E-Medicine and Patient Assessment in Respiratory Care

Chapter 07 - E-Medicine in Respiratory Care Kacmarek et al.: Egan’s Fundamentals of Respiratory Care, 11th Edition MULTIPLE CHOICE 9. Computers are often used to interpret which of the following tests in respiratory care patients? a. Chest radiograph b. Complete blood count c. Pulmonary function testing d. EEG testing ANS: C 10. In what area are computers used to apply quality assurance measures in respiratory care departments? a. Arterial blood gas analyzers b. O 2 delivery systems c. Interpreting ECGs d. Equipment cleaning and sterilization ANS: A 11. Which of the following is considered an emerging application of information technology that may improve national health care issues in the future? a. Clinical simulation for training b. A nationally available electronic health record c. Medical ID bracelets d. The national database for organ donors ANS: B Chapter 16 - Bedside Assessment of the Patient Kacmarek et al.: Egan’s Fundamentals of Respiratory Care, 11th Edition MULTIPLE CHOICE 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 4 only

c. 1, 2, and 3 only d. 2, 3, and 4 only ANS: D 5. What term is used to describe difficult breathing in the reclining position? a. Orthopnea b. Platypnea c. Eupnea d. Apnea ANS: A 6. What term is used to describe shortness of breath in the upright position? a. Orthopnea b. Platypnea c. Eupnea d. Apnea ANS: B 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 10. What term is used to describe sputum that has pus in it? a. Fetid b. Mucoid c. Purulent d. Tenacious ANS: C 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 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 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. 1, 2, and 3 only d. 1, 2, 3, and 4 ANS: A 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 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 24. Which of the following is least likely to cause tachycardia? a. Fever b. Severe pain c. Hypotension d. Hypothermia ANS: D 27. Which of the following are common causes of tachypnea? 1. Hypoxemia 2. Exercise

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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 49. What breathing pattern is associated with diabetic ketoacidosis? a. Kussmaul breathing b. Apneustic breathing c. Biot’s breathing d. Apnea ANS: A 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 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 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

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 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 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 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 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

Chapter 17 - Interpreting Clinical and Laboratory Data Kacmarek et al.: Egan’s Fundamentals of Respiratory Care, 11th Edition MULTIPLE CHOICE 1. Which of the following are formed elements in the blood? 1. Leukocytes 2. Erythrocytes 3. Thrombocytes 4. Electrolytes a. 1 and 2 only b. 1, 2, and 3 only c. 2, 3, and 4 only d. 1, 2, and 4 only ANS: B 2. What term is used to describe a white blood cell (WBC) count that is above normal values? a. Leukocytosis b. Leukopenia c. Neutropenia d. Polycythemia ANS: A 3. What term is used to describe a white blood cell (WBC) count that is below normal values? a. Anemia b. Thrombocytopenia c. Leukopenia d. Hypoleukemia ANS: C 5. What type of white blood cell increases in response to allergic reactions? a. Neutrophils b. Eosinophils c. Lymphocytes d. Monocytes ANS: B 6. What type of white blood cell increases in response to viral infections? a. Neutrophils b. Eosinophils c. Lymphocytes d. Monocytes ANS: C 7. What is the name used for immature neutrophils? a. Segs

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b. Bands c. Polys d. Neutros ANS: B 8. What term is used to describe a result significantly outside the reference range that may represent a pathophysiologic condition? a. Reference range b. Biological reference intervals c. Expected value d. Critical test value ANS: D 9. What term is used to describe a red blood cell (RBC) count that is below normal values? a. Leukocytosis b. Leukopenia c. Anemia d. Polycythemia ANS: C 10. What term is used to describe a red blood cell (RBC) count that is above normal values? a. Leukocytosis b. Leukopenia c. Anemia d. Polycythemia ANS: D 11. What abnormality in the complete blood count is often seen in a patient with significant hypoxemia caused by chronic lung disease? a. Leukocytosis b. Anemia c. Polycythemia d. Leukopenia ANS: C 13. What test is useful for evaluating the blood-clotting ability of your patient? a. Red blood cell count b. Platelet count c. Neutrophil count d. Hematocrit ANS: B 14. What term is used to describe a platelet count below normal? a. Anemia b. Leukopenia c. Thrombocytopenia d. Thrombocytosis

ANS: C 25. A patient receiving heparin has a prothrombin time (PT) of 19 sec and an International Standardized Ratio (INR) of approximately 5.0, what does this indicate? a. High likelihood of excessive bleeding. b. Patient’s results are normal. c. High likelihood of increased clotting. d. Possible embolism. ANS: A 29. Which of the following Gram stain results suggests the most legitimate sputum sample in a patient with pneumonia? a. Many epithelial cells and many pus cells b. Few pus cells and many epithelial cells c. Few pus cells and few epithelial cells d. Few epithelial cells and many pus cells ANS: D 30. What should be done in response to a sputum sample that has many epithelial cells in it? a. Repeat Gram stain. b. Sputum culture. c. Sputum sensitivity. d. Obtain new sputum sample. ANS: D 37. What is the name used for mature neutrophils? a. Segs b. Bands c. Polys d. Neutros ANS: A Chapter 23 - Nutrition Assessment Kacmarek et al.: Egan’s Fundamentals of Respiratory Care, 11th Edition MULTIPLE CHOICE 1. What is the primary purpose of nutrition assessment? a. To identify how much weight the patient needs to lose b. To identify the patient’s ideal body weight c. To develop a nutrition care plan d. To identify the proper caloric intake for the patient ANS: C

2. Which of the following is not considered part of the anthropometric assessment? a. Body mass index b. Activity level c. History of weight loss d. Triceps skin fold ANS: B 3. If your patient is 2 m in height and weighs 80 kg, what is his body mass index (BMI)? a. 40 kg/m 2 b. 30 kg/m 2 c. 20 kg/m 2 d. 15 kg/m 2 ANS: C 4. What is the normal BMI for adults? a. 15.5 to 20.6 kg/m 2 b. 18.5 to 24.9 kg/m 2 c. 20.6 to 25.9 kg/m 2 d. 22.5 to 26.0 kg/m 2 ANS: B 5. Obesity is defined as a BMI over what value? a. 20 kg/m 2 b. 25 kg/m 2 c. 30 kg/m 2 d. 35 kg/m 2 ANS: C 6. Which of the following statements is true regarding kwashiorkor? 1. Occurs with a long-term loss of protein. 2. Often causes facial and limb edema. 3. Child often has a pot belly. 4. May occur in combination with marasmus. a. 1, 2, and 3 only b. 2 and 3 only c. 2, 3, and 4 only d. 1 and 4 only ANS: C 7. Protein-energy malnutrition may be reflected in reduced values for which of the following? 1. Albumin levels 2. Lymphocyte count 3. Transferrin 4. Red blood cell count

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a. 1, 2, and 3 only b. 1 and 2 only c. 2 and 4 only d. 3 and 4 only ANS: A 8. Which of the following blood tests is most useful for day-to-day monitoring of long-term trends in the nutrition status of the patient? a. Albumin levels b. Total white blood cell count c. Hematocrit d. Serum potassium levels ANS: A 9. Your male patient has a creatinine excretion level of 8 mg/kg body weight/day. What does this indicate? a. It is normal. b. There is mild muscle wasting. c. There is moderate muscle wasting. d. There is severe muscle wasting. ANS: D 10. Which of the following complications is least likely to influence creatinine excretion? a. Sepsis b. Trauma c. Hypoxemia d. Diet ANS: C 11. What is the recommended measurement for nitrogen balance? a. Blood urea nitrogen b. Serum urea nitrogen c. Urinary nitrogen d. Urinary urea nitrogen ANS: C 12. What changes in lung function are associated with malnutrition? a. Reduced VC b. Increased TLC c. Increased RV d. Decreased FRC ANS: A 13. Your patient is reported to be cachexic. Which of the following physical findings would support this statement? a. The patient’s belly is swollen.

b. The patient has facial edema. c. The patient’s ribs protrude. d. The patient’s hair falls out easily. ANS: C 14. What is the classic measure of energy expenditure? a. Basal oxygen consumption b. Basal metabolic rate (BMR) c. Resting caloric uptake d. Resting carbon dioxide production ANS: B 15. When is the basal metabolic rate (BMR) best obtained? a. After 10 hr of fasting b. While walking on a treadmill c. On rising in the morning d. 1 hr after lunch ANS: A 16. What procedure is used to overcome the limitations associated with estimating resting energy expenditures? a. Measuring blood glucose before and after exercise b. Monitoring body temperature during heavy exercise c. Indirect calorimetry d. The Douglas procedure ANS: C 17. Which of the following statements is false regarding energy needs? a. They vary with state of health. b. They vary with activity level. c. They are increased with obese patients. d. They increase with sepsis. ANS: C 18. In which of the following patients would indirect calorimetry be indicated? 1. Patients who are difficult to wean from mechanical ventilation 2. Patients with morbid obesity 3. Patients with a high level of stress a. 1 only b. 1 and 2 only c. 1 and 3 only d. 3 only ANS: C 19. Which of the following pieces of equipment is not needed to perform indirect calorimetry? a. Oxygen analyzer

b. Tissot spirometer c. Douglas bag d. Nitrogen analyzer ANS: D 20. What probably represents the most significant problem while performing calorimetry on a patient being mechanically ventilated? a. Compensating for mechanical dead space b. Leaks in the circuit c. Volume compression during inspiration d. High PEEP levels ANS: B 21. What does the RQ represent? a. Matching of respiration to perfusion b. Ratio of the moles of CO 2 produced to O 2 consumed c. Ratio of O 2 consumed to kilograms of ideal body weight d. Ratio of calories consumed to CO 2 produced ANS: B 22. Which of the following has an RQ of 1.0? a. Fat b. Carbohydrates c. Protein d. Soy ANS: B 23. Which of the following is associated with primary protein-energy malnutrition (PEM)? a. Poor diet due to living in a developing country b. Anorexia c. Malabsorption d. Severe infection ANS: A 24. Which of the following diseases is/are associated with protein-energy malnutrition (PEM)? 1. Asthma 2. Emphysema 3. Cancer a. 1 only b. 1 and 2 only c. 2 and 3 only d. 3 only ANS: C 25. Which of the following illnesses are associated with acute catabolic disease?

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1. Trauma 2. Sepsis 3. Burns 4. Pulmonary embolism a. 3 only b. 1, 2, and 3 only c. 2, 3, and 4 only d. 3 and 4 only ANS: B 26. Which of the following is not associated with zinc deficiencies? a. Poor blood clotting b. Impaired wound healing c. Bronchospasm d. Reduced immunity ANS: C 27. Which of the following is not associated with magnesium deficiencies? a. Reduced diaphragm strength b. Neurologic abnormalities c. Cardiac abnormalities d. Liver enlargement ANS: C 28. Which of the following is associated with acute cardiac muscle weakness and potential cardiopulmonary failure? a. Hyperkalemia b. Hypophosphatemia c. Hypernatremia d. Low folic acid levels ANS: B 29. Which of the following abnormalities in the respiratory system is/are associated with malnutrition? 1. Reduced hypoxic drive 2. Increased airway clearance 3. Loss of lung surfactant a. 1 only b. 1 and 3 only c. 2 and 3 only d. 2 only ANS: B 30. Which of the following statements is false regarding malnutrition in patients with chronic obstructive pulmonary disease (COPD)? a. Use of a nasal cannula may contribute to the problem. b. Depression is common and may reduce appetite.

c. A high work of breathing increases caloric needs. d. Vitamin deficiencies increased the need for oxygen. ANS: D 31. Ideally, approximately what percent of a patient’s estimated calorie needs should be provided by protein? a. 20% b. 40% c. 50% d. 60% ANS: A 32. What effect does high carbohydrate intake have on metabolism? a. Increases CO 2 production. b. Reduces oxygen consumption. c. Increases caloric needs. d. Reduces protein catabolism. ANS: A 33. What percent of the patient’s caloric intake should come from fat in most circumstances? a. 10% to 15% b. 20% to 30% c. 30% to 40% d. 40% to 50% ANS: B 34. Which of the following situations is not an indication for enteral nutritional support? a. Burns over 30% of the body surface area b. Persistent inability to eat orally c. Severe pancreatitis d. Renal failure ANS: D 35. Which of the following are reasons to use enteral feeding over parenteral? 1. Reduced incidence of stress ulcers. 2. Enteral route may avoid intestinal atrophy. 3. Enteral causes less hypoglycemia. 4. Enteral is safer and cheaper. a. 1 and 3 only b. 1, 2, and 4 only c. 2 and 3 only d. 3 and 4 only ANS: B 36. What tube feeding method is associated with an increased risk of aspiration?

a. Bolus b. Intermittent c. Continuous drip d. Pressurized ANS: A 37. What tube feeding method must be used when the food substance is delivered beyond the pylorus? a. Bolus b. Intermittent c. Continuous drip d. Pressurized ANS: C 38. Why raise the head of the bed during tube feedings? a. It reduces the time needed. b. It improves absorption. c. It reduces the risk of aspiration. d. It is easier for the caregiver. ANS: C 39. Which of the following metabolism issues is not associated with systemic inflammatory response syndrome (SIRS)? a. Hypoglycemia b. Protein catabolism c. Increased macronutrient requirement d. Triglyceride intolerance ANS: A 40. What are the primary goals of nutritional support during mechanical ventilation? 1. Avoid loss of lean body mass. 2. Avoid lung infection. 3. Keep muscles of breathing strong enough for weaning. a. 1 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3 ANS: C 41. Which of the following statements is false with regard to nutritional support of the patient with advanced chronic obstructive pulmonary disease? a. Provide low-calorie options. b. Provide high-protein nutrition. c. Provide small, frequent meals. d. Provide good patient education.

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ANS: A 42. Which of the following pulmonary diseases is similar to chronic obstructive pulmonary disease with regard to metabolic abnormalities? a. Asthma b. Cystic fibrosis c. Pulmonary fibrosis d. Acute respiratory distress syndrome ANS: B 43. Which of the following instructions must be followed to prepare a patient for indirect calorimetry? 1. Suction the patient 30 min before the test. 2. Fasting 10 hr before test. 3. Avoid physical activity 4 hr before the test. 4. 24-hr urine urea nitrogen collection. a. 1 and 2 only b. 2, 3, and 4 only c. 4 only d. 3 and 4 only ANS: B 44. Which of the following tools for nutritional assessment requires the patient to maintain a daily record of food intake for a 3- or 7-day period? a. The 24-hr recall b. Usual intake recall c. Food frequency questionnaire d. Food diary ANS: D 45. Which of the following is not a nutritional goal for the management of a cystic fibrosis patient? a. Maximize nutritional intake. b. Meet clinical and psychological needs. c. Avoid caloric dense foods. d. Encourage mineral and vitamin supplementation. ANS: C 46. Morbid obesity is defined as a BMI over what value? a. 20 kg/m 2 b. 25 kg/m 2 c. 30 kg/m 2 d. 35 kg/m 2 ANS: D Chapter 21 - Review of Thoracic Imaging

Kacmarek et al.: Egan’s Fundamentals of Respiratory Care, 11th Edition MULTIPLE CHOICE 1. What lung problem is ventilation/perfusion ( ) scanning used to detect? a. Asthma b. Pulmonary embolism c. Pneumonia d. Lung cancer ANS: B 2. Which of the following structures will result in the most radiopaque shadow on the chest radiograph? a. Aorta b. Heart c. Lungs d. Ribs ANS: D 4. In which of the following situations is obtaining a chest radiograph least useful? a. Following intubation b. Following placement of a central venous pressure line c. When the static pressure drops by 2 cm H 2 O during CMV d. When the patient’s oxygenation status deteriorates for no known reason ANS: C 7. Your patient just had an anteroposterior chest film taken. When you view the film, what may be a consideration? a. The lungs may appear smaller than they really are. b. The heart may appear less dense then it really is. c. The ribs may appear more horizontal than normal. d. The heart may appear larger than it really is. ANS: D 9. What problem exists when interpreting an overexposed chest film? a. There is difficulty in seeing the peripheral blood vessels. b. The ribs appear wider than normal. c. The heart shadow is blurred. d. The lymph nodes in the mediastinum cannot be seen. ANS: A 10. In the standard posteroanterior chest film, the heart shadow should be less than what proportion of the chest width? a. 33% b. 40% c. 50%

d. 65% ANS: C 17. Blunting of the costophrenic angles seen on the posteroanterior or lateral chest film typically indicates: a. emphysema. b. excess pleural fluid. c. obesity. d. rib fractures. ANS: B 18. Which chest x-ray view is best used to identify excess pleural fluid? a. Posteroanterior b. Anteroposterior c. Lateral decubitus d. Apical lordotic ANS: C 20. An air-fluid level in the pleural space typically indicates: a. tension pneumothorax. b. hydropneumothorax. c. pleural effusion. d. an aerobic infection. ANS: B 21. In which of the following would location of pleural fluid be as likely to occur? 1. Empyema 2. Exudative fluid 3. Hemothorax 4. Congestive heart failure a. 4 only b. 2 and 3 only c. 1, 2, and 4 only d. 1, 2, and 3 only ANS: D 23. Which of the following statements is false regarding the use of the chest x-ray to detect a pneumothorax? a. An expiratory film may be best for a small pneumothorax. b. The standard chest film is of limited use in detecting a pneumothorax. c. The film will show a lack of vascular markings in the affected region. d. The lung margin is often visible with a pneumothorax. ANS: B 24. Which of the following statements is false regarding the recognition and treatment of a tension pneumothorax as seen on the chest radiograph? a. The hemidiaphragm on the affected side will be pushed downward.

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b. The mediastinum will be pushed toward the unaffected side. c. It requires immediate insertion of a chest tube. d. The patient should be intubated. ANS: D 25. What term is used to describe the shadows seen on the chest film when the alveoli fill with pus, fluid, or blood? a. Consolidates b. Infiltrates c. Alveolar lesions d. Densities ANS: B 26. Which of the following is false regarding the visualization of air bronchograms on the chest film? a. They indicate fluid in the pleura. b. They are caused by air-filled airways surrounded by consolidation. c. They are the hallmark of alveolar consolidation. d. They signify airspace disease. ANS: B 29. What term is used to describe the predominance of edema in the hilar regions of both lungs with progressively less edema in the more peripheral areas of the lungs as seen on the chest film? a. Bat’s wing b. Hilar wings c. Butterfly wings d. Heart wings ANS: A 30. Which of the following statements best describe the typical findings on a chest radiograph for a patient with interstitial lung disease? a. Unilateral upper lobe infiltrates b. Diffuse bilateral infiltrates c. Diffuse pulmonary hyperinflation d. Diffuse pleural inflammation ANS: B 36. Which of the following are common radiographic findings seen in patients with volume loss due to atelectasis? 1. Elevation of the hemidiaphragm 2. Narrowing of the space between the ribs 3. Increase in the retrosternal airspace

4. Shift of the mediastinum a. 1 only b. 3 only c. 1, 2, and 4 only d. 3 and 4 only ANS: C 43. What is the optimal position of the endotracheal tube following intubation as seen on the chest radiograph? a. 1 to 2 cm above the carina b. 3 to 4 cm above the carina c. 5 to 7 cm above the carina d. In the upper third of the carina ANS: C 45. What are the two most common reasons for placing a chest tube? a. Pneumothorax and pleural effusion b. Pneumothorax and empyema c. Hemothorax and hydrothorax d. To place medicine in the pleural space and to withdraw excess fluid ANS: B 46. A 49-year-old COPD patient arrives to the ER complaining of shortness of breath (SOB) and difficulty breathing. The physical examination reveals bilateral coarse crackles throughout the lung fields, pedal edema, and hepatomegaly. The chest x-ray shows bilateral fluffy infiltrates with a “bat’s wing” configuration. What clinical condition you may suspect on this patient? a. Acute coronary syndrome b. COPD exacerbation c. Hypertensive crisis d. Left heart failure ANS: D Chapter 03 - Quality, Patient Safety, and Communication, and Recordkeeping Kacmarek et al.: Egan’s Fundamentals of Respiratory Care, 11th Edition MULTIPLE CHOICE 1. Which of the following is/are potential area(s) of risk to patients receiving respiratory care? 1. Movement and ambulation 2. Electrical shock 3. Fire hazards a. 1 only b. 2 and 3 only c. 3 only d. 1, 2, and 3

ANS: D 2. Lifting heavy objects is best done with which of the following techniques? a. Straight spine, bent legs b. Straight spine, straight legs c. Bent spine, bent legs d. Bent spine, straight legs ANS: A 3. Which of the following factors are most critical in determining when a patient can be ambulated? 1. Willingness of patient 2. Stability of vital signs 3. Absence of severe pain a. 2 and 3 only b. 1 and 2 only c. 1, 2, and 3 d. 1 and 3 only ANS: A 10. If 120 V are applied to a system with 1000 Ohms of resistance, what is the current? a. 100 A b. 100 Ohms c. 120 mA d. 120 A ANS: C 11. Which of the following organs is the most sensitive to the effects of electrical shock? a. Liver b. Heart c. Kidneys d. Lungs ANS: B 16. Which of the following currents passing through the chest can cause ventricular fibrillation, diaphragm dysfunction (due to severe, persistent contraction), and death? a. 100 mA b. 100 A c. 100 µA d. 10 µA ANS: A 18. Where do most hospital fires initially start? a. Clinical laboratory b. Kitchen c. Electrical engineering post

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d. Patient’s room ANS: B 20. Which of the following conditions must be met for a fire to occur? 1. Temperature high enough for combustion 2. Presence of O 2 3. Presence of flammable material a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3 ANS: D 23. In the standard approach to hospital fires, the RACE plan has been suggested. What does the letter “C” stand for in this approach? a. Capture b. Contain c. Call for help d. Collapse ANS: B 25. Which of the following components of communication is a method used to transmit messages? a. Sender b. Channel c. Receiver d. Feedback ANS: B 35. What form of patient record is most designed to succinctly report data in a time-oriented format and to decrease time needed for documentation? a. Subjective, objective, assessment, and plan (SOAP) record b. Problem-oriented, medical record (POMR) record c. Flowsheet d. Progress note ANS: C 37. Information about a patient’s nearest kin, physician, and initial diagnosis can be found in which section of the medical record? a. History and physical exam b. Admission sheet c. Physician’s orders d. Consultation sheet ANS: B

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38. To verify a physician’s prescription for a drug that you need to give to a patient, you would go to which section of the medical record? a. History and physical exam b. Laboratory sheet c. Physician’s orders d. Medication record ANS: C 39. To determine the most recent medical status of a patient whom you are about to start treating, you would go to which section of the medical record? a. Progress sheet b. Nurses’ notes c. Physician’s orders d. History and physical exam ANS: A 40. To find out what drugs or intravenous fluids a patient has received recently, you would go to which section of the medical record? a. Progress sheet b. Nurses’ notes c. Physician’s orders d. Medication record ANS: D 41. What is a time-based record of measurement during a specialized procedure such as mechanical ventilation? a. Consultation sheet b. Specialized flowsheet c. Progress notes d. Graphic sheet ANS: B 42. A pulmonary specialist has been called in by an internist to examine a patient and assist with a diagnosis. Where in the patient’s medical record would you look for the pulmonary specialist’s report? a. Progress sheet b. Consultation sheet c. Physician’s orders d. History and physical exam ANS: B Death and Dying 1. Advanced directives Informs healthcare staff and family members of the patients wishes regarding any life saving measures.

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2. Common fears about death Pain and becoming a burden. 3. Do not resuscitate order (DNR) Can only be written by a physician based on the patients living will or durable power of attorney. 4. Durable power of attorney A type of advanced directive that gives decision-making power concerning health choices to a person designated by the patient. Must be set up and signed before the patient becomes incapacitated. 5. End of life care The care of someone who is dying. 6. Guilt Hard to manage and is dependent on circumstances dealing with the families dynamics and past history. 7. Helplessness while grieving Educate family members on how to assist with normal functions such as washing hands, bathing and holding patients hand for comfort. 8. Hospice Care that focuses on palliative care of terminally ill patients. 9. Living Will Legal document drawn up before the person is incapacitated that describes the wishes of the person concerning end-of-life care. Carries more weight than verbal statement made to family. 10. Palliative Care Reducing symptoms and improving quality of life for seriously ill patients. Not meant to stop or treat the underlying disease. 11. Physiological Death Begins when the body begins to lose function and health deteriorates. 12. Psychological Death When someone finds out they have a terminal illness or when someone close dies and they believe they will be next (i.e. Final Destination) 13. Stages of Grief Denial, Anger, Bargaining, Depression and Acceptance (DABDA) 14. Therapeutic presence Involves accepting patient's emotional outbursts and expressions of anger and encouraging venting and verbalization

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2240 Practice FInal

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