10 free AEMT practice questions: Pulmonary Disease Processes: Sorting the Dyspneic Patient

Loud wheezing heard across all lung fields: Loud wheezing sounds severe, and it is the finding most people grade an asthma attack by. Wheezing requires air movement to make sound, so loudness tracks how much air is moving rather than how tight the airways are, which is why a chest that goes quiet is worse than one that is loud.

A heart rate of 124 after two treatments: A heart rate of 124 belongs in the assessment and it can reflect both the hypoxia and the work of breathing. The patient has had two bronchodilator treatments, and tachycardia is an expected effect of that drug, so this number is carrying two explanations at once and cannot cleanly measure the patient's airways.

A respiratory rate of 30 breaths per minute: A rate of 30 is abnormal and fast breathing is part of a severe attack, so it earns attention. Rate alone says nothing about how much air each breath moves, and a patient breathing 30 shallow times a minute and one breathing 30 effective times a minute look identical on that number.

Flat on the back with the head turned: Flat on the back is the position that just made this patient worse, because everything pooled in the legs and abdomen drains back toward a full heart. Turning the head does nothing about where the fluid is going.

On the left side with the knees drawn up: The left side with the knees drawn up is a comfort position for abdominal pain and a cousin of the recovery position. It takes no load off a heart that is already overwhelmed.

Flat with the legs raised above the heart: Raising the legs above the heart is meant for a patient who needs more blood returning to the center, such as a patient in shock. This patient has too much volume coming back already, and raising the legs sends still more of it to the lungs.

A patient whose lower airways are narrowed by bronchospasm: Bronchospasm is the textbook target for this drug, which is why it feels like the odd one out here. The muscle is squeezing, the drug relaxes it, so this patient does improve.

A patient whose airways are tightened by an allergic reaction: An allergic reaction brings other problems albuterol will not fix, which makes this feel right. The lower airway tightening in that reaction is still smooth muscle, and it still relaxes.

A patient wheezing during a chronic obstructive pulmonary disease flare: A flare is tempting because these patients are often sicker overall, and severity does not decide whether a drug reaches its target. Bronchospasm is part of that flare, so the muscle relaxes and air moves.

Extra carbon dioxide produced by a rising temperature: A rising temperature does raise carbon dioxide production, and that is real physiology. A patient who can ventilate blows the extra off, so that alone does not march a number up like this.

A leak in the sampling line diluting the sample: Checking for a leak whenever a number surprises you is a good habit, which is what makes this tempting. A leak pulls the reading down toward room air rather than driving it up.

Bronchospasm narrowing the lower airways: Bronchospasm does drive end-tidal numbers up in a tiring patient, so the direction is right. Bronchospasm also bends the waveform into an upslope, and this one held its shape.

Leave the flow where it is, since a bag that empties shows the oxygen is being used: A bag that moves is doing its job, and you should expect it to shrink on every breath. Emptying all the way is a different finding: the flow ran out before the breath did, and the patient finished that breath on room air.

Switch to a simple face mask, which has no reservoir bag to empty: Changing devices is a fair instinct when the one in your hand looks like it is failing. A simple face mask delivers roughly 35 to 60 percent, which is less than the non-rebreather was already giving this hypoxic patient.

Recheck the mask seal, since a leak at the cheeks is what empties the bag: Checking the seal is never wasted, and a poor seal does lower the concentration a patient actually receives. A leak pulls room air in around the edges, which would empty the bag more slowly rather than faster, so the seal is not what is draining it.

It is doing both jobs, since oxygen at 15 L per minute pushes air into the chest: Fifteen liters a minute is the highest flow you run through a mask, and it does feel like the device is delivering something forceful. That flow fills the mask and the reservoir; it never becomes a breath, because there is no seal and no squeeze behind it.

It is clearing carbon dioxide, because the valve vents each exhalation out of the mask: The valve does exactly what you describe, letting each exhalation leave the mask instead of going back into the reservoir. Moving carbon dioxide out of the mask is not the same as moving it out of the patient, and that depends entirely on how much air travels in and out of the lungs.

It is all this patient needs while the saturation stays at or above 94 percent: A saturation of 96 percent is a genuinely reassuring number, and it tells you the oxygen side is handled for the moment. The oximeter reports only one of the two jobs, and a patient breathing 6 times a minute with almost no chest movement is failing the other one.

Whether the saturation has fallen below 94% on room air: A falling saturation earns oxygen and it flags a sick patient, which is why this looks decisive. Saturation tells you about oxygenation, not about what is producing the sound.

Whether the wheeze is heard on inspiration or on expiration: The timing of a wheeze does carry information about how obstructed the airways are. It still will not tell you whether the narrowing is bronchospasm or fluid, and that is the question a nebulizer answers to.

The loudness of the wheeze on auscultation: Loudness feels like it should track severity, and there is a grain of truth in a wheeze that grows louder as air starts moving again. Volume says nothing about whether smooth muscle is the cause.

A response to the oxygen that should be given more time: Oxygen does help, and giving a treatment time to work is usually wise. A saturation of 94% on oxygen is the lagging number here, and waiting on it means waiting through the window where ventilation should have started.

A normal pause between episodes of increased effort: Children do tire and rally in waves, so watching for a pattern is reasonable. A quiet child with a worsening appearance and a rate that has fallen to 16 is not resting between rounds.

Improvement, since the work of breathing has come down: Less work of breathing is the goal of everything you are doing, which is exactly why this trap works so well. Effort dropping while appearance worsens is exhaustion, and in a child it never means improvement.

The oxygen has taken effect and the sound will keep fading: Oxygen is the right thing to be giving and it does help this child, so crediting it feels natural. Oxygen does not shrink upper airway swelling, and the saturation is still 89% with it running.

The swelling has come down and the patient is improving: Less noise does sound like less swelling, and that is what improvement would look like if the child looked better. This child looks worse in every other way, so the quiet is lost airflow rather than lost swelling.

The stridor has moved lower into the chest as a wheeze: Sounds do change character as a child's condition shifts, so this is a thoughtful guess. Stridor comes from a narrowed upper airway, and it does not migrate down into the chest.

The sensor has become disconnected: A disconnected sensor produces a sudden loss of the waveform, not a well-formed waveform with a flat plateau. The question describes a specific normal morphology with a measured value, which requires exhaled gas actually reaching a connected sensor.

The patient is now hypoventilating: Hypoventilation drives the EtCO₂ up, and this value has come down from 52 to 43 mmHg. The patient is also speaking in longer sentences with less accessory muscle use, which is more air movement rather than less.

Air trapping has become more severe: Worsening air trapping exaggerates the sloped expiratory segment and pushes the plateau further out of reach, so the waveform would move further from square rather than back toward it. The rising carbon dioxide that goes with worsening trapping is also absent here.