CRE Patient Assessment & Diagnosis 2 — Questions and Answers
Question 1: A patient with COPD presents with accessory muscle use, pursed-lip breathing, and a barrel chest. Which physical finding is most consistent with hyperinflation?
- Increased tactile fremitus
- Decreased diaphragmatic excursion (Correct answer)
- Dullness to percussion
- Bronchial breath sounds over peripheral lung fields
Correct answer: Decreased diaphragmatic excursion
Hyperinflation flattens the diaphragm, reducing its excursion and limiting effective breathing mechanics.
Question 2: Which spirometry pattern is characterized by a reduced FVC, reduced FEV1, and a normal or elevated FEV1/FVC ratio?
- Obstructive pattern
- Restrictive pattern (Correct answer)
- Mixed pattern
- Normal variant
Correct answer: Restrictive pattern
A restrictive pattern shows proportionally reduced FVC and FEV1 with a preserved or elevated FEV1/FVC ratio.
Question 3: A respiratory educator is reviewing a patient's ABG: pH 7.30, PaCO2 55 mmHg, HCO3 27 mEq/L. What is the primary disorder?
- Metabolic acidosis
- Respiratory alkalosis
- Respiratory acidosis with partial compensation (Correct answer)
- Metabolic alkalosis
Correct answer: Respiratory acidosis with partial compensation
Elevated PaCO2 with low pH indicates respiratory acidosis; the elevated HCO3 shows renal compensation has begun.
Question 4: When performing a 6-minute walk test (6MWT) on a COPD patient, which finding most indicates a need to stop the test immediately?
- SpO2 drop from 97% to 93%
- Patient reports dyspnea rating of 3/10
- SpO2 drops below 80% (Correct answer)
- Heart rate increases to 120 bpm
Correct answer: SpO2 drops below 80%
An SpO2 below 80% is a critical stopping criterion for the 6MWT due to severe hypoxemia risk.
Question 5: Which auscultation finding is most commonly associated with pulmonary fibrosis?
- Expiratory wheezing
- Coarse crackles at the bases
- Fine, late-inspiratory crackles (Velcro crackles) (Correct answer)
- Pleural friction rub
Correct answer: Fine, late-inspiratory crackles (Velcro crackles)
Pulmonary fibrosis produces fine, late-inspiratory crackles often described as Velcro-like due to fibrotic tissue opening during inspiration.
Question 6: A peak flow reading of 65% of a patient's personal best indicates the patient is in which asthma action zone?
- Green zone — good control
- Yellow zone — caution (Correct answer)
- Red zone — medical alert
- Blue zone — severe exacerbation
Correct answer: Yellow zone — caution
A peak flow of 50–79% of personal best places a patient in the yellow (caution) zone, warranting use of rescue medication and reassessment.
Question 7: Which clinical sign best differentiates cardiac pulmonary edema from an acute asthma exacerbation on physical exam?
- Use of accessory muscles
- S3 gallop and jugular venous distension (Correct answer)
- Bilateral expiratory wheezing
- Respiratory rate above 30 breaths/min
Correct answer: S3 gallop and jugular venous distension
An S3 gallop and jugular venous distension point to cardiac failure as the etiology of pulmonary edema rather than bronchoconstriction.
CRE Patient Assessment & Diagnosis 2
A patient with COPD presents with accessory muscle use, pursed-lip breathing, and a barrel chest.
Which physical finding is most consistent with hyperinflation?