TEST BANK
Clinical Manifestations and Assessment of Respiratory Disease
Terry Des Jardins, and George G. Burton
9th Edition
,Table of Contents
Chapter 01 The Patient Interview 1
Chapter 02 The Physical Examination 4
Chapter 03 The Pathophysiologic Basis for Common Clinical Manifestations Observed
During Inspection 7
Chapter 04 Pulmonary Function Testing 11
Chapter 05 Blood Gas Assessment 15
Chapter 06 Assessment of Oxygenation 20
Chapter 07 Assessment of the Cardiovascular System 24
Chapter 08 Radiologic Examination of the Chest 28
Chapter 09 Diagnostic Tests and Procedures 31
Chapter 10 The Therapist-Driven Protocol Program 35
Chapter 11 Respiratory Failure and Ventilatory Management Protocols 37
Chapter 12 Recording Skills and Intra-professional Communication 41
Chapter 13 Chronic Obstructive Pulmonary Disease, Chronic Bronchitis and Emphysema 44
Chapter 14 Asthma 49
Chapter 15 Cystic Fibrosis 54
Chapter 16 Bronchiectasis 59
Chapter 17 Atelectasis 64
Chapter 18 Pneumonia, Lung Abscess Formation and Important Fungal Diseases 68
Chapter 19 Tuberculosis 76
Chapter 20 Pulmonary Edema 80
Chapter 21 Pulmonary Vascular Disease-Pulmonary Embolism and Pulmonary
Hypertension 85
Chapter 22 Flail Chest 91
Chapter 23 Pneumothorax 95
Chapter 24 Pleural Effusion and Empyema 99
Chapter 25 Kyphoscoliosis 103
Chapter 26 Cancer of the Lung 107
Chapter 27 Interstitial Lung Diseases 111
Chapter 28 Acute Respiratory Distress Syndrome 115
Chapter 29 Guillain-Barre Syndrome 119
Chapter 30 Myasthenia Gravis 124
Chapter 31 Cardiopulmonary Assessment and Care of Patients with Neuromuscular
Disease 129
Chapter 32 Sleep Apnea 135
Chapter 33 Newborn Assessment and Management 140
Chapter 34 Pediatric Assessment and Management 144
Chapter 35 Meconium Aspiration Syndrome 147
Chapter 36 Transient Tachypnea of the Newborn 152
Chapter 37 Respiratory Distress Syndrome 155
Chapter 38 Pulmonary Air Leak Syndrome 160
,Chapter 39 Respiratory Syncytial Virus Infection (Bronchiolitis) 165
Chapter 40 Bronchopulmonary Dysplasia 168
Chapter 41 Congenital Diaphragmatic Hernia 172
Chapter 42 Congenital Heart Diseases 176
Chapter 43 Croup and Croup-like Syndromes-Laryngotracheobronchitis, Bacterial
Tracheitis, and Acute Epiglottitis 179
Chapter 44 Near Drowning-Wet Drowning 182
Chapter 45 Smoke Inhalation, Thermal Lung Injuries, and Carbon Monoxide Intoxication 186
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Test Bank - Clinical Manifestations and Assessment of Respiratory Disease, 9th Edition (Des Jardins, 2024)
Chapter 01: The Patient Interview
Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 9th
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 therapist and the patient. It allows the
collection of subjective data about the patient's feelings regarding his/her condition.
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
Listening is not a passive process. Listening is active and demanding. It requires the
practitioner's complete attention. If the examiner is preoccupied with personal needs or
concerns, he or she will invariably miss something important. Active listening is a cornerstone
to understanding.
3. Which of the following would be found on a history form?
a. Present health, patient history, and family history
b. Chief complaint and present health
c. Age, medications, present health, and family history
d. Age, chief complaint, present health, and family history
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
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Test Bank - Clinical Manifestations and Assessment of Respiratory Disease, 9th Edition (Des Jardins, 2024)
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 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
In addition, the interviewer's focus is often shifted from the patient to the EHR and this can
cause him/her to overlook important verbal and nonverbal messages. This situation also has
the potential to cause patients to think they are not important.
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
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Test Bank - Clinical Manifestations and Assessment of Respiratory Disease, 9th Edition (Des Jardins, 2024)
Reflection is used to echo the patient's words. The examiner repeats a part of what the patient
has just said to clarify or stimulate further communication. Reflection helps the patient focus
on specific areas and continue in his or her own way.
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
The open-ended question is unbiased; it allows the patient freedom to answer in any way. This
type of question encourages the patient to respond at greater length and give a spontaneous
account of the condition. As the patient answers, the examiner should stop and listen. Patients
often answer in short phrases or sentences and then pause, waiting for some kind of direction
from the examiner.
9. 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.
10. 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.
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Test Bank - Clinical Manifestations and Assessment of Respiratory Disease, 9th Edition (Des Jardins, 2024)
Chapter 02: The Physical Examination
Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 9th
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 refers to the intentional lowering of a patient's body temperature to
reduce the oxygen demand of the tissue cells. 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 pulse 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
A pulse rate greater than 100 bpm in adults is called tachycardia.
3. The respiratory therapist is performing palpation on a patient recently admitted to the medical
ward. The therapist notes decreased tactile fremitus over the right lung. Which of the
following could most likely be the cause for this physical examination finding?
a. Right-sided atelectasis
b. Right-sided pneumothorax
c. Right-sided pleural effusion
d. Right-sided pleural tumor
ANS: A
Tactile fremitus decreases when anything obstructs the transmission of vibration. Such
conditions include tumors or thickening of the pleural cavity, pleural effusion, and
pneumothorax. Tactile fremitus increases in patients with atelectasis.
4. A 50-year-old patient would be said to have hypotension when her:
a. blood pressure is 130/90 mm Hg.
b. blood pressure is 85/55 mm Hg.
c. heart rate is 55 bpm.
d. pulse pressure is 40 mm Hg.
ANS: B
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Test Bank - Clinical Manifestations and Assessment of Respiratory Disease, 9th Edition (Des Jardins, 2024)
Hypotension is said to be present when the patient’s blood pressure falls below 90/60 mm Hg.
A heart rate of 55 bpm would be bradycardia. Pulse pressure is normally about 40 mm Hg.
5. A dull percussion note would be heard in which of the following situations?
a. Consolidation, air trapping, and pneumothorax
b. Pleural effusion and air trapping
c. Air trapping, atelectasis, and consolidation
d. Pleural thickening, pleural effusion, atelectasis, and consolidation
ANS: D
A dull percussion note is heard when the chest is percussed over areas of pleural thickening,
pleural effusion, atelectasis, and consolidation.
6. The respiratory therapist is examining a patient in the medical ward and notes that the trachea
is deviated to the right. Which of the following may be causing the tracheal deviation to the
right?
a. A right-sided tension pneumothorax.
b. A right-sided pleural effusion.
c. A tumor mass on the right.
d. Atelectasis of the right upper lobe.
ANS: D
A number of abnormal pulmonary conditions can cause the trachea to deviate from its normal
position. For example, a tension pneumothorax, pleural effusion, or tumor mass may push the
trachea to the unaffected side (in this case to the left), whereas atelectasis pulls the trachea to
the affected side (in this case to the right).
7. While assessing an unconscious patient, the respiratory therapist observes that the patient’s
breathing becomes progressively faster and deeper and then progressively becomes slower
and shallower. After that, there is a period of apnea before the cycle begins again. This
breathing pattern would be identified as:
a. Cheyne-Stokes.
b. Tachypnea.
c. Kussmaul.
d. Hyperventilation.
ANS: A
The abnormal breathing pattern called Cheyne-Stokes is identified by progressively faster and
deeper breathing that then progressively becomes slower and shallower. After that there is a
period of apnea before the cycle begins again. Tachypnea is rapid breathing. Kussmaul
breathing is consistently fast and deep breathing. Hyperventilation is confirmed by a low
carbon dioxide level.
8. The respiratory therapist is monitoring the blood pressure of a patient in the emergency
department and notes that the blood pressure is 15 mm Hg less on inspiration than on
expiration. Which of the following would most likely result in this finding?
a. The patient is hypovolemic.
b. The patient has a pulmonary embolism.
c. The patient is having a myocardial infarction.
d. The patient is having a severe exacerbation of asthma.
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Test Bank - Clinical Manifestations and Assessment of Respiratory Disease, 9th Edition (Des Jardins, 2024)
ANS: D
A change in blood pressure that is more than 10 mm Hg lower on inspiration than on
expiration is known as pulsus paradoxus. This exaggerated waxing and waning of arterial
blood pressure can be detected with a sphygmomanometer or, in severe cases, by palpating
the pulse at the wrist or neck. Commonly associated with severe asthmatic episodes, pulsus
paradoxus is believed to be caused by the major intrapleural pressure swings that occur during
inspiration and expiration.
9. A patient comes into the emergency department with a complaint of centrally located,
constant chest pain. What is his most likely problem?
a. Pleurisy
b. Myocardial ischemia
c. Pneumothorax
d. Fractured rib
ANS: B
Often a patient with myocardial ischemia will complain of centrally located, constant chest
pain. The pain may also radiate down an arm or up the neck.
10. A patient with bronchiectasis has a productive cough. Which of the following should the
respiratory therapist be evaluating about the patient’s sputum?
1. Color
2. Odor
3. Frequency of cough
4. Consistency
a. 3
b. 1, 2
c. 3, 4
d. 1, 2, 4
ANS: D
The respiratory therapist should evaluate a patient’s sputum for color, odor, amount,
consistency, and any other significant factors. This could include time of greater or smaller
amounts or a change in consistency after inhaling a mucolytic medication.
11. You are assessing a patient and determine their SpO2 to be 88% while breathing room air.
How would you document this?
a.Normal oxygenation level
b.Mild hypoxemia
c.Moderate hypoxemia
d.Severe hypoxemia
ANS: C
In the adult, normal SpO2 values range from 95% to 99%. SpO2 values of 91% to 94%
indicate mild hypoxemia. Mild hypoxemia warrants additional evaluation by the respiratory
practitioner but does not usually require supplemental oxygen. SpO2 readings of 86% to 90%
indicate moderate hypoxemia. These patients often require supplemental oxygen. SpO2 values
of 85% or lower indicate severe hypoxemia and warrant immediate medical intervention,
including the administration of oxygen, ventilatory support, or both.
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Test Bank - Clinical Manifestations and Assessment of Respiratory Disease, 9th Edition (Des Jardins, 2024)
Chapter 03: The Pathophysiologic Basis for Common Clinical Manifestations Observed
During Inspection
Des Jardins: Clinical Manifestations and Assessment of Respiratory Disease, 9th
Edition
MULTIPLE CHOICE
1. Which of the following is considered a normal tidal volume for a normal adult?
a. 4 to 6 mL/kg
b. 7 to 9 mL/kg
c. 9 to 11 mL/kg
d. 10 to 12 mL/kg
ANS: B
In normal adults, the VT is about 500 mL (7 to 9 mL/kg), the ventilatory rate is about 15 (with
a range of 12 to 18) breaths per minute, and the I:E ratio is about 1:2. In patients with
respiratory disorders, however, an abnormal ventilatory pattern is often present.
2. Which of the following is considered a symptom a patient with pulmonary disease may
complain of when in distress?
a. Dyspnea
b. Tachypnea
c. Retractions of intercostal spaces
d. Distressed facial expressions
ANS: A
Dyspnea is a general term often used—although incorrectly—to describe the patient's
difficulty in breathing. In fact, the term dyspnea is likely the most common symptom the
respiratory therapist is asked to evaluate and treat. Dyspnea is defined as the “breathlessness,”
or “shortness of breath,” or the “labored or difficult breathing” felt and described only by the
patient.
3. Which of the following terms is used to describe shortness of breath in the reclining position?
a. Orthopnea
b. Eupnea
c. Exertional dyspnea
d. Cardiac dyspnea
ANS: A
Common types of dyspnea include (1) positional dyspnea, which occurs only when the patient
is in the reclining position—and is also known as orthopnea, (2) cardiac dyspnea, which is
labored breathing caused by heart disease (e.g., congestive heart failure), (3) exertional
dyspnea, which is provoked by physical exercise or exertion, (4) paroxysmal nocturnal
dyspnea, which is a form of respiratory distress related to posture (especially reclining while
sleeping) and is usually associated with congestive heart failure with pulmonary edema, and
(5) renal dyspnea, which is difficulty in breathing due to kidney disease. Eupnea is defined as
the normal breathing rate (between 12 and 20 breaths/min) and regular rhythm and moderate
depth for an adult.
4. What ventilatory pattern occurs when the compliance of the lungs decreases?
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