Chapter 5 & 21 Wilkins
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The patient record is a(an):
a. financial document
b. legal document
c. educational tool
d. all of the above
What is the primary goal of The Joint Commission?
a. Monitor financial reimbursement of hospitals.
b. Review healthcare organizations to improve the quality of healthcare and patient safety.
c. Provide healthcare workers with a safe work environment.
d. Monitor the ethical practice of medicine at healthcare organizations.
- b. Review healthcare organizations to improve the quality of healthcare and patient safety.
Which of the following organizations influences what needs to be documented in a patient's medical record?
a. The Joint Commission
b. Center for Medicare and Medicaid Services (CMS)
c. Financial intermediaries
d. All of the above
Which of the following definitions is consistent with negligence?
a. Failure to document a procedure performed on a patient
b. Failure to explain to a patient the purpose of a therapy
c. Failure to obtain a license to practice despite good clinical performace
d. Failure to use a reasonable amt of care that results in injury or damage to another
- d. Failure to use a reasonable amt of care that results in injury or damage to another
Which of the following conditions is NOT required for the legal definition of negligence?
a. The defendant owed a duty of care to the plaintiff.
b. The defendant breached that duty.
c. The plaintiff suffered a legally recognizable injury.
d. The defenant's breach of duty of care did not cause the plaintiff's injury.
- d. The defenant's breach of duty of care did not cause the plaintiff's injury.
Which of the following outlines the professional standards for respiratory therapists?
I. AARC clinical practice guidelines
II. Respiratory care practice act and regulations
III. Place of employment
IV. The Joint Commission
a. I, II, and IV
b. I, II, and III
c. I, II, III, and IV
d. II and IV
The absence of information or the lack of documented recognition of specific problems could result in one of the following situations?
b. Reduction in salary for the respiratory therapist
c. Reduction in workload
d. Probation status for the clinician at fault
Which of the following sections of the patient assessment or procedures should be charted immediately?
a. Date and time of test or treatment
b. Vital Signs
c. Result, or response to treatment, including adverse reactions
d. Drugs and their dosages
Which of the following words is not consistent with the definition of the SOAP charting method?
d. Physical exam
All of the following are examples of "objective" data, except:
a. laboratory results.
b. observation of a patient's sleep apnea.
c. the patient's report of the amount of sputum that he or she produces daily.
d. the physician's interpretation of the patient's ECG.
- c. the patient's report of the amount of sputum that he or she produces daily.
According to experts, obtaining a good medical history from the patient can give you a ____% chance of correctly identifying a patient's problem before you do a single test.
Which of the following data does not constitute part of the objective part of the SOAP charting method?
a. vital signs
b. review of systems
c. review of clinical laboratory data
d. review of pulmonary function test results
What does the letter "I" stand for in the APIE method of documentation?
Which method of documentation is probably best for a clinician who is pressed for time?
Which of the following charting methods has been promoted with implementation of rapid response teams (RRTs)?
What problem is associated with cyanosis of the oral mucosa?
a. Low cardiac output
b. Reduced arterial oxygenation
- b. Reduced arterial oxygenation
What is associated with nasal flaring?
b. Increased lung compliance
c. Increased work of breathing
d. Increased dead space ventilation
- c. Increased work of breathing
Which of the following is not associated with dilated and unresponsive pupils?
c. Brain Death
What term is used to describe constriction of the puils of the eye?
What term is used to descrive drooping of the eyelids?
Which of the following physical examination findings is associated with myasthenia gravis?
What term is used to describe double vision?
d. None of the above
Which of the following is most likely to cause tracheal deviation?
a. left upper lobe pneumonia
b. right upper lobe pneumothorax
c. left lower lobe pleural effusion
d. right lower lobe pleural effusion
- b. right upper lobe pneumothorax
Which of the following is the most common cause of jugular venous distention?
a. auto-positive end-expiratory pressure (PEEP)
d. right heart failure
At what angle should the head of the bed be elevated to to assess jugular vein pressure (JVP)?
a. 15 degrees
b. 30 degrees
c. 45 degrees
d. 90 degrees
In the patien's chart the physician documented fining lymphadenopathy in the neck region that is tender to the touch. This problem is consistent with:
a. respiratory infection
d. lung cancer
The horizontal fissure that separates the right upper lobe from the right middle lobe begins at what rib in the midsternal line?
a. between T4 and T6
b. between T6 and T8
c. Between T9 and T12
d. None of the above
What term describes an abnormal lateral curvature of the spine?
What disorder is associated with a barrel chest?
a. Chronic bronchitis
d. Chest trauma
What pattern of breathing is associated with a loss in lung volume?
a. slow and deep
b. rapid and deep
c. slow and shallow
d. rapid and shallow
What disease is most likely to cause a prolonged expiratory time?
d. Pulmonary fibrosis
What disease is most likely to cause a prolonged inspiratory time?
a. Chronic obstructive pulmonary disease (COPD)
d. Acute bronchitis
What term describes the sinking inward of the skin overlying the rib cage with each inspiratory effort?
Which of the following is a sign of more severe chronic obstructive pulmonary disease?
a. Prolonged inspiratory time
b. Decrease in AP diameter of the chest
c. Significant use of accessory muscles at rest
d. small retrosternal airspace on the lateral chest film
- c. Significant use of accessory muscles at rest
What breathing pattern is associated with fatigue of the diaphragm?
b. Deep and fast breathing
c. Biot's breathing
d. Abdominal paradox
In patients with severe COPD and hyperinflation, the low, flat diaphragm causes inward movement of the lateral chest walls with inspiration. What is this called?
a. Abdominal paradox
b. Biot's breathing
c. Hoover's sign
d. Respiratory alternans
What clinical condition is associated with central cyanosis?
b. Renal failure
c. Poor circulation
d. Respiratory failure
Which of the following will cause an increase in vocal fremitus upon palpation?
Which of the following will cause a decrease in vocal fremitus upon palpation?
c. Lung tumor
What clinical disorder will cause a decrease in vocal fremitus upon palpation?
b. Lobar pneumonia
c. Acute asthma attack
d. Neuromuscular Disease
On assessment of chest expanstion with palpation, the right lower chest is found to lag behind the left. With what problem is this finding consistent?
b. Right lower lobe pneumonia
c. left lower lobe pneumonia
d. Severe asthma
- b. Right lower lobe pneumonia
What clinical disorder will cause increased resonance to percussion?
d. Pleural effusion
What clinical disorder will cause decreased resonance to percussion?
The bell portion of the stethoscope is best designed to listen to _______-pitched ______ sounds.
a. low; lung
b. low; heart
c. high; lung
d. high; heart
What technique is most useful for application of the bell portion of the stethoscope?
a. Press lightly against the chest wall.
b. Press firmly against the chest wall.
c. Hold it 1 cm from the chest wall.
d. Slide it in a circle.
- a. Press lightly against the chest wall.
The diaphragm portion of the stethoscope is used to listen for:
a. heart murmurs
b. pleural friction rubs.
c. low-pitched heart sounds.
d. most lung sounds.
Where is the best anatomical place to begin auscultation in most patients.
a. Over the trachea
b. Over the upper lobes
c. In the axillary regions
d. In the dependent regions
- d. In the dependent regions
What term is used to describe the normal breath sounds heard around the sternum on the anterior chest and between the scapulae on the posterior chest?
Which of the following characteristics does not apply to normal tracheal breath sounds?
b. Low pitched
c. High pitched
d. Fairly equal insp and exp components
Which of the following descriptions does not apply to ormal vesicular breath sounds?
a. Soft with low intensity
b. Minimal expiratory component
c. Heart primarily over lung parechyma
d. High pitched as compared with tracheal breath sounds
- d. High pitched as compared with tracheal breath sounds
What term best describes a louder version of a vesicular sound that can be heard over long consolidation?
d. Harsh or bronchial
What term has had a confusing history with regard to its use and has been replaced with the term crackles?
What term best describes types of adventitious lung sounds?
d. Sibilant rales
What term is used to describe a continuous type of adventitious lung sound heard loudest over the nek of the patient with an upper airway obstruction?
d. Sonorous rales
What mechanism is believed to be responsible for the normal vesicular breath sound?
a. Air entering the alveoli
b. Contraction of the inspiratory muscles
c. Rubbing together of the two layers of pleura
d. Filtration of turbulent flow sounds in the larger airways
- d. Filtration of turbulent flow sounds in the larger airways
Which of the following statements is not true about vesicular or normal breath sounds?
a. They have minimal expiratory sounds.
b. They are produced somewhat regionally.
c. They are produced when air enters the alveoli.
d. They are used to help confirm proper placement of the ET tube.
- c. They are produced when air enters the alveoli.
- (...by diffusion, which is silent.)
Which of the following lung conditions is associated with diminished breath sounds becuase of airflow limitation and poor transmission of sound through the lung?
c. Lung tumor
Which of the following factors most closely relates to the pitch of a wheeze?
a. The patient's I:E ratio.
b. The patiet's respiratory rate.
c. The length of the involved airway.
d. The degree of airway compression.
- d. The degree of airway compression.
Which of the following characteristics of wheezing is the least reliable for predicting the degree of airway obstruction?
d. Sound Frequency
What type of wheezing is likely to be heard over the chest of a patient with a tumor that is partially obstructing a single airway?
a. Sibilant wheezing
b. Sonorous wheezing
c. Polyphonic wheezing
d. Monophonic wheezing
Which of the following adventitous lung sounds is related most closely to a life-threatening problem?
Which of the following adventitious lung sounds is associated most closely with restrictive types of lung diseases?
a. Polyphonic wheezing
b. Monophonic wheezing
c. late-inspiratory crackles
d. Early-inspiratory crackles
- c. late-inspiratory crackles
What adventitous lung sound is most likely to be heard in the patient with croup?
c. Polyphonic wheeze
d. Late-inspiratory crackles
What term applies to an abnormal increase in vocal resonance?
d. None of the above
Which of the following abnormalities would be associated with an increase in vocal resonance?
d. Large pleural effusion
What term describes the area of the chest wall that overlies the heart?
d. None of the above
The point of miscimal impulse normally is felt where during palpation of the chest wall?
a. Midaxillary line at the 5th intercostal space
b. Midclavicular line at the 5th intercostal space
c. Just left of the sternum at the 3rd intercostal space
d. Just right of the sternum at the 4th intercostal space
- b. Midclavicular line at the 5th intercostal space
What may cause the PMI to shift to the antrior axillary region on the left?
a. A tension pneumothorax on the right
b. Right ventricular hypertrophy
c. Cor pulmonale
- a. A tension pneumothorax on the right
What is the clinical disorder characterized by the point of maximal impulse being felt in the epigastric area?
c. Chronic bronchitis
At what site on the chest wall is the pulmonic valve best auscultated?
a. 2nd left intercostal space near the sternal border
b. 5th intercostal space on the left near the sternal border
c. 6th intercostal space on the left at the midaxillary line
d. 1st intercostal space on the right at the midclavicular line
- a. 2nd left intercostal space near the sternal border
What is believed to be responsible for production of the first heart sound?
- Closure of the AV valves (mitral, tricuspid)
What mechanism is responsible for production of an abnormal third heart sound?
- Rapid filling of the ventricles immediately after systole
What clinical problem is associated with a gallop rhythm?
- Left-to-right shunt, post myocardial infarction, overdistention of the ventricles (all of the above)
What clinical condition may cause diminished heart sounds?
What change in the heart sounds is associated with cor pulmonale?
What type of murmur is associated with mitral valve stenosis?
Which of the following is responsible for the production of murmurs?
- Stenotic AV valves, Incompetent AV valves, Incompetent semilunar valve (all of the above)
What is a common cause of hepatomegaly?
- Chronic right heart failure
What is the normal distance that the liver spans in the right upper quadrant of the abdomen?
What is the term used to describe an abnormal collection of fluid in the peritoneal cavity?
Digital clubbing is associated with:
- COPD, CF, bronchogenic carcinoma, *all of the above
Which of the following findings is consistant with reduced perfusion?
a. Peripheral cyanosis
c. Loud P2 sound
d. Jugular vein distention (JVD)
What clinical condition is associated with the onset of pedal edema?
a. liver failure
b. right heart failure
c. status asthmaticus
d. tension pneumothorax
Normal capillary refill is less than ____ seconds?
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