Question 1

Which breath sounds would be expected to be heard when auscultating the chest of a patient with a flail chest?

Accepted Answer

A)  Diminished over the flail chest section only 
B)  Diminished over both lungs 
C)  Crackles over the flail chest section 
D)  Bilateral wheezing 
A)  Diminished over the flail chest section only 
B)  Diminished over both lungs 
C)  Crackles over the flail chest section 
D)  Bilateral wheezing B

Question 2

Which of the following statements is true regarding paradoxical chest movement?

Accepted Answer

A)  With inspiration, the flail section moves outward. 
B)  The trachea deviates away from the flail side of the chest. 
C)  During inspiration, the flail section moves inward. 
D)  During exhalation, the flail area moves inward. 
A)  With inspiration, the flail section moves outward. 
B)  The trachea deviates away from the flail side of the chest. 
C)  During inspiration, the flail section moves inward. 
D)  During exhalation, the flail area moves inward. C

Question 3

Which of the following would be recommended for the management of an adult with a severe flail chest?
1) Continuous positive airway pressure (CPAP)
2) Pain management
3) Mechanical ventilation
4) Positive end-expiratory pressure (PEEP)

Accepted Answer

A) 1, 2 
B) 2, 3 
C) 2, 3, 4 
D) 1, 3, 4 
A) 1, 2 
B) 2, 3 
C) 2, 3, 4 
D) 1, 3, 4 C

Question 4

Which of the following chest radiograph findings would be expected for a patient with a flail chest?
1) Increased opacity
2) Rib fractures
3) Decreased opacity
4) Tracheal deviation

Accepted Answer

A) 1, 2 
B) 1, 4 
C) 2, 3 
D) 2, 4 
A) 1, 2 
B) 1, 4 
C) 2, 3 
D) 2, 4

Question 5

When a patient has a flail chest, what happens during the ventilatory cycle?

Accepted Answer

A)  The I:E ratio becomes inverse. 
B)  Air leaks out through the flail area. 
C)  Air leaks in through the flail area. 
D)  Air is shunted from one lung to the other. 
A)  The I:E ratio becomes inverse. 
B)  Air leaks out through the flail area. 
C)  Air leaks in through the flail area. 
D)  Air is shunted from one lung to the other.

Question 6

A patient with a flail chest is experiencing pendelluft. Which of the following would be expected in a patient with a flail chest with pendelluft?
1) Hypoventilation
2) Hypertension
3) Cyclical deeper and then more shallow breathing
4) Rebreathing dead-space gas

Accepted Answer

A) 1, 4 
B) 1, 3 
C) 2, 3, 4 
D) 1, 3, 4 
A) 1, 4 
B) 1, 3 
C) 2, 3, 4 
D) 1, 3, 4

Question 7

What is the primary cause of hypoxemia in a patient with a severe flail chest?

Accepted Answer

A)  Myocardial contusion 
B)  Hemorrhage 
C)  Pulmonary edema 
D)  Alveolar atelectasis 
A)  Myocardial contusion 
B)  Hemorrhage 
C)  Pulmonary edema 
D)  Alveolar atelectasis

Question 8

While assessing a patient who was involved in a serious car crash and hit his steering wheel, the respiratory therapist observes that a section of his left anterior chest wall sinks inward during inspiration. What is the most likely cause?

Accepted Answer

A)  Pulmonary fibrosis 
B)  Flail chest 
C)  Pneumothorax 
D)  Cardiac tamponade 
A)  Pulmonary fibrosis 
B)  Flail chest 
C)  Pneumothorax 
D)  Cardiac tamponade

Question 9

What is the most common finding at the site of the flail portion of a flail chest?

Accepted Answer

A)  Pulmonary contusion 
B)  Pulmonary abscess 
C)  Pulmonary edema 
D)  Pulmonary fibrosis 
A)  Pulmonary contusion 
B)  Pulmonary abscess 
C)  Pulmonary edema 
D)  Pulmonary fibrosis

Question 10

Which of the following initial blood gas results would a respiratory therapist expect to find in a patient with a mild flail chest?

Accepted Answer

A)  Elevated pH and elevated SaO2 
B)  Decreased pH and decreased SaO2 
C)  Increased pH and decreased SaO2 
D)  Decreased pH and increased SaO2 
A)  Elevated pH and elevated SaO2 
B)  Decreased pH and decreased SaO2 
C)  Increased pH and decreased SaO2 
D)  Decreased pH and increased SaO2

Question 11

How many days of ventilatory support are anticipated for a patient with a flail chest to allow sufficient time for bone healing?

Accepted Answer

A)  3 to 5 days 
B)  5 to 10 days 
C)  12 to 15 days 
D)  18 to 21 days 
A)  3 to 5 days 
B)  5 to 10 days 
C)  12 to 15 days 
D)  18 to 21 days

Question 12

Which of the following accurately describes a flail chest?

Accepted Answer

A)  Double fractures of two adjacent ribs 
B)  Double fractures of three adjacent ribs 
C)  Single fracture of three adjacent ribs 
D)  Triple fractures of two adjacent ribs 
A)  Double fractures of two adjacent ribs 
B)  Double fractures of three adjacent ribs 
C)  Single fracture of three adjacent ribs 
D)  Triple fractures of two adjacent ribs

Question 13

Which of the following are pathologic changes associated with a flail chest?
1) Pneumothorax
2) Secondary pneumonia
3) Pleural effusion
4) Elevated diaphragms

Accepted Answer

A) 1, 2 
B) 3, 4 
C) 1, 3, 4 
D) 2, 3, 4 
A) 1, 2 
B) 3, 4 
C) 1, 3, 4 
D) 2, 3, 4

Question 14

Which of the following are causes of a flail chest?
1) Blast injury
2) Motor vehicle accident
3) Split sternum for open heart surgery
4) Fall from heights

Accepted Answer

A) 1, 3 
B) 1, 2, 4 
C) 2, 3, 4 
D) 1, 2, 3 
A) 1, 3 
B) 1, 2, 4 
C) 2, 3, 4 
D) 1, 2, 3

Question 15

What is the term for abnormal gas movement from one lung to the other?

Accepted Answer

A)  Paradoxical movement 
B)  Pendelluft 
C)  Palindromic breathing 
D)  Pneumatic shift 
A)  Paradoxical movement 
B)  Pendelluft 
C)  Palindromic breathing 
D)  Pneumatic shift

Question 16

Which of the following can stimulate an increased respiratory rate when a flail chest is present?
1) Activation of deflation receptors
2) Activation of irritant receptors
3) Stimulation of J receptors
4) Hypotension

Accepted Answer

A) 1, 3 
B) 1, 4 
C) 1, 2, 3 
D) 2, 3, 4 
A) 1, 3 
B) 1, 4 
C) 1, 2, 3 
D) 2, 3, 4

Exam 22: Flail Chest

Which breath sounds would be expected to be heard when auscultating the chest of a patient with a flail chest?

Which of the following statements is true regarding paradoxical chest movement?

Which of the following would be recommended for the management of an adult with a severe flail chest? 1) Continuous positive airway pressure (CPAP) 2) Pain management 3) Mechanical ventilation 4) Positive end-expiratory pressure (PEEP)

Which of the following chest radiograph findings would be expected for a patient with a flail chest? 1) Increased opacity 2) Rib fractures 3) Decreased opacity 4) Tracheal deviation

When a patient has a flail chest, what happens during the ventilatory cycle?

A patient with a flail chest is experiencing pendelluft. Which of the following would be expected in a patient with a flail chest with pendelluft? 1) Hypoventilation 2) Hypertension 3) Cyclical deeper and then more shallow breathing 4) Rebreathing dead-space gas

What is the primary cause of hypoxemia in a patient with a severe flail chest?

While assessing a patient who was involved in a serious car crash and hit his steering wheel, the respiratory therapist observes that a section of his left anterior chest wall sinks inward during inspiration. What is the most likely cause?

What is the most common finding at the site of the flail portion of a flail chest?

Which of the following initial blood gas results would a respiratory therapist expect to find in a patient with a mild flail chest?

How many days of ventilatory support are anticipated for a patient with a flail chest to allow sufficient time for bone healing?

Which of the following accurately describes a flail chest?

Which of the following are pathologic changes associated with a flail chest? 1) Pneumothorax 2) Secondary pneumonia 3) Pleural effusion 4) Elevated diaphragms

Which of the following are causes of a flail chest? 1) Blast injury 2) Motor vehicle accident 3) Split sternum for open heart surgery 4) Fall from heights

What is the term for abnormal gas movement from one lung to the other?

Which of the following can stimulate an increased respiratory rate when a flail chest is present? 1) Activation of deflation receptors 2) Activation of irritant receptors 3) Stimulation of J receptors 4) Hypotension

The Patient Interview

The Physical Examination

The Pathophysiologic Basis for Common Clinical Manifestations

Pulmonary Function Testing

Blood Gas Assessment

Assessment of Oxygenation

Assessment of the Cardiovascular System

Radiologic Examination of the Chest

Other Important Tests and Procedures

The Therapist-Driven Protocol Program

Respiratory Insufficiency, Respiratory Failure and Ventilatory Management Protocols

Recording Skills and Intra-Professional Communication

Chronic Obstructive Pulmonary Disease, Chronic Bronchitis and Emphysema

Asthma

Cystic Fibrosis

Bronchiectasis

Atelectasis

Pneumonia, Lung Abscess Formation, and Important Fungal Diseases

Tuberculosis

Pulmonary Edema

Pulmonary Vascular Disease: Pulmonary Embolism and Pulmonary Hypertension

Pneumothorax

Pleural Effusion and Empyema

Kyphoscoliosis

Cancer of the Lung, Prevention and Palliation

Interstitial Lung Diseases

Acute Respiratory Distress Syndrome

Guillain-Barré Syndrome

Myasthenia Gravis

Cardiopulmonary Assessment and Care of Patients With Neuromuscular Disease

Sleep Apnea

Newborn Assessment and Management

Pediatric Assessment, Protocols, and Pals Management

Meconium Aspiration Syndrome

Transient Tachypnea of the Newborn

Respiratory Distress Syndrome

Pulmonary Air Leak Syndrome

Respiratory Syncytial Virus Infection Bronchiolitis

Chronic Lung Disease of Infancy

Congenital Diaphragmatic Hernia

Congenital Heart Disease

Croup and Croup-Like Syndromes: Laryngotracheobronchitis, Bacterial Tracheitis, and Acute Epiglottitis

Near Drowningwet Drowning

Smoke Inhalation, Thermal Injuries, and Carbon Monoxide Intoxication

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