Practice Question 1

Increased tactile fremitus is noted in the patient’s right lower lobe. Which of the following conditions would explain this?

1. Pneumothorax
2. Pneumonia
3. Pleural effusion
4. COPD

Answer

1. Incorrect. Pneumothorax is associated with decreased fremitus due to excessive air in the pleural space.
2. Correct. Consolidations such as pneumonia transmit vibrations very well.
3. Incorrect. Pleural effusions lack an attached or conducting airway to transmitvibrations.
4. Incorrect. COPD is associated with decreased fremitus due to air trapping.

Practice Question 2

Palpation of the patient’s trachea reveals a tracheal shift to the right side. Which of the following would most likely cause this finding?

1. Right side atelectasis
2. Right side pneumothorax
3. Right side pleural effusion
4. Left side pneumonia

Answer

1. Correct. Lung problems inside the lung pull the trachea toward them.
2. Incorrect. Lung problems outside the lung push the trachea away.
3. Incorrect. Lung problems outside the lung push the trachea away.
4. Incorrect. Lung problems inside the lung pull the trachea toward them

Practice Question 3

A patient with multiple right sided rib fractures would present with which the following findings?

1. Dull percussion on right side
2. See-saw chest movement
3. Symmetrical chest expansion
4. Flail chest

Answer

1. Incorrect. Percussion is not assessed on a patient with broken ribs. In addition, percussion may or may not be affected depending on if the lung is affected or there is excessive bleeding.
2. Incorrect. See-saw chest movement is a sign of diaphragm fatigue rather than chest trauma.
3. Incorrect. Chest expansion would be asymmetrical in a patient with broken ribs.
4. Correct. Flail chest is associated with severe chest wall trauma.

Practice Question 4

Auscultation of a patient’s lungs reveals coarse bilateral crackles. This is most likely due to?

1. Secretions
2. Pulmonary edema
3. Pulmonary fibrosis
4. Atelectasis

Answer

1. Correct. Coarse crackles are associated with secretions.
2. Incorrect. Pulmonary edema is associated with fine crackles.
3. Incorrect. Pulmonary fibrosis is associated with fine crackles.
4. Incorrect. Atelectasis is associated with fine crackles.

Practice Question 5

Auscultation of a 3-year-old child’s lungs reveals unilateral wheezing. This patient most likely has?

1. Asthma
2. Secretions in the airway
3. Foreign body airway obstruction
4. Pneumonia

Answer

1. Incorrect. Asthma would produce bilateral wheezing.
2. Incorrect. Secretions in the airways produce coarse crackles.
3. Correct. A child with unilateral wheezing is highly suspicious for foreign bodyairway obstruction.
4. Incorrect. Pneumonia would produce bronchial breath sounds.

Practice Question 6

Increased accessory muscle use is most often due to?

1. Hyperventilation
2. Increased airway resistance
3. Increased lung compliance
4. Poor cardiac output

Answer

1. Incorrect. Patients can hyperventilate without increasing their accessory muscles use.
2. Correct. Increased airway resistance is the most common cause of increased accessory muscle use.
3. Incorrect. Increased lung compliance does not increase accessory muscle use. Decreased lung compliance may increase accessory muscle use.
4. Incorrect. Cardiac output does not affect accessory muscle use.

Practice Question 7

Auscultation and percussion of a hemodynamically unstable patient’s left lung reveals distant breath sounds and hyperresonance. The respiratory therapist suspects a pneumothorax. What should the therapist recommend NEXT?

1. Obtain an ABG
2. Order a chest X-ray
3. Needle decompression
4. Chest tube insertion

Answer

1. Incorrect. An arterial blood gas cannot confirm or rule out a pneumothorax.
2. Incorrect. A chest X-ray could help confirm the presence of a pneumothorax, however, this patient needs an immediate intervention because they areunstable. A chest X-ray takes too long to obtain and would delay care of thisunstable patient.
3. Correct. This patient is unstable and needs an immediate intervention.Needle decompression is the quickest and most appropriate intervention.
4. Incorrect. Chest tube insertion will be needed, however, this takes too longand delays care to an unstable patient needing an immediate intervention.

Practice Question 8

Following endotracheal intubation, chest assessment reveals breath sounds on the left side are distant and resonant to percussion. This is most likely due to?

1. Right mainstem intubation
2. Left side pneumothorax
3. Large pleural effusion
4. Esophageal intubation

Answer

1. Correct. Distant breath sounds on the left side following an intubation procedure is consistent with right mainstem intubation.
2. Incorrect. Pneumothorax would be hyperresonant to percussion.
3. Incorrect. Pleural effusions would be dull to percussion.
4. Incorrect. There are no signs of esophageal intubation.

Practice Question 9

While auscultating voice sounds the therapist hears the soft A sound, or ahhhh, when the patient says the letter “E”. This change in sound is associated with which of the following conditions?

A. Pneumothorax
B. Pneumonia
C. Pulmonary Edema D. COPD

Answer

1. Incorrect. Increased air does not alter voice sounds as they pass through the lungs.
2. Correct. Pneumonia is a consolidation that alters sounds as it passes through.
3. Incorrect. Pulmonary edema is not a consolidation and does not alter soundas it passes through.
4. Incorrect. COPD is associated with air trapping. Air does not alter voicesounds as they pass through the lungs.

Practice Question 10

A patient receiving mechanical ventilation has distant breath sounds on the left side with a tracheal shift to the right. The therapist should suspect?

1. Right mainstem intubation
2. Left side pneumothorax
3. Left upper lobe pneumonia
4. Pulmonary embolus

Answer

1. Incorrect. A right mainstem intubation would not shift the trachea.
2. Correct. Pneumothorax causes the trachea to shift away from it.
3. Incorrect. Unlike a pneumothorax, pneumonia occurs inside the lungs andtherefore the trachea is pulled towards the pneumonia.
4. Incorrect. Pulmonary embolus does not cause a tracheal shift.