Respiratory Therapy Assessment Quiz

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Questions and Answers

Which of the following is NOT considered one of the four critical life functions?

Oxygenation

Perfusion

Ventilation

Respiration (correct)

A patient is diaphoretic before a breathing treatment, which of the following is the BEST course of action?

Stop, assess the patient, and call a rapid response if necessary. (correct)

Start the breathing treatment immediately.

Administer the breathing treatment, and then assess the patient after.

Continue with the treatment and check the patient again in 15 minutes.

A patient desaturates while receiving respiratory treatment. What should the respiratory therapist do?

Continue the treatment but increase the oxygen flow rate.

Immediately stop the treatment and assess the patient's level of consciousness.

Stop the treatment and immediately start any form of oxygen therapy.

Stop the treatment, stabilize the patient with oxygen, and call a rapid response if needed. (correct)

Which of the following is an example of a 'sign' as it relates to patient assessment?

Blood pressure reading of 140/90 Signup and view all the answers

Which of the following is considered a 'symptom'?

Dyspnea Signup and view all the answers

What is the purpose of a 'pack year' history?

To quantify a patient's smoking history. Signup and view all the answers

A patient smoked 1 pack per day for 30 years. What is the patients pack year history?

30 pack years Signup and view all the answers

Which of the following would be found in the patients 'progress notes'?

Patient's respiratory treatment records including date, time and reactions Signup and view all the answers

A patient experiencing euphoria is MOST likely exhibiting symptoms related to which condition?

Drug overdose (morphine) Signup and view all the answers

Which of the following questions is MOST appropriate to use when trying to obtain neutral information from a patient?

How is your breathing now? Signup and view all the answers

A patient reports having difficulty breathing when lying flat but feels better when sitting up. This condition is known as:

Orthopnea Signup and view all the answers

When assessing a patient's dyspnea it is important to ask patients for which descriptions?

The subjective feeling of the patient Signup and view all the answers

A patient with asthma is MOST likely to express dyspnea using which language?

A sensation of chest tightness Signup and view all the answers

Which of the following is NOT a typical symptom associated with psychogenic dyspnea?

Productive cough Signup and view all the answers

A weak cough is often caused by which of the following factors?

High Raw, poor lung recoil, weak muscles or pain Signup and view all the answers

Which type of lung diseases is typically characterized by a nonproductive cough?

Restrictive lung diseases Signup and view all the answers

The term 'purulent' is used to describe sputum that:

Contains pus cells Signup and view all the answers

Blood-streaked sputum is MOST commonly associated with which condition?

Chronic lung disease Signup and view all the answers

Which of the following is NOT a component of a patient's general appearance assessment?

Blood type Signup and view all the answers

What does a pale appearance with cold, clammy skin typically suggest?

Shock or hypotension Signup and view all the answers

Which of the following best describes diaphoresis?

Excessive sweating Signup and view all the answers

What does central cyanosis refer to?

Cyanosis of the oral mucosa or trunk Signup and view all the answers

A patient presents with a bright cherry-red skin color. What might be the cause?

Carbon monoxide poisoning Signup and view all the answers

What does the term 'lethargic' indicate about a patient's level of consciousness?

Drowsy, sleepy state Signup and view all the answers

Which of the following physical findings is associated with emphysema?

Barrel chest Signup and view all the answers

What is 'pectus excavatum'?

Abnormal depression of the sternum Signup and view all the answers

What is indicated if a patient's skin sucks inward during inspiration?

Retractions Signup and view all the answers

What does the term 'ecchymosis' refer to?

Superficial bleeding under the skin Signup and view all the answers

What is a potential cause of angioedema?

Allergic reaction Signup and view all the answers

What does an emaciated appearance typically indicate about a patient?

Poor nutritional status and weakness Signup and view all the answers

If a patient's SpO2 is low, what should be noted in addition to the SpO2 value?

Any supplemental oxygen in use Signup and view all the answers

What is triad asthma characterized by?

Skin rash combined with mucosal edema, nasal polyps, and aspirin intolerance Signup and view all the answers

What should a clinician note if a patient is on cardiac monitoring equipment?

The cardiac rate, rhythm, and presence of gross arrhythmias Signup and view all the answers

What characteristic distinguishes massive hemoptysis from non-massive hemoptysis?

The volume of blood expectorated over 24 hours. Signup and view all the answers

A patient's sputum is green and thick. What does this MOST likely indicate?

Possible gram-negative bacterial infection. Signup and view all the answers

What type of pain is described as arising from skin, muscles, and soft tissues?

Somatic pain. Signup and view all the answers

A patient describes their pain as 'deep, aching and pressing'. What is the MOST likely source of this pain?

Visceral Signup and view all the answers

A patient reports a sharp, stabbing chest pain that worsens with deep breaths. Where is this pain most likely located?

Laterally or posteriorly. Signup and view all the answers

Which of the following is a potential cause of nonpleuritic chest pain?

Coronary artery disease. Signup and view all the answers

What physiological effects may result from a fever in a patient?

Increased metabolic rate, oxygen consumption and carbon dioxide production. Signup and view all the answers

Hypothermia has a specific effect on the body when induced. What is the main intention for this?

To decrease O2 consumption and CO2 production Signup and view all the answers

Which of the following describes insensible water loss?

Water loss from lungs and skin. Signup and view all the answers

An imbalance between fluid intake and output where intake exceeds output can lead to what physiological changes?

Weight gain, electrolyte imbalance, and decreased lung compliance. Signup and view all the answers

Which condition is MOST commonly associated with pedal edema?

Heart failure. Signup and view all the answers

What does 'weeping edema' indicate?

A severe form of edema where fluid leaks from the skin. Signup and view all the answers

Which of the following best describes tachycardia?

An increased heart rate above 100 beats per minute. Signup and view all the answers

What condition is commonly associated with bradycardia?

Heart failure or shock Signup and view all the answers

An athlete with a normal resting heart rate of 50 bpm would be classified as having which of the following?

Normal heart rate for them Signup and view all the answers

A patient with a pulmonary disease has decreased $PaO_2$ and increased $O_2$ consumption. As a compensatory mechanism, which of the following changes would the body most likely exhibit?

Increased heart rate. Signup and view all the answers

A patient exhibiting pulsus paradoxus will have a blood pressure decrease of how much during inspiration?

Greater than 10 mmHg. Signup and view all the answers

Which of the following is NOT a typical cause of tachypnea?

Hypothermia. Signup and view all the answers

A patient's breathing pattern is characterized by a gradually increasing rate and depth, followed by a decreasing rate and depth, with periods of apnea. Which breathing pattern best describes this?

Cheyne-Stokes. Signup and view all the answers

Which of the following is NOT a characteristic of Kussmaul's breathing?

Regular rhythm. Signup and view all the answers

What effect does vessel dilation have on blood pressure?

Decreases blood pressure. Signup and view all the answers

Inadequate delivery of $O_2$ and nutrients to the organs is characteristic of which condition?

Shock. Signup and view all the answers

A tracheal shift to the left or right can indicate which anatomical abnormality?

Mediastinal tumors. Signup and view all the answers

Increased tactile vocal fremitus is commonly associated with which condition?

Pneumonia. Signup and view all the answers

Which percussion sound is characterized by a hollow sound heard over normal, air-filled lungs?

Resonant. Signup and view all the answers

If a patient says 'E' and it sounds like 'A' during auscultation, which of the following is indicated?

Consolidation, such as pneumonia. Signup and view all the answers

Which of the following findings would be considered abnormal if heard over peripheral lung regions?

Bronchial breath sounds. Signup and view all the answers

Which of the following findings is consistent with airway obstruction, such as in asthma or COPD?

Wheezes. Signup and view all the answers

Which of the following conditions is associated with fine crackles/rales?

Pulmonary edema. Signup and view all the answers

Digital clubbing is least likely to be seen in which of the following disease states?

Acute bronchitis Signup and view all the answers

What is one common indication for administering supplemental oxygen in patients?

Hypoxemia Signup and view all the answers

What is the primary function of the respiratory system?

Exchange gases between the body and the environment Signup and view all the answers

Which of the following is a common indication for respiratory therapy?

Chronic obstructive pulmonary disease (COPD) Signup and view all the answers

What does “Clear” sputum color indicate?

Normal Signup and view all the answers

What does “Brown/dark” sputum color indicate?

Old blood Signup and view all the answers

What does “Bright red” sputum color indicate?

Hemoptysis (Bleeding tumor), TB Signup and view all the answers

What does “Pink frothy” sputum color indicate?

Pulmonary Edema Signup and view all the answers

What is the posturing of a patient with arms like “e”s and has problems with Midbrain or Pons — Considered as very bad sign of posturing due to brain damage?

Decerebrate Signup and view all the answers

What does Apnea mean?

Cessation of breathing Signup and view all the answers

What is Orthostatic Hypotension?

A postural change which causes a quick decrease in blood pressure Signup and view all the answers

What is the type of breathing when a patient is not getting enough oxygen and is gasping for air? It typically occurs as sign of medical distress such as cardiac arrest, stroke or respiratory failure.

Agonal breathing Signup and view all the answers

What is the name of the method to determine the patient’s level of consciousness? And what is the highest and lowest number of assessment?

GCS. The highest number is 15, lowest is 3 Signup and view all the answers

Why do patients with CHF (excess fluids) in lungs feel shortness of breath when laying down?

Because there is a reduced pulmonary compliance due to fluids shift from lower extremities to lungs. Signup and view all the answers

What are 4 critical life functions?

Ventilation, Oxygenation, Circulation, Perfusion Signup and view all the answers

How can we assess the presence of ventilation in the patient?

By RR, Chest movement, Breath sounds, PaCO2 Signup and view all the answers

How can we assess if there is oxygenation in the patient?

By HR, Color, Sensorium, PaO2 Signup and view all the answers

How can we assess patient’s circulation?

By HR, Pulse, strength and cardiac output Signup and view all the answers

How can we assess patient’s perfusion?

By Blood pressure, sensorium, Temp, Urine output and hemodynamics Signup and view all the answers

What is pleghm?

Muscus from tracheobronchial tree not contaminated by oral secretion Signup and view all the answers

What is Sputum?

mucus from the lower airways expectorated through mouth. Signup and view all the answers

Study Notes

Life Functions

Crucial life functions monitored include ventilation, oxygenation, circulation, and perfusion.
Ventilation involves the movement of air in and out of the lungs, assessed by respiratory rate (RR), chest movement, breath sounds, and PaCO2 levels.
Oxygenation refers to oxygen uptake into the blood, evaluated via heart rate (HR), skin color, responsiveness, and PaO2.
Circulation involves blood movement throughout the body, gauged by pulse rate and strength, heart rate, and cardiac output.
Perfusion assesses blood and oxygen delivery to tissues, evaluated through blood pressure, responsiveness, temperature, urine output, and hemodynamic parameters.

Monitoring Life Functions

Assessments directly relate to these vital functions.
Urgent action is needed if patient shows signs of problems in any of these areas.
Stop treatments like breathing treatments if the patient is excessively sweating (diaphoretic); assess, call rapid response, and seek immediate medical intervention.
Stabilize the desaturating patient before starting a treatment. Use oxygen. Call rapid response as needed.
If any life function is absent, call a code blue immediately.

Reviewing Patient Records

Admission notes include the admitting diagnosis, medical history, and patient complaint.
Signs are objective observations (color, pulse, edema, blood pressure).
Symptoms are subjective experiences reported by the patient (dyspnea, pain, nausea).
Employment history, allergies, prior treatments, surgeries, illnesses, and injuries are important factors to note.
Vital signs (respiration rate, pulse, blood pressure, temperature) are crucial.
Physical examination of the chest, including inspection, palpation, percussion, and auscultation, aids in assessing lung function.
Smoking history (pack years) is important for evaluating potential risks and complications.
Advance directives and code status documentation are essential.

Patient Evaluation

Respiratory orders detail treatments, frequencies, and medications.
Progress notes track respiratory issues, reactions, and changes.
Nursing notes report patient condition monitoring.
Admission notes supply pertinent medical data.
Physician notes document any changes in the patient's condition that lead to alterations in respiratory orders.
General appearance and overall condition are observed immediately. This should immediately highlight the patient's emotional state.
Identifying data such as gender, ethnicity, age, height, and weight should be noted. Nutritional status is an important component.

General Appearance & Condition

The patient's general appearance, overall condition, level of consciousness, breathing rate, respiratory patterns, and any signs of respiratory distress should be observed and documented.
Document skin color and any signs of excessive sweating.
The clinician needs to note the patient’s oxygen saturation (SpO2) and supplemental oxygen use.
If cardiac monitoring is present, the heart rate and rhythm should be logged, along with any significant arrhythmias.
A complete inspection should also encompass the head and face, neck, hands and nails, skin of the arms and extremities.

Patient Appearance - Emaciation

An emaciated patient is extremely thin; wasting away.
This indicates poor nutrition, which can further increase the risk of atelectasis, pneumonia, and other respiratory problems.

Skin Assessment

Skin color varies with pigmentation; healthy nail beds, fingers, toes and gums should appear pink.
Pale color with cold, clammy skin may suggest shock or hypotension.
Swelling in the face, tongue, larynx, hands, or feet (angioedema) could indicate an allergic reaction.

Diaphoresis

Excessive sweating (diaphoresis) could signal respiratory distress or cardiac issues (e.g., myocardial infarction or congestive heart failure), infection, fever, drug reactions, anxiety, or acute distress..

Skin Color Assessment

Abnormal decrease in color (pale skin) may indicate anemia or acute blood loss.
Jaundice is yellowing of the skin, which could reflect liver dysfunction.
Erythema is redness of the skin due to capillary congestion, inflammation or infection.
Ecchymosis is superficial bleeding under the skin, common in older patients.

Skin Color Assessment - Cyanosis

Cyanosis is a bluish discoloration of the skin caused by desaturated hemoglobin.
It's most noticeable in lips, gums, and nail beds.
Central cyanosis appears in the mouth and trunk; peripheral cyanosis in hands and feet.
Cyanosis typically develops when the level of unsaturated hemoglobin exceeds 4–5 g/dL.
The cause of cyanosis should be differentiated between cardiac and respiratory problems.

Skin Color Assessment - Other

Skin rash combined with mucosal edema, nasal polyps and aspirin intolerance sometimes indicate allergic asthma.
Carbon monoxide poisoning may cause bright cherry red skin.

Patient Interview - Level of Consciousness

Assess the patient's level of consciousness (LOC) through orientation to time, place, and person.
Normal awareness, responsiveness, & cooperation (e.g., correctly answering simple questions like name & DOB) indicate a healthy state of mind.
Lethargy, confusion, stupor, obtundation, and coma signify various degrees of diminished consciousness. These can be caused by medication overdoses, intoxication, sleep apnea, or brain injury.

Examination of the Thorax

Barrel chest is associated with emphysema, indicating impaired lung recoil.
Retractions (inward pulling of the skin during inspiration) and tracheal tugging indicate respiratory distress.
Pectus carinatum and pectus excavatum are abnormal chest wall deformities.
Kyphoscoliosis is curvature of the backbone, often causing restrictive lung problems.

Patient Interview - Emotional State

Note anxiety or nervousness, depression, anger, irritability, euphoria, or panic, as these might point to particular conditions.

Interviewing Technique

Maintain an appropriate social distance and ensure a comfortable environment for the interview.
Apply interviewing techniques that are open-ended and closed-ended.
Use neutral, and respectful communication for direct questions and encourage detailed responses. Avoid responding using only single words or leading questions.

Cardiopulmonary Symptoms - Dyspnea

Dyspnea is difficulty breathing.
Orthopnea is difficulty breathing while lying down.
Platypnea is difficulty breathing in an upright position.

Cardiopulmonary Symptoms - Dyspnea (cont)

Subjective responses from patients describe the feeling of dyspnea. Assess the patients' breathing patterns and reactions. Note the cause of the dyspnea.

Cardiopulmonary Symptoms - Dyspnea (cont) - Psychogenic Dyspnea

Psychogenic Dyspnea can be caused by panic disorders or hyperventilation.
The patient reports intense dyspnea (breathing discomfort), but the cardiopulmonary function is normal. The patient may complain of chest pain anxiety, palpitation and paresthesia(tingling).
Do not assume that any shortness of breath is anxiety-related.
Evaluate underlying causes (hypoxemia, pain, temperature, etc.).

Cardiopulmonary Symptoms - Cough

Coughs are triggered by inflammations of the airways, mucus, or foreign bodies.
Coughs are classified as productive (sputum) or nonproductive (dry).
Common causes of chronic coughs include asthma, postnasal drip, bronchitis, and GERD.

Cardiopulmonary Symptoms - Sputum Production

Sputum refers to the expectorated mucus from the airways, not saliva.
Sputum quality describes its consistency, color, and amount.
Sputum analysis includes evaluating its consistency, color.
Changes in sputum quality can indicate infections.

Cardiopulmonary Symptoms - Hemoptysis

Hemoptysis is coughing up blood.
It can be massive (over 300 mL in 24 hours) or non-massive.
Common causes include bronchiectasis, lung abscess, and tuberculosis..
Hemoptysis needs to be distinguished from hematemesis (vomiting blood).

Sputum Analysis

Color variations of sputum provide valuable clues about potential conditions (clear, mucoid, yellow, green, brown/dark/ or bright red).
Use different stain methods (Gram Stain, Acid fast stain) to identify bacteria, or mycobacteria, like TB.

Pain

Pain can be somatic (from skin, muscle), visceral (from internal organs), or neuropathic (from nerve injury).
Types of pain include sharp, stabbing pain, generalized pain, burning, aching pain or a pressing pain.

Causes and Types of Pain

Pain in people with cardiopulmonary diseases can be widespread or localized.
Chest pain is common in many cardiopulmonary conditions (heart disease, pneumonia, pleurisy, rib fracture, pneumothorax, and tumors).
Abdominal pain can be caused by various issues like gastric disease, reflux, appendicitis, or diverticulitis.

Pain Assessment

Assess the patient's pain through self-reporting, using a 0-10 pain scale.
Differentiate between pleuritic (sharp, stabbing) and nonpleuritic (central chest or radiating) chest pain.

Fever (Hyperthermia)

Fever (hyperthermia or febrile state) is elevated body temperature caused by infection or neurologic causes.
This increase in temperature increases oxygen demand.
Hypothermia reduces oxygen and carbon dioxide production, dropping the respiratory rate and heart rate.

Intake and Output

Normal urine output is approximately 1 liter (40 mL/hr) per day.
Intake exceeding output causes potential weight gain and electrolyte imbalances.

Pedal Edema

Pedal edema (swelling in the feet) is common in heart failure, as increased hydrostatic pressure leads to fluid leakage.
Pitting edema is marked by an indentation after pressure; weeping edema involves fluid leakage.

Pulses

Pulse evaluation includes rate, rhythm, and strength. (60–100 bpm).
Tachycardia is an elevated heart rate; bradycardia is a decreased rate.
These changes can reflect various conditions like hypoxemia, anxiety, stress, heart failure, or shock.
Normal heart rate for patients like athletes and certain conditions is also normal.

Physical Exam - Pulsus Paradoxus

Pulsus paradoxus is a decrease in blood pressure during inspiration, common with acute COPD, asthma, cardiac tamponade ,and restrictive pericarditis.
This occurs because vigorous inspiration decreases left ventricular contraction.

Respiratory Rate

Normal respiratory rate is 12–20 breaths per minute.
Apnea (cessation of breathing) and respiratory arrest are critical conditions.
Tachypnea (RR > 20) occurs with infection, hypoxemia, anxiety, pulmonary edema, lung fibrosis.
Bradypnea (RR < 12) occurs during sleep, or with traumatic brain injuries, hypothermia, medications, and narcotic use.

Breathing Patterns

Different breathing patterns are associated with different conditions (Apnea, Biot's, Kussmaul's, Apneustic).

Blood Pressure

Blood pressure is influenced by the heart, amount of blood, and vessel condition.
Shock is inadequate oxygen and nutrient delivery to vital organs.
Cardiogenic shock results from left ventricular failure.
Septic shock is triggered by overwhelming infections.

Head and Neck Exam

Trachea should be midline, any shifts may indicate abnormalities.
Jugular venous distension is a sign of heart failure.
Look at the whole patient.

Chest Palpation – Fremitus

Increased tactile vocal fremitus indicates pneumonia or atelectasis.
Reduced fremitus may suggest emphysema, pneumothorax, or pleural effusion.
Rhonchial fremitus is associated with secretions in larger airways.

Chest Percussion

Resonant, flat, dull (fluid),and tympanic percussion sounds are used to assess lung sounds and possible infections.
hyperresonance signifies air trapping (pneumothorax or emphysema).

Breath Sounds

Normal breath sounds are vesicular sounds.
Abnormal sounds (e.g., bronchial breath sounds in peripheral lung regions, diminished or absent sounds, other types of abnormal sounds) indicate various conditions.

Chest Auscultation – Wheezes & Stridor

Wheezes (polyphonic or unilateral) indicate airway obstruction (asthma, COPD, or foreign body).
Stridor is a high-pitched, monophonic wheeze that points to upper airway obstruction (epiglottitis, croup, post-extubation swelling)

Chest Auscultation - Crackles

Coarse crackles are due to larger airway secretions and may be cleared by suctioning. Fine crackles are due to small airway opening and are caused by Congestive Heart Failure, pulmonary edema, and atelectasis.
Treat with heart drugs, diuretics, and oxygen.

Examination of Extremities – Digital Clubbing

Digital clubbing is associated with various chronic conditions (congenital heart disease, chronic bronchitis, cancer, and interstitial lung diseases).

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Description

Test your knowledge of critical life functions, patient assessment signs and symptoms, and respiratory treatment protocols. This quiz covers essential concepts for respiratory therapists, focusing on patient history and assessment techniques to improve clinical outcomes. Get ready to challenge yourself on your understanding of respiratory therapy!