Respiratory System

1. Mr. Jean-Pierre Tremblay, a 55-year-old man with a known diagnosis of obstructive sleep apnea (OSA), is hospitalized for a routine check-up of his chronic conditions, including obesity and hypertension. Despite using a CPAP machine at night, he reports feeling tired throughout the day and frequently falls asleep while doing simple tasks like watching TV or reading. His wife mentions that he occasionally still snores and sometimes pauses in breathing if he removes his CPAP in the middle of the night. His vital signs are as follows: BP at 140/85, pulse at 80 bpm, respiration at 18 bpm, and SpO2 at 96%. Which of the following clinical manifestations is most concerning for the LPN regarding Mr. Tremblay’s obstructive sleep apnea? *
2. Mr. Gervais, a 68-year-old lifelong smoker with COPD, presents with increased shortness of breath over 48 hours. His daughter notes confusion and unusual irritability. His oxygen saturation is 88% on room air. He has a barrel chest, pursed-lip breathing, and a chronic productive cough. He reports that he ran out of his maintenance inhalers last week. Which clinical manifestation corresponds to his condition? *
3. Ms. Tremblay, a 54-year-old woman recovering from knee surgery, suddenly experiences sharp chest pain and shortness of breath while waiting for a physiotherapy appointment. She becomes pale and tachycardic. She reports calf pain that started yesterday but assumed it was part of rehab. She now appears panicked and is breathing rapidly. Which clinical manifestation is associated with her suspected condition? *
4. Mr. Dagenais, a 72-year-old resident of a long-term care facility, has had increasing fatigue and coughing for three days. Today he developed fever and chills. The nurse notices crackles in his right lower lung. He complains of pleuritic chest pain when inhaling, and his oxygen saturation is 90% on room air. Which clinical manifestation is consistent with his condition? *
5. Ms. Ricci, a 27-year-old athletic woman with no chronic illness, suddenly develops sharp right-sided chest pain while stretching. She reports difficulty breathing and feels “air trapped” in her chest. On assessment, her trachea is midline, but breath sounds on the right are absent. She is slightly tachycardic and anxious. Which clinical manifestation supports the suspected diagnosis? *
6. Mr. Andrew, a 41-year-old man, arrives at the clinic after choking briefly while eating. Although the obstruction resolved, he now complains of difficulty breathing and a high-pitched noise when inhaling. He appears frightened and is using neck muscles to breathe. Which clinical manifestation is most characteristic of upper airway obstruction? *
7. Ms. Rivera, a 44-year-old woman recently immigrated to Canada, reports night sweats, ongoing fatigue, and a cough that has lasted more than three weeks. She denies fever but states she has lost weight unintentionally. On exam, her breath sounds are diminished at the upper lobes. Which clinical manifestation suggests tuberculosis? *
8. Mr. Cho, a 59-year-old man admitted for severe pancreatitis, suddenly develops worsening respiratory distress. His oxygen saturation remains low despite receiving high-flow oxygen. His breathing becomes rapid and shallow, and he appears fatigued and confused. Lung auscultation reveals diffuse crackles bilaterally. Which clinical manifestation is associated with ARDS? *
9. Mr. Pelletier, a 47-year-old factory worker, presents with a persistent productive cough, low-grade fever, and chest discomfort that worsens when he coughs. He has smoked for 20 years and reports symptoms started after a cold. On auscultation, coarse rhonchi are heard that clear somewhat after coughing. Which clinical manifestation corresponds to his condition? *
10. Mme. Brière, a 63-year-old woman undergoing cancer treatment, reports increasing shortness of breath and a sense of heaviness on her left side. She denies fever. On physical exam, breath sounds are diminished over the lower left lung, and percussion reveals a dull sound in the same region. Which clinical manifestation is related to her condition? *
11. Ms. Dubois, a 29-year-old woman with a history of moderate persistent asthma, arrives at the clinic after spending the weekend visiting a friend who owns multiple cats. She reports that she forgot her maintenance inhaler at home and has been relying only on her rescue inhaler, which she used three times in the past two hours with limited relief. She feels increasing chest tightness and says it’s becoming harder to take a full breath. On assessment, she is sitting forward, breathing rapidly, and appears visibly anxious. The nurse notices prolonged expiration and high-pitched sounds upon auscultation of her lungs. Which clinical manifestation relates to the patient’s condition? *
12. Mr. Jeremy Fontaine, 29, diagnosed with moderate persistent asthma since childhood, arrives at the urgent care clinic with worsening wheezing over the past 12 hours. He reports using his rescue inhaler “every 30 minutes” with little relief. He had a recent cold, slept poorly, and admits he forgot his maintenance corticosteroid inhaler for the past week. On arrival, RR is 28/min, HR 118 bpm, SpO₂ 92% on room air. He is speaking in full sentences but appears anxious.

One hour later, the nurse notices that Jeremy is now hunched forward, using accessory muscles. His wheezing becomes faint and eventually decreases. He is unable to speak more than one to two words at a time. SpO₂ drops to 86% despite 6 L O₂. His skin becomes pale and his level of consciousness begins to decline. Peak flow has dropped significantly from baseline.

Which complication is developing? *
13. Mrs. Linda Charbonneau, 76, with severe COPD (emphysema predominant), is admitted for shortness of breath and productive cough. She normally uses 2 L/min O₂ at home. On admission she is placed on 5 L/min O₂ because she appears hypoxic (SpO₂ 86%). Initial RR is 24/min with pursed-lip breathing. She reports poor appetite and 3-kg weight loss.

Three hours later, Mrs. Charbonneau becomes unusually drowsy and difficult to arouse. Her RR drops to 8/min and her skin is warm and flushed. SpO₂ shows 97% on high oxygen flow. The nurse notes shallow respirations and her ABG shows pH 7.28, PaCO₂ 78 mmHg.

Which complication is occurring? *
14. Mr. André Moreau, 67, with type 2 diabetes and chronic kidney disease, is admitted with a 4-day history of productive cough, fever, and pleuritic chest pain. His temperature is 38.9°C, RR 26/min, HR 112 bpm, and SpO₂ 90% RA. Chest X-ray reveals right lower-lobe consolidation.

Later that evening, André becomes increasingly confused. His skin is warm and flushed, and capillary refill exceeds 3 seconds. BP drops from 132/84 to 92/56 mmHg, HR rises to 128 bpm, and temperature spikes to 39.5°C. He is breathing rapidly at 32/min with audible crackles.

Which complication has most likely developed? *
15. Mr. Ramesh Patel, 42, recently diagnosed with pulmonary tuberculosis, is in his third week of treatment. He reports persistent cough and night sweats but overall improvement. His vitals are stable and he is afebrile.

During the night, the nurse is called urgently: Ramesh is coughing violently and produces a large amount of bright-red blood. He is pale, breathing rapidly at 34/min, and clutching his chest. His HR is 128 bpm, and he appears frightened and dizzy. Lung sounds reveal coarse crackles.

Which complication is developing? *
16. Ms. Olivia Gervais, 25, tall and thin, with no significant history, presents with sudden sharp left-sided chest pain after stretching. She reports difficulty breathing. On assessment, HR is 112 bpm, RR 28/min, and SpO₂ 93% RA. Breath sounds are decreased on the left. Initial pneumothorax is suspected.

Thirty minutes later, Olivia becomes increasingly anxious and cyanotic. Her trachea is now deviated to the right. BP drops to 82/46 mmHg, HR rises to 140 bpm, and jugular veins are distended. Breath sounds on the left are absent.

Which complication is developing? *
17. Mr. Claude Laramée, 63, is 1 day post-op after abdominal surgery. He is obese, smokes one pack per day, and avoids deep breathing due to incisional pain. His vitals: RR 20/min, HR 98 bpm, SpO₂ 94% RA.

By the evening, Claude becomes increasingly short of breath and lethargic. His RR is 30/min, HR 112 bpm, and SpO₂ drops to 88%. Breath sounds are diminished at the bases. Temperature rises to 38.2°C. He admits he has not used his incentive spirometer.

Which respiratory complication is likely? *
18. Mrs. Helen Papadopoulos, 58, with type 2 diabetes and obesity, is admitted with confirmed COVID-19 pneumonia. She is on 6 L/min O₂ with SpO₂ 92%. She reports increasing fatigue and cough. Chest X-ray shows bilateral infiltrates.

12 hours later, Helen becomes acutely distressed. RR jumps to 40/min, HR 134 bpm, and SpO₂ falls to 82% despite 15 L NRB. She is cyanotic, unable to speak, and using accessory muscles. Lung sounds reveal diffuse crackles. ABG shows PaO₂ 48 mmHg on high FiO₂.

Which complication is occurring? *
19. Mr. Lionel St-Pierre, 82, with history of dementia and dysphagia, is eating soup when he suddenly begins coughing and choking. He becomes red in the face and reports difficulty breathing. After the episode, he appears tired but stable. RR is 22/min, HR 102 bpm.

Several hours later, Lionel’s temperature rises to 38.5°C. He becomes lethargic, RR 28/min, HR 118 bpm, and SpO₂ drops to 89%. Breath sounds reveal crackles in the right lower lobe.

Which complication has likely developed? *
20. Four-year-old Lucas Martel arrives at the emergency department with his mother. He has had a barky cough, low fever, and hoarse voice for 2 days. His RR is 26/min, HR 112 bpm, and he has mild stridor when agitated. He is diagnosed with viral croup.

One hour later, Lucas suddenly becomes more distressed. Stridor is now present at rest, suprasternal retractions are visible, and nasal flaring begins. His RR increases to 40/min and SpO₂ falls to 89% RA. He becomes anxious and clings to his mother, unable to speak in full sentences.

Which complication is developing? *
21. A 53-year-old woman receives outpatient services for a sleeping disorder. Upon reading the woman’s file, the LPN learns that she feels very tired when she wakes up and has trouble getting through her work day. She wakes up several times a night due to episodes of suffocation, and has a BMI of 30. She says that seasonal allergies often cause her to become congested. She also suffers from frequent headaches. The physician diagnoses sleep apnea. Which of the following clinical manifestations relates to the patient’s condition? *
22. An eight-year-old child has had asthma a very young age. It is unusually kept under control with inhalation medication. Today, he is admitted to the pediatric unit since, for the past two days, he has had a constant cough sometimes accompanied by vomiting. The worried parents explain to the LPN that their child seems to be out of breath at the slightest effort, breathes noisily, and that, as of last night, his nostrils widen when he breathes. The LPN takes the patient’s vital signs, which are as follows: B.P. at 112/62, pulse at 100 beats/minute, resp. at 28 breaths/min, SpO2 at 90% and buccal temperature at 36.7’C. Which of the following clinical manifestations relates to the patient’s condition? *
23. A patient is hospitalized for a bronchial superinfection and is known COPD patient. His son is worried and tells the LPN that his father’s condition has gotten worse since last week. He also surprised his father this morning when he caught him urinating in the corner of his room, a behaviour he’s never displayed before. At home, the patient receives oxygen 24 hours a day at a rate of 2L/min. The LPN notes that the patient is more dyspneic, has a productive cough with green expectoration, and has difficulty speaking. His voice has waned, and he’s out of breath when answering questions from the LPN, who notices that the patient’s extremities are cold and bluish. The patient’s vital signs are as follows: B.P. at 90/42, pulse at 112 beats/minute, resp. at 32 breaths/min, SpO2 at 85% and temperature at 38’C. Which of the following clinical manifestations relates to the patient’s condition? *