Answers and Explanations

Review Questions

1. D

   The correct answer is (D). The order would be oropharynx, cricoid cartilage, trachea, bronchi, and bronchioles.

2. A

   The correct answer is (A). The lower airway is defined as all structures inferior to the larynx. Therefore, the cricoid cartilage, trachea, bronchi, and bronchioles are all considered part of the lower airway. The oropharynx is the posterior portion of the mouth, is superior to the larynx, and therefore the only structure listed that is part of the upper airway.

3. A

   The correct answer is (A). In a person with COPD, atelectasis and the retention of CO₂ result in an increase in the residual volume in the lungs, which is the amount of air left in the lungs after a forceful exhalation. All the other volumes will remain the same or decrease as the residual volume takes up an increasing amount of the total available lung volume.

4. C

   The correct answer is (C). An increase in CO₂ concentration in the blood is more likely to make a person breathe faster. When pH increases, the solution becomes more basic and the concentration of hydrogen ion decreases. Remember the equation:
   

   

   According to this equation, if [H⁺] decreases, the reaction will proceed to the left to create more. This means that the patient will breathe less frequently to retain some CO₂. An increase in acidity—and, therefore, a decrease in pH—is 1 of the primary stimuli prompting a person to take a breath. This makes (A) and (B) incorrect. Increased FiO₂ of the atmosphere means that a person is getting more O₂ with each breath and is more likely to cause his or her breathing to slow down, if there is any change at all, making (D) incorrect.

5. B

   The correct answer is (B). External respiration is the ability to load O₂ into the bloodstream at the alveolar level. This is most likely causing her low O₂ saturation and dizziness. In this case, the patient is ventilating well, as indicated by the clear and equal lung sounds, making (A) incorrect. Perfusion (D) and internal respiration (C) have to do with the delivery of blood to the tissues and the offloading of O₂ to those tissues, respectively. Problems with each of these is ruled out because her skin color and temperature are unremarkable, and she is not showing signs of hypoperfusion (shock).

6. C

   The correct answer is (C). This patient is most likely experiencing a new PE. Because of her lengthy bed rest from her total knee replacement and resulting infection, it is possible for a clot to develop in the deep veins of the leg (DVT). If a piece of this clot breaks free, it could travel to and become lodged in the lungs. This condition is called a PE. Pulmonary edema (A) would have adventitious breath sounds. Pulmonary stenosis (B) is a narrowing of the pulmonary artery and is not typically a sudden onset. There is no indication of chest trauma that would suggest a pulmonary contusion (D).

7. D

   The correct answer is (D). This patient is the most appropriate patient to receive a nasopharyngeal airway because he may still have a gag reflex, ruling out the use of oropharyngeal airway, and has not sustained any trauma to his head or face but may have difficulty maintaining his own airway. (A) should receive an oropharyngeal airway or be intubated because she is apneic. The patient in (B) may have sustained facial and head trauma, increasing the likelihood that the basal skull also is fractured; here is it best to avoid. The patient in (C) should not receive the nasopharyngeal airway because he is awake at this point, although he may become a candidate later.

8. A

   The correct answer is (A). Whenever a previously successfully intubated patient has a decline in pulse oximetry, EtCO₂, or both, immediately check the DOPE mnemonic: displacement, obstruction, pneumothorax, and equipment. Of the choices given, checking to see if the tube is still in the trachea is the best option. (B) and (C) are checked only after correct placement is confirmed. Reintubation (D) should be done only as a last resort.

9. B

   The correct answer is (B). The presented symptoms likely indicate a left-sided pneumothorax. Once other noninvasive problems have been ruled out, needle thoracostomy is the best option. This patient needs only a left thoracostomy, making (A) and (C) incorrect. (D) would be most appropriate if the lung sounds and chest rise were diminished on the right side; a right main-stem intubation is much more likely than a left main-stem intubation.

10. B

    The correct answer is (B). During a pneumothorax, breath sounds will be diminished on the side of the collapsing lung, and the trachea deviates to the unaffected side. Tracheal deviation is a late sign and indicates a significant buildup of pressure. JVD will become more pronounced as venous return to the heart becomes inhibited.

11. C

    The correct answer is (C).  The best option here would be to initiate CPAP, so the answer is (C). Answer choices (A), (B) and (D) are all reasonable options and should be attempted after CPAP is initiated.

12. C

    The correct answer is (C). This is a classic presentation of epiglottitis with tripod positioning and drooling. Streptococcus pyogenes also is 1 of the more common causes of epiglottitis and strep throat. Anaphylaxis is a possibility if the patient is still on penicillin; however, the patient should be able to swallow. Croup (B) is almost always accompanied with the “barking seal” cough. Laryngitis (D) is possible but does not usually prevent a person from swallowing.