Chapter 16: Bedside Assessment of the Patient

Kacmarek: Egan’s Fundamentals of Respiratory Care, 12th Edition

MULTIPLE CHOICE

1. Which of the following can be considered a purpose of the interview the RT performs?
1. To collect diagnostic information
2. To establish a rapport with the patient
3. To identify plans for payment
4. To identify the effect of therapy
a. 1 and 4 only
b. 2 and 3 only
c. 1, 2, and 4 only
d. 2, 3, and 4 only
ANS: C
Interviewing furnishes unique information because it provides the patient’s perspective. It
serves the following three related purposes: (1) to establish a rapport between clinician and
patient, (2) to obtain essential diagnostic information, and (3) to help monitor changes in the
patient’s symptoms and response to therapy.

DIF: Recall OBJ: 1

2. The patient interview conducted by the clinician is done in which space?

a. Social space
b. Personal space
c. Intimate space
d. Critical space
ANS: B
Move to the personal space (2 to 4 ft from the patient) to begin the interview.

DIF: Recall OBJ: 2

3. Which of the following is an example of a leading question?

a. Is your breathing better now?
b. How is your breathing now?
c. When did your breathing change?
d. Where is your pain located?
ANS: A
Asking the patient, “Is your breathing better now?” leads the patient toward a desired response
and may elicit false information.

DIF: Recall OBJ: 3

4. Which of the following are common causes of an increase in the drive to breathe, which
would increase the sensation of dyspnea?
1. Hypoxemia
2. Acidosis
 3. High fever
4. Hypocapnia
a. 1 and 4 only
b. 2 and 3 only
c. 1, 2, and 3 only
d. 2, 3, and 4 only
ANS: D
Increases in the drive to breathe occur with hypoxemia, acidosis, fever, exercise, or anxiety.

DIF: Recall OBJ: 6

5. What term is used to describe difficult breathing in the reclining position?

a. Orthopnea
b. Platypnea
c. Eupnea
d. Apnea
ANS: A
Dyspnea may be present only when the patient assumes the reclining position, in which case it
is referred to as orthopnea.

DIF: Recall OBJ: 7

6. What term is used to describe shortness of breath in the upright position?

a. Orthopnea
b. Platypnea
c. Eupnea
d. Apnea
ANS: B
Shortness of breath in the upright position is known as platypnea.

DIF: Recall OBJ: 7

7. Which of the following factors has minimal or no impact on the effectiveness of the patient’s
cough?
a. Lung recoil
b. Airways resistance
c. Lung volume
d. Pulmonary vascular resistance
ANS: D
The effectiveness of a cough depends on the individual’s ability to take a deep breath, his or
her lung recoil, the strength of his or her expiratory muscles, and the level of airway
resistance.

DIF: Recall OBJ: 9

8. Which of the following conditions is most likely to cause a dry, nonproductive cough?
a. Chronic bronchitis
b. Cystic fibrosis
 c. Pulmonary fibrosis
d. Chronic obstructive pulmonary disease
ANS: C
For example, a dry, nonproductive cough is typical for restrictive lung diseases such as
congestive heart failure or pulmonary fibrosis.

DIF: Recall OBJ: 10

9. What is the technical term for secretions from the tracheobronchial tree that have not been
contaminated by the mouth?
a. Sputum
b. Phlegm
c. Mucus
d. Pus
ANS: B
Technically, mucus from the tracheobronchial tree that has not been contaminated by oral
secretions is called phlegm.

DIF: Recall OBJ: 11

10. What term is used to describe sputum that has pus in it?
a. Fetid
b. Mucoid
c. Purulent
d. Tenacious
ANS: C
Sputum that contains pus cells is said to be purulent, suggesting a bacterial infection.

DIF: Recall OBJ: 11

11. Which of the following terms is used to describe coughing up blood-streaked sputum?
a. Hematemesis
b. Hemoptysis
c. Hemolysis
d. Hemostasis
ANS: B
Coughing up blood or blood-streaked sputum from the lungs is referred to as hemoptysis.

DIF: Recall OBJ: 12

12. Which of the following characteristics are typical for pleuritic chest pain?
1. Located laterally.
2. Sharp and stabbing in nature.
3. Increases with breathing.
4. Radiates to the arm.
a. 3 and 4 only
b. 1 and 3 only
c. 1, 2, and 3 only
 d. 1, 2, and 4 only
ANS: C
Pleuritic chest pain usually is located laterally or posteriorly. It worsens when the patient takes
a deep breath and is described as a sharp, stabbing type of pain.

DIF: Recall OBJ: 13

13. What term is used to describe the chest pain associated with blockage of the coronary arteries?
a. Angina
b. Myocarditis
c. Myalgia
d. Infarction
ANS: A
A common cause of nonpleuritic chest pain is angina, which classically is a pressure sensation
with exertion or stress and results from coronary artery occlusion.

DIF: Recall OBJ: 13

14. What change in the patient’s respiratory breathing pattern is commonly seen with significant
fever?
a. Slower rate
b. More rapid rate
c. More prolonged expiratory time
d. More prolonged inspiratory time
ANS: B
The increased need for oxygen intake and carbon dioxide removal may cause tachypnea.

DIF: Recall OBJ: 14

15. What is the most common cause of pedal edema?

a. Liver failure
b. Kidney failure
c. Heart failure
d. Electrolyte imbalances
ANS: C
Swelling of the lower extremities is known as pedal edema. It most often occurs with heart
failure, which causes an increase in the hydrostatic pressure of the blood vessels in the lower
extremities.

DIF: Recall OBJ: 15

16. Which of the following are critical elements of a patient’s past medical history?
1. Childhood diseases
2. Prior major illnesses or surgery
3. Marital status
4. Drugs and immunizations
a. 1 and 2 only
b. 1 and 3 only
 c. 1, 2, and 3 only
d. 1, 2, and 4 only
ANS: C
The next step is to review the patient’s past medical history, which describes all past major
illnesses, injuries, surgeries, hospitalizations, allergies, and health-related habits.

DIF: Recall OBJ: 16

17. Which of the following are elements of a patient’s social and environmental history?
1. Occupation and employment history
2. Drugs and medications
3. Recent travel
4. Living arrangements
a. 1, 3, and 4 only
b. 1 and 4 only
c. 2 and 3 only
d. 2, 3, and 4 only
ANS: A
Review the family and social/environmental history. This part of the medical history focuses
on potential genetic or occupational links to disease and the patient’s current life situation.
Pulmonary disorders such as asthma, lung cancer, cystic fibrosis, and chronic obstructive
pulmonary disease are believed to have a genetic link in many cases.

DIF: Recall OBJ: 16

18. Which of the following are associated with diaphoresis?

1. Fever
2. Severe stress
3. Acute anxiety
4. Hemoptysis
a. 2 and 3 only
b. 1 and 4 only
c. 1, 2, and 3 only
d. 2, 3, and 4 only
ANS: C
Diaphoresis (sweating) can indicate fever, pain, severe stress, increased metabolism, or acute
anxiety.

DIF: Recall OBJ: 5

19. Which of the following is most commonly associated with tripodding?

a. Severe pulmonary hyperinflation
b. Congestive heart disease
c. Pneumonia
d. Pulmonary fibrosis
ANS: A
 The patient with severe pulmonary hyperinflation tends to sit upright while bracing his or her
elbows on a table. This helps the accessory muscles gain a mechanical advantage for
breathing and is called tripodding.

DIF: Recall OBJ: 34

20. Your patient has an abnormal sensorium. Which of the following is most likely true?
a. The patient knows his or her name.
b. The patient is confused about where he or she is.
c. The patient is aware of the correct day.
d. The patient knows the name of the hospital he or she has been taken to.
ANS: B
This often is called evaluating the sensorium. The alert patient who is well oriented to time,
place, person, and situation is said to be “oriented 4,” and sensorium is considered normal.

DIF: Recall OBJ: 19

21. What structure in the body is responsible for regulating the body temperature?
a. Pituitary gland
b. Thyroid gland
c. Hypothalamus
d. Thymus gland
ANS: C
The hypothalamus plays an important role in regulating heat loss.

DIF: Recall OBJ: 14

22. What is the most common cause of hypothermia?

a. Exposure to cold environment
b. Head injury
c. Stroke
d. Thyroid gland dysfunction
ANS: A
The most common cause of hypothermia is prolonged exposure to cold.

DIF: Recall OBJ: 14

23. Which of the following sites is closest to core body temperature?

a. Axillary
b. Oral
c. Rectal
d. Forehead
ANS: C
Rectal temperatures are closest to actual core body temperature.

DIF: Recall OBJ: 14

24. Which of the following is least likely to cause tachycardia?

 a. Fever
b. Severe pain
c. Hypotension
d. Hypothermia
ANS: D
Common causes of tachycardia are exercise, fear, anxiety, low blood pressure, anemia, fever,
reduced arterial blood oxygen levels, and certain medications.

DIF: Recall OBJ: 14

25. Which of the following is a term used to describe a list of all possible causes of a symptom or
sign?
a. Environmental factors
b. Differential diagnosis
c. Dyspnea
d. Subjective information
ANS: B
Differential diagnosis refers to a situation when many diseases share the similar signs and
symptoms, making their exact cause unclear. Therefore, differential diagnosis is the list of all
possible causes of a symptom or sign.

DIF: Recall OBJ: 4

26. Which of the following is a common cause of pulsus paradoxus?

a. Acute asthma attack
b. Severe pneumonia
c. Congestive heart failure
d. Myocardial infarction
ANS: A
Pulsus paradoxus can be quantified with a blood pressure cuff and is common in patients with
acute obstructive pulmonary disease, especially those suffering from an asthma attack.

DIF: Recall OBJ: 20

27. Which of the following are common causes of tachypnea?

1. Hypoxemia
2. Exercise
3. Narcotic overdose
4. Metabolic acidosis
a. 2, 3, and 4 only
b. 1, 2, and 4 only
c. 2 and 3 only
d. 1 and 4 only
ANS: B
Rapid respiratory rates are associated with exertion, fever, arterial hypoxemia, metabolic
acidosis, anxiety, atelectasis, and pain.

DIF: Recall OBJ: 18

28. What is the normal range for systolic blood pressure in the adult patient?
a. 90 to 140 mm Hg
b. 80 to 100 mm Hg
c. 75 to 100 mm Hg
d. 60 to 100 mm Hg
ANS: A
In general, the normal range for systolic blood pressure in the adult is 90 to 140 mm Hg.

DIF: Recall OBJ: 21

29. What is the normal range for diastolic blood pressure in the adult patient?
a. 40 to 80 mm Hg
b. 60 to 90 mm Hg
c. 80 to 110 mm Hg
d. 60 to 110 mm Hg
ANS: B
Diastolic pressure is the force in the major arteries remaining after relaxation of the ventricles;
it is normally 60 to 90 mm Hg.

DIF: Recall OBJ: 21

30. What is the normal range for pulse pressure?

a. 20 to 35 mm Hg
b. 30 to 60 mm Hg
c. 30 to 40 mm Hg
d. 30 to 60 mm Hg
ANS: C
A normal pulse pressure is 30 to 40 mm Hg.

DIF: Recall OBJ: 21

31. Which of the following is a true statement about the cause of systemic hypertension in adult
patients?
a. The cause is often unknown.
b. The cause is often related to poor diet.
c. The cause is often related to a lack of exercise.
d. The cause is often related to sleep apnea.
ANS: A
Hypertension is a common medical problem in adults, and the cause is often unknown.

DIF: Recall OBJ: 22

32. Which of the following are causes of hypotension?

1. Heart failure
2. Hypovolemia
3. Mild tachycardia
4. Peripheral vasoconstriction
 a. 2 and 4 only
b. 1, 2, and 4 only
c. 3 and 4 only
d. 2, 3, and 4 only
ANS: B
The usual causes are left ventricular failure, low blood volume, and peripheral vasodilation.

DIF: Recall OBJ: 23

33. What artery is most often used to assess arterial blood pressure?
a. Femoral
b. Radial
c. Ulnar
d. Brachial
ANS: D
When the cuff is applied to the upper arm and pressurized to exceed systolic blood pressure,
the brachial artery blood flow stops.

DIF: Recall OBJ: 24

34. Why should the respiratory therapist perform a blood pressure assessment fairly quickly?
a. The procedure is expensive.
b. The procedure cuts off blood flow to the forearm temporarily.
c. The respiratory therapist has other procedures to do.
d. The procedure is billed by the time involved.
ANS: B
The clinician must perform the procedure rapidly, because the pressurized cuff impairs
circulation to the forearm and hand.

DIF: Recall OBJ: 24

35. Which of the following is/are advantages of the digital blood pressure measurement devices?
a. They reduce the risk of human error.
b. They reduce the cost.
c. They have an alarm.
d. They measure blood pressure and stroke volume.
ANS: A
Most hospitals and clinics now use digital blood pressure measuring devices that do not
require clinicians to listen for the Korotkoff sounds. These devices are very accurate and
eliminate variances in recorded blood pressures based on human perception. The clinician
only needs to apply the blood pressure cuff correctly and press the start button. The device
inflates and deflates the cuff automatically and displays the blood pressure and pulse rate on a
digital screen.

DIF: Recall OBJ: 24

36. What is indicated by the presence of central cyanosis?

a. Respiratory failure
 b. Circulatory failure
c. Anemia
d. Hypotension
ANS: A
When respiratory disease reduces arterial oxygen content, cyanosis (a bluish discoloration of
the tissues) may be detected, especially around the lips and in the oral mucosa of the mouth
(central cyanosis).

DIF: Recall OBJ: 25

37. What is the advantage of COPD patients breathing through pursed lips during exhalation?
a. Helps the patient focus on breathing.
b. Promotes more complete emptying of the lungs.
c. Reduces the patient’s anxiety level.
d. Improves arterial pH levels.
ANS: B
Breathing through pursed lips during exhalation creates resistance to flow. The increased
resistance causes development of a slight backpressure in the small airways during exhalation,
which prevents their premature collapse and allows more complete emptying of the lung.

DIF: Recall OBJ: 26

38. Which of the following may cause the trachea to shift to the right?
a. Right-sided tension pneumothorax
b. Right-sided large pleural effusion
c. Right upper lobe atelectasis
d. Left lower lobe pneumonia
ANS: C
The trachea shifts away from areas with increased air, fluid, or tissue (e.g., in tension
pneumothorax or large pleural effusion) and toward atelectasis. In general, abnormalities in
the lung bases do not shift the trachea.

DIF: Application OBJ: 25

39. What is the most common cause of jugular venous distention (JVD)?
a. Right-sided heart failure
b. Arterial hypoxemia
c. Tension pneumothorax
d. Acute systemic hypertension
ANS: A
The most common cause of JVD is the failure of the right side of the heart.

DIF: Recall OBJ: 25

40. Which of the following is the least likely cause of lymphadenopathy in the neck?
a. Lymphoma
b. Pulmonary infection
c. Congestive heart failure
 d. Lung cancer
ANS: C
Lymphadenopathy occurs with a variety of medical disorders including infection, malignancy,
and sarcoidosis. Tender lymph nodes in the neck are suggestive of a nearby infection. The
lymph nodes are not tender when malignancy is the cause.

DIF: Recall OBJ: 25

41. What disease is associated with a barrel chest?

a. Emphysema
b. Heart failure
c. Pneumonia
d. Pleural effusions
ANS: A
This abnormal increase in anteroposterior diameter is called barrel chest and is associated with
emphysema.

DIF: Recall OBJ: 25

42. What term is used to describe an abnormal anteroposterior curvature of the spine?
a. Scoliosis
b. Pectus excavatum
c. Kyphosis
d. Pectus carinatum
ANS: C
Kyphosis is a spinal deformity in which the spine has an abnormal anteroposterior curvature.

DIF: Recall OBJ: 25

43. You observe a patient’s breathing pattern as very irregular and interspersed with long periods
of apnea. Which of the following is the most likely cause of this problem?
a. Central nervous system disorder
b. Congestive heart failure
c. Metabolic acidosis
d. Increased intracranial pressure
ANS: D
Table 16-2 describes some of the common abnormal patterns of breathing and their causes.

DIF: Application OBJ: 28

44. While observing a patient’s breathing, you note that the depth and rate first increase, then
decrease, followed by a period of apnea. Which of the following terms would you use in
charting this observation?
a. Apneustic breathing
b. Cheyne-Stokes breathing
c. Biot’s breathing
d. Paradoxical breathing
ANS: B
 Table 16-2 describes some of the common abnormal patterns of breathing.

DIF: Recall OBJ: 27

45. While observing a patient’s breathing, you note that the depth and rate first increase, then
decrease, followed by a period of apnea. Which of the following are potential causes of this
abnormality?
1. Central nervous system disorder
2. Congestive heart failure
3. Metabolic acidosis
a. 1 and 2 only
b. 2 and 3 only
c. 1 and 3 only
d. 1, 2, and 3
ANS: A
Table 16-2 describes some of the common abnormal patterns of breathing and their causes.

DIF: Recall OBJ: 27

46. What is indicated by retractions?

a. An increase in PaCO2
b. An increase in the work of breathing
c. A decrease in blood flow to the lungs
d. Reduction in lung volumes
ANS: B
Increased work of breathing also can result in retractions.

DIF: Recall OBJ: 25

47. What breathing pattern is associated with severe atelectasis?

a. Rapid and deep
b. Rapid and shallow
c. Slow and shallow
d. Slow and deep
ANS: B
A significant reduction in lung volume, such as that which occurs with atelectasis, usually
results in rapid, shallow breathing.

DIF: Recall OBJ: 29

48. A patient with asthma would tend to exhibit which of the following?
a. Prolonged inhalation
b. Slow and shallow breathing
c. Prolonged exhalation
d. Deep and fast breathing
ANS: C
Obstruction of the intrathoracic airways (as occurs with asthma) results in a prolonged
exhalation time because airways within the chest tend to narrow more on exhalation.
 DIF: Recall OBJ: 27

49. What breathing pattern is associated with diabetic ketoacidosis?

a. Kussmaul breathing
b. Apneustic breathing
c. Biot’s breathing
d. Apnea
ANS: A
Patients with diabetic ketoacidosis often breathe with a deep and rapid pattern, which is called
Kussmaul breathing.

DIF: Recall OBJ: 28

50. What term is used to describe the breathing pattern seen in COPD patients in whom the lower
costal margins of the chest wall draw inward with each inspiration?
a. Hoover’s sign
b. Kussmaul’s sign
c. Abdominal paradox sign
d. Respiratory alternans sign
ANS: A
Contraction of a flat diaphragm tends to draw in the lateral costal margins, instead of
expanding them (Hoover’s sign), and does little to help move air into the thorax.

DIF: Recall OBJ: 29

51. What is indicated by the breathing pattern known as abdominal paradox?

a. Obstructive lung disease
b. Restrictive lung disease
c. Heart failure
d. Diaphragm fatigue
ANS: D
This is recognized by inward movement of the anterior abdominal wall during inspiratory
efforts and is seen best with the patient in the supine position. This sign is called abdominal
paradox.

DIF: Recall OBJ: 27

52. Which of the following would cause an increase in tactile fremitus?

a. Pleural effusion
b. Pneumonia
c. Emphysema
d. Pneumothorax
ANS: B
Any condition that increases the density of the lung, such as the consolidation (or alveolar
filling) that occurs in pneumonia, increases the intensity of fremitus.

DIF: Recall OBJ: 31

53. While palpating the chest of a patient who repeats the words “ninety-nine,” you note an area
of increased tactile fremitus over the left lower lobe. Which of the following could explain
this finding?
1. Pneumothorax
2. Emphysema
3. Pneumonia
4. Pleural effusions
a. 2 only
b. 1 and 4 only
c. 1, 2, and 4
d. 3 only
ANS: D
Tactile fremitus is increased when the lung becomes consolidated as with pneumonia because
sound vibrations travel better through a more solid medium.

DIF: Application OBJ: 31

54. While palpating the thorax of a patient who repeats the words “ninety-nine,” you note a
localized area of decreased tactile fremitus on the lower right side. Which of the following
could explain this finding?
1. Atelectasis on the right
2. Right-sided lower pneumothorax
3. Right-sided lower pleural effusion
4. Obstruction of a bronchus in the right lung
a. 2, 3, and 4 only
b. 1 and 3 only
c. 3 and 4 only
d. 1, 3, and 4 only
ANS: A
Tactile fremitus is reduced most often in patients who are obese or overly muscular. In
addition, when the pleural space lining the lung becomes filled with air (pneumothorax) or
fluid (pleural effusion), fremitus is significantly reduced or absent.

DIF: Application OBJ: 31

55. On palpating the neck region of a patient on a mechanical ventilator, you notice a crackling
sound and sensation. What is the most likely cause of this observation?
a. Subcutaneous emphysema
b. Upper bronchial obstruction
c. Pneumonia of the upper lobes
d. Atelectasis of the upper lobes
ANS: A
Subcutaneous emphysema is caused by air trapped in the subcutaneous tissues and is usually
due to an air leak from the lung.

DIF: Recall OBJ: 25

56. The vibration created by percussion penetrates the lung to approximately what depth?
a. 1 to 2 cm
b. 3 to 5 cm
c. 5 to 7 cm
d. 8 to 10 cm
ANS: C
The vibration created by percussion penetrates the lung to a depth of 5 to 7 cm below the
chest wall.

DIF: Recall OBJ: 25

57. To minimize bony interference with percussion on the posterior chest wall, the practitioner
should have the patient do which of the following?
a. Lean forward at a 45-degree angle.
b. Keep his or her arms at the sides of the body.
c. Raise his or her arms above the shoulders.
d. Place his or her hands on the hips.
ANS: C
Asking patients to raise their arms above their shoulders will help move the scapulae laterally
and minimize their interference with percussion on the posterior chest wall.

DIF: Recall OBJ: 25

58. While percussing a patient’s chest wall, you encounter an area that produces a decreased
resonance to percussion. Which of the following are potential causes of this finding?
1. Pneumothorax
2. Pleural effusion
3. Pneumonia
4. Atelectasis
a. 1 and 3 only
b. 2 and 4 only
c. 2, 3, and 4 only
d. 1, 3, and 4 only
ANS: C
Any abnormality that increases lung tissue density, such as pneumonia, tumor, or atelectasis,
results in a loss of resonance and decreased resonance to percussion over the affected area.
Pleural spaces filled with fluid, such as blood or water, also produce decreased resonance to
percussion.

DIF: Application OBJ: 25

59. While percussing a patient’s chest wall, you detect an abnormal increase in resonance. Which
of the following are possible causes of this finding?
1. Asthma
2. Pneumothorax
3. Emphysema
4. Pneumonia
a. 1, 2, and 3 only
 b. 2 and 4 only
c. 1, 3, and 4 only
d. 1, 2, 3, and 4
ANS: A
Increased resonance can be detected in patients with hyperinflated lungs. Hyperinflation can
result from acute or chronic bronchial obstruction, such as asthma or emphysema.

DIF: Application OBJ: 29

60. Which of the following represent proper chest auscultation technique?

1. The practitioner should begin auscultation at the lung bases.
2. The patient should be instructed to breathe through an open mouth.
3. The patient should be placed in a comfortable upright position.
4. The patient should avoid deeply inhaling because it can mask certain lung sounds.
a. 1 and 4 only
b. 1, 2, and 3 only
c. 3 only
d. 1, 2, and 4 only
ANS: B
When possible, the patient should be sitting upright in a relaxed position. Instruct the patient
to breathe a little more deeply than normal through an open mouth. Inhalation should be
active, with exhalation passive. Place the bell or diaphragm directly against the chest wall
when possible, because clothing may produce distortion. The tubing must not be allowed to
rub against any objects, because this may produce extraneous sounds, which could be
mistaken for adventitious lung sounds.

DIF: Recall OBJ: 30

61. Soft, muffled sounds heard mainly during inspiration over the peripheral lung parenchyma
best describe which of the following breath sounds?
a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal
ANS: A
When auscultating over the lung parenchyma of a healthy individual, soft, muffled sounds are
heard. These normal breath sounds, referred to as vesicular breath sounds, are lower in pitch
and intensity than bronchovesicular breath sounds. Vesicular sounds are heard primarily
during inhalation, with only a minimal exhalation component.

DIF: Recall OBJ: 31

62. Loud, tubular breath sounds with an expiratory component equal to the inspiratory component
best describes which of the following breath sounds?
a. Adventitious
b. Bronchial
c. Vesicular
d. Bronchovesicular
 ANS: B
When the expiratory component of harsh breath sounds equals the inspiratory component,
they are described as bronchial breath sounds.

DIF: Recall OBJ: 31

63. During auscultation of a patient’s chest, you hear abnormal discontinuous “bubbling” sounds
at the lung bases. Which of the following chart entries best describes this finding?
a. “Bronchial sounds heard at lung bases.”
b. “Wheezes heard at lung bases.”
c. “Crackles heard at lung bases.”
d. “Rhonchi heard at lung bases.”
ANS: C
Discontinuous adventitious lung sound types are described as crackles.

DIF: Recall OBJ: 31

64. What term best describes a loud, high-pitched continuous sound heard (often with the unaided
ear) primarily over the larynx or trachea during inhalation in patients with upper airway
obstruction?
a. Stridor
b. Rhonchi
c. Crackles
d. Wheeze
ANS: A
Another continuous type of adventitious lung sounds heard in certain situations, primarily
over the larynx and trachea during inhalation, is stridor. Stridor is a loud, high-pitched sound,
which sometimes can be heard without a stethoscope. Most common in infants and small
children, stridor is a sign of obstruction in the trachea or larynx. Stridor is most often heard
during inspiration.

DIF: Recall OBJ: 31

65. What does the presence of stridor indicate?

a. Lower airway obstruction
b. Increased secretions in the large airways
c. Upper airway obstruction
d. Bronchial spasm
ANS: C
Another continuous type of adventitious lung sounds heard in certain situations, primarily
over the larynx and trachea during inhalation, is stridor. Stridor is a loud, high-pitched sound,
which sometimes can be heard without a stethoscope. Most common in infants and small
children, stridor is a sign of obstruction in the trachea or larynx. Stridor is most often heard
during inspiration.

DIF: Recall OBJ: 31

66. Which of the following can cause decreased breath sounds?

1. Air or fluid in the pleural space
 2. Hyperinflation of lung tissue
3. Mucus plugging of the airways
4. Shallow or slow breathing
a. 2 and 4 only
b. 1, 2, and 3 only
c. 1, 2, 3, and 4
d. 2, 3, and 4 only
ANS: C
Airways plugged with mucus and hyperinflated lung tissue attenuate sounds through the
lungs. Air or fluid in the pleural space and obesity also reduce sound transmission through the
chest wall.

DIF: Application OBJ: 31

67. Which of the following changes in the characteristics of wheezing indicate improvement in
airway obstruction following bronchodilator therapy?
a. Lower pitch, shorter duration
b. Higher pitch, shorter duration
c. Lower pitch, longer duration
d. Higher pitch, longer duration
ANS: A
It is useful to monitor the pitch and duration of wheezing. Improved expiratory flow is
associated with a decrease in the pitch and length of the wheezing. For example, if
high-pitched wheezing is present during the entire expiratory time before treatment but
becomes lower pitched and occurs only late in exhalation after therapy, the pitch and duration
of the wheeze have diminished. This suggests that the degree of airway obstruction has
decreased.

DIF: Recall OBJ: 31

68. During auscultation of a patient’s chest, you hear coarse crackles throughout both inspiration
and expiration. These sounds clear when the patient coughs. Which of the following is the
most likely cause of these adventitious sounds?
a. Opening of closed smaller airways or alveoli
b. Opening of collapsed large, proximal airways
c. Variable obstruction to flow in the upper airway
d. Movement of excessive secretions in the airways
ANS: D
Excessive mucus in the airways causes crackles that are usually coarse (low pitched) and
heard during inspiration and expiration. These crackles often clear when the patient coughs or
when the upper airway is suctioned.

DIF: Recall OBJ: 31

69. Inspiratory crackles in patients without excess secretions are most commonly associated with
which of the following?
a. Reduced chest-wall sound transmission
b. Airways popping open during inspiration
 c. Complete obstruction of the upper airway
d. Mucosal edema or inflammation
ANS: B
Crackles also may be heard in patients without excess secretions. These crackles occur when
collapsed airways pop open during inspiration. Airway collapse or closure can occur in
peripheral bronchioles or in larger, more proximal bronchi.

DIF: Recall OBJ: 31

70. Which of the following are true of early inspiratory crackles?

1. They most often occur in COPD patients.
2. They generally indicate severe airway obstruction.
3. They are affected by coughing or positional change.
4. They are usually scant (few in number).
a. 2 and 4 only
b. 1, 2, and 3 only
c. 3 and 4 only
d. 1, 2, and 4 only
ANS: D
Early inspiratory crackles are usually scanty but may be loud or faint. They often are
transmitted to the mouth and are not silenced by a cough or a change in position. They most
often occur in patients with COPD, such as chronic bronchitis, emphysema, or asthma, and
usually indicate a severe airway obstruction.

DIF: Recall OBJ: 31

71. In which of the following conditions would late-inspiratory crackles be most likely to occur?
1. Emphysema
2. Pulmonary fibrosis
3. Pneumonia
4. Pulmonary edema
a. 2, 3, and 4 only
b. 1, 3, and 4 only
c. 3 and 4 only
d. 1 and 2 only
ANS: A
Late-inspiratory crackles are most common in patients with respiratory disorders that reduce
lung volume. These disorders include atelectasis, pneumonia, pulmonary edema, and
pulmonary fibrosis.

DIF: Recall OBJ: 31

72. A creaking or grating sound that increases in intensity with deep breathing and is similar to
coarse crackles, but is not affected by coughing, best describes which of the following?
a. Rhonchi
b. Friction rub
c. Rales
d. Wheezing
 ANS: B
A pleural friction rub is a creaking or grating sound that occurs when the pleural surfaces
become inflamed and the roughened edges rub together during breathing, as in pleurisy. It
may be heard only during inhalation but often is identified during both phases of breathing.

DIF: Recall OBJ: 31

73. An increase in intensity and clarity of vocal resonance because of enhanced transmission of
sound is referred to as which of the following?
a. Bronchophony
b. Vesicularity
c. Pectoriloquy
d. Egophony
ANS: A
An increase in the intensity and clarity of vocal resonance produced by enhanced transmission
of vocal vibrations is called bronchophony.

DIF: Recall OBJ: 31

74. What is the area of the anterior chest wall overlying the heart called?
a. Epigastrium
b. Precordium
c. Pericardium
d. Axillary
ANS: B
The techniques for physical examination of the chest wall overlying the heart (precordium)
include inspection, palpation, and auscultation.

DIF: Recall OBJ: 32

75. Where is the normal apical impulse (point of maximal impulse [PMI]) usually identified?
a. Third right intercostal space, left sternal border
b. Fifth left intercostal space, midclavicular line
c. Third left intercostal space, anterior axillary line
d. Fifth right intercostal space, midclavicular line
ANS: B
In healthy individuals who are not obese or overly muscular, the PMI can be felt and
visualized near the left midclavicular line in the fifth intercostal space.

DIF: Recall OBJ: 32

76. Right ventricular hypertrophy often produces a systolic thrust that can be felt and seen near
which of the following?
a. Lower left border of the sternum
b. Upper right border of the sternum
c. Left fifth intercostal space, midclavicular line
d. Lower right border of the sternum
ANS: A
 Right ventricular hypertrophy, a common manifestation of chronic lung disease, often
produces a systolic thrust called a heave that is felt and possibly visualized near the lower left
sternal border.

DIF: Recall OBJ: 32

77. In which of the following patient categories would the intensity of the point of maximal
impulse (PMI) be most difficult to palpate?
a. Chronic pulmonary hyperinflation
b. Mitral (bicuspid) stenosis
c. Left ventricular hypertrophy
d. Right ventricular hypertrophy
ANS: A
In patients with chronic pulmonary hyperinflation (emphysema), the PMI may be difficult to
locate. Because of the increase in anteroposterior diameter and the changes in lung tissue,
systolic vibrations are not well transmitted to the chest wall.

DIF: Recall OBJ: 33

78. Which of the following conditions would tend to shift the point of maximal impulse (PMI)
farther to the left?
1. Pulmonary emphysema
2. Collapse of the left lower lobe
3. Collapse of the right lower lobe
4. Right-sided tension pneumothorax
a. 1, 2, and 3 only
b. 2 and 4 only
c. 2, 3, and 4 only
d. 1, 3, and 4 only
ANS: B
The PMI may shift either left or right, following deviations in the position of the lower
mediastinum, which may be caused by pneumothorax or lobar collapse. Typically, the PMI
shifts toward lobar collapse but away from a tension pneumothorax. The PMI in patients with
emphysema and low flat diaphragms may be shifted centrally to the epigastric area.

DIF: Recall OBJ: 33

79. Normal heart sounds are created primarily by which of the following?
a. Opening of the heart valves
b. Rush of blood during systole
c. Closing of the heart valves
d. Electrical conduction in the heart
ANS: C
Normal heart sounds are created by closure of the heart valves.

DIF: Recall OBJ: 33

80. The first heart sound (S1) is created primarily by which of the following?
a. Closure of the semilunar valves
 b. Opening of the semilunar valves
c. Opening of the atrioventricular valves
d. Closure of the atrioventricular valves
ANS: D
The first heart sound (S1) is produced by closure of the mitral and tricuspid (atrioventricular
[AV]) valves during contraction of the ventricles.

DIF: Recall OBJ: 33

81. The second heart sound (S2) is created primarily by which of the following?
a. Closure of the semilunar valves
b. Opening of the atrioventricular valves
c. Closure of the atrioventricular valves
d. Opening of the semilunar valves
ANS: A
When systole ends, the ventricles relax, and the pulmonic and aortic (semilunar) valves close,
creating the second heart sound (S2).

DIF: Recall OBJ: 33

82. Splitting of the second heart sound (S2) is normally most pronounced during which of the
following?
a. Exhalation
b. Breath holding
c. Inhalation
d. Forced exhalation
ANS: C
The normal splitting of S2 is increased during inhalation because of the decrease in
intrathoracic pressure, which improves venous return to the right side of the heart and further
delays pulmonic valve closure.

DIF: Recall OBJ: 33

83. In which of the following conditions might the intensity of the heart sounds be reduced?
1. Heart failure
2. Severe cachexia
3. Pneumothorax
4. Pleural effusion
a. 1, 3, and 4 only
b. 2 and 4 only
c. 2, 3, and 4 only
d. 1, 2, and 3 only
ANS: A
Pulmonary hyperinflation, pleural effusion, pneumothorax, and obesity make identification of
both S1 and S2 difficult. The intensity of S1 and S2 also decreases when the force of ventricular
contraction is poor, as in heart failure, or when valvular abnormalities exist.

DIF: Recall OBJ: 33

84. In auscultating the heart sounds of a patient with chronic hypoxemia, you notice a marked
increase in the intensity of the second heart sound (S2) and no splitting during inhalation. This
finding is most consistent with which of the following?
a. Mitral insufficiency
b. Left ventricular hypertrophy
c. Tricuspid valve stenosis
d. Pulmonary hypertension
ANS: D
Pulmonary hypertension produces an increased intensity of S2. This sound is referred to as a
loud P2 and is a result of more forceful closure of the pulmonic valve.

DIF: Recall OBJ: 33

85. In auscultating the precordium of a patient, you hear a high-pitched “whooshing” noise
occurring simultaneously with S1. This finding is most consistent with which of the
following?
a. Incompetent mitral valve
b. Stenotic tricuspid valve
c. Incompetent pulmonic valve
d. Stenotic mitral valve
ANS: A
Systolic murmurs are produced by an incompetent atrioventricular (AV) valve or a stenotic
semilunar valve. An incompetent AV valve allows a backflow of blood into the atrium,
usually producing a high-pitched “whooshing” noise simultaneously with S1.

DIF: Recall OBJ: 33

86. Diastolic murmurs are generally associated with which of the following?
1. Stenotic semilunar valve
2. Incompetent atrioventricular (AV) valve
3. Incompetent semilunar valve
4. Stenotic atrioventricular valve
a. 1, 2, and 3 only
b. 2 and 4 only
c. 3 and 4 only
d. 1, 2, 3, and 4
ANS: C
Diastolic murmurs are created by an incompetent semilunar valve or a stenotic AV valve.

DIF: Recall OBJ: 33

87. Which of the following are potential causes of cardiac murmurs?

1. Backflow of blood through an incompetent valve
2. Forward flow through a stenotic valve
3. Rapid flow through a normal valve
a. 2 and 3 only
b. 1 and 2 only
 c. 1, 2, and 3
d. 1 and 3 only
ANS: C
Murmurs are created by the following: (1) a backflow of blood through an incompetent valve,
(2) a forward flow of blood through a stenotic valve, and (3) a rapid flow of blood through a
normal valve.

DIF: Recall OBJ: 33

88. Which of the following pulmonary disorders is most likely to result in hepatomegaly?
a. Pulmonary atelectasis
b. Acute viral infections
c. Cor pulmonale
d. Acute asthma
ANS: C
An enlarged liver is called hepatomegaly and may be caused by right-sided heart failure from
chronic hypoxemia (cor pulmonale), although many other causes exist.

DIF: Recall OBJ: 34

89. Which of the following abnormalities should the practitioner be on the lookout for during
inspection of the extremities?
1. Digital clubbing
2. Peripheral cyanosis
3. Ascites
4. Impaired capillary refill
a. 1 and 2 only
b. 1, 2, and 4 only
c. 3 and 4 only
d. 2 only
ANS: B
Respiratory disease may cause several abnormalities of the extremities, including digital
clubbing, cyanosis, and pedal edema.

DIF: Recall OBJ: 35

90. In which of the following disorders is digital clubbing a common physical sign?
1. Congenital heart disease
2. Lung cancer
3. Chronic obstructive pulmonary disease
4. Pancreatic cancer
a. 1 and 3 only
b. 2 and 4 only
c. 2, 3, and 4 only
d. 1, 2, and 3 only
ANS: D
 Many causes of clubbing exist, including infiltrative or interstitial lung disease,
bronchiectasis, various cancers (including lung cancer), congenital heart problems that cause
cyanosis, chronic liver disease, and inflammatory bowel disease.

DIF: Recall OBJ: 35

91. Which of the following is true of peripheral cyanosis?

a. Reliable indicator of tissue hypoxia.
b. Develops early in patients with anemia.
c. Develops late in patients with polycythemia.
d. Sign of inadequate tissue perfusion.
ANS: D
Cyanosis of the digits is referred to as peripheral cyanosis and is mainly the result of poor
blood flow, especially in the extremities.

DIF: Recall OBJ: 35

92. In patients with chronic respiratory disease, what does pedal edema indicate?
a. Right ventricular failure
b. Impaired pulmonary diffusion
c. Systemic hypertension
d. Left ventricular hypertrophy
ANS: A
Pedal edema most often results from heart failure, which causes an increase in the hydrostatic
pressure of the venous system and leaking of fluid from the vessels into the surrounding
tissues.

DIF: Recall OBJ: 35

93. During examination of a patient’s extremities, you press firmly for a brief period on a
fingernail. You observe that it takes approximately 5 sec for the color to return to the nail bed.
This finding is most consistent with which of the following?
a. Reduction in cardiac output or poor peripheral perfusion
b. Presence of a disorder causing chronic hypoxemia
c. Reduction in venous return to the right side of the heart
d. Presence of a disorder causing systemic hypertension
ANS: A
When cardiac output is reduced and digital perfusion is poor, capillary refill is slow, taking
several seconds to complete. In healthy individuals with good cardiac output and digital
perfusion, capillary refill time is less than 3 sec.

DIF: Recall OBJ: 35

94. In palpating a patient’s feet and hands, you note extreme coolness to the touch. This finding is
most consistent with which of the following?
a. Presence of a disorder causing chronic hypoxemia
b. Reduction in venous return to the right side of the heart
c. Peripheral vasoconstriction due to inadequate perfusion
d. Presence of a disorder causing systemic hypertension
 ANS: C
When perfusion is poor (as in heart failure or shock), the compensatory vasoconstriction in the
extremities helps shunt blood to the vital organs. This reduction in peripheral perfusion causes
the extremities to become cool to the touch. The extent to which the coolness to touch extends
toward the body is an indication of the degree of circulatory failure.

DIF: Recall OBJ: 35

95. An RT is examining a patient suspected to have a left-sided tension pneumothorax. During

inspection and palpation, the RT notices the patient’s trachea has shifted to the left. Is the
patient’s diagnosis correct?
a. Yes, the patient may have left-sided tension pneumothorax.
b. No, the patient may have left upper lobe atelectasis.
c. No, the patient may have right lower lobe pneumonia.
d. No, patient may have left-sided large pleural effusion.
ANS: B
The trachea shifts away from areas with increased air, fluid, or tissue (e.g., in tension
pneumothorax or large pleural effusion) and toward atelectasis. In general, abnormalities in
the lung bases do not shift the trachea.

DIF: Analysis OBJ: 25

96. An emergency room patient is lying on his bed with his head elevated at a 45-degree angle.
An RT, who is coming to examine the patient, notices that the patient’s jugular vein extends
approximately 7 cm above his sternal angle. What can the RT assume about this patient’s
condition?
a. Cor pulmonale
b. Pneumonia
c. Kussmaul’s sign
d. Pneumothorax
ANS: A
When lying in a supine position, a healthy individual has neck veins that are full. When the
head of the bed is elevated gradually to a 45-degree angle, the level of the blood column
descends to a point no more than a few centimeters above the clavicle. With elevated venous
pressure, the neck veins may be distended as high as the angle of the jaw, even when the
patient is sitting upright. Jugular venous distention (JVD) is present when the jugular vein is
enlarged and it can be seen more than 3 to 4 cm above the sternal angle. The most common
cause of JVD is heart failure (cor pulmonale). Heart failure frequently occurs with advanced
COPD because of hypoxemia. This causes chronic pulmonary vasoconstriction and
hypertension which leads to right heart failure from the excessive workload. Other conditions
associated with JVD include left heart failure, cardiac tamponade, tension pneumothoraces,
and mediastinal tumors.

DIF: Analysis OBJ: 25

97. A clinician unsuccessfully tried to take the pulse of a patient who is suffering from an asthma
attack in the ER. The patient’s breath sounds are diminished to absent bilaterally with a BP of
110 mm Hg systolic and 90 mm Hg diastolic. What can be concluded about this patient’s
condition?
1. Abdominal paradox is present.
2. Lung hyperinflation is present.
3. Pulsus paradoxus is present.
4. Pulse pressure is greater than 30 mm Hg.
a. 2 and 3 only
b. 1 and 2 only
c. 2 only
d. 1, 3, and 4 only
ANS: A
When the pulse pressure is less than 30 mm Hg during spontaneous inhalation, the peripheral
pulse is difficult to detect, which is called pulsus paradoxus, or paradoxical pulse. Pulsus
paradoxus is the consequence of lung hyperinflation experienced during a severe asthma
attack or status asthmaticus.

DIF: Analysis OBJ: 21

98. A 55-year-old patient has been smoking a pack and a half of cigarettes (30 cigarettes) per day
for 30 years. What is the patient’s smoking history?
a. 30 pack-years
b. 35 pack-years
c. 40 pack-years
d. 45 pack-years
ANS: D
If a patient describes his or her smoking in terms of the number of cigarettes, or fractions of a
pack, the calculation is as follows: there are 20 cigarettes per pack. If a patient states he or she
has smoked a pack and a half of cigarettes per day for 30 years, then the smoking history is
calculated as follows: 30 cigarettes/20 cigarettes-per-pack = 1.5 packs × 30 years = 45
pack-year smoking history.

DIF: Application OBJ: 17

99. A 23-year-old patient enters the emergency room complaining of dyspnea. The RT places the
patient on oxygen as per hospital protocol and begins to interview the patient about her
symptoms. She states that she is having difficulty taking a breath with chest tightness. Patient
has a respiratory rate of 28 breaths/min with a loose productive cough. During auscultation,
the RT hears bilateral wheezing in the lungs. What is the most likely cause of the patient’s
symptoms?
a. Asthma
b. Bronchitis
c. Congestive heart failure
d. Emphysema
ANS: A
 A patient with asthma would suffer from dyspnea caused by the airway obstruction. Usually a
patient with asthma will complain of chest tightness and difficulty to take a breath. Bilateral
wheezing and a loose, productive cough are also signs of an asthma attack.

DIF: Analysis OBJ: 5

100. What term is used to describe the absence of breathing?

a. Orthopnea
b. Platypnea
c. Eupnea
d. Apnea
ANS: D
Apnea is the term used to describe no breathing and is typically caused by cardiac arrest,
narcotic overdose, and severe brain trauma.

DIF: Recall OBJ: 7