, CHAPTER 3
1. Which of the following specialized imaging tests would be most useful in diagnosing
a pulmonary emboli?
A) chest X-ray
B) pulmonary function test (PFT)
C) ventilation-perfusion scan (V/Q scan)
D) arterial blood gas (ABG)
Ans: C
Response:
A chest X-ray and an ABG might be useful in detecting an abnormality, but not specifically a
pulmonary emboli. Pulmonary function testing (PFTs) may reveal abnormal flows and
volumes/capacities but no perfusion problems inherent in a pulmonary emboli. A ventilation-
perfusion scan would show a lack of blood flow due to emboli (a clot) in the blood pulmonary
circulation. Ventilation to lung regions would be shown as well.
2. While examining a patient in the ICU, you note that they appear somewhat edematous and the
nurse has indicated that the patient's urine output is “minimal.” In what section of the
medical record would you check to determine the patient's fluid balance (intake vs. output)?
A) physican orders
B) consent
C) lab results
D) nurses notes and flowsheet
Ans: D
Response:
A patient's fluid balance is the relationship between fluid intake and outputs primarily from
urination. It is normally noted in the nurses notes and flowsheet section of the medical record.
The normal fluid intake and output for adults is 1 to 2 liters per day, or 25 to 50 ml per hour.
A positive fluid balance results from excessive intake and/or decreased output and may
contribute to pulmonary or peripheral edema and hypertension. A negative fluid balance is
generally due to insufficient hydration and/or excessive urination from medications such as
diuretics or theophylline and may lead to hypotension and low cardiac output.
3. Which of the following physical findings would you expect to see in an alert but anxious
asthmatic who has just been admitted to the ED?
A) respiratory acidosis
B) respiratory alkalosis
C) clubbing
D) cor pulmonale
Ans: B
Response:
Asthmatics typically present with respiratory alkalosis. Shortness of breath and accompanying
hypoxemia cause the patient to increase his rate of breathing and alkalosis occurs. It is
important to note here that once hypoxemia is relieved by the administration of supplemental
oxygen, patient's PaCO2 and pH will normalize.
Page 1
,4. In the lab results section of a patient's medical record, the overall WBC is shown as of
22,000, for a febrile patient who appear acutely ill and in moderate respiratory distress.
Which of the following is this patient's most likely diagnosis?
A) bacterial pneumonia
B) emphysema
C) pulmonary embolus
D) pulmonary fibrosis
Ans: A
Response:
The elevated WBC suggests a bacterial infection. The respiratory distress further points to
a respiratory infection such as bacterial pneumonia. In addition, the other choices are not
infectious processes and therefore you would not likely see an elevated WBC.
5. A PET scan would be most useful in the diagnosis of which of the following conditions?
A) bronchogenic carcinoma
B) chronic bronchitis
C) pulmonary fibrosis
D) smoke inhalation
Ans: A
Response:
A PET scan is a nuclear imaging technique used in the diagnosis/staging/management of
tumors and cancer. The answer choice bronchogenic carcinoma describes lung cancer.
6. Negative inspiratory pressure (NIF; MIP) is useful in the determination of which of
the following?
A) airway resistance
B) functional residual capacity
C) respiratory muscle strength
D) sustained maximal inspiration
Ans: C
Response:
Negative inspiratory force (NIF) or Maximal Inspiratory Pressure (MIP) is used for the
bedside assessment of respiratory muscle strength. You probably know that it is a
measurement of pressure only. Since airway resistance is a measurement of pressure divided
by flow, and since Functional Residual Capacity and Sustained Maximal Inspiration are
measurements of volume, the process of elimination leaves muscle strength as the only correct
answer.
7. Assessment of a 28 y/o trauma patient reveals diminished breath sounds, asymmetrical chest
expansion, severe chest pain and an SpO2 of 90%, despite receiving oxygen via cannula at 5
L/min. These findings are most consistent with what diagnosis?
A) complete airway obstruction
B) pneumothorax
C) viral pneumonia
D) pleural effusion
Ans: B
Response:
Both viral pneumonia and pleural effusion can be ruled out as correct answers as they are not
related to trauma. Breath sounds, though diminished, can be heard and chest expansion,
though asymmetrical, is present; both of which are not consistent with a complete airway
obstruction. The physical assessment is consistent with the correct answer, pneumothorax.
Page 2
, 8. A 23 y/o firefighter is admitted with suspected smoke inhalation. You place him on a non-
rebreathing mask. What is the most appropriate method of monitoring his oxygenation?
A) arterial blood gas analysis
B) co-oximetry
C) pulse oximetry
D) calculation of P(A-
a)O2 Ans: B
Response:
In the case of smoke inhalation, carbon monoxide (CO) binds to the hemoglobin molecule in
place of oxygen. Neither ABGs, pulse oximetry nor calculation of the A-a gradient will
provide indication of how much oxygen is bound to hemoglobin. Any victim of suspected
smoke inhalation must be monitored with CO-oximetry.
9. The ratio of lecithin to sphingomyelin, or L/S ratio, is a test to determine fetal lung maturity.
Such a test may be done in the later stages of pregnancy and the values will initially be
noted in the lab results section of the mother's medical record. Approximately what ratio is
associated with the onset of mature surfactant production?
A) 2:1
B) 20:1
C) 1:2
D) 1:20
Ans: A
Response:
The lecithin to sphingomyelin ratio, or L/S ratio, which is used to determine fetal lung
maturity. Generally, this ratio reaches 2:1 (twice as much lethicin then sphingomyelin) near
week 35 of gestation, which corresponds to the onset of mature surfactant production. The L/S
ratio will generally be noted in the lab results section of the mother's medical record.
10. Sputum culture and sensitivity would be indicated in the evaluation of which of the
following clinical conditions?
A) pulmonary edema
B) bacterial pneumonia
C) bronchiectasis
D) empyema
Ans: B
Response:
Sputum culture & sensitivity is used to identify microorganisms and their most appropriate
drug therapy. Bacterial pneumonia is the obvious infectious process in the choice of answers.
11. When interviewing a patient, which of the following might be relevant to the
patient's pulmonary status?
I. occupational history
II. medical history
III. smoking history
IV. family history
A) I and IV
B) II and III
C) I, III and IV
D) I, II, III and IV
Ans: D
Response:
In addition to a patient's chief complaint, a variety of history relating to the patient's
occupation, family, smoking and past medical conditions, should be gathered to help in your
assessment.
Page 3
1. Which of the following specialized imaging tests would be most useful in diagnosing
a pulmonary emboli?
A) chest X-ray
B) pulmonary function test (PFT)
C) ventilation-perfusion scan (V/Q scan)
D) arterial blood gas (ABG)
Ans: C
Response:
A chest X-ray and an ABG might be useful in detecting an abnormality, but not specifically a
pulmonary emboli. Pulmonary function testing (PFTs) may reveal abnormal flows and
volumes/capacities but no perfusion problems inherent in a pulmonary emboli. A ventilation-
perfusion scan would show a lack of blood flow due to emboli (a clot) in the blood pulmonary
circulation. Ventilation to lung regions would be shown as well.
2. While examining a patient in the ICU, you note that they appear somewhat edematous and the
nurse has indicated that the patient's urine output is “minimal.” In what section of the
medical record would you check to determine the patient's fluid balance (intake vs. output)?
A) physican orders
B) consent
C) lab results
D) nurses notes and flowsheet
Ans: D
Response:
A patient's fluid balance is the relationship between fluid intake and outputs primarily from
urination. It is normally noted in the nurses notes and flowsheet section of the medical record.
The normal fluid intake and output for adults is 1 to 2 liters per day, or 25 to 50 ml per hour.
A positive fluid balance results from excessive intake and/or decreased output and may
contribute to pulmonary or peripheral edema and hypertension. A negative fluid balance is
generally due to insufficient hydration and/or excessive urination from medications such as
diuretics or theophylline and may lead to hypotension and low cardiac output.
3. Which of the following physical findings would you expect to see in an alert but anxious
asthmatic who has just been admitted to the ED?
A) respiratory acidosis
B) respiratory alkalosis
C) clubbing
D) cor pulmonale
Ans: B
Response:
Asthmatics typically present with respiratory alkalosis. Shortness of breath and accompanying
hypoxemia cause the patient to increase his rate of breathing and alkalosis occurs. It is
important to note here that once hypoxemia is relieved by the administration of supplemental
oxygen, patient's PaCO2 and pH will normalize.
Page 1
,4. In the lab results section of a patient's medical record, the overall WBC is shown as of
22,000, for a febrile patient who appear acutely ill and in moderate respiratory distress.
Which of the following is this patient's most likely diagnosis?
A) bacterial pneumonia
B) emphysema
C) pulmonary embolus
D) pulmonary fibrosis
Ans: A
Response:
The elevated WBC suggests a bacterial infection. The respiratory distress further points to
a respiratory infection such as bacterial pneumonia. In addition, the other choices are not
infectious processes and therefore you would not likely see an elevated WBC.
5. A PET scan would be most useful in the diagnosis of which of the following conditions?
A) bronchogenic carcinoma
B) chronic bronchitis
C) pulmonary fibrosis
D) smoke inhalation
Ans: A
Response:
A PET scan is a nuclear imaging technique used in the diagnosis/staging/management of
tumors and cancer. The answer choice bronchogenic carcinoma describes lung cancer.
6. Negative inspiratory pressure (NIF; MIP) is useful in the determination of which of
the following?
A) airway resistance
B) functional residual capacity
C) respiratory muscle strength
D) sustained maximal inspiration
Ans: C
Response:
Negative inspiratory force (NIF) or Maximal Inspiratory Pressure (MIP) is used for the
bedside assessment of respiratory muscle strength. You probably know that it is a
measurement of pressure only. Since airway resistance is a measurement of pressure divided
by flow, and since Functional Residual Capacity and Sustained Maximal Inspiration are
measurements of volume, the process of elimination leaves muscle strength as the only correct
answer.
7. Assessment of a 28 y/o trauma patient reveals diminished breath sounds, asymmetrical chest
expansion, severe chest pain and an SpO2 of 90%, despite receiving oxygen via cannula at 5
L/min. These findings are most consistent with what diagnosis?
A) complete airway obstruction
B) pneumothorax
C) viral pneumonia
D) pleural effusion
Ans: B
Response:
Both viral pneumonia and pleural effusion can be ruled out as correct answers as they are not
related to trauma. Breath sounds, though diminished, can be heard and chest expansion,
though asymmetrical, is present; both of which are not consistent with a complete airway
obstruction. The physical assessment is consistent with the correct answer, pneumothorax.
Page 2
, 8. A 23 y/o firefighter is admitted with suspected smoke inhalation. You place him on a non-
rebreathing mask. What is the most appropriate method of monitoring his oxygenation?
A) arterial blood gas analysis
B) co-oximetry
C) pulse oximetry
D) calculation of P(A-
a)O2 Ans: B
Response:
In the case of smoke inhalation, carbon monoxide (CO) binds to the hemoglobin molecule in
place of oxygen. Neither ABGs, pulse oximetry nor calculation of the A-a gradient will
provide indication of how much oxygen is bound to hemoglobin. Any victim of suspected
smoke inhalation must be monitored with CO-oximetry.
9. The ratio of lecithin to sphingomyelin, or L/S ratio, is a test to determine fetal lung maturity.
Such a test may be done in the later stages of pregnancy and the values will initially be
noted in the lab results section of the mother's medical record. Approximately what ratio is
associated with the onset of mature surfactant production?
A) 2:1
B) 20:1
C) 1:2
D) 1:20
Ans: A
Response:
The lecithin to sphingomyelin ratio, or L/S ratio, which is used to determine fetal lung
maturity. Generally, this ratio reaches 2:1 (twice as much lethicin then sphingomyelin) near
week 35 of gestation, which corresponds to the onset of mature surfactant production. The L/S
ratio will generally be noted in the lab results section of the mother's medical record.
10. Sputum culture and sensitivity would be indicated in the evaluation of which of the
following clinical conditions?
A) pulmonary edema
B) bacterial pneumonia
C) bronchiectasis
D) empyema
Ans: B
Response:
Sputum culture & sensitivity is used to identify microorganisms and their most appropriate
drug therapy. Bacterial pneumonia is the obvious infectious process in the choice of answers.
11. When interviewing a patient, which of the following might be relevant to the
patient's pulmonary status?
I. occupational history
II. medical history
III. smoking history
IV. family history
A) I and IV
B) II and III
C) I, III and IV
D) I, II, III and IV
Ans: D
Response:
In addition to a patient's chief complaint, a variety of history relating to the patient's
occupation, family, smoking and past medical conditions, should be gathered to help in your
assessment.
Page 3
