DES JARDINS: CLINICAL MANIFESTATIONS AND ASSESSMENT OF RESPIRATORY
DISEASE, 8TH EDITION
TABLE OF CONTENT
PART 1: Assessment of Cardiopulmonary Disease
SECTION I: Bedside Diagnosis
Chapter 1. The Patient Interview
Chapter 2. The Physical Examination
Chapter 3. The Pathophysiologic Basis for Common Clinical
Manifestations
SECTION II: clinical data obtained from laboratory tests
and special procedures—objective findings
Chapter 4. Pulmonary Function Testing
Chapter 5. Blood Gas Assessment
Chapter 6. Assessment of Oxygenation
Chapter 7. Assessment of the Cardiovascular System
Chapter 8. Radiologic Examination of the Chest
Chapter 9. Other Important Tests and Procedures
SECTION III: the therapist-driven protocol program—the essentials
Chapter 10. The Therapist-Driven Protocol Program
Chapter 11. Respiratory Insufficiency, Respiratory Failure and Ventilatory Management
Protocols
Chapter 12. Recording Skills and Intra-Professional Communication
PART II: Obstructive Lung Disease
Chapter 13. Chronic Obstructive Pulmonary Disease, Chronic Bronchitis and
Emphysema
Chapter 14. Asthma
Chapter 15. Cystic Fibrosis
Chapter 16. Bronchiectasis
PART III: Loss of Alveolar Volume
Chapter 17. Atelectasis
PART IV: Infectious Pulmonary Disease
Chapter 18. Pneumonia, Lung Abscess Formation and Important Fungal Diseases
Chapter 19. Tuberculosis
PART V: Pulmonary Vascular Disease
Chapter 20. Pulmonary Edema
Chapter 21. Pulmonary Vascular Disease: Pulmonary Embolism and Pulmonary Hypertension
,PART VI: Chest and Pleural Trauma
Chapter 22. Flail Chest
Chapter 23. Pneumothorax
PART VII: Disorders of the Pleura and of the Chest Wall
Chapter 24. Pleural Effusion and Empyema
Chapter 25. Kyphoscoliosis
PART VIII: Lung Cancer
Chapter 26. Cancer of the Lung: Prevention and Palliation
PART IX: Environmental Lung Diseases
Chapter 27. Interstitial Lung Diseases
PART X: Diffuse Alveolar Disease
Chapter 28. Acute Respiratory Distress Syndrome
PART XI: Neuro-Respiratory Disorders
Chapter 29. Guillain-Barre Syndrome
Chapter 30. Myasthenia Gravis
Chapter 31. Respiratory Insufficiency in the Patient with Neuro-Respiratory Disease
PART XII: Sleep-Related Breathing Disorders
Chapter 32. Sleep Apnea
PART XIII: Newborn and Early Childhood Cardiopulmonary Disorders
Chapter 33. The Newborn Disorders
Chapter 34. Pediatric Assessment, Protocols, and PALS Management
Chapter 35. Meconium Aspiration Syndrome
Chapter 36. Transient Tachypnea of the Newborn
Chapter 37. Respiratory Distress Syndrome
Chapter 38. Pulmonary Air Leak Syndrome
Chapter 39. Respiratory Syncytial Virus Infection (Bronchiolitis)
Chapter 40. Chronic Lung Disease of Infancy
Chapter 41. Congenital Diaphragmatic Hernia
Chapter 42. Congenital Heart Disease
Chapter 43. Croup and Croup-like Syndromes: Laryngotracheobronchitis, Bacterial Tracheitis
and Acute Epiglottitis
PART XIV: Other Important Topics
Chapter 44. Near Drowning/Wet Drowning
Chapter 45. Smoke Inhalation, Thermal Injuries, and Carbon Monoxide
, Chapter 01: The Patient Interview
DES JARDINS: CLINICAL MANIFESTATIONS AND ASSESSMENT OF RESPIRATORY DISEASE, 8TH EDITION
MULTIPLE CHOICE
1. The respiratory care practitioner is conducting a patient interview. The main purpose of this
interview is to:
a. review data with the patient.
b. gather subjective data from the patient.
c. gather objective data from the patient.
d. fill out the history form or checklist.
ANS: B
The interview is a meeting between the respiratory care practitioner and the patient. It allows the
collection of subjective data about the patient’s feelings regarding his/her
condition. The history should be done before the interview. Although data can be reviewed, that is not
the primary purpose of the interview.
2. For there to be a successful interview, the respiratory therapist must:
a. provide leading questions to guide the patient.
b. reassure the patient.
c. be an active listener.
d. use medical terminology to show knowledge of the subject matter. ANS: C
The personal qualities that a respiratory therapist must have to conduct a successful interview
include being an active listener, having a genuine concern for the patient, and having empathy.
Leading questions must be avoided. Reassurance may provide a false sense of comfort to the patient.
Medical
3. Which of the following would be found on a history form?
1. Age
2. Chief complaint
3. Present health
4. Family history
5. Health insurance provider a. 1, 4
b. 2, 3
c. 3, 4, 5
d. 1, 2, 3, 4
ANS: D
Age, chief complaint, present health, and family history are typically found on a health history
form because each can impact the patient’s health. Health insurance provider information, while
needed for billing purposes, would not be found on the history form.
4. External factors the respiratory care practitioner should make efforts to provide during an
interview include which of the following?
1. Minimize or prevent interruptions.
2. Ensure privacy during discussions.
3. Interviewer is the same sex as the patient to prevent bias.
4. Be comfortable for the patient and interviewer. a. 1, 4
b. 2, 3
c. 1, 2, 4
d. 2, 3, 4
ANS: C
External factors, such as a good physical setting, enhance the interviewing process. Regardless of the
, interview setting (the patient’s bedside, a crowded emergency room, an office in the hospital or
clinic, or the patient’s home), efforts should be made to (1) ensure privacy, (2) prevent interruptions,
and (3) secure a comfortable physical environment (e.g., comfortable room temperature, sufficient
lighting, absence of noise). An interviewer of either gender, who acts professionally, should be able
to interview a patient of either gender.
5. The respiratory therapist is conducting a patient interview. The therapist chooses to use open-
ended questions. Open-ended questions allow the therapist to do which of the following?
1. Gather information when a patient introduces a new topic.
2. Introduce a new subject area.
3. Begin the interview process.
4. Gather specific information.
a. 4
b. 1, 3
c. 1, 2, 3
d. 2, 3, 4
ANS: C
An open-ended question should be used to start the interview, introduce a new section of questions,
and gather more information from a patient’s topic. Closed or direct questions are used to gather
specific information.
6. The direct question interview format is used to:
1. speed up the interview.
2. let the patient fully explain his/her situation.
3. help the respiratory therapist show empathy.
4. gather specific information. a. 1, 4
b. 2, 3
c. 3, 4
d. 1, 2, 3
ANS: A
Direct or closed questions are best to gather specific information and speed up the interview.
Open- ended questions are best suited to let the patient fully explain his/her situation and possibly
help the respiratory therapist show empathy.
7. During the interview the patient states, “Every time I climb the stairs I have to stop to catch my
breath.” Hearing this, the respiratory therapist replies, “So, it sounds like you get short of breath
climbing stairs.” This interviewing technique is called:
a. clarification.
b. modeling.
c. empathy.
d. reflection.
ANS: D
With reflection, part of the patient’s statement is repeated. This lets the patient know that what
he/she said was heard. It also encourages the patient to elaborate on the topic.
Clarification, modeling, and empathy are other communication techniques.
8. The respiratory therapist may choose to use the patient interview technique of silence in which
of the following situations?
a. To prompt the patient to ask a question
b. After a direct question
c. After an open-ended question
d. To allow the patient to review his/her history
ANS: C
After a patient has answered an open-ended question, the respiratory therapist should pause (use
, silence) before asking the next question. This pause allows the patient to add something else before
moving on. The patient may also choose to ask a question.
9. To have the most productive interviewing session, which of the following types of responses to assist
in the interview shou ld t he r esp iratory t herapist avoid?
a. Confrontation
b. Reflection
c. Facilitation
d. Distancing
ANS: D
With confrontation, the respiratory therapist focuses the patient’s attention on an action, feeling, or
statement made by the patient. This may prompt a further discussion. Reflection helps the patient
focus on specific areas and continues in his/her own way. Facilitation encourages patients to say
more, to continue with the story. The respiratory therapist should avoid giving advice, using
avoidance language, and using distancing language.
10. When closing the interview, the respiratory therapist should do which of the following?
1. Recheck the patient’s vital signs.
2. Thank the patient.
3. Ask if the patient has any questions.
4. Close the door behind himself/herself for patient privacy.
a. 2
b. 2, 3
c. 1, 3, 4
d. 1, 2, 4 ANS: B
To end the interview on a positive note, the respiratory therapist should thank the patient and ask if
the patient has any questions. If there is no need for the vital signs to be checked, they should not
be. The door may be left open or closed, depending on the situation.
11. The respiratory therapist should be aware of a patient’s culture and religious beliefs for which of
the following reasons?
a. To be able to engage in a meaningful conversation
b. To change any misguided notions the patient has that may impact his/her health
c. To explain to the patient how these beliefs will lead to discrimination and
stereotyping
d. To better understand how the patient’s beliefs may impact how the patient thinks and
behaves
ANS: D
Culture and religious beliefs may have a profound effect on how patients think and behave, and this
may impact their health or health care decisions. The role of the respiratory
therapist is not to change the patient’s beliefs, engage in sensitive conversations, or discuss
discrimination. Rather, the respiratory therapist needs to understand how these beliefs may impact
the patient’s health care decisions.
12. Which of the following are the most important components of a successful interview?
a. Communication and understanding
b. Authority and the use of medical terminology
c. Providing assurance and giving advice
d. Asking leading questions and anticipating patient responses to questions ANS: A
Communication and understanding are the basis for a good patient interview. Authority, the use of
medical jargon, providing assurance, giving advice, asking leading questions, and anticipating are all
types of nonproductive communication forms and create barriers to patient communication.
, 13. The respiratory therapist is conducting a patient interview and recording responses in the patient’s
electronic health record. The respiratory therapist should take which of the following into account
regarding the use of the computer to record responses?
a. The therapist’s attention may be shifted from the patient to the computer.
b. The patient will feel more important than if the information is recorded on paper.
c. The therapist will be less likely to make spelling errors if using a spell-check program.
d. The environment will be more professional and the patient will be more likely to open up
if the interview is conducted with paper.
ANS: A
The therapist’s use of the computer can be threatening and may, in some cases, be a potential hazard
to good patient communication. The patient can be intimidated to the point of “shutting down.” In
addition, the therapist who has to shift focus from the patient to the computer can miss important
verbal and nonverbal messages.
Chapter 02: The Physical Examination
Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th Edition
MULTIPLE CHOICE
1. When would induced hypothermia be indicated?
a. During brain surgery
b. During bowel surgery
c. To break a fever
d. To treat carbon monoxide poisoning
ANS: A
Induced hypothermia may involve only a portion of the body or the whole body. Induced hypothermia is
often indicated before certain surgeries, such as heart or brain surgery, or after return of spontaneous
circulation after a cardiac arrest.
2. A 50-year-old patient has a heart rate by palpation of 120 bpm. How should this be
interpreted?
a. Within the normal range for an adult
b. An error since a stethoscope was not used
c. Bradycardia
d. Tachycardia
ANS: D
.
In an adult, a heart rate of g rea ter t han 100 /m i nute is considered
less than 60/minute in an adult is considered to be bradycardia. Palpation
to be tachycardia. A heart rate of
and
auscultation are both acceptable to check heart rate.
3. Tachypnea may be the result of:
1. hypoxemia.
2. hypothermia.
3. fever.
4. sedation. a. 2, 4
b. 1, 3
c. 2, 3, 4
d. 1, 2, 3
ANS: B
DISEASE, 8TH EDITION
TABLE OF CONTENT
PART 1: Assessment of Cardiopulmonary Disease
SECTION I: Bedside Diagnosis
Chapter 1. The Patient Interview
Chapter 2. The Physical Examination
Chapter 3. The Pathophysiologic Basis for Common Clinical
Manifestations
SECTION II: clinical data obtained from laboratory tests
and special procedures—objective findings
Chapter 4. Pulmonary Function Testing
Chapter 5. Blood Gas Assessment
Chapter 6. Assessment of Oxygenation
Chapter 7. Assessment of the Cardiovascular System
Chapter 8. Radiologic Examination of the Chest
Chapter 9. Other Important Tests and Procedures
SECTION III: the therapist-driven protocol program—the essentials
Chapter 10. The Therapist-Driven Protocol Program
Chapter 11. Respiratory Insufficiency, Respiratory Failure and Ventilatory Management
Protocols
Chapter 12. Recording Skills and Intra-Professional Communication
PART II: Obstructive Lung Disease
Chapter 13. Chronic Obstructive Pulmonary Disease, Chronic Bronchitis and
Emphysema
Chapter 14. Asthma
Chapter 15. Cystic Fibrosis
Chapter 16. Bronchiectasis
PART III: Loss of Alveolar Volume
Chapter 17. Atelectasis
PART IV: Infectious Pulmonary Disease
Chapter 18. Pneumonia, Lung Abscess Formation and Important Fungal Diseases
Chapter 19. Tuberculosis
PART V: Pulmonary Vascular Disease
Chapter 20. Pulmonary Edema
Chapter 21. Pulmonary Vascular Disease: Pulmonary Embolism and Pulmonary Hypertension
,PART VI: Chest and Pleural Trauma
Chapter 22. Flail Chest
Chapter 23. Pneumothorax
PART VII: Disorders of the Pleura and of the Chest Wall
Chapter 24. Pleural Effusion and Empyema
Chapter 25. Kyphoscoliosis
PART VIII: Lung Cancer
Chapter 26. Cancer of the Lung: Prevention and Palliation
PART IX: Environmental Lung Diseases
Chapter 27. Interstitial Lung Diseases
PART X: Diffuse Alveolar Disease
Chapter 28. Acute Respiratory Distress Syndrome
PART XI: Neuro-Respiratory Disorders
Chapter 29. Guillain-Barre Syndrome
Chapter 30. Myasthenia Gravis
Chapter 31. Respiratory Insufficiency in the Patient with Neuro-Respiratory Disease
PART XII: Sleep-Related Breathing Disorders
Chapter 32. Sleep Apnea
PART XIII: Newborn and Early Childhood Cardiopulmonary Disorders
Chapter 33. The Newborn Disorders
Chapter 34. Pediatric Assessment, Protocols, and PALS Management
Chapter 35. Meconium Aspiration Syndrome
Chapter 36. Transient Tachypnea of the Newborn
Chapter 37. Respiratory Distress Syndrome
Chapter 38. Pulmonary Air Leak Syndrome
Chapter 39. Respiratory Syncytial Virus Infection (Bronchiolitis)
Chapter 40. Chronic Lung Disease of Infancy
Chapter 41. Congenital Diaphragmatic Hernia
Chapter 42. Congenital Heart Disease
Chapter 43. Croup and Croup-like Syndromes: Laryngotracheobronchitis, Bacterial Tracheitis
and Acute Epiglottitis
PART XIV: Other Important Topics
Chapter 44. Near Drowning/Wet Drowning
Chapter 45. Smoke Inhalation, Thermal Injuries, and Carbon Monoxide
, Chapter 01: The Patient Interview
DES JARDINS: CLINICAL MANIFESTATIONS AND ASSESSMENT OF RESPIRATORY DISEASE, 8TH EDITION
MULTIPLE CHOICE
1. The respiratory care practitioner is conducting a patient interview. The main purpose of this
interview is to:
a. review data with the patient.
b. gather subjective data from the patient.
c. gather objective data from the patient.
d. fill out the history form or checklist.
ANS: B
The interview is a meeting between the respiratory care practitioner and the patient. It allows the
collection of subjective data about the patient’s feelings regarding his/her
condition. The history should be done before the interview. Although data can be reviewed, that is not
the primary purpose of the interview.
2. For there to be a successful interview, the respiratory therapist must:
a. provide leading questions to guide the patient.
b. reassure the patient.
c. be an active listener.
d. use medical terminology to show knowledge of the subject matter. ANS: C
The personal qualities that a respiratory therapist must have to conduct a successful interview
include being an active listener, having a genuine concern for the patient, and having empathy.
Leading questions must be avoided. Reassurance may provide a false sense of comfort to the patient.
Medical
3. Which of the following would be found on a history form?
1. Age
2. Chief complaint
3. Present health
4. Family history
5. Health insurance provider a. 1, 4
b. 2, 3
c. 3, 4, 5
d. 1, 2, 3, 4
ANS: D
Age, chief complaint, present health, and family history are typically found on a health history
form because each can impact the patient’s health. Health insurance provider information, while
needed for billing purposes, would not be found on the history form.
4. External factors the respiratory care practitioner should make efforts to provide during an
interview include which of the following?
1. Minimize or prevent interruptions.
2. Ensure privacy during discussions.
3. Interviewer is the same sex as the patient to prevent bias.
4. Be comfortable for the patient and interviewer. a. 1, 4
b. 2, 3
c. 1, 2, 4
d. 2, 3, 4
ANS: C
External factors, such as a good physical setting, enhance the interviewing process. Regardless of the
, interview setting (the patient’s bedside, a crowded emergency room, an office in the hospital or
clinic, or the patient’s home), efforts should be made to (1) ensure privacy, (2) prevent interruptions,
and (3) secure a comfortable physical environment (e.g., comfortable room temperature, sufficient
lighting, absence of noise). An interviewer of either gender, who acts professionally, should be able
to interview a patient of either gender.
5. The respiratory therapist is conducting a patient interview. The therapist chooses to use open-
ended questions. Open-ended questions allow the therapist to do which of the following?
1. Gather information when a patient introduces a new topic.
2. Introduce a new subject area.
3. Begin the interview process.
4. Gather specific information.
a. 4
b. 1, 3
c. 1, 2, 3
d. 2, 3, 4
ANS: C
An open-ended question should be used to start the interview, introduce a new section of questions,
and gather more information from a patient’s topic. Closed or direct questions are used to gather
specific information.
6. The direct question interview format is used to:
1. speed up the interview.
2. let the patient fully explain his/her situation.
3. help the respiratory therapist show empathy.
4. gather specific information. a. 1, 4
b. 2, 3
c. 3, 4
d. 1, 2, 3
ANS: A
Direct or closed questions are best to gather specific information and speed up the interview.
Open- ended questions are best suited to let the patient fully explain his/her situation and possibly
help the respiratory therapist show empathy.
7. During the interview the patient states, “Every time I climb the stairs I have to stop to catch my
breath.” Hearing this, the respiratory therapist replies, “So, it sounds like you get short of breath
climbing stairs.” This interviewing technique is called:
a. clarification.
b. modeling.
c. empathy.
d. reflection.
ANS: D
With reflection, part of the patient’s statement is repeated. This lets the patient know that what
he/she said was heard. It also encourages the patient to elaborate on the topic.
Clarification, modeling, and empathy are other communication techniques.
8. The respiratory therapist may choose to use the patient interview technique of silence in which
of the following situations?
a. To prompt the patient to ask a question
b. After a direct question
c. After an open-ended question
d. To allow the patient to review his/her history
ANS: C
After a patient has answered an open-ended question, the respiratory therapist should pause (use
, silence) before asking the next question. This pause allows the patient to add something else before
moving on. The patient may also choose to ask a question.
9. To have the most productive interviewing session, which of the following types of responses to assist
in the interview shou ld t he r esp iratory t herapist avoid?
a. Confrontation
b. Reflection
c. Facilitation
d. Distancing
ANS: D
With confrontation, the respiratory therapist focuses the patient’s attention on an action, feeling, or
statement made by the patient. This may prompt a further discussion. Reflection helps the patient
focus on specific areas and continues in his/her own way. Facilitation encourages patients to say
more, to continue with the story. The respiratory therapist should avoid giving advice, using
avoidance language, and using distancing language.
10. When closing the interview, the respiratory therapist should do which of the following?
1. Recheck the patient’s vital signs.
2. Thank the patient.
3. Ask if the patient has any questions.
4. Close the door behind himself/herself for patient privacy.
a. 2
b. 2, 3
c. 1, 3, 4
d. 1, 2, 4 ANS: B
To end the interview on a positive note, the respiratory therapist should thank the patient and ask if
the patient has any questions. If there is no need for the vital signs to be checked, they should not
be. The door may be left open or closed, depending on the situation.
11. The respiratory therapist should be aware of a patient’s culture and religious beliefs for which of
the following reasons?
a. To be able to engage in a meaningful conversation
b. To change any misguided notions the patient has that may impact his/her health
c. To explain to the patient how these beliefs will lead to discrimination and
stereotyping
d. To better understand how the patient’s beliefs may impact how the patient thinks and
behaves
ANS: D
Culture and religious beliefs may have a profound effect on how patients think and behave, and this
may impact their health or health care decisions. The role of the respiratory
therapist is not to change the patient’s beliefs, engage in sensitive conversations, or discuss
discrimination. Rather, the respiratory therapist needs to understand how these beliefs may impact
the patient’s health care decisions.
12. Which of the following are the most important components of a successful interview?
a. Communication and understanding
b. Authority and the use of medical terminology
c. Providing assurance and giving advice
d. Asking leading questions and anticipating patient responses to questions ANS: A
Communication and understanding are the basis for a good patient interview. Authority, the use of
medical jargon, providing assurance, giving advice, asking leading questions, and anticipating are all
types of nonproductive communication forms and create barriers to patient communication.
, 13. The respiratory therapist is conducting a patient interview and recording responses in the patient’s
electronic health record. The respiratory therapist should take which of the following into account
regarding the use of the computer to record responses?
a. The therapist’s attention may be shifted from the patient to the computer.
b. The patient will feel more important than if the information is recorded on paper.
c. The therapist will be less likely to make spelling errors if using a spell-check program.
d. The environment will be more professional and the patient will be more likely to open up
if the interview is conducted with paper.
ANS: A
The therapist’s use of the computer can be threatening and may, in some cases, be a potential hazard
to good patient communication. The patient can be intimidated to the point of “shutting down.” In
addition, the therapist who has to shift focus from the patient to the computer can miss important
verbal and nonverbal messages.
Chapter 02: The Physical Examination
Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 8th Edition
MULTIPLE CHOICE
1. When would induced hypothermia be indicated?
a. During brain surgery
b. During bowel surgery
c. To break a fever
d. To treat carbon monoxide poisoning
ANS: A
Induced hypothermia may involve only a portion of the body or the whole body. Induced hypothermia is
often indicated before certain surgeries, such as heart or brain surgery, or after return of spontaneous
circulation after a cardiac arrest.
2. A 50-year-old patient has a heart rate by palpation of 120 bpm. How should this be
interpreted?
a. Within the normal range for an adult
b. An error since a stethoscope was not used
c. Bradycardia
d. Tachycardia
ANS: D
.
In an adult, a heart rate of g rea ter t han 100 /m i nute is considered
less than 60/minute in an adult is considered to be bradycardia. Palpation
to be tachycardia. A heart rate of
and
auscultation are both acceptable to check heart rate.
3. Tachypnea may be the result of:
1. hypoxemia.
2. hypothermia.
3. fever.
4. sedation. a. 2, 4
b. 1, 3
c. 2, 3, 4
d. 1, 2, 3
ANS: B
