Homework Lance
MULTIPLE CHOICE
1. Which of the following is not classified as a classic vital sign?
a.
Pulse
b.
Sensorium
c.
Blood pressure
d.
Respiratory rate
ANS: B
The four classic vital sign measurements are temperature, pulse, respirations, and blood pressure.
REF: pg. 57 OBJ: 1
2. How often should vital signs be recorded in a patient who is hospitalized but is not in intensive care?
a.
Every hour
b.
Every 2 hours
c.
Every 4 to 6 hours
d.
Every 12 hours
ANS: C
For patients who are hospitalized but are not in intensive care, routine vital signs are recorded most commonly every 4 to 6 hours (at the beginning of a shift and in the middle of a shift).
REF: pg. 58 OBJ: 1
3. Which of the following statements regarding vital signs is most accurate?
a.
Vital signs are used only to establish a baseline.
b.
Vital signs monitor only the response to therapy.
c.
Trends in vital signs are far more important than a single measurement.
d.
Vital signs at baseline should never be compared with those that were obtained 24 hours earlier.
ANS: C
The initial reading generally is referred to as the baseline measurement. A series of vital sign measurements over time establishes a trend and is far more important clinically than any single measurement. Each time vital signs are measured, they should be compared with baseline values and the most recent measurements. Sometimes the patient’s condition may be changing slowly, and comparison with one or two previous measurements does not indicate a trend, whereas comparison over the span of an entire shift or 24-hour period may indicate clearly that the patient is deteriorating slowly.
REF: pg. 58 OBJ: 2
4. Which of the following statements best reflects the importance of comparing changes in vital signs?
a.
It allows assessment of important subjective patient data.
b.
It allows recognition of the development of a particular problem.
c.
It allows detection of additional symptoms.
d.
It does not allow changes in therapy.
ANS: B
Information about the probability that a patient is experiencing or may be developing a particular problem is obtained by comparing changes in vital signs and other signs and symptoms.
REF: pgs. 58-59 OBJ: 2
5. When vital signs are compared with other signs and symptoms to arrive at a conclusion about what is wrong with a patient, this is known as the:
a.
review of systems.
b.
differential diagnosis.
c.
general clinical presentation.
d.
objective assessment information.
ANS: B
In the field of medicine, this comparison of multiple signs and symptoms to arrive at the patient’s diagnosis is called a differential diagnosis.
REF: pg. 59 OBJ: 2
6. If dehydration is suspected in a patient, which of the following parameters should be monitored often?
a.
Height
b.
Weight
c.
Fluid intake and output
d.
Blood pressure
ANS: C
If a question arises regarding dehydration or fluid overload, fluid intake and output (I & O) and weight may be recorded during each shift until the patient’s fluid balance is stable.
REF: pg. 59 OBJ: 2
7. A patient’s general clinical presentation indicates to the respiratory therapist (RT) that the patient is in distress. The RT’s first step should be to:
a.
call a code and stand by to assist with cardiopulmonary resuscitation (CPR).
b.
do a complete physical examination to determine the precise cause of the distress.
c.
evaluate the problem quickly and intervene or locate someone to assist the patient.
d.
follow the procedure learned in class to introduce himself or herself to the patient and ask the patient what is wrong.
ANS: C
If the patient is in distress, the priorities are to evaluate the problem in the most efficient and rapid way possible and to intervene or locate someone who can assist the patient.
REF: pg. 59 OBJ: 2
8. A well-written description of an RT’s initial observations is beneficial to other healthcare providers because it:
a.
shows that the RT has established rapport with the patient.
b.
helps them know how to plan care and relate to the patient’s needs.
c.
decreases the length of hospitalization of the patient and keeps costs down.
d.
allows them to read the information quickly without confusion and misunderstandings.
ANS: B
A written description of these initial observations helps others involved in the patient’s care to know how to plan care and relate to the patient’s needs.
REF: pg. 60 OBJ: 2
9. Assessing the patient’s level of consciousness is important because it:
a.
suggests the types of questions that the therapist should ask.
b.
evaluates the adequacy of cerebral perfusion and oxygenation.
c.
indicates whether the patient will take an active role in his or her treatment.
d.
documents the patient’s mental status at the time of the physical examination.
ANS: B
Adequate cerebral oxygenation must be present for the patient to be conscious, alert, and well oriented.
REF: pg. 61 OBJ: 3
10. Which of the following scales is the gold standard for assessing trends in the neurologic function of patients who have suffered head trauma?
a.
Murray scale
b.
PRISM
c.
APACHE
d.
Glasgow scale
ANS: D
The Glasgow coma scale has become the gold standard for assessing trends in the neurologic function of patients who have been sedated, have received anesthesia, have suffered head trauma, or are near coma.
REF: pg. 61 OBJ: 3
11. The normal range for oral body temperature in most people is _____ to _____° F.
a.
97; 99.5
b.
96.7; 98.5
c.
98.7; 100.5
d.
97.7; 98.5
ANS: A
Normal body temperature for most persons is approximately 98.6° F (37° C), with a normal range from 97 to 99.5° F and daily variations of 1° to 2° F.
REF: pg. 61 OBJ: 3
12. Fever is defined as an:
a.
infection in the body.
b.
elevation of body temperature above normal.
c.
increase in the oxygen requirements of the body.
d.
elevation of body temperature above normal because of disease.
ANS: D
When the body temperature is elevated from disease, this elevation is called fever, and the patient is said to be febrile.
REF: pg. 62 OBJ: 3
13. What is the most common cause of fever above 102° F?
a.
Aspiration pneumonitis
b.
Infection
c.
Blood transfusion reaction
d.
Head injury
ANS: B
Infection is most likely to be the cause of fever when the body temperature exceeds 102° F.
REF: pg. 62 OBJ: 3
14. For every elevation in body temperature of 1° C, oxygen consumption and carbon dioxide production increase by approximately ____%.
a.
2
b.
5
c.
10
d.
20
ANS: C
For every elevation in body temperature of 1° C, oxygen consumption and carbon dioxide production increase by approximately 10%.
REF: pg. 62 OBJ: 3
15. Which of the following conditions causes hypothermia?
a.
Damage to the hypothalamus
b.
Excessive shivering and vasoconstriction
c.
Exposure to high environmental temperatures
d.
Invasion of the body by microorganisms that produce an infection
ANS: A
Hypothermia is not common but can occur in persons with a severe head injury that damages the hypothalamus and in those suffering from exposure to cold environmental temperatures.
REF: pg. 62 OBJ: 3
16. Which of the following is not considered a typical site for temperature measurement?
a.
Oral
b.
Rectal
c.
Axillary
d.
Fingertip
ANS: D
Body temperature is measured most often at one of four sites: the mouth, ear, axilla, or rectum.
REF: pg. 62 OBJ: 4
17. What site is used to measure body temperature in comatose patients?
a.
Oral
b.
Axillary
c.
Rectal
d.
Ear
ANS: C
Rectal temperatures may be used for patients who are comatose, in intensive care, or confused.
REF: pg. 63 OBJ: 4
18. Which of the following is the method of choice for measuring temperature in neonates?
a.
Oral
b.
Rectal
c.
Axillary
d.
Tympanic
ANS: C
Axillary is the method of choice for neonates because it approximates their core temperature and avoids injury to the rectal tissues.
REF: pg. 63 OBJ: 4
19. Which of the following statements is true regarding oral temperature measurements?
a.
They are the most convenient to obtain and are most readily accepted by alert adults.
b.
They are useful in infants.
c.
They are acceptable in orally intubated patients.
d.
They are affected by delivery of oxygen by nasal cannula.
ANS: A
Oral temperature measurement remains a common, convenient, and acceptable method for awake adult patients.
REF: pg. 63 OBJ: 4
20. What is the main advantage of tympanic thermometry over the classic forms of temperature measurement?
a.
It is fast, clean, and noninvasive.
b.
Multiple studies have shown a high correlation with core temperature.
c.
It is the preferred method of temperature measurement in the pediatric population.
d.
It uses infrared emissions from the surface of the tympanic membrane and is not in contact with skin or other tissue.
ANS: A
This method has the advantage of being fast, clean, and noninvasive and avoids the embarrassment and time delays associated with the classic forms of temperature measurement.
REF: pg. 63 OBJ: 4
21. Which of the following reasons has been listed as the number one concern regarding use of the tympanic site for body temperature measurement?
a.
Speed
b.
Safety
c.
Accuracy
d.
Cost
ANS: C
Concerns have been expressed about its accuracy and use in the hospital setting.
REF: pg. 63 OBJ: 4
22. The normal pulse rate range for adults is _____ beats/min.
a.
60 to 100
b.
70 to 110
c.
80 to 120
d.
90 to 160
ANS: A
The normal pulse rate for adults is 60 to 100 beats/min and is regular in rhythm.
REF: pg. 64 OBJ: 5
23. A pulse rate above the normal range is the definition of which of the following terms?
a.
Tachypnea
b.
Arrhythmia
c.
Bradycardia
d.
Tachycardia
ANS: D
A pulse rate exceeding 100 beats/min in an adult is termed tachycardia.
REF: pg. 64 OBJ: 6
24. What is an important reason to monitor the heart rate in patients with lung disease?
a.
A heart rate above or below the normal range is dangerous.
b.
As the heart rate increases, the tissue’s demand for oxygen decreases.
c.
The more efficiently the heart is pumping, the lower is the resting pulse rate.
d.
Tachycardia is a common finding when hypoxemia is present.
ANS: D
When the oxygen content of arterial blood falls below normal, usually from lung disease, the heart tries to compensate by increasing cardiac output to maintain adequate oxygen delivery to the tissues. An increase in cardiac output is attained by an increase in heart rate in most persons. For this reason, it is important to monitor the heart rate in patients with lung disease.
REF: pg. 64 OBJ: 5
25. Which of the following characteristics should be included in the assessment of a patient’s pulse?
a.
Age, rate, and strength
b.
Rate, rhythm, and strength
c.
Age, rhythm, and status
d.
Strength, amplitude, and volume
ANS: B
The rhythm and strength of the pulse are evaluated, the pulse rate is evaluated, and then the pulse rate is counted.
REF: pg. 64 OBJ: 5
26. Which of the following arteries is most appropriate for measuring the pulse of a patient with very low blood pressure?
a.
Radial artery
b.
Popliteal artery
c.
Brachial artery
d.
Femoral artery
ANS: D
When the blood pressure is abnormally low, the more centrally located pulses, such as the carotid pulse in the neck and femoral pulses in the groin, can be identified more easily than the peripheral pulse.
REF: pg. 64 OBJ: 7
27. Which of the following terms is used to describe a significant decrease in pulse pressure during spontaneous inspiration?
a.
Pulsus alternans
b.
Pulsus paradoxus
c.
Pulsus respiratory
d.
Pulsus asymmetrical
ANS: B
When the patient’s pulse strength decreases with spontaneous inhalation, this is referred to as pulsus paradoxus.
REF: pg. 65 OBJ: 6
28. An alternating succession of strong and weak pulses that usually is not related to respiratory disease is known as pulsus:
a.
tardus.
b.
alternans.
c.
paradoxus.
d.
asymmetrical.
ANS: B
Pulsus alternans is an alternating succession of strong and weak pulses that usually is not related to respiratory disease.
REF: pg. 65 OBJ: 6
29. A respiratory rate of greater than _____ breaths/min is considered abnormal at any age.
a.
60
b.
50
c.
40
d.
30
ANS: A
A respiratory rate of 40 breaths/min is unusual for an adult, and a rate greater than 60 breaths/min is abnormal at any age.
REF: pg. 65 OBJ: 3
30. In postoperative patients, the degree of tachypnea typically is related to the degree of:
a.
anesthetic received during surgery.
b.
pain medication received.
c.
pneumonia.
d.
atelectasis.
ANS: D
Tachypnea in the postoperative patient is common when significant fever develops or when the lungs partially collapse (atelectasis) as a side effect of surgery. Atelectasis causes the lungs to become stiffer than normal, and the patient adopts a breathing pattern that is made up of rapid and shallow breaths, which serves as a compensatory mechanism. The degree of atelectasis determines the degree of tachypnea in such cases.
REF: pg. 65 OBJ: 6
31. Which of the following breathing patterns describes Kussmaul breathing?
a.
Normal
b.
Shallow
c.
Fast and shallow
d.
Fast and deep
ANS: D
In the case of ketoacidosis resulting from uncontrolled diabetes, a fast and deep breathing pattern known as Kussmaul breathing is often evident.
REF: pg. 65 OBJ: 6
32. Bradypnea may be caused by which of the following?
a.
Hypothermia
b.
Narcotic overdose
c.
Head injury
d.
All of the above
ANS: D
A slow respiratory rate, referred to as bradypnea, is uncommon but may occur in patients with head injury or hypothermia, as a side effect of certain medications such as narcotics, and in patients with drug overdose.
REF: pg. 65 OBJ: 6
33. Which of the following techniques is not useful in measuring the respiratory rate in patients who are spontaneously breathing and alert?
a.
Ask the patient to breathe normally.
b.
Lay the hand you are using to count the patient’s pulse on the patient’s abdomen, and watch abdominal movements.
c.
Count the rate for 30 seconds and multiply by 2.
d.
Pretend to be counting the pulse while counting the respiratory rate.
ANS: A
Never ask the patient to “breathe normally” while you are assessing the rate of respiration. When individuals think about their breathing, they often voluntarily change their breathing rate and pattern.
REF: pg. 66 OBJ: 8
34. The diastolic blood pressure is a reflection of:
a.
the pressure exerted during left ventricular relaxation.
b.
the peak pressure exerted during left ventricular contraction.
c.
the difference between systolic and diastolic pressures.
d.
the force exerted against the walls of the arteries as blood flows through them.
ANS: A
Diastolic blood pressure is the force that occurs when the heart is relaxed.
REF: pg. 66 OBJ: 8
35. Which of the following is not true about pulse pressure?
a.
It normally is between 35 and 40 mm Hg.
b.
It is calculated from the 12-lead electrocardiographic printout.
c.
It is the difference between the systolic and diastolic pressures.
d.
The peripheral pulse is difficult to detect when the pulse pressure falls to below 30 mm Hg.
ANS: B
Pulse pressure is the difference between the systolic and diastolic pressures. The normal pulse pressure is 35 to 40 mm Hg. When the pulse pressure is less than 30 mm Hg, the peripheral pulse is difficult to detect. Patients with heart failure and inadequate stroke volume usually have a reduced pulse pressure.
REF: pg. 66 OBJ: 7
36. Which of the following organs is not at risk for disease in the presence of systemic hypertension?
a.
Heart
b.
Kidneys
c.
Blood vessels
d.
Pancreas
ANS: D
Persistent pressures at the level of systemic hypertension are associated with an escalating risk for the development of heart, vascular, and renal diseases.
REF: pg. 66 OBJ: 9
37. Which of the following is not a cause of hypotension?
a.
Left ventricular failure
b.
Peripheral vasodilation
c.
Hypovolemia
d.
Right heart failure
ANS: D
Hypotension may occur as the result of peripheral vasodilation, left ventricular failure, or low blood volume.
REF: pg. 67 OBJ: 9
38. Hypotension associated with changes in posture in patients with hypovolemia is known as _____ hypotension.
a.
persistent
b.
orthostatic
c.
hypovolemic
d.
peristaltic
ANS: B
Changes in posture may produce abrupt changes in arterial blood pressure, especially in the hypovolemic patient. Normally, when the patient moves from the supine to the sitting position, the blood pressure changes very little, but when hypovolemia or vasodilation is present, the blood pressure may fall significantly; this is referred to as postural (or orthostatic) hypotension.
REF: pg. 67 OBJ: 9
39. When the blood pressure is measured, the sounds that are heard through the stethoscope between the systolic and diastolic pressures are known as _____ sounds.
a.
Meckel
b.
brachial
c.
Korotkoff
d.
succussion
ANS: C
The auscultatory method of pressure measurement uses the stethoscope to listen for the sounds produced by arterial pulse waves (Korotkoff sounds) when blood flow in the artery resumes. As the pressure is reduced during deflation of the occluding cuff, the Korotkoff sounds change in quality and intensity.
REF: pg. 68 OBJ: 8
40. What is the most probable cause for the significant decrease in blood pressure that occurs during inhalation in some patients?
a.
Hypovolemia
b.
Variable systemic vascular resistance
c.
Early left ventricular failure caused by coronary artery insufficiency
d.
Negative intrathoracic pressure that diminishes blood flow out of the left ventricle
ANS: D
This decrease in systolic blood pressure is more significant during a forced maximal inhalation. When the systolic pressure drops by more than 10 mm Hg during inhalation at rest, a definite abnormality exists; this is termed paradoxic pulse. Paradoxic pulse, also called pulsus paradoxus, occurs in various circulatory and respiratory conditions such as asthma and cardiac tamponade. The most probable mechanism responsible for this fluctuation in blood pressure centers around the negative intrathoracic pressure created by the respiratory muscles during inhalation.
REF: pg. 70 OBJ: 11
41. Which of the following conditions is not associated with the presence of pulsus paradoxus?
a.
Hypervolemia
b.
Cardiac tamponade
c.
Constrictive pericarditis
d.
Asthma
ANS: A
Pulsus paradoxus is commonly seen in patients with restrictions around the heart, such as cardiac tamponade, constrictive pericarditis, or restrictive cardiomyopathy. It also may occur in patients with severe pulmonary diseases, such as acute asthma.
REF: pg. 70 OBJ: 11
42. A 42-year-old male patient with a history of poorly controlled asthma is seen in the emergency department by the respiratory therapist (RT). The patient is seated in a chair and clearly is in extreme respiratory distress, with inspiratory and expiratory wheezing throughout. He reports that he has had a fever for the past 2 days and has eaten and drunk very little. He also reports some chest pain, and his blood pressure is 95/55 mm Hg. At one point, the patient stands to move from the chair to the stretcher and has an episode of syncope. The differential diagnosis for this patient should include all of the following except:
a.
Myocardial infarction (MI).
b.
Acute asthma exacerbation.
c.
Dehydration.
d.
Cerebrovascular accident (CVA; stroke).
ANS: D
The chest pain, although minor, requires evaluation for MI. The wheezing and respiratory distress strongly suggest asthma exacerbation, and the combination of syncope, restricted fluid restriction, and low blood pressure strongly suggest hypovolemia. No signs or symptoms of CVA are present.
REF: pg. 70 OBJ: 9
43. An RT attempts to take the blood pressure of the patient in question 42. The RT notes that the pulse intensity determined from palpation of the radial artery decreases during inspiration. The most likely explanation for this would be:
a.
an (MI).
b.
an acute asthma exacerbation.
c.
dehydration.
d.
a cerebrovascular accident (CVA; stroke).
ANS: B
Because of the high airway resistance caused by the asthma exacerbation, the intrathoracic pressure decreases abnormally during patient inspiration. This results in decreased cardiac filling, decreased blood pressure, and decreased pulse intensity during inspiration. This is an example of pulsus paradoxus.
REF: pg. 70 OBJ: 11
44. An RT is called to the emergency department on New Year ’s Eve to assist in the treatment of a 5-year-old child pulled from under the ice of a local pond. When the child arrives, he has been intubated and has a weak, irregularly irregular pulse of 55 beats/min, no spontaneous respiratory effort, and a body temperature of 30o C. The normal practice in this hospital is to use heat–moisture exchangers (HMEs) for all mechanically ventilated patients. Which of the following should the therapist suggest for the ventilator setup?
a.
Greater than normal rate and tidal volume
b.
Higher than usual inspiratory flow rate
c.
Heated humidity in place of the HME
d.
All of the above
ANS: C
This patient is clearly hypothermic; therefore, along with other warming measures, heated, humidified air will significantly aid in raising the patient’s body temperature. Normally, ventilator settings for these patients require lower minute ventilation than usual. An increased rate and tidal volume would result in increased minute ventilation, whereas an increased inspiratory flow rate would result in an elevated peak inspiratory pressure.
REF: pg. 62 OBJ: 3
45. An RT has just finished administering an aerosol treatment by a small-volume nebulizer to a patient who has a serious case of pneumonia. For the past 24 hours, the patient has had a fever of 39 to 40o C. Just as the therapist is finishing, a nursing aide comes in to record the vital signs. She uses an electronic thermometer to record an oral temperature of 36.5o C and comments to the patient, “Well, Mr. Jones, you must be getting better because your fever is completely gone.” The therapist should:
a.
also verbally encourage the patient by saying that he is getting better.
b.
totally ignore the situation and continue with the posttreatment assessment.
c.
complete the treatment and assessment, record the results in the patient’s chart, then go on to the next patient.
d.
go to the nursing aide after she leaves the room and tell her that the temperature she recorded is probably not accurate and should be repeated.
ANS: D
A small-volume nebulizer produces an aerosol mist that may temporarily cool the inside of the mouth. Hence, an oral temperature should not be measured for at least 10 to 15 minutes following the completion of the nebulizer treatment.
REF: pg. 63 OBJ: 3
46. An RT is taking the blood pressure in the arm of a 12-year-old girl. The only sphygmomanometer available has a cuff in which the ends overlap slightly when it is inflated. The pressure that the RT records:
a.
should be accurate if the measurement is otherwise done properly.
b.
is likely to be in error, showing a value that is too low.
c.
is likely to be in error, showing a value that is too high.
d.
will have a value that cannot be predicted to be either too high or too low.
ANS: A
When measuring the blood pressure in a child, it is permissible to use a cuff where the ends overlap slightly.
REF: pg. 68 OBJ: 10
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