate. The patient’s status may have changed abruptly recently. REF: Table 1-1, pg. 4 OBJ: 3 8. What is the appropriate distance for the social space from the patient? a. 3 to 5 feet b. 4 to 12 feet c. 6 to 18 feet d. 8 to 20 feet ANS: B The social space is 4 to 12 feet. REF: pg. 5 OBJ: 5 9. What is the appropriate distance for the personal space? PRIMEXAM.COM a. 0 to 18 inches b. 18 inches to 4 feet c. 4 to 12 feet d. 6 to 15 feet ANS: B The personal space is about 2 to 4 feet from the patient. REF: pg. 5 OBJ: 5 10. Which of the following activities is best performed in the personal space? a. The interview b. The introduction c. The physical examination d. Listening for breath sounds ANS: A The interview is best performed with you sitting about 2 to 4 feet from the patient. If you sit farther away, the patient will have to answer your questions in a louder voice, and because some of the information may be private, this would diminish communication. REF: Table 1-1, pg. 4 OBJ: 5 11. What type of behavior is least appropriate in the patien t’s intimate space? a. Eye contact b. Pulse check c. Auscultation d. Simple commands ANS: A Eye contact is inappropriate in the intimate space and will make the patient very uncomfortable. REF: pg. 3 OBJ: 5 12. You are riding in an elevator at the hospital where you are employed as an RT. The elevator is full, but standing next to you is Joe, the RT who is scheduled to relieve you. He turns to you and asks, “How is Mr. Copper doing?” Earlier in the day, Mr. Coppe r had a cardiac arrest, and he is now being mechanically ventilated. How should you respond to Joe? a. “He took a turn for the worse.” b. “He is fine.” c. “Let’s talk later in the report room.” d. “He is on a ventilator and will keep you very busy.” ANS: C The patient’s right to privacy prevents care providers from discussing a patient’s clinical status in public places. All answers other than “c” are unethical; giving such answers could cause an RT to be in legal trouble and get fired. REF: Table 1-2, pgs. 4-5 OBJ: 6 13. In 1996, Congress passed the HIPAA. What does the letter “P” stand for? PRIMEXAM.COM a. Patient b. Payment c. Portability d. Personal ANS: C HIPAA stands for Health Insurance Portability and Accountability Act. REF: pg. 4 OBJ: 6 14. Which of the following techniques for expressing genuine concern is the most difficult to use appropriately? a. Touch b. Posture c. Eye contact d. Proper introductions ANS: A Touch is most difficult to use properly because gender and cultural differences often become an issue. REF: Table 1-1, pgs. 3 -4 OBJ: 5 | 7 15. Which of the following techniques is not associated with the demonstration of active listening? a. Good eye contact b. Taking notes while a patient is talking c. Asking for clarification d. Use of touch ANS: D Use of touch helps with demonstrating empathy but has little to do with active listening. REF: pg. 2 OBJ: 2 16. Two respiratory care students are taking their lunch break and want to compare notes about patients they have seen during the morning. Which of the fol lowing locations would be considered a violation of HIPAA standards? a. The unit nursing station in front of the unit clerk’s desk b. A table in the cafeteria with no one within hearing distance c. The respiratory department report room d. The intensive care unit (ICU) staff break room ANS: A Patient Health Information (PHI) should be discussed only in nonpublic areas of the hospital. The space in front of the unit clerk’s desk is likely to be occupied with members of the public asking for information. REF: Table 1-2, pgs. 4 -5 OBJ: 6 PRIMEXAM.COM 17. A 20 -year-old respiratory care student enters the room of a 65 -year-old female patient, saying, “Hi, Linda! I am Joe from Respiratory Care.” He immediately approaches her, looks her in the eye, and places his stethoscope on her chest. a. Joe’s approach to this patient is appropriate. b. Joe has inappropriately entered the patient’s social space. c. Joe has inappropriately entered the patient’s personal space. d. Joe has inappropriately entered the patient’s intimate space. ANS: D Joe has established no rapport with this patient, has touched her without asking permission, and looks her in the eye while examining her. REF: pg. 4 OBJ: 7 18. A respiratory care student returns from a clinical experience , excited that she has had the opportunity to perform cardiopulmonary resuscitation (CPR) for the first time. She immediately goes to her Facebook page and describes her day. Which of the follow ing entries would be a violation of HIPAA standards? a. “At clinical today got to do CPR on a patient on the 6th floor of Mercy Hospital. Patient survived! What a rush!!” b. “Got to do CPR for the first time today. Patient survived!! What a rush!” c. “Got to do CPR for the first time in clinical today! What a rush!!” d. All of the above ANS: D Patient Health Information (PHI) must not be shared in a public location. Facebook is considered a public forum. Although the student did not give specific identifiers in answers a, b, or c, there was enough information that someone familiar with either the patient or the student could possibly have deduced the identity of the patient. REF: Table 1-2, pgs. 4 -5 OBJ: 6 19. Which of the following would be the most appropriate way for respiratory care student Amy Long to initially approach a 58-year-old female patient, Mrs. Nora Jones? a. “Hello, Mrs. Jones. I am Amy from respiratory care, and with your permission I would like to assess you for your treatment.” (Amy stands 5 feet from the patient and makes direct eye contact.) b. Hey there, Nora! Isn’t this a great day!?! I’m Amy and I need to listen to you.” (Amy holds out her stethoscope in front of her and approaches the patient to within 1.5 feet.) c. “Hi, I’m Amy, here to give you your treatment.” (Amy makes no eye contact and looks around the room for a nebulizer.) d. Hi, Mrs. Jones. I’m here for your treatment.” (Amy makes direct eye contact.) ANS: A The initial contact with a patient should be from the patient’s social space (4 to 12 feet). Patients should be addressed by their last name. When first speaking to a patient, the therapist should make direct eye contact, but he or she should not use direct eye contact when in the patient’s intimate space. REF: Table 1-1, pgs. 3 -4 OBJ: 2 | 7 PRIMEXAM.COM 20. The umbrella term patient -centered care includes all of the following elements except : a. Individualized care. b. Assistance with financial and insurance issues. c. Patient involvement. d. Provider collaboration. ANS: B Patient -centered care involves individualized care, patient involvement, and provider collaboration. REF: pg. 2 OBJ: 1 21. The golden rule of bedside care can be summarized as: a. Patients should be cared for primarily at the bedside. b. All patient services (e.g., x -ray, nursing care, respiratory care) should be delivered to the patient at the bedside whenever possible. c. As a caregiver, at all times treat a patient as you would hope to be treated if you were the patient. d. Make sure that all safety equipment is in place at the bedside for maximum patient protection from hazards such as falls. ANS: C The golden rule is that as a caregiver, you treat patients the way you wish to be treated. REF: pg. 2 OBJ: 1 22. In interacting with patients, behaviors such as body movements, touch and eye movements, and facial expressions would be examples of: a. Nonverbal communication. b. Expressions of caregiver interest in patient welfare. c. Mechanisms to put patients at ease. d. None of the above. ANS: A These are mechanisms of nonverbal communication that help to put patients at ease and can be used to communicate caregiver concern to patients. REF: pg. 2 OBJ: 2 23. In determining the course of treatment for a 20 -year-old patient hospitalized for exacerbation of cystic fibrosis, the most effective course of action would be: a. Formulating a treatment plan based on the therapist’s knowledge of the disease and its treatment and then presenting it to the patient. b. Formulating a treatment plan with the physician and nurse and then presenting it to the patient. c. Interviewing the patien t and strictly following the patient’s preferences with regard to treatment. d. Interviewing the patient to determine his or her preferences for treatment, formulating a treatment plan in collaboration with the nurse and physician based on both patient prefer ences and the team’s knowledge of the disease and its PRIMEXAM.COM treatment, and presenting it to the patient. ANS: D Patient -centered care must be highly collaborative, with input from both the patient and caregivers. REF: pg. 7 OBJ: 4 | 8 24. While interviewing a patient in a room with another patient and that patient’s family present, the appropriate course of action for an RT would be to: a. Introduce himself or herself to the patient from a distance of about 5 to 7 feet and proceed with the interview. b. Introduce himself or herself to the patient from a distance of about 5 to 7 feet, move to within 2 to 3 feet of the patient, and proceed with the interview. c. Introduce himself or herself to the patient from a distance of about 5 to 7 feet, move to within 2 to 3 feet of the patient, draw the privacy curtain around the bed, and proceed with the interview. d. Introduce himself or herself to the patient from a distance of about 5 to 7 feet, draw the privacy curtain around the bed, sit on the bed ab out 1 foot from the patient, and proceed with the interview. ANS: C Normally, interviews are carried out in the personal space (within 18 inches to 4 feet of the patient), not the intimate space (from 1 to 18 inches from the patient). The privacy curtain should be in place because others are in the room. REF: pg. 3 OBJ: 3 25. A male therapist is discussing a treatment plan with a female patient who is sitting up in bed, dressed in a hospital gown and wearing a full head covering with only her face showing. Her husband is in the room, and from previous encounters it is clear that she defers to him. The most effective way to present this treatment plan would be for the therapist to: a. Present the patient with a written summary of the plan and ask her to look it over. b. Ask the woman’s husband to step out of the room while the plan is being discussed with the patient. c. Explain the plan to the patient, maintaining eye contact with her at all times and encouraging her to ask any questions she might have. d. Explain the plan to the patient and her husband, and encourage both to ask any questions they might have. ANS: D From the woman’s dress and previous behavior, it is likely that she is Muslim, with traditional values and customs. Therefore, both she and her husband will find it inappropriate, if not offensive, that he not be included in discussions of treatment. Cultural values must be taken into account if truly effective patient treatment is to occur. REF: pg. 5 OBJ: 4 | 7 PRIMEXAM.COM 26. The therapist enters the room of a 6 -year-old victim of an automobile accident who is unconscious and receiving ventilation therapy. The therapist assesses the patient, gives a treatment, and suctions the patient. The patient’s mother then asks in a worried voice, “Is he going to be all right?” The appropriate response for the therapist would be: a. “I just looked at the CT scan of his brain, and I believe the swelling is going down. He should recover within the next couple of weeks.” b. “I’m unable to give you any information about your child’s condition.” c. “I am just the respiratory therapist, and I really do not know anything.” d. “I’m sorry, but our policy is that only the doctor can give you information about your child’s prognosis. Let me step out and find out when the doctor will be back in the unit.” ANS: D Response “a” is inappropriate because it is not within the scope of practice of an RT to render medical opinions about a patient’s condition to the family. Answer “b,” while correct, is unnecessarily abrupt. Answer “c” is both abrupt and is probably not tr ue. Answer “d” meets HIPAA and hospital policy requirements while also providing good patient care and customer service. REF: pgs. 4-5 OBJ: 6 27. In order to deliver effective patient education for use of a particular treatment, the first step should be to: a. Describe to the patient the equipment that will be used for the treatments. b. Describe to the patient the medications that will be used for the treatments. c. Assess the patient’s learning needs by identifying learning barriers, determining the way the patient best learns, and evaluating the patient’s readiness to learn. d. Describe to the patient the schedule for the treatments to be given. ANS: C Although the patient will eventually have to learn about equipment, medications, and schedules, this learning will not occur effectively until the patient’s learning needs are determined. REF: pgs. 6-7 OBJ: 9 28. One effective teaching tool is the teach -back method. This is: a. A technique where the teacher explains the procedure to the learn er and has the learner repeat the information in his or her own words. b. A technique where the teacher explains the procedure to the learner and then has the learner explain it to family members after the teacher has left the room. c. A technique where the teacher gives the equipment to the learner and has the learner experiment with it until he or she can use it correctly. d. None of the above. ANS: A The teach -back method has the learner hear the explanation and then give a “return demonstration” to the teacher to be sure that the learner has the correct information. REF: pg. 7 OBJ: 9 PRIMEXAM.COM 29. Prior to discharge, patients should receive a written action plan that establishes treatment goals and self -care activities. The acronym SMART is helpful in establishing the action plan. The “M” in SMART stands for: a. Meaningful (the goal pertains to the action plan). b. Mastering (the goal). c. Modular (the goal is divided into sections). d. Measurable (the outcome should be measurable). ANS: D In order for a treatment to be effective, its outcome must be measurable. REF: pg. 7 OBJ: 10 30. Failure of care providers to collaborate with one another potentially results in: a. Patient safety placed at risk. b. Duplication of effort by different caregivers. c. Delivery of less-than-optimum care. d. All of the above. ANS: D In addition to “a,” “b,” and “c,” lack of collaboration also may result in an increased length of stay and wasted healthcare resources. REF: pgs. 9-11 OBJ: 13 | 14 | 15 31. An RT enters a room for a patient’s second treatment of the day and notes that the patient is dyspneic and tachycardic and has rales that can be heard throughout all lung fields but are especially prominent in the bases. A treatment is given with little positive change. The therapist should: a. Note the treatment and its results in the patient chart. b. Note the treatment and its results in the patient chart and tell the unit clerk to have the nurse see the patient soon. c. Find the patient’s nurse and together determine what is needed for the patient (e.g., different drug therapy, call physician, call rapid response team). Once the patient’s condition has been adequately addressed, the therapi st’s actions should be documented in the chart. d. Tell the patient you will check back with him in an hour to see how he is doing. ANS: C It is critical that results of an assessment and treatment be communicated to other members of the health team, either in the chart or verbally if the situation demands immediate action. Chart documentation should include findings of the assessment, results of any treatments delivered, and actions taken to resolve the situation. REF: pg. 10 OBJ: 15 32. Good communication is especially critical when “handing off” a patient to another caregiver at the end of the shift. To ensure that adequate information is transmitted, the SBAR format is useful. This acronym stands for situation, background, assessment, and . a. Recommendation. b. Results. PRIMEXAM.COM c. References. d. Repeat (information) ANS: A The fourth letter in SBAR stands for recommendation. REF: pg. 10 OBJ: 14 33. According to the American Association for Respiratory Care (AARC), patient discharge plans should include which of the following? a. Transportation for the patient when the patient goes home b. Ascertaining that once the patient has been discharged, the patient has adequate financial resources to pay rent and utilities c. Notification of the patient’s family and/or other caregivers of the patient’s imminent discharge d. Methods for the ongoing assessment of outcomes ANS: D Discharge planning should focus on providing a continuum of care with transition from the hospital to the alternate site. REF: pg. 11 OBJ: 14 34. All of the following represent good hygiene practices except : a. Gloves should be worn when touching a patient only when a caregiver is likely to come into contact with secretions or infectious materials. b. Hands should be washed when first encountering a patient, after leaving a patient, and before and after any sterile or clean procedure is performed on a patient. c. All infectious waste should be disposed of in proper waste containers. d. Place all needles and b lades in “sharps” containers when you are finished with them. ANS: A Gloves should be worn whenever a patient is touched. REF: pg. 9, Box 1 -4 OBJ: 12 35. The main objective of the I Speak Up initiative from the National Institute of Health (NIH) is: a. Be sure that all billing for patient medical expenses occurs correctly. b. Let caregivers know that the family wants to be informed at all times. c. Let the hospital know when ancillary services such as food quality and parking are inadequate. d. Help ensure that a patient’s care is as safe and effective as possible. ANS: D The I Speak Up initiative is a comprehensive program focused on making sure that patient care is as safe and effective as possible. It especially emphasizes the importance of active patient and fa mily involvement in all aspects of patient care, including enhanced patient safety and reduction in medical errors. REF: pg. 8, Box 1 -3 OBJ: 11 PRIMEXAM.COM Chapter 2: The Medical History and the Interview Test Bank MULTIPLE CHOICE 1. Communication between two people can occur only if: a. The speaker speaks clearly. b. The receiver understands the message. c. Each person is willing to listen to the other. d. All of the above. ANS: D Communication occurs only if both parties speak clearly and listen carefully. REF: pg. 16 OBJ: 1 2. Communication between individuals is affected by all of the following factors except : a. The time of day. b. The cultural heritage. c. The religious beliefs. d. The level of education. ANS: A The time of day is not likely to affect communication in a significant way. REF: pg. 16 OBJ: 2 3. When one is conducting an interview with a patient, which of the following points is most important in facilitating an effective interaction with the patient? a. Recognizing the nonverbal signals that the patient is sending b. Your ability to project a sense of undivided interest in the patient c. Introducing yourself appropriately at the beginning of the interview d. Answering all of the patient’s questions completely without using jargon ANS: B Patients can sense when we are distracted and will not communicate well in such a situation. Glancing out the window or at the television will tell the patient that you are distracted and are not that interested in what he or she has to say. REF: pgs. 16-17 OBJ: 3 4. Which of the following types of questions are preferred for all interactions with a patient? a. Direct questions b. Neutral questions c. Indirect questions d. Open -ended questions ANS: B Neutral questions encourage the patient to respond with sentences and honest answers. REF: pg. 17 OBJ: 3 PRIMEXAM.COM 5. If a patient is unable to provide an accurate history, the respiratory therapist (RT) should: a. Ask a family member or friend to supply the information. b. Ask shorter and more direct questions to determine the cause of the problem. c. Proceed to treat the patient’s symptoms based on information already obtained. d. Refuse to treat the patient because effective therapy cannot be initiated without a complete history. ANS: A In many situations, the patient is unable to answer questions. Family members are often the next best source for important information. REF: pg. 18 OBJ: 4 6. Which of the following should the RT keep in mind when obtaining a pulmonary history? a. Assessment usually is limited to the respiratory system. b. Evaluation of the patient’s entire health status is essential. c. Signs and symptoms of pulmonary diseas e will rarely be seen outside the cardiopulmonary system. d. Patients with long -standing chronic disease can give a detailed account of how their lives have changed and of the signs and symptoms that the disease has caused. ANS: B Pulmonary problems often cause health issues in other body systems, and health problems in other systems often cause pulmonary problems. REF: pg. 18 OBJ: 2 | 6 7. Obtaining background information during an interview is very important because it allows the interviewer to: a. Learn the impact of culture, relationships, and finances on his or her health. b. Predict whether the patient is willing to cooperate in the treatment of his or her disease. c. Develop a basic understanding of the patient’s experience with his or her disease. d. Achieve all of the above. ANS: D Background information is often overlooked but is important for assessing the impact of chronic illness on the patient and for identifying how the patient is coping with the illness. It also tells the interviewer whether the patient is able to cooperate with the treatment plan. REF: pg. 18 OBJ: 2 | 6 8. Screening information is: a. Obtained at health fairs to determine whether the person should see a physician. b. Designed to uncover problem areas that the patient forgot to mention or omitted. c. Given to the interviewer by the patient at the very beginning of the interview process. d. Obtained by the triage nurse in the emergency department to determine how life - threatening the patient’s symptoms are. PRIMEXAM.COM ANS: B Screening information is designed to identify important facts that the patient may have overlooked in the interview. REF: pgs. 18-19 OBJ: 2 9. The review of systems is very important because it provides the interviewer with: a. Information grouped by major organs and physiologic systems. b. Additional subjective information about the patient’s problem. c. A combination of subjective and objective data in a narrative form. d. Information relevant to the patient’s problem that may have been overlooked. ANS: D The review of systems helps identify key information that may have been overlooked in the interview. REF: pg. 19 OBJ: 2 10. A pertinent negative is defined as: a. Any negative response made by the patient during the interview. b. Refusal by the patient to answer questions about a certain topic. c. Any negative response by the patient to an important question about possible symptoms. d. A negative response by a patient to a therapist who asks whether the patient needs a breathing treatment. ANS: C If the patient appears to have pneumonia but denies having a cough, the patient’s negative response to the question about coughing would be a pertinent negative. REF: pg. 19 OBJ: 3 11. A pertinent positive is defined as: a. Any positive response made by the patient during the interview. b. A direct question asked during the interview that elicits a positive response. c. An affirmative response by the patient when asked whether he or she needs a breathing treatment. d. An affirmative response to an important interview question about the patient’s symptoms. ANS: D A positive response from the patient regarding a symptom associated with the possible diagnosis would be a pertinent positive. REF: pg. 19 OBJ: 3 12. The main purpose of the chief complaint is to: a. Give a brief explanation about why the patient sought health care. b. Direct the interviewer to the organ system in which the problem is located. c. Present a diagnosis that is based on information obtained during the interview. d. List symptoms in order from most severe to least severe according to organ system involvement. PRIMEXAM.COM ANS: A The chief complaint explains why the patient sought medical help. REF: pg. 19 OBJ: 2 | 3 13. Which of the following cardiopulmonary conditions would not be found in the chief complaint list? a. Asthma b. Wheezing c. Chest pain d. Hemoptysis ANS: A Asthma is a diagnosis and not a complaint. REF: pg. 19 | pg. 21 OBJ: 2 14. When a patient is interviewed so the chief complaint can be determined, the best questions that can be asked to elicit this information are: a. Direct questions. b. Neutral questions. c. Open -ended questions. d. A combination of the above. ANS: D Use of a variety of types of questions usually yields the best interview results. REF: pg. 17 | pg. 19 OBJ: 2 15. Which of the following would not be found in the past medical history? a. Injuries and accidents b. Surgeries and hospitalizations c. Associated symptoms and aggravating factors d. Over -the-counter medications, vitamins, and “home remedies” ANS: C Associated symptoms and aggravating factors would be found in the history of present illness. REF: pg. 22 OBJ: 2 16. Which of the following formulas should be used to calculate the pack -year history of cigarette consumption? a. Packs per day times Years smoked b. Packs per day minus Years smoked c. Packs per day plus Years smoked d. Packs per day plus Years smoked ANS: A Pack -years is the standard way to document a patient’s smoking history. This is determined by multiplying the number of packs smoked times the number of years smoked. REF: pg. 24 OBJ: 2 PRIMEXAM.COM 17. One disadvantage of using the pack -year method for calculating cigarette consumption is that: a. The method is not used widely throughout the United States. b. Advanced mathematical calculations are required to obtain the figure. c. The method does not reveal how many packs per day were smoked over how many years. d. The values are more meaningful to RTs and physicians than to other healthcare providers. ANS: C Although pack -years is an industry standard for documenting quantity of tobacco consumption, this value does not provide the details. REF: pg. 24 OBJ: 2 18. Which of the following is not a reason for obtaining a family history? a. To assess the current health status of the extended family b. To learn about the health status of the patient’s blood relatives c. To determine whether the patient is adopted d. To identify the presence in the family of diseases with a hereditary tendency ANS: C The reason for obtaining a family history is to identify blood relatives who may have a disease that the patient has inherited. REF: pg. 25 OBJ: 2 19. Which of the following diseases would not be recorded in the family history as a hereditary disorder? a. Asthma b. Pneumonia c. Cystic fibrosis d. Alpha 1-antitrypsin deficiency ANS: B Pneumonia is not hereditary. REF: pg. 25 OBJ: 2 20. Modern -day office workers may be exposed to which of the following occupational and environmental diseases? a. Bagassosis b. Monday fever c. Pneumoconiosis d. Sick building syndrome ANS: D Sick building syndrome occurs when employees are exposed to low doses of toxic gases in a building that is airtight and has poor ventilation. REF: Table 2-1, pg. 27 OBJ: 2 PRIMEXAM.COM 21. Which of the following symptoms is often seen in patients with tight building syndrome? a. Headache b. Stuffy nose c. Cough d. All of the above ANS: D Tight building syndrome can cause a variety of symptoms. REF: Table 2-1, pg. 27 OBJ: 2 22. What pulmonary disorder is associated with visiting or living in Ohio, Maryland, and the central Mississippi Valley? a. Blastomycosis b. Histoplasmosis c. Coccidioidomycosis d. Silicosis ANS: B Histoplasmosis occurs only in the midwestern regions of the country. REF: Table 2-1, pg. 28 OBJ: 2 23. Who writes the initial admission note? a. The physician b. The head nurse c. The head RT d. Any of the above ANS: A Only the physician writes the initial admission note, which describes why the patient is being admitted. REF: pg. 28 OBJ: 2 | 6 24. Who writes the progress notes each day? a. The physician b. The physical therap ist c. The nurse d. Any of the above ANS: D Any clinician who provides treatment to the patient can write a progress note in the chart. REF: pg. 28 OBJ: 2 | 6 25. A good interview should contain all of the following elements except: a. The interviewer should dress and act professionally. b. The interviewer should project a sense of undivided interest. c. The interviewer should use a formal speaking style. d. The interviewer should respect the patient’s beliefs and attitudes. ANS: C PRIMEXAM.COM The interviewer should use an informal, relaxed, conversational style. REF: pg. 17 OBJ: 2 | 3 26. In the physical examination, objective data gathered are referred to as: a. Measurements. b. Symptoms. c. Variables. d. Signs. ANS: D Objective data are referred to as “signs” in the physical examination. These are data that can be perceived by the examiner, either by measurements or observations. REF: pg. 19 OBJ: 5 27. In the physical examination, subjective data gathered are referred to as: a. Measurements. b. Symptoms. c. Variables. d. Signs. ANS: B Subjective data in the physical examination are referred to as symptoms. These are data that can only be perceived by the patient. A good interviewer, however, is able to ask questions that prompt the patient to give complete and accurate descriptions of his or her symptoms. REF: pg. 19 OBJ: 5 28. An RT examining a patient auscultates wheezes in the right lower lobe (RLL). This would be an example of: a. Objective data (a sign). b. Objective data (a symptom). c. Subjective data (a sign). d. Subjective data (a symptom). ANS: A Because wheezes are perceived by the examiner, this would be an example of a sign. REF: pg. 19 OBJ: 5 29. A patient being interviewed says that he wakes up nearly every night feeling very hot and with his body bathed in sweat. This fact, along with his hemoptysis, is a very strong indication that he may have tuberculosis. The night sweats would be an example of: a. Objective data (a sign). b. Objective data (a symptom). c. Subjective data (a sign). d. Subjective data (a symptom). ANS: D Because the night sweats are perceived only by the patient and then described to the examiner, they would be an example of subjective data (a symptom). PRIMEXAM.COM REF: pg. 19 OBJ: 5 30. A “constitutional” symptom would include all of the following except: a. Chills and fever. b. Anorexia and/or weight loss. c. Fatigue. d. Wheezing. ANS: D Constitutional symptoms generally involve the whole body and are not specific to individual systems. Wheezing is definitely specific to the respiratory system. REF: pg. 21 OBJ: 6 31. All of the following questions would be effective in eliciting additional information about a patient’s location and level of pain except for question . a. Earlier, you briefly mentioned some pain around your lower ribs. Could you tell me more about it? b. Earlier, you briefly mentioned some pain around your lower ribs. Could you point to exactly where it is? c. Earlier, you briefly mentioned some pain around your lower ribs. What do you think is causing it? d. Earlier, you briefly mentioned some pain around your lower ribs. Could you rate this pain for me on a scale of 1 to 10, with 1 meaning no pain and 10 meaning the worst pain possible? ANS: C A good interviewer is looking for a precise description of a symptom. It is unlikely that the patient has any idea what is causing the pain. REF: pg. 21 OBJ: 2 32. A history of a patient’s tobacco use is important for all of the following reasons except : a. There is a strong relationship between smoking and chronic obstructive pulmonary disease (COPD). b. There is a strong relationship between smoking and the use of illicit drugs such as marijuana, cocaine, and heroin. c. There is a strong relationship between smok ing and cardiovascular disease. d. There is a strong relationship between smoking and lung cancer. ANS: B There is no published evidence that shows that smoking increases the likelihood that a person will use illicit drugs. There is ample evidence of the relationship between smoking and COPD, cardiovascular disease, and lung cancer. REF: pg. 22 OBJ: 2 | 3 | 6 33. Monday fever is: a. The term describing workers who habitually do not want to return to work after the weekend. b. The tendency of workers to have poor levels of concentration in the workplace PRIMEXAM.COM after the weekend. c. An example of a hypersensitivity reaction to a toxic inhaled substance that is worst after the initial exposure but becomes progressively less pronounced as the exposure continues. d. None of the above. ANS: C First exposure to a toxic inhaled substance may c ause an immediate reaction (as on Monday following a weekend), which gradually becomes less severe with continued exposure (i.e., exposure throughout the rest of the week). REF: pg. 27 OBJ: 6 34. In which section of the patient record should the following entry appear? “Day 4 of hospitalization. Patient febrile (39o C). Rales in both lung bases; sputum moderate, thick, green, tinged with blood. Plan: Continue ordered antibiotic therapy. Bronchoscop y tomorrow in AM.” a. Admission note b. Physician orders c. Progress notes d. Discharge plan ANS: C The physician should see the hospitalized patient at least once daily to identify the patient’s general condition, progress, and response to treatment. These findings are summarized in the progress notes. REF: pg. 28 OBJ: 6 | 7 35. The RT has been called STAT to the bedside of a patient who is in extreme respiratory distress in the intensive care unit (ICU). Shortly after arriving, the patient’s cardiac monitor shows a pattern of ventricular fibrillation, and shortly thereafter the patient ceases breathing. The nurse states that the patient has a do not resuscitate (D NR) order. The RT should take which of the following actions? a. Do nothing, because a DNR order means that no resuscitative measures should be attempted. b. Call a full code and institute full resuscitative measures because the therapist knows that the physician who wrote the DNR order is not working in the unit this week. c. Call a code so that cardiac medications can be given to correct the ventricular fibrillation; the DNR order means that the patient cannot be intubated. d. Place a non–rebre ather mask on the patient for “comfort measures.” ANS: A A DNR order signed by a physician means that no resuscitative measures should be undertaken. REF: pg. 28 OBJ: 8 PRIMEXAM.COM Chapter 3: Cardiopulmonary Symptoms Test Bank MULTIPLE CHOICE 1. Which of the following sequences of events best describes the cough mechanism? a. Inspiration, closure of glottis, forceful opening of glottis b. Opening of glottis, relaxation of diaphragm, closure of glottis c. Inspiration, forceful opening of glottis, contraction of diaphragm d. Opening of glottis, contraction of diaphragm, explosive release of trapped intrathoracic air ANS: A The cough mechanism can be divided into three phases: 1. Inspiratory phase: Reflex opening of the glottis and contraction of the diaphragm and the thoracic and abdominal muscles cause a deep inspiration with a concomitant increase in lung volume accompanied by an increase in the caliber and length of the bronchi . 2. Compression phase: Closure of the glottis and relaxation of the diaphragm while the expiratory muscles contract against the closed glottis can generate very high intrathoracic pressures and narrowing of the trachea and bronchi. 3. Expiratory phase: Opening of the glottis and explosive release of trapped intrathoracic air occur, along with vibration of the vocal cords and of the mucosal lining of the posterior laryngeal wall, which shakes secretions loose from the larynx and moves un desired material out of the respiratory tract. REF: pg. 33 OBJ: 1 2. Which of the following mechanisms does not explain why patients with chronic obstructive pulmonary disease (COPD) have a poor cough? a. Weak muscles of breathing b. Increased elastic recoil c. Airway obstruction d. Glottis function failure ANS: B The effectiveness of a cough is reduced when one or more of the following conditions exist: (1) weakness of the inspiratory or expiratory muscles; (2) inability of the glottis to open or close correctly; (3) obstruction, collapsibility, or alteration in shape or contours of the airways; (4) decrease in lung recoil, as occurs with emphysema; and (5) abnormal quantity or quality of mucus production (e.g., thick sputum). REF: pg. 33 OBJ: 1 3. Chronic productive cough is caused most commonly by which of the following clinical conditions? a. Postnasal drip b. Viral infection c. Upper airway infection d. Bronchopulmonary disease PRIMEXAM.COM ANS: A Chronic persistent cough is caused most commonly by pos tnasal drip syndrome, followed by acute asthma, acute exacerbation of COPD, allergic rhinitis, gastroesophageal reflux disease (GERD), chronic bronchitis, bronchiectasis, and other conditions such as left heart failure, bronchogenic cancer, and sarcoidosis . REF: pg. 34 OBJ: 1 4. Which of the following is not a complication of forceful coughing? a. Rib fracture b. Pneumothorax c. Pleural effusion d. Torn chest muscle ANS: C The vigorous muscular activity and high intrathoracic pressures created by forceful coughing may produce a number of complications, such as torn chest muscles, rib fractures, disruption of surgical wounds, pneumothorax or pneumomediastinum, syncope (fainting), arrhythmia, esophageal rupture, and urinary incontinence. REF: pg. 34 OBJ: 1 5. Which of the following conditions is not associated with a characteristic “hacking” cough? a. Smoking b. Viral infection c. Nervous habit d. Lung cancer ANS: D Hacking (frequent brief periods of coughing or clearing the throat) may be dry and may be the result of smoking, a viral infection, a nervous habit, or difficult -to-move secretions, as occur with postnasal drip. REF: pg. 34 OBJ: 1 6. Which of the following is the best definition of sputum ? a. Secretions b. Thick tenacious secretions c. Secretions from the lungs and lower airways d. Secretions from the nose, mouth, and tracheobronchial tree ANS: D Sputum is the substance expelled from the tracheobronchial tree, pharynx, mouth, sinuses, and nose by coughing or clearing the throat. REF: pg. 35 OBJ: 1 7. What term is used to describe secretions strictly from the lungs and lower airways? a. Phlegm b. Sputum c. Mucus PRIMEXAM.COM d. Empyema ANS: A The term phlegm refers strictly to secretions from the lungs and tracheobronchial tree. REF: pg. 35 OBJ: 1 8. Excessive sputum production is associated with all the following conditions except : a. Allergies. b. Cigarette smoking. c. Airway infection. d. Pleural infection. ANS: D Excessive sputum production is caused most often by inflammation of the mucous glands that line the tracheob ronchial tree. Inflammation of these glands occurs most often with airway infection, cigarette smoking, and allergies. REF: pg. 35 OBJ: 1 9. Which of the following terms best describes foul-smelling sputum? a. Fetid b. Mucoid c. Purulent d. Mucopurulent ANS: A Copious, foul -smelling (fetid) sputum that separates into layers when standing occurs with bronchiectasis and lung abscess when the patient’s position is changed. REF: pg. 36 OBJ: 1 10. A patient presents in the emergency department with blood -tinged sputu m. The term associated with such sputum is: a. Gelatinous. b. Hemoptysis. c. Hematemesis. d. Mucopurulent. ANS: B Hemoptysis, expectoration of sputum that contains blood, varies in severity from slight streaking to frank bleeding. REF: pg. 36 OBJ: 1 11. Which of the following conditions is believed to be the most common cause of hemoptysis? a. Tuberculosis b. Erosive bronchitis c. Bronchogenic carcinoma d. Pneumonia ANS: B PRIMEXAM.COM Erosive bronchitis in smokers with chronic bronchitis now accounts for nearly half the cases of hemoptysis. REF: pg. 36 OBJ: 1 12. Which of the following definitions is consistent with massive hemoptysis? a. 400 mL in 3 hours b. 400 mL in 12 hours c. 600 mL in 48 hours d. 600 mL in 72 hours ANS: A Massive hemoptysis (400 mL in 3 hours, or more than 600 mL in 24 hours) is seen with lung cancers, tuberculosis, bronchiectasis, and trauma. REF: pg. 37 OBJ: 1 13. Hemoptysis in a patient with sudden onset of chest pain who is at risk for venostasis is suggestive of which of the following conditions? a. Pneumonia b. Pulmonary embolism c. Myocardial infection d. Atelectasis ANS: B Hemoptysis associated with sudden onset of chest pain and dyspnea in a patient at risk for venous stasis of the legs must lead to assessment of that patient for pulmonary embolism and possible infarction. REF: pg. 37 OBJ: 1 14. In the presence of nausea an d vomiting, a history of cirrhosis of the liver suggests which of the following organs as the source of hematemesis? a. Kidneys b. Duodenum c. Esophagus d. Liver ANS: C The presence of symptoms such as nausea and vomiting, especially with a history of alcoholism or cirrhosis of the liver, may suggest the esophagus or stomach as the source of hematemesis. REF: pg. 37 OBJ: 1 15. Dyspnea is defined as: a. A visible increase in the work of breathing. b. An increase in respiratory rate and depth. c. Breathlessness as perceived by the patient. d. Difficulty breathing in the upright position. ANS: C PRIMEXAM.COM Dyspnea (dys, difficult; pnea, breathing) is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. REF: pg. 38 OBJ: 1 16. Which of the following grading systems is useful in qualifying the degree of dyspnea? a. Murray lung injury score b. Modified Borg scale c. Dubowitz score d. Asthma score ANS: B The modified Borg scale, as shown as Table 3 -5, pg. 39, uses a 0 to 10 grading system, with descriptive terms to depict the perceived intensity of a symptom such as dyspnea after a specified task. REF: Table 3-5, pg. 39 OBJ: 1 17. Dyspnea tends to occur when which of the following is present? a. Work of breathing that is adequate for a given level of exertion b. Decrease in ventilatory drive to breathe c. Increase in ventilatory capacity d. Increase in ventilatory drive to breathe ANS: D It is helpful to remember that patients with respiratory disorders will complain of dyspnea when any of the following is present alone or in combination: 1. The work of breathing is abnormally high for the given level of exertion. This is common with narrowed airways, as in asthma, and when the lung is stiff, as in pneumonia. 2. The ventilatory capacity is reduced. This is common when the vital capacity is abnormally low, as is seen in patients with neuromuscular disease. 3. The drive to breathe is elevated beyond normal (e.g., hypoxemia, acidosis, exercise). REF: pg. 39 OBJ: 1 18. Breathing at a rate and depth in excess of the body’s metabolic need is known as: a. Hyperventilating. b. Hyperpnea. c. Platypnea. d. Psychogenic dyspnea. ANS: A Hyperventilating is breathing at a rate and depth in excess of the body’s metabolic need, which causes a decrease in arterial carbon dioxide (Pa CO 2) and results in a decrease in cerebral blood flow. REF: pg. 40 OBJ: 1 19. All of the following conditions are associated with acute dyspnea in children except : a. Asthma. b. Cystic fibrosis. c. Bronchiolitis. PRIMEXAM.COM d. Croup. ANS: B Acute dyspnea in children is associated most frequently with asthma, bronchiolitis, croup, and epiglottitis. REF: pg. 41 OBJ: 1 20. Which of the following diseases is one of the most common causes of chronic dyspnea in adults? a. Asthma b. Bronchiolitis c. Cystic fibrosis d. Congestive heart failure (CHF) ANS: D COPD and chronic CHF are the most common causes of chronic dyspnea in adults. REF: pg. 41 OBJ: 1 21. Paroxysmal nocturnal dyspnea is associated commonly with which of the following conditions? a. Asthma b. COPD c. CHF d. Obstructive sleep apnea ANS: C Paroxysmal nocturnal dyspnea (PND) is the sudden onset of difficulty in breathing that occurs when a sleeping patient is in the recumbent position. It often is associated with coughing and is relieved when the patient assumes an upright position. In patients with CHF, PND usually occurs 1 to 2 hours after lying down and is caused by the gradual tra nsfer to the lungs of fluid in the lower extremities. REF: pg. 41 OBJ: 1 22. An inability to breathe while lying down is known as: a. Dyspnea. b. Platypnea. c. Orthopnea. d. PND. ANS: C Orthopnea is the inability to breathe when lying down. REF: pg. 41 OBJ: 1 23. Chest pain is the cardinal symptom of which of the following diseases? a. Heart disease b. Pleural disease c. Chest wall disease d. Neuromuscular disease