Respiratory Assessment Practice Questions

30 multiple-choice questions on Respiratory assessment for paramedic and EMT students, from Chapter 17 (Respiratory Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. A 64-year-old with dyspnea says he has smoked 1.5 packs of cigarettes a day for 40 years. How many pack-years should you document?

   1. A. 60 pack-years
   2. B. 40 pack-years
   3. C. 27 pack-years
   4. D. 41.5 pack-years
   Show answer

   Answer: A. 60 pack-years

   Pack-years are packs per day multiplied by years smoked: 1.5 x 40 = 60. Writing 40 counts only the years and ignores the amount. 27 comes from dividing 40 by 1.5 instead of multiplying. 41.5 adds the two numbers. A history of 20 or more pack-years is a major COPD and lung cancer risk.

2. You are monitoring a dyspneic patient with darkly pigmented skin. What limitation of standard pulse oximetry should guide your assessment?

   1. A. It may read lower than the true saturation
   2. B. It cannot find a pulse signal through dark skin
   3. C. It may read higher than the true saturation
   4. D. Its reading lags several minutes behind
   Show answer

   Answer: C. It may read higher than the true saturation

   Studies and an FDA safety notice show that pulse oximeters can overestimate oxygen saturation in patients with darker skin, so true hypoxemia can hide behind a reading in the low to mid 90s. Judge the patient by work of breathing, mental status, and trends, not one number. The documented bias is toward falsely high, not falsely low, readings. Skin pigment does not prevent the device from finding a pulse signal. Delay in the reading depends on perfusion and probe site, not skin color.

3. A 70-year-old with COPD has been in distress for an hour. Now his abdomen sinks inward each time his chest rises. What does this suggest?

   1. A. His diaphragm is tiring, and he may fail soon
   2. B. This is normal with pursed-lip breathing
   3. C. He has a flail segment from a rib fracture
   4. D. Anxiety is making his breaths fast and shallow
   Show answer

   Answer: A. His diaphragm is tiring, and he may fail soon

   Abdominal paradox means the fatigued diaphragm is being pulled up into the chest by the negative pressure the neck and rib muscles generate, instead of pushing the abdomen out. It signals impending ventilatory failure, so prepare to assist ventilation. Pursed-lip breathing does not reverse abdominal motion. A flail segment is a section of chest wall moving inward after trauma, which he does not have. Anxiety speeds breathing but does not produce paradoxical abdominal motion.

4. A 40-year-old says her shortness of breath began abruptly 20 minutes ago while she was sitting at her desk. Which pair of causes does this onset most favor?

   1. A. Pneumonia or acute bronchitis
   2. B. COPD or chronic heart failure
   3. C. Pulmonary embolism or pneumothorax
   4. D. Anemia or a slow-growing lung tumor
   Show answer

   Answer: C. Pulmonary embolism or pneumothorax

   Dyspnea that starts abruptly at rest points to sudden events such as pulmonary embolism, pneumothorax, an aspirated object, anaphylaxis, or flash pulmonary edema. Pneumonia and bronchitis build over hours to days with fever and cough. COPD and heart failure usually worsen over days. Anemia and tumors cause gradually progressive symptoms over weeks.

5. An asthmatic who earlier wheezed only at the end of exhalation now wheezes through both inspiration and expiration. How should you interpret this?

   1. A. Her bronchospasm is starting to resolve
   2. B. This is an expected effect of albuterol
   3. C. She has developed pneumonia in one lobe
   4. D. Her airway narrowing is getting worse
   Show answer

   Answer: D. Her airway narrowing is getting worse

   Wheezing usually progresses as obstruction worsens: first at end-expiration, then through all of expiration, then on both inspiration and expiration, and finally a quiet chest when too little air moves. Wheezing spreading into inspiration is worsening, not resolution. Albuterol does not cause inspiratory wheezing. Pneumonia causes focal crackles or bronchial sounds rather than diffuse two-phase wheezing.

6. A dyspneic patient must stay supine on the stretcher. Where should you listen to best hear the lower lobes?

   1. A. Over the second intercostal spaces in front
   2. B. Just above each clavicle in front
   3. C. Along the midaxillary lines at the bases
   4. D. Over the sternum at the nipple line
   Show answer

   Answer: C. Along the midaxillary lines at the bases

   The lower lobes fill most of the posterior and lateral lower chest, so in a supine patient listen laterally along the midaxillary lines, and roll or sit the patient if you can. The anterior second intercostal spaces mostly cover the upper lobes. Above the clavicles you hear the apices. Over the sternum you mainly hear the heart and large airways.

7. A patient's pulse oximeter shows 100% with a pulse rate of 48, while the ECG shows a regular rate of 112. How should you treat the SpO2 value?

   1. A. As accurate, because 100% is a normal reading
   2. B. As proof that the ECG leads are faulty
   3. C. As evidence of a new second-degree block
   4. D. As unreliable until its pulse matches the ECG
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   Answer: D. As unreliable until its pulse matches the ECG

   An oximeter should count the same pulse rate as the ECG. When it does not, the probe is not reading a true arterial signal (motion, poor perfusion, a loose probe), so its saturation cannot be trusted; reposition it and check the waveform. A normal-looking number from a bad signal is still a bad reading. A regular ECG rate of 112 fits the patient, so the leads are not the problem. A heart block would appear on the ECG, not only on the oximeter.

8. A 25-year-old asthmatic is using her neck muscles to breathe and can speak only single words, but her SpO2 is 96% on room air. How should you rate this attack?

   1. A. Severe; SpO2 often stays normal until late
   2. B. Mild, because her oxygen saturation is normal
   3. C. Moderate, unless the SpO2 drops below 90%
   4. D. Not asthma, because asthma lowers SpO2
   Show answer

   Answer: A. Severe; SpO2 often stays normal until late

   GINA rates severity mainly by talking, position, accessory muscle use, respiratory rate, and heart rate. Single words and accessory muscle use mean a severe attack. Hyperventilation keeps the saturation up until the patient tires, so a normal SpO2 does not make the attack mild or moderate. Asthma does lower SpO2 eventually, but a normal reading does not rule it out.

9. Which finding is a late and ominous sign of respiratory failure in an adult with dyspnea?

   1. A. Use of accessory muscles
   2. B. Altered mental status
   3. C. Tachypnea
   4. D. Anxiety and restlessness
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   Answer: B. Altered mental status

   Confusion, lethargy, or decreased responsiveness signals hypoxia and hypercapnia affecting the brain. Accessory muscle use and tachypnea occur earlier, while the patient is still compensating.

10. A 70-year-old woman reports waking up suddenly at night short of breath and having to sit up to breathe. This symptom is called:

    1. A. Exertional pleuritic chest pain
    2. B. Cheyne-Stokes respirations
    3. C. Paroxysmal nocturnal dyspnea
    4. D. Orthostatic hypotension
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    Answer: C. Paroxysmal nocturnal dyspnea

    Paroxysmal nocturnal dyspnea is sudden nighttime breathlessness that wakes the patient and is classically associated with left-sided heart failure.

11. A 72-year-old with COPD says he is "more short of breath." Which question best shows how far he has declined from his usual state?

    1. A. "Do you have allergies to medications or foods?"
    2. B. "How many years ago was your COPD diagnosed?"
    3. C. "Did you take your inhaler this morning?"
    4. D. "How far can you usually walk before you stop?"
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    Answer: D. "How far can you usually walk before you stop?"

    Comparing today's function with his usual function (for example, walking to the mailbox versus not crossing the room) shows the size of the decline. Allergies are important for treatment but say nothing about severity. Years since diagnosis describes the disease, not today's change. Inhaler use this morning is useful history but does not measure decline.

12. Every few minutes a patient's SpO2 drops into the 70s with a flat waveform, then recovers. Each drop happens as the automatic BP cuff inflates on the same arm. What should you do?

    1. A. Increase the oxygen during each cuff cycle
    2. B. Prepare to assist ventilations with a BVM
    3. C. Set the cuff to cycle once a minute
    4. D. Move the oximeter probe to the other arm
    Show answer

    Answer: D. Move the oximeter probe to the other arm

    An inflating cuff blocks arterial flow to the finger, so the oximeter loses its pulse signal and reads falsely low. The patient is not desaturating; move the probe to the other limb. More oxygen or bag-mask ventilation treats an artifact. Cycling the cuff more often makes the false drops more frequent.

13. Which patient with dyspnea should have oxygen titrated to an SpO2 of 88% to 92% rather than 94% to 98%?

    1. A. A man with severe kyphoscoliosis and a high baseline CO2
    2. B. A healthy 30-year-old with community pneumonia
    3. C. A 50-year-old with a pulmonary embolism after knee surgery
    4. D. A 20-year-old with an acute asthma attack
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    Answer: A. A man with severe kyphoscoliosis and a high baseline CO2

    Patients at risk of hypercapnic respiratory failure, such as those with COPD, severe kyphoscoliosis, neuromuscular disease, or obesity hypoventilation, are titrated to 88% to 92%. Patients with pneumonia or pulmonary embolism and no CO2 retention use 94% to 98%. Adults with acute asthma are not CO2 retainers early on; GINA suggests about 93% to 95%, not 88% to 92%.

14. You need an accurate respiratory rate on an anxious, alert patient. Which technique gives the most reliable count?

    1. A. Ask the patient to breathe normally while you count
    2. B. Count for 5 seconds and multiply by 12
    3. C. Estimate the rate from his speech pattern
    4. D. Count while you appear to be taking the pulse
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    Answer: D. Count while you appear to be taking the pulse

    People change their breathing once they know it is being watched, so count discreetly, for example while your fingers stay on the radial pulse, for at least 30 seconds. Asking the patient to breathe normally draws attention to his breathing and alters the rate. A 5-second count multiplied by 12 magnifies small errors. Speech patterns show severity but do not give a rate.

15. You are listening to the lungs of a dyspneic patient wearing a thick sweater. How should you auscultate?

    1. A. Over the sweater to save time
    2. B. With quiet breathing through the nose
    3. C. On bare skin, with deep mouth breaths
    4. D. Over the front of the chest alone
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    Answer: C. On bare skin, with deep mouth breaths

    Fabric rubbing on the stethoscope creates noise that can mimic crackles and muffles real sounds, so listen on bare skin while the patient breathes slowly and deeply through an open mouth, comparing side to side, front and back. Listening over the sweater is the error. Quiet breathing through the nose makes lung sounds faint. The front of the chest alone misses most of the lower lobes, which lie posteriorly.

16. A 72-year-old woman with diabetes has had dyspnea on exertion for 2 days that eases with rest. Her lungs are clear and her SpO2 is 97%. Which cause must you consider?

    1. A. Cardiac ischemia (an angina equivalent)
    2. B. Anxiety-related hyperventilation syndrome
    3. C. Normal deconditioning from getting older
    4. D. Exercise-induced bronchospasm
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    Answer: A. Cardiac ischemia (an angina equivalent)

    Exertional dyspnea that resolves with rest can be an anginal equivalent, especially in women, older adults, and people with diabetes. Get a 12-lead ECG and treat it as possible ACS. Anxiety is a diagnosis of exclusion. Calling a new symptom normal aging misses ischemia. Exercise-induced bronchospasm causes wheezing and is uncommon as a new problem at this age.

17. While assessing a 60-year-old with chronic lung disease, you see that his fingertips are enlarged and rounded, with the normal nail-bed angle lost. What does this finding most suggest?

    1. A. Acute carbon monoxide exposure at home
    2. B. A long-standing lung or heart disease
    3. C. An allergic reaction in progress
    4. D. Hyperventilation earlier today
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    Answer: B. A long-standing lung or heart disease

    Clubbing develops over months to years with chronic disease such as lung cancer, bronchiectasis, cystic fibrosis, interstitial lung disease, or cyanotic heart disease. It is not a feature of COPD by itself, so new clubbing in a COPD patient raises concern for lung cancer. Carbon monoxide exposure, allergic reactions, and hyperventilation are acute and do not change the shape of the fingers.

18. A barrel-shaped chest with an increased anterior-posterior diameter is most typical of:

    1. A. Acute asthma
    2. B. Pneumothorax
    3. C. Emphysema
    4. D. Pulmonary embolism
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    Answer: C. Emphysema

    Chronic air trapping in emphysema enlarges the AP diameter of the chest over time, producing the barrel chest.

19. A peak expiratory flow measurement is most useful in the field for:

    1. A. Gauging airflow obstruction in asthma
    2. B. Confirming endotracheal tube placement
    3. C. Diagnosing pulmonary embolism
    4. D. Measuring blood oxygen content
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    Answer: A. Gauging airflow obstruction in asthma

    Peak flow estimates how fast air can be forced out and, compared with a patient's baseline, helps gauge asthma severity and response to treatment.

20. You are assessing a 45-year-old woman with dyspnea. Which question best addresses the 'P' (provocation) in OPQRST?

    1. A. "How bad is it from 1 to 10?"
    2. B. "Where exactly do you feel it?"
    3. C. "When did this first start today?"
    4. D. "What makes it better or worse?"
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    Answer: D. "What makes it better or worse?"

    Provocation/palliation explores what worsens or relieves the symptom, such as lying flat, exertion, or using an inhaler.

21. A woman wearing dark blue nail polish has an SpO2 of 89% on a finger probe, but she is pink, calm, and breathing normally. What should you do?

    1. A. Start high-flow oxygen by nonrebreather
    2. B. Accept 89% as her true saturation
    3. C. Prepare to assist her ventilations
    4. D. Reposition the probe and recheck
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    Answer: D. Reposition the probe and recheck

    Dark nail polish (especially black, blue, or green) can absorb the oximeter's light and give falsely low readings, so reposition the probe (sideways across the finger or on another site) or remove the polish and recheck. Starting high-flow oxygen by nonrebreather treats a number, not the patient. Accepting 89% as her true saturation ignores a likely artifact that does not match her appearance. Assisted ventilation is not indicated in a patient breathing normally.

22. A patient's breathing is rapid but very shallow. Why is this pattern concerning even if the rate looks adequate?

    1. A. Minute volume may be too low
    2. B. It blows off too much CO2
    3. C. It raises the blood pH quickly
    4. D. It overinflates the alveoli
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    Answer: A. Minute volume may be too low

    Minute volume equals rate times tidal volume. Rapid, shallow breaths move mostly dead-space air and may not ventilate the alveoli adequately. Because shallow breaths move mostly dead-space gas, CO2 tends to rise rather than fall and the pH drops rather than rises, and the alveoli are underfilled rather than overinflated.

23. You coach an asthmatic through three peak flow attempts: 210, 250, and 240 L/min. Which value should you record?

    1. A. 233 L/min, the average
    2. B. 250 L/min, the best effort
    3. C. 210 L/min, the first effort
    4. D. 240 L/min, the last effort
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    Answer: B. 250 L/min, the best effort

    Peak flow depends on effort, so the highest of three good attempts is recorded and compared with the patient's personal best. The average (233) mixes in weaker efforts. The first and last attempts have no special value.

24. You arrive to find a 34-year-old man with dyspnea, unilateral absent breath sounds, and a tracheal shift. Where is the trachea usually palpated for this?

    1. A. Just below the xiphoid
    2. B. At the angle of Louis
    3. C. Over the thyroid cartilage
    4. D. At the suprasternal notch
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    Answer: D. At the suprasternal notch

    Tracheal position is assessed at the suprasternal notch. Tracheal deviation is a late finding of tension pneumothorax.

25. On a cold night, a patient's fingers look bluish, but his lips and tongue are pink and his SpO2 is 97%. What best explains the blue fingers?

    1. A. Severe hypoxemia from his chronic lung disease
    2. B. Carbon monoxide binding to hemoglobin
    3. C. Peripheral vasoconstriction from the cold
    4. D. Methemoglobin from a medication
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    Answer: C. Peripheral vasoconstriction from the cold

    Blue fingers with pink lips and tongue is peripheral cyanosis from slow flow in cold, constricted vessels. Central cyanosis in the lips and tongue reflects low arterial saturation, which he does not have. Carbon monoxide does not turn the skin blue. Methemoglobinemia causes central cyanosis of the lips with a low SpO2 reading.

26. A patient in severe respiratory distress can answer only one word at a time. What is the best way to get his history?

    1. A. Ask open-ended questions so he can explain
    2. B. Hold the questions until he reaches the hospital
    3. C. Ask yes-or-no questions and use the medication list
    4. D. Have him write out a full timeline of the events today
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    Answer: C. Ask yes-or-no questions and use the medication list

    Short closed questions, family members, and the medication list gather key history without using up his breath. Open-ended questions make him talk, which worsens dyspnea. Holding all questions loses information that guides treatment now. Writing a full timeline takes effort and time he cannot spare.

27. A 74-year-old has had a dry cough and slowly worsening dyspnea for 3 months. His lungs have fine crackles, and he has no fever. Which of his home medications is most likely responsible?

    1. A. Amiodarone
    2. B. Atorvastatin
    3. C. Amlodipine
    4. D. Omeprazole
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    Answer: A. Amiodarone

    Amiodarone can cause pulmonary toxicity (inflammation and fibrosis) months after it is started, with dry cough, progressive dyspnea, and crackles; mention the drug to the receiving team. Atorvastatin is a cholesterol drug with muscle side effects, not lung fibrosis. Amlodipine causes ankle swelling and flushing. Omeprazole reduces stomach acid and does not cause this lung injury.

28. When auscultating breath sounds in an adult, which approach is best?

    1. A. Compare upper to lower on one side
    2. B. Listen at a single posterior site
    3. C. Compare side to side at each level
    4. D. Listen only over the anterior apices
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    Answer: C. Compare side to side at each level

    Comparing symmetrical points side to side, front and back, reveals unilateral changes such as pneumothorax, consolidation, or effusion.

29. Which question best identifies a patient who is likely to need ventilatory support soon?

    1. A. "Have you traveled by air or by car recently?"
    2. B. "Do you have a cough that brings up green phlegm?"
    3. C. "Did the trouble start after you ate?"
    4. D. "Have you been getting more sleepy or confused?"
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    Answer: D. "Have you been getting more sleepy or confused?"

    Increasing drowsiness or confusion in a dyspneic patient suggests rising CO2 or worsening hypoxia and predicts the need for assisted ventilation. Air travel points toward a cause (PE) rather than impending failure. A productive cough suggests infection or bronchitis. Onset after eating points toward aspiration or an allergic reaction, but does not measure how close he is to failing.

30. Which skin finding most supports a pulmonary infection as the cause of a patient's dyspnea?

    1. A. Pale, dry skin
    2. B. Mottled, cold skin
    3. C. Cool, clammy skin
    4. D. Hot, flushed skin
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    Answer: D. Hot, flushed skin

    Warm, flushed skin suggests fever, supporting an infectious cause such as pneumonia. Cool, clammy skin suggests shock or a sympathetic response.