Patient Assessment
Terminology

Terminology
Terminolgy
Terminology
 Definition
 Association
4 Life Functions
1.
2.
3.
4.
Ventilation
Oxygenation
Circulation
Perfusion
You have finished charting on your patient when you
notice that an error was made. You should do which of
the following?
A. Tell the nurse so that she will tell the physician
B. Tell the nurse so that she will chart the correct
information
C. Place a line through the error, initial it, and write in the
correct information
D. Have your supervisor chart the correct information
What maximum inspiratory pressure (MIP)
should a patient be able to generate before
attempting extubation?
A. -5 cm H 2 O
B. -10 cm H 2 O
C. -15 cm H 2 O
D. -20 cm H 2 O
All of the following could cause a
capnography reading to change from 36
torr to 30 torr, EXCEPT
A.endotracheal tube positioned in the right
mainstem bronchus
B.Hyperventilation
C.pulmonary emboli
D.hypovolemia
A patient is on a ventilator and is in the
process of being weaned. What is the best
way to continuously monitor the minute
ventilation?
A.Chest transducers
B.Thermistors
C.Water seal spirometer
D.Pneumotachometer

In listening to a patient’s lungs you notice bronchial
breath sounds in her right lower lobe. These
would indicate which of the following?
A.She has normal lungs
B.She has a pneumothorax
C.She has a consolidation in her right lower lobe
D.She has a pleural effusion in her right lower lobe
A 77-year-old male patient is admitted to the
emergency room with shortness of
breath, fine basilar crackles, +2 pitting
edema and a chest radiogram with a
butterfly pattern. These results are most
consistent with which of the following?
A. Pulmonary edema
B. Pulmonary interstitial emphysema
C. Pneumothorax
D. Emphysema
Radiology Terminology and Interpretation
Description
Diagnosis
Terminology
1. Radiolucent
Dark pattern, air
Normal for lungs
2. Radiodense
White pattern, solid, fluid
Normal for bones, organs
3. Infiltrate
Any ill-defined radiodensity
Atelectasis
4. Consolidation
Solid white area
Pneumonia/ Pleural effusion
5.Hyperlucency
Extra pulmonary air
COPD, asthma, ptx
6. Vascular markings
Lymphatics, vessels, lung tissue
Increased with CHF
Absent with pneumothorax
7. Diffuse
Spread throughout
Atelectasis/ pneumonia
8. Opaque
Fluid, solid
Consolidation
9. Bilateral
On both sides
10. Unilateral
On one side
Diagnostic Descriptions and Interpretations
Description
Diagnosis
Terminology
1. Fluffy infiltrates
Diffuse whiteness
Pulmonary edema
2. Butterfly/ batwing pattern
Infiltrate shape
Pulmonary edema
3. Patchy infiltrates
Scattered densities
Atelectasis
4. Platelike infiltrates
Thin-layered densities
Atelectasis
5. Ground glass appearance
Reticulogranular
ARDS/ IRDS
6. Honeycomb Pattern
Reticulogranular
ARDS/ IRDS
7. Air bronchogram
Pneumonia
8. Peripheral wedge-shaped infiltrate
Pulmonary embolus
9. Concave superior interface/ border
Pleural effusion
10. Basilar infiltrates with meniscus
Pleural effusion
A pulmonologist determines a patient has
dyspnea, diminished breath sounds, with
a dull percussion note on the left. The
chest radiograph indicates a tracheal
shift to the right. Which of the following
disease states should the therapist
suspect is affecting the patient?
A. Tension pneumothorax
B. Lung abscess
C. Atelectasis
D. Pleural effusion
Causes of tracheal deviation
Pulled toward pathology
1. Atelectasis
2. Pulmonary fibrosis
3. Pneumonectomy
4. Diaphragmatic
paralysis
Pushed away from
pathology
1. Massive pleural effusion
2. Tension pneumothorax
3. Neck or thyroid tumors
4. Large mediastinal mass
An adult patient is intubated after being pulseless
for several minutes. An exhaled CO 2 detection
device indicates 0.03% CO 2 despite confirmation
of tracheal placement with bilateral breath sounds
and chest rise. Which of the following should the
respiratory therapist recommend to rapidly
confirm correct endotracheal tube placement?
A. direct laryngoscopy
B. another CO 2 detection device
C. stat chest radiograph
D. pulse oximetry
Which of the following clinical observations is
most commonly associated with right heart
failure?
A. peripheral edema
B. muscle wasting
C. tracheal deviation
D. skin flushing
The respiratory therapist is called to deliver a second
dose of 5 mg aerosolized albuterol to a patient with
acute asthma. The patient had wheezing audible without
a stethoscope after the first treatment 20 minutes ago.
Auscultation now demonstrates no wheezing with very
decreased breath sounds. The patient is receiving
oxygen by nasal cannula at 3 L/min and the SpO 2 is
88%. Which of the following has MOST likely occurred?
A. The albuterol reversed the bronchospasm.
B. The airways obstruction has worsened.
C. The SpO 2 value was inaccurate.
D. The first treatment was ineffective.
A scan reveals ventilation and perfusion are equally
decreased in the right mid-lung field. With which of the
following is this finding compatible?
I. acute pulmonary embolus
II. bronchogenic carcinoma
III. pneumonia
IV. atelectasis
A. I, II, and III only
B. I, II, and IV only
C. I, III, and IV only
D. II, III, and IV only
Which of the following are characteristic findings in
patients with emphysema?
I. a decreased FEV 1
II. flattening of the hemidiaphragms
III. an increased AP diameter on a chest radiograph
IV. ventilatory accessory muscle atrophy
A. I, II, and III only
B. I, II, and IV only
C. I, III, and IV only
D. II, III, and IV only
The respiratory therapist performs an assessment prior
to initiating aerosol therapy and chest physiotherapy.
The therapist notices the patient has a rapid respiratory
rate and is using accessory muscles to breathe. During
the interview, the patient states, "I seem to breathe fast
and lift my shoulders a lot, but I feel like I am getting
enough air." The therapist can conclude that the patient
likely has
A. dyspnea on exertion.
B. orthopnea.
C. increased work of breathing.
D. hypopnea.
A patient receiving CPR was just intubated. There was
decreased chest wall movement on the left compared
to the right and decreased breath sounds on the left
during manual ventilation. Which of the following
should the respiratory therapist do?
A. Assess endotracheal tube placement.
B. Add additional air to the endotracheal tube cuff.
C. Continue cardiac compressions and ventilation.
D. Place a large-gauge needle in the left anterior chest
wall.
A male patient who is receiving mechanical ventilation
has just been turned in bed. The low tidal volume alarm
is activated. The respiratory therapist notes the
endotracheal tube is positioned at 18 cm at the incisor.
Which of the following should the therapist do to correct
the problem?
I. Suction the patient's airway.
II. Request a chest radiograph.
III. Deflate the cuff and advance the ET tube to 21 cm.
IV. Decrease the low tidal volume alarm.
A. I and II only
B. I and IV only
C. II and III only
D. III and IV only
If a patient demonstrates poor cooperation when
respiratory care is being administered, he should be
evaluated for
I. acute hypercapnia.
II. impaired hearing.
III. language difficulties.
IV. hyperoxia.
A. I, II, and III only
B. I, II, and IV only
C. I, III, and IV only
D. II, III, and IV only
Characteristics associated with point-of-care
data entry such as hand-held systems
include
I. standardizing documentation.
II. measuring the quality of patient care.
III. monitoring charge capture.
IV. evaluating clinician productivity.
A. I, II, and III only
B. I, II, and IV only
C. I, III, and IV only
D. II, III, and IV only
Three days postoperatively, a patient is febrile
and the white blood cell count is 18,000/cu mm.
A chest radiograph shows patchy bilateral
infiltrates with air bronchograms. Which of the
following is the most probable diagnosis?
A. pneumonia
B. atelectasis
C. pulmonary edema
D. pleural effusion
The respiratory therapist is assisting a
physician during an intubation procedure. After
several unsuccessful attempts, interrupted by
bag-valve-mask ventilation, blind intubation is
performed. The therapist reports a color change
of the CO 2 detector after six breaths. The most
appropriate action for the therapist to perform
NEXT is to
A. secure the endotracheal tube.
B. auscultate the chest.
C. prepare for reintubation.
D. obtain an arterial blood gas.
While performing a chest physical examination
on a patient receiving mechanical ventilation, the
respiratory therapist notes the right side of the
patient's chest is not moving and the trachea is
deviated to the left. These findings would be
most consistent with
A. left tension pneumothorax.
B. left mainstem intubation.
C. right-sided atelectasis.
D. right tension pneumothorax.
The respiratory therapist assigned to a new employee's
orientation is describing the clinical applications of pulse
oximetry (SpO 2 ). Which of the following should the
therapist explain are useful applications of pulse
oximetry?
I. documenting oxygenation for Medicare reimbursement
requirements
II. evaluating the severity of carbon monoxide poisoning
III. preventing retinopathy of prematurity in neonates
IV. monitoring the effectiveness of ventilation
A. I and III only
B. I and IV only
C. II and III only
D. II and IV only
Which of the following are indications of sudden upper
airway obstruction?
I. retraction of intercostal spaces
II. panic
III. marked use of the accessory muscles of ventilation
IV. an elevation in body temperature
A. I, II, and III only
B. I, II, and IV only
C. I, III, and IV only
D. II, III, and IV only
A 54-year-old female with asthma is receiving oxygen by
nasal cannula at 4 L/min and complains of shortness of
breath and appears very anxious. Her temperature is 34.6 °
C (94.3 ° F), heart rate 115/min and regular, respiratory rate
26/min, and blood pressure 75/55 mm Hg. The respiratory
therapist notices the patient's hands are cool and clammy.
Arterial blood gas results are: pH 7.52, PaO2 92 torr, PaCO2
29 torr, HCO3- 23 mEq/L, BE +1, SaO2 97%, SpO2 89%.
Which of the following could cause the difference in
oxygen saturation measurements?
A. hyperventilation
B. hypoperfusion
C. tachycardia
D. radiated light
Activity of respiratory accessory muscles most
likely indicates
A. normal ventilation.
B. increased pulmonary compliance.
C. increased airway resistance.
D. decreased work of breathing.
A 57-year-old male is admitted to the hospital
complaining of dyspnea on exertion and a dry, nonproductive cough. He states his symptoms have been
worsening for the past 2 months. The patient's
respiratory rate is 28 with fine inspiratory crackles
(rales) throughout his lung fields, but are most
noticeable in his lower lobes. Spirometry shows some
restrictive component. Which of the following would
the respiratory therapist recommend?
A. chest radiograph
B. ventilation/perfusion studies
C. exercise stress testing
D. bronchoprovocation studies
A patient with COPD is sitting on the edge of his
bed, leaning over a bedside table, and using his
accessory muscles of ventilation at a regular
rate of 32/min. He explains that he cannot
breathe comfortably lying down. These findings
are most characteristic of
A. orthopnea.
B. eupnea.
C. bradypnea.
D. Cheyne-Stokes respiration.
An upright PA chest radiograph reveals a left
lower chest density with a concave superior
interface. A left lateral decubitus radiograph
shows a density, with a distinct line from the
diaphragm to the apices in the left lung. The
most likely diagnosis is
A. pulmonary edema.
B. emphysema.
C. congestive heart failure.
D. pleural effusion.
Which of the following would provide the most
information about a patient's orientation to time and
place?
I. The patient knows she is in a hospital.
II. The patient knows her diagnosis.
III. The patient recognizes her physician.
IV. The patient correctly states the year.
A. I and II only
B. I and IV only
C. II and III only
D. III and IV only
While manually ventilating an intubated patient
during transport, the respiratory therapist
observes a significant decrease in SpO 2 . Which
of the following should the therapist do first?
A. Continue ventilation since desaturation is
expected during transport.
B. Instill saline down the endotracheal tube to
dislodge a mucus plug.
C. Verify that the resuscitator bag is connected to
oxygen.
D. Reposition the oximeter probe.
While checking a patient's progress notes, the
respiratory therapist reviews a physician's treatment
plan that includes changes in respiratory care. The
therapist's most appropriate action is to
A. initiate the physician's changes immediately.
B. confer with the patient's nurse about when to
implement the changes.
C. check to see whether there are new respiratory care
orders.
D. review the planned changes with the shift supervisor.
During a bedside interview of a patient with
COPD, the respiratory therapist asks the
patient how he accepts the limitations of his
daily activities. Which of the following is the
therapist most likely assessing?
A. emotional state
B. exercise tolerance
C. level of cooperation
D. work of breathing
The respiratory therapist takes over bag-valve
ventilation during resuscitation of a 71-year-old
patient with COPD. The therapist notes
increasing resistance to ventilation, decreased
chest excursion, and absence of breath sounds
on the right. The therapist should
A. insert a nasogastric tube.
B. perform a needle thoracostomy.
C. increase ventilatory pressures.
D. reposition the endotracheal tube.
Secondary polycythemia can be associated with an
adult patient who has
I. long-standing COPD.
II. an anoxic episode during anesthesia.
III. a congenital right-to-left shunt.
IV. Guillain-Barré syndrome.
A. I and III only
B. I and IV only
C. II and III only
D. II and IV only
Which of the following are clinical signs and
symptoms of a pneumothorax when detected
on the affected side of the chest?
I. diminished breath sounds
II. hyperresonance on percussion
III. increased chest motion
IV. increased vocal fremitus
A. I and II only
B. I and IV only
C. II and III only
D. III and IV only
A patient with a persistent dry cough suddenly
starts producing copious amounts of pus-like,
yellow, mucoid sputum. Which of the following
actions should the respiratory therapist take?
A. Request an order for aerosolized
acetylcysteine (Mucomyst).
B. Notify the physician a draining lung
abscess is suspected.
C. Obtain an order for postural drainage and
percussion.
D. Perform nasotracheal suctioning.
A patient has received chest physiotherapy
and bronchodilator therapy for 48 hours.
Sputum production has decreased, but the
patient is now coughing up blood-tinged
secretions. Breath sounds are decreased and
crackles (rales) are present in the left lower
lobe. Which of the following diagnostic studies
should the respiratory therapist recommend?
A. coagulation studies
B. chest radiograph
C. arterial blood gas analysis
D. ventilation/perfusion scan
An AP portable chest radiograph will show a
heart shadow larger than a PA film because
A. the heart is farther away from the film in the
AP position.
B. radiation waves pass through the heart at an
angle in the PA position.
C. the PA position is taken at maximum
inspiration.
D. a larger film is used for the AP position.
A patient was involved in a motor vehicle crash. The
patient has been immobilized, is breathing
spontaneously, and is receiving oxygen by
nonrebreathing mask. The patient is responsive and has
the following vital signs: Heart rate 147
Heart rhythm: atrial fibrillation
Blood Pressure 110/50 mmHg
Respiratory Rate 30
Which of the following should the respiratory therapist
recommend?
A. Transport immediately to a trauma center.
B. Intubate and initiate mechanical ventilation.
C. Perform electrical cardioversion.
D. Administer lidocaine HCl (Xylocaine).
A 21-year-old male patient with a diagnosis of status
asthmaticus is intubated and has been receiving
mechanical ventilation. There is a sudden increase in
airway pressures. The patient is hemodynamically stable
and breath sounds are clear, but significantly decreased
on the right. Which of the following should the
respiratory therapist recommend?
A. Turn the patient onto his left side.
B. Suction the airway through the endotracheal tube.
C. Order a portable chest radiograph.
D. Decrease the PEEP setting to zero.
During the 24 hours following a kidney
transplant, a 54-year-old woman has received
3000 mL of intravenous fluids. Blood chemistry
results identified decreases in BUN and
hemoglobin values. The urine output has been
30 mL/hr. Which of the following would
assessment most likely reveal?
A. inspiratory crackles
B. chest wall crepitus
C. hyperresonance to percussion
D. bronchial breath sounds
Recommend a nicotine patch if you have a
heavy smoker who is very agitated.
 General malaise = electrolyte imbalance
 If HR increases from 70 to 95 bpm turing a
tx, what do you do?

 Stop

the tx
What is the treatment for a unilateral
wheeze?
 Bronch

What is the treatment for severe stridor
 Intubation

What are normal heart sounds?
 S1
and S 2
 Anything else… consider an echo

Proper ETT placement?
2

– 2.5 cm OR 1 inch
What test quickly evaluates sputum?
 Gram
stain
 Culture and sensitivity takes a long time

Normal RBC?
5

mill/cu mm (4-6)
Normal Hb
gm/dl (12 – 16)
 3 x RBC
 15

Normal Hct?
 45%
(40-50%)
 3 x Hb

Normal PaCo2?
 35

– 45 mmHg
Normal K+?
 Just
add a decimal point!
 3.5 – 4.5 mEq/L

Normal Na+?
 Just
ad a 1 on front!
 135 – 145 mEq/L

Normal PaO2?
 80-100

mmHg
Normal Cl 80-100
mEq/L
THE END
A patient's fluid balance is relevant
because it provides information about
I. renal function.
II. congestive heart failure.
III. pulmonary hypertension.
IV. pulmonary edema.
A. I, II, and III only
B. I, II, and IV only
C. I, III, and IV only
D. II, III, and IV only
A 34-week gestational age infant is
receiving mechanical ventilation and the
chest is being transilluminated. The
transillumination device produces a
small halo appearance at the point of
contact with the skin. Which of the
following does this indicate?
A. pneumothorax
B. pneumomediastinum
C. pneumopericardium
D. normal lung appearance
During which of the following should apnea
monitoring be implemented for an infant?
I. night time
II. breast feeding
III. naps
A. I only
B. I and II only
C. I and III only
D. II and III only
An intubated premature newborn is
experiencing increased signs of respiratory
distress. Which of the following
tests/procedures would be helpful in diagnosing
a pneumothorax?
A. suction
B. bronchoscopy
C. transillumination
D. capillary blood gas
The major component of pulmonary surfactant is
A. protein.
B. glucose.
C. phospholipid.
D. polysaccharide.