TEST BANK for Mosby’s Respiratory Care Equipment 10th Edition by J. M. Cairo by ACADEMIAMILL

Mosby’s Respiratory Care Equipment 10th Edition Cairo Test Bank Chapter 01: Basic Physics for the Respiratory Therapist Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. Power is a measure of which of the following? a. Mechanical energy b. Gravitational potential energy c. The rate at which work is being performed d. The rate at which atoms and molecules move ANS: C Power is a measure of the rate at which work is being performed. The formula P = W/J, where W = watts and 1 watt is equal to 1 J/s, expresses this. Joules are the international standard for expressing energy and work. PTS:

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2. When effort produces a change in the position of matter a. work is performed. b. it is known as a joule. c. mechanical power is created. d. the law of the conservation of energy is being used. ANS: A Work is performed only T wE heSnTeB ffA orNt K orSoEuL tsL idE eR fo.rcCeO s pMroduce a change in the position of matter. PTS:

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3. The unit used to express the force of 1 N acting on a 1-kg object to move it 1 m is which of the following? a. Watt b. Joule c. Kilowatt d. Kinetic energy (KE) ANS: B One joule is equal to the force of 1 N acting on 1 kg. A watt is equivalent to 1 J/s. A kilowatt is simply 1000 W. KE is energy an object possesses when it is in motion. PTS:

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4. Power is expressed in which of the following units? a. Newtons b. Joules c. Ohms d. Watts ANS: D

Power is a measure of the rate at which work is being performed. Energy and work are measured in joules. One joule is the force of 1 N acting on a 1-kg object to move it 1 m. Ohms is the resistance an electrical circuit possesses. PTS:

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5. Four horsepower (hp) is equal to how many kilowatts (kW)? a. 5.36 b. 2.98 c. 2984 d. 186.5 ANS: B 1 hp = 0.746 kW. 1 hp/0.746 = 4 hp/X. X = 4  0.476 = 2.98 kW. PTS:

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6. The energy that an object possesses when it is in motion is called a. sound. b. kinetic. c. thermal. d. potential. ANS: B KE is the energy an objeT ctEpS osTsB esA seNs KwShE enLiL t sEtaRy. sC inOmMotion. Potential energy is stored energy, and it exists in many forms such as thermal energy or sound waves. PTS:

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7. If the velocity of an object is reduced by half, its KE will be which of the following? a. Reduced to one-eighth b. Increased twofold c. Reduced twofold d. Not changed ANS: A Kinetic energy = 1/2(mass of object  square of velocity it is traveling, or mv2) or KE = 1/2(V  V). If the velocity is reduced by half, then KE = 1/2(1/2V  1/2V), or 1/2(1/2) = 1/8 reduction. PTS:

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8. Energy that is stored in an object is called which of the following? a. Kinetic b. Potential c. Chemical d. Mechanical ANS: B

Energy that is stored or possessed by an object because of its position is called potential energy. Mechanical energy can be divided into either KE or potential energy. Chemical potential energy often refers to the bonds in petroleum oils that, if broken, can be converted to KE. PTS:

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9. The potential energy of a compressed spring is known as which of the following? a. Gravitational b. Chemical c. Inelastic d. Elastic ANS: D The potential energy stored in a compressed spring is called elastic potential energy. This energy is released when the spring is allowed to uncoil. Gravitational potential energy is the energy an object possesses if it is held above any surface, energy that the object’s weight gains as it falls. Chemical potential energy resides in the chemical bonds of the atoms that make up the object. Inelastic potential energy would not apply once the spring is compressed. PTS:

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10. The energy stored in heating oil is known as which of the following? a. Elastic b. Atomic c. Chemical d. Gravitational ANS: C Petroleum reserves of coal, oil, and gas represent chemical potential energy by virtue of the chemical bond that must be broken to release energy. Heating oil potential energy has chemical-to-chemical bonds. Atomic energy involves two processes—fission (splitting atoms) and fusion (joining two atoms). PTS:

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11. The kinetic theory holds that a. all matter is composed of tiny particles. b. elements combine in fixed proportions to form molecules. c. the energy that an object gains as it falls is a result of gravity. d. atoms and molecules that make up matter are in constant motion. ANS: D KE is the energy an object possesses while in motion. PTS:

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12. Which is the correct order for increasing size? a. Atoms, molecules, mixtures, compounds, elements

b. Atoms, elements, molecules, compounds, mixtures c. Elements, atoms, molecules, compounds, mixtures d. Atoms, elements, mixtures, molecules, compounds ANS: B All matter, whether in gas, liquid, or solid form, is made up of atoms that can combine to form elements; the elements can then combine to form molecules. Molecules can combine to form compounds. Combining compounds makes a mixture. PTS:

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13. Atoms and molecules arranged in an orderly fashion are called a. solids. b. mixtures. c. crystalline. d. amorphous. ANS: C Crystalline solids are highly organized structures whose atoms and molecules are arranged in a lattice configuration. Amorphous solids have atoms and molecules that are less rigidly arranged. PTS:

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14. The most potential energy is contained by which state of matter? a. Gases b. Solids c. Liquids d. Mixtures ANS: B Of all states of matter, solids contain the most potential energy; solids are followed by liquids and then gases. PTS:

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15. Which of the following are amorphous solids? 1. Iron 2. Glass 3. Steel 4. Margarine a. 1 b. 1 and 3 c. 2 and 4 d. 2, 3, and 4 ANS: C Glass and margarine are always considered amorphous solids. Steel and iron, however, have well-organized atoms in a crystalline arrangement. PTS:

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16. Supercooled liquids are also known as which of the following? a. Elements b. Compounds c. Crystalline solids d. Amorphous solids ANS: D Amorphous solids are sometimes called supercooled liquids. Elements and compounds alone can combine to form either crystalline or amorphous solids. PTS:

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17. The least amount of KE is possessed by which one of the following? a. Air b. Iron c. Water d. Plastic ANS: B Of the three states of matter, solids possess the least amount of KE. The bonds holding their atoms together limit the mobility of the particles that make up the solid. PTS:

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18. Incompressible substances that are able to maintain their volume and shape are called a. gases. b. solids. c. liquids. d. compounds. ANS: B Solids are characterized as incompressible substances that can maintain their volume and shape. Gases and liquids do not maintain their volume and shape as well as solids do. PTS:

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19. The weakest cohesive forces between constituent particles are present in which of the following? a. Water b. Plastic c. Hydrogen d. Liquid oxygen ANS: C Gases have extremely weak or no cohesive forces between their atoms. Hydrogen is the only gas among the four choices. PTS:

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20. What forces must be overcome for evaporation to occur?

1. The mass attraction of the molecules for each other 2. The pressure of the gas above the liquid 3. The decrease of KE 4. The pressure of the gas below the liquid a. 1 and 4 b. 1 and 2 c. 2 and 3 d. 3 and 4 ANS: B Two forces must be overcome for evaporation to occur: the mass attraction of the molecules for each other (i.e., dipole–dipole interactions, hydrogen bonding, and Van der Waals forces) and the pressure of the gas above the liquid. PTS:

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21. The temperature at which a solid converts to a liquid is the a. freezing b. melting c. boiling d. critical

point.

ANS: B This is the definition of melting point. Freezing is the change of a substance from a liquid to a solid. Melting is the change from a solid to a liquid. The temperature at which a liquid converts to a gaseous state is the boiling point. The critical point is used to describe the critical temperature and cTrE itiS caTl B prAeN ssK urSeEoL f aLsEuR bs.taCnO ceM. PTS:

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22. Which of the following statements are true concerning the latent heat of fusion? 1. It is also called evaporation. 2. It is expressed in calories per gram. 3. It will cause a complete change of state. 4. It is expressed in grams per degree Celsius. a. 1 and 2 b. 1 and 3 c. 2 and 3 d. 2, 3, and 4 ANS: C Latent heat of fusion is the amount of heat, in calories, that must be added to cause a complete change of state. Evaporation is change from liquid to gas. Latent heat is expressed as calories per gram. Evaporation is the passive change of state over time, with no addition of heat. PTS:

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23. The process whereby a solid directly becomes a gas is known as a. latent heat.

b. sublimation. c. evaporation. d. condensation. ANS: B The direct change of state from solid to gas is called sublimation. Evaporation involves change from liquid to gas. Latent heat involves a change of state in matter of any form. PTS:

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24. Which two of the following are ways to increase the rate of evaporation? 1. Decrease the temperature of the liquid 2. Increase the temperature of the liquid 3. Decrease atmospheric pressure 4. Increase atmospheric pressure a. 1 and 3 b. 1 and 4 c. 2 and 3 d. 2 and 4 ANS: C The rate of evaporation increases with an increase in temperature, an increase in surface area, or a decrease in pressure. PTS:

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25. How much pressure musT t bEeSaT ppBlA ieN dK toSm eqCuO iliM brium between liquid and gaseous EaLinLtaEinR. oxygen at its critical temperature? a. 1 atm b. 37 atm c. 43.9 atm d. 49.7 atm ANS: D When the atmospheric pressure is maintained at 49.7 atm, at a temperature of 119°C (oxygen’s critical temperature), oxygen maintains an equal balance between its liquid and gaseous states. PTS:

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26. The temperature at which a liquid converts to a gaseous state is known as which of the following? a. Critical temperature b. Vapor pressure c. Boiling point d. Latent heat ANS: C

The boiling point is the temperature at which the vapor pressure of a liquid equals atmospheric pressure. Critical temperature is the temperature above which gases cannot convert back to liquid. Critical pressure is the amount of pressure applied at the critical temperature to maintain balance between the liquid and gas phases. PTS:

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27. The temperature above which gas molecules cannot be converted back to a liquid, no matter how much pressure is exerted, is known as which of the following? a. Critical temperature b. Critical point c. Boiling point d. Latent heat ANS: A This is the definition of critical temperature. PTS:

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28. The boiling point of liquid oxygen is which of the following? a. 119°C b. 182°F c. 183°C d. 49.7°C ANS: C This is the boiling point T ofEliSqT uiB dA oxNyKgS enE. LLER.COM PTS:

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29. Which two of the following are considered vapors? 1. Carbon dioxide 2. Nitrogen 3. Oxygen 4. Nitrous oxide a. 1 and 3 b. 1 and 4 c. 2 and 3 d. 2 and 4 ANS: B Substances such as nitrous oxide and carbon dioxide have critical temperatures above room temperature and thus can exist as vapors. PTS:

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30. How many degrees Fahrenheit is 200°K? a. 99.4°F b. 58.3°F c. 32°F

d. 0°F ANS: A Use the formula in Box 1.3 to calculate this conversion. PTS:

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31. Absolute zero is which of the following? a. 0°K b. The freezing point of water c. Routinely measured in Fahrenheit d. The temperature at which all molecular motion stops ANS: A On the Kelvin scale, 0°K is absolute zero. PTS:

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32. 20°C equals how many Kelvin? a. 32°K b. 68°K c. 253°K d. 293°K ANS: D See Fig. 1.3 in the textbook. PTS:

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33. How many degrees Celsius is 373°K? a. 32°C b. 100°C c. 273°C d. 341°C ANS: B See Box 1.3. PTS:

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34. How many degrees Fahrenheit is 100°K? a. 331°F b. 279°F c. 173°F d. 212°F ANS: B See Box 1.3. PTS:

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35. How many degrees Fahrenheit is 425°K? a. 152°F b. 274°F c. 306°F d. 698°F ANS: C See Box 1.3. PTS:

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36. Which two of the following temperatures are not equal? 1. 15°C = 288°K 2. 98.6°C = 32°F 3. 20°F = 6.7°C 4. 100°C = 273°K a. 2 and 4 b. 1 and 3 c. 3 and 4 d. 1 and 2 ANS: A See Box 1.3. PTS:

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37. How many degrees CelsiTuE s iSs T 10B1A°F N?KSELLER.COM a. 24°C b. 145°C c. 38.3°C d. 56.1°C ANS: C See Box 1.3. PTS:

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38. How many degrees Kelvin is 25°F? a. 298°K b. 277°K c. 269°K d. 266°K ANS: C See Box 1.3. PTS:

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39. How many millimeters of mercury is 25 cm H2O? a. 2.45 b. 18.4

c. 188 d. 34 ANS: B See Box 1.4. PTS:

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40. How many kilopascals are equal to 15 mm Hg? a. 2 b. 11 c. 153 d. 1.47 ANS: A See Box 1.4. PTS:

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41. A reduction in the force of gravity will cause the atmospheric pressure to a. shift. b. increase. c. decrease. d. remain constant. ANS: C Atmospheric pressure is highest at sea level. An increase in altitude will cause atmospheric pressure to decrease, whiTcE hS leT adBsAtoNaKdSeE crL eaLsE eR in.thCeOfM orce of gravity. PTS:

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42. What are the two opposing forces in a mercury barometer? a. The weight of the mercury column and the force of the gas molecules b. The weight of the mercury column and the spring tension c. The spring tension and the gas pressure d. The gravity and the gas pressure ANS: A In a mercury barometer the weight of a column of mercury must equilibrate with the force of the gas molecules. PTS:

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43. The effects of buoyancy are best explained by a. Archimedes principle. b. Bernoulli principle. c. Dalton’s law. d. Boyle’s law. ANS: A

Buoyancy occurs when an object is submerged in water. The object feels lighter than it is above water. The Bernoulli principle, Dalton’s law, and Boyle’s law relate to how gases or fluids vary with changes in pressure, volume, or temperature. PTS:

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44. Specific gravity is best described as which of the following? 1. A measure of density 2. An application of Archimedes principle 3. A measurement that can be performed on liquids only 4. An application of Boyle’s law a. 1 and 4 b. 1 and 2 c. 2 and 3 d. 2, 3, and 4 ANS: B Specific gravity calculations use Archimedes principle in comparing a substance’s weight and density relative to a standard. The measurement of specific gravity can also be applied to gases. PTS:

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45. The viscosity of a fluid is primarily determined by 1. the cohesive forces between its molecules. 2. its density. 3. the number of collisioT nsEoSf T thBe A mNoK leS cuEleLsL . ER.COM 4. free flow. a. 1 b. 1 and 2 c. 3 and 4 d. 2 and 4 ANS: B Viscosity can be defined as the force opposing deformation of a fluid. The viscosity of a fluid depends on its density and on the cohesive forces between its constituent molecules (i.e., as the cohesive forces of a fluid increase, so does its viscosity). PTS:

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46. In which of the following substances can sublimation take place? a. Dry ice b. Gelatin (e.g., Jell-O) c. Water d. Glass ANS: A

This process, called sublimation, occurs when the heat content of a substance increases to a point at which the molecules in the solid state gain enough energy to break loose and enter the gaseous state while remaining below its melting point. The conversion of solid carbon dioxide (i.e., dry ice) to gaseous carbon dioxide is the most common example of this process. PTS:

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47. A hydrometer is usually associated with measuring which of the following? 1. Hydrogen content 2. Specific gravity 3. Weight density 4. Water vapor a. 1 and 3 b. 2 and 4 c. 2 and 3 d. 1, 2, and 3 ANS: C Hydrometers are used to measure the weight density or specific gravity of liquids. PTS:

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48. Which of the following are components in respiration? 1. Sublimation 2. Condensation 3. Evaporation 4. Vaporization a. 1 b. 2 and 3 c. 2 and 4 d. 1, 2, and 4 ANS: B Evaporation and condensation are essential components of respiration. Specifically, effective ventilation requires a balance between the evaporation and condensation of the moisture of respired gases so that the airway mucosa are not dried and irritated. PTS:

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49. Forces at the molecular interface between oil and water are known as a. van der Waals b. hydrostatic c. cohesive d. adhesive ANS: C

_ forces.

Surface tension is generated by the cohesive forces of molecules at a gas–liquid interface or at the interface of two immiscible liquids, such as oil and water. Adhesive forces are attractive forces between two different kinds of molecules, and van der Waals forces are physical intermolecular forces that cause molecules to be attracted to each other. PTS:

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50. Surface tension is present in a container with which of the following? a. Oxygen and hydrogen b. Water and mercury c. Water and chlorine d. Water and salt ANS: B When water and mercury are mixed together, they will separate into two distinct liquids because of surface tension. Oxygen and hydrogen will combine to form water. Both salt and chlorine will dissolve in water easily. PTS:

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51. A small-diameter glass tube is placed upright in a container of mercury. The meniscus at the top of the column of mercury is convex. This demonstrates that the a. cohesive forces of mercury are weak. b. cohesive forces of mercury are strong. c. adhesive forces within the mercury are strong. d. adhesive forces between the mercury and the glass are strong. ANS: B The cohesive forces within the mercury are stronger than the adhesive forces between the mercury and the glass. If the cohesive forces within the mercury were weaker than the adhesive forces, the meniscus would be concave. See Box 1.5. PTS:

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52. According to the Système International d’Unités, surface tension is measured in a. cc3. b. lb/in2. c. lb/cc3. d. dyne/cm. ANS: D In the Système International d’Unités system of measurements, surface tension is measured in dyne per centimeter. PTS:

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53. Which substance has the lowest surface tension? a. Water at 20°C b. Water at 37°C c. Blood at 37°C

d. Ethyl alcohol at 20°C ANS: D See Table 1.2. PTS:

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54. The surface tension of a liquid a. does not vary with temperature. b. increases as temperature increases. c. increases as temperature decreases. d. decreases as temperature increases. ANS: D The surface tension of any given liquid varies inversely with its temperature. Adding heat to a liquid causes the molecules to move more vigorously and break the bonds that are holding them in liquid form. PTS:

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55. According to Laplace’s law, if the surface tension of a sphere is doubled, what will happen to the pressure within the sphere? a. The pressure will decrease by one half. b. The pressure will increase by one half. c. The pressure will quadruple. d. The pressure will double. ANS: D Laplace’s law, P = 2(ST/r), states that the pressure within a sphere is directly related to the surface tension of the liquid and inversely related to the radius of the sphere; that is, both surface tension and pressure within a sphere will change equally in the same proportion. PTS:

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56. What will happen to the surface tension of water droplets when a surface-active agent is added? a. Nothing will happen. b. It will increase. c. It will decrease. d. It will be eliminated. ANS: C Surface tension is the force exerted by like molecules at the liquid’s surface. The introduction of a surface-active agent (e.g., soap) would decrease the cohesive forces between the water droplets, thus reducing their surface tension at the surface. With liquids (e.g., water), surface tension can be made to increase or decrease, but it cannot be eliminated. See Fig. 1.9. PTS:

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57. Which of the following shows the correct relationship among density, volume, and mass?

1. Density = volume/mass 2. Volume = density/mass 3. Mass = (density)/(volume) 4. Weight density = weight/volume a. 1 and 3 b. 1 and 4 c. 2 and 3 d. 3 and 4 ANS: D Given density, d = mass (m)/volume (v), the equation can be solved for each variable: m = dv, v = m/d. When mass is substituted by weight, dw = w/v. PTS:

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58. Under what conditions is the relationship between mass and weight constant? a. In outer space b. At zero gravity c. At the center of the Earth d. Near the surface of the Earth ANS: D Near the surface of the Earth, two equations apply: d = m/v, dw = w/v. In space and at zero gravity, weight is not a factor; at the Earth’s core, extreme gravitational forces would increase the weight as mass remained constant. PTS:

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59. For solids and liquids, density can be expressed in which of the following units? 1. g/L 2. mg/mL 3. g/cc 4. L/cc a. 1 b. 2 and 3 c. 2 and 4 d. 1, 2, and 3 ANS: D For solids and liquids, density = grams (g)/liter (L) or grams (g)/cubic centimeter (cm3). Using d = g/L, divide both sides by 1000. Density can also be expressed in mg/mL. PTS:

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60. Boyle’s law describes the relationship between which of the following? a. Pressure and temperature b. Volume and temperature c. Volume and pressure d. Pressure and density ANS: C

Boyle’s law states that at a constant temperature, the volume of a gas varies inversely proportional to pressure [V = 1/P]. The relationship between volume and temperature is expressed in Charles’ law. The relationship between pressure and temperature is described by Gay-Lussac’s law. PTS:

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61. If temperature is constant, which pressure results in the largest volume? a. 15 mm Hg b. 760 mm Hg c. 1520 mm Hg d. 2000 mm Hg ANS: A See Fig. 1.10. PTS:

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62. Which of the following formulas represents Boyle’s law? a. V = 2P b. V = 1/2P c. P1V1 = P2V2 d. P1/P2 = V1/V2 ANS: C Boyle’s law can be expressed as a ratio: P1V1 = P2V2. PTS:

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63. The relationship of how the volume of a gas varies with temperature is known as a. Gay-Lussac’s b. Newton’s c. Charles’ d. Boyle’s

law.

ANS: C The relationship between pressure and volume is described by Boyle’s law; between volume and temperature, by Charles’ law; between pressure and temperature, by Gay-Lussac’s law. Newton detailed the many relationships of gravitational force and motion. PTS:

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64. Which of the following formulas represents Gay-Lussac’s law? a. P1/T1 = T2/P2 b. P1/T1 = P2/T2 c. P1T2 = P2T1 d. P = 1/T ANS: B Gay-Lussac expressed the relationship between pressure and temperature. If P/T = K (where K = constant), then P1/T1 = P2/T2.

PTS:

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65. Which gas law describes the relationship between the temperature and pressure of a gas when volume is constant? a. Gay-Lussac’s law b. Charles’ law c. Dalton’s law d. Boyle’s law ANS: A Gay-Lussac expressed the relationship between pressure and temperature. PTS:

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66. The direct relationship between the volume and temperature of a gas is the basic principle of law. a. Gay-Lussac’s b. Charles’ c. Dalton’s d. Boyle’s ANS: B Charles’ law is stated as follows: that the volume of a given amount of gas held at a constant pressure increases proportionately with increases in the temperature of the gas. The relationship between volume and temperature can be explained by the fact that as the temperature of the gas inT crEeaSsT esB, A thN eK KS EEoL f tLhE eR ga.sCmOoM lecules increases. PTS:

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67. It is implied that the absolute temperature of a gas will rise as the pressure is increased when which of the following occurs? a. Absolute temperature of the gas reaches absolute zero b. Size of the container remains constant c. Volume of the gas is held constant d. Volume of the gas is increased ANS: C When the volume of a gas is constant, the temperature of the gas will rise as the pressure is increased (Gay-Lussac’s law). Absolute zero is a theoretical temperature that has never been reached. The size of the container does not vary directly with volume. PTS:

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68. The combined-gas law best describes which of the following? a. The behavior of all gases when volume is constant b. The combined behavior of pressure, volume, and temperature c. The additive properties of individual gases occupying the same space d. The macroscopic behavior of gases when any or all variables change simultaneously

ANS: D The combined-gas law describes the macroscopic behavior of gases when any or all of the variables change simultaneously. As such, the combined-gas law states that the absolute pressure of a gas is inversely related to the volume it occupies and directly related to its absolute temperature, or PV/T = nR. PTS:

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69. Which is the correct formula for the principles of the combined-gas law? a. P1V1/T1 = P2V2/T2 b. PVT = nR c. P1V1/T2 = P2V2/T1 d. T2/P1V1 = T1/P2V2 ANS: A That is the formula for the combined-gas law. PTS:

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70. In the combined-gas law, n represents a. Boltzmann’s universal gas constant. b. the atomic mass of the gas. c. the number of moles of gas. d. the partial pressure of a gas. ANS: C Boltzmann’s constant is T reE prSeT seB ntAedNK asSRE. L TL heEcRo. mC biOnM ed-gas laws do not use the atomic mass or the partial pressure of any gas as a variable in any calculations presented in answers B and D. PTS:

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71. The sum of the partial pressures of a gas mixture equals the total gas pressure of the system. This statement represents which of the following laws? a. Dalton’s law b. Avogadro’s law c. The combined-gas law d. Boltzmann’s Universal Gas Constant ANS: A The correct answer is Dalton’s law. This law states that the total pressure of a gas is equal to the sum of the partial pressure of the gases that make up the mixture. The partial pressure of a gas within a gas mixture can be calculated by multiplying the total pressure of the mixture by the percentage of the mixture it occupies. PTS:

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72. The partial pressure of a gas can be obtained by doing which of the following? a. Multiplying the total mixture pressure by the percentage area a particular gas occupies

b. Multiplying the atmospheric pressure by the percentage of water vapor present c. Subtracting the partial pressure of water vapor from the atmospheric pressure d. Dividing the total pressure of a gas mixture by the atmospheric pressure ANS: A Dalton’s law states that the sum of the partial pressures of a gas mixture equals the total pressure of the system. Therefore, the partial pressure of a single gas may be calculated by multiplying the percentage of the gas in the gas mixture by the total pressure. PTS:

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73. The partial pressure of nitrogen at 1 atm is a. 661.2 b. 592.8 c. 159.6 d. 0.228

mm Hg.

ANS: B The partial pressure of nitrogen can be calculated by multiplying the barometric pressure by the percentage of nitrogen in the air, or 760 mm Hg  0.78 = 592.8 mm Hg. PTS:

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74. The partial pressure of oxygen when there is 25% oxygen in a gas mixture at an atmospheric pressure of 760 mm Hg is mm Hg. a. 190 b. 30.4 c. 1900 d. 159.6 ANS: A Partial pressure of oxygen = % oxygen  barometric pressure, or 0.25  760 mm Hg = 190 mm Hg. PTS:

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75. Which of the following does not follow Dalton’s law at sea level? a. Oxygen b. Nitrogen c. Water vapor d. Trace gases ANS: C Water vapor pressure does not follow Dalton’s law because such pressure primarily depends upon temperature. Water vapor pressure must be subtracted from the total pressure of a given mixture if the gas mixture is saturated with water. PTS:

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76. One mole of any gas will occupy 22.4 L and contain a. 6.02  1023

molecules.

b. 6.2  1023 c. 0.602  1023 d. 6.2  10-23 ANS: A 1 mole of oxygen (mw = 32 g) occupies a volume of 22.4 L and contains 6.02  1023 molecules when measured at 0°C (273°K) and 1 atm. PTS:

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77. A practical application of Avogadro’s law is seen in the calculation of which of the following? 1. Specific gravity 2. Diffusion rate 3. Gas density 4. Osmosis a. 1 and 2 b. 1 and 3 c. 2 and 4 d. 3 and 4 ANS: B A practical application of Avogadro’s law is seen in the calculation of gas densities and specific gravity. PTS:

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78. The molecular weight of a gas divided by 22.4 L is used to express which of the following? a. Density b. Diffusion rate c. Partial pressure d. Specific gravity ANS: A The density of a gas per unit volume can be calculated with the following formula: Density (gm/L) = mw of gas/22.4 L. PTS:

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79. At what temperature would you expect to see the highest water–vapor pressure? a. 0°C b. 40°C c. 100°C d. Absolute zero ANS: C The higher the temperature, the more water vapor a gas can hold. PTS:

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80. The movement of gas molecules from an area of high concentration to one of lower concentration describes the property of which of the following? a. Osmosis b. Effusion c. Diffusion d. Suspension ANS: C Diffusion is movement of molecules from areas of high concentrations to low concentrations. Effusion refers to the seepage or loss of blood through torn blood vessels. Osmosis describes the movement of water across a semipermeable membrane from a less-concentrated to a more-concentrated area. Suspensions are mixtures of solutions with undissolved particles or molecules. PTS:

REF: Page 15

81. Which gas has the lowest specific gravity at 25°C and 760 mm Hg? a. Water vapor b. Helium c. CO2 d. O2 ANS: B See Fig. 1.13. PTS:

REF: Page 15

82. Which law states that same temperature and pressure, when two gases placed proportional under the to the square root of their the rates of diffusion of both gases are are inversely densities? a. Graham’s law b. Henry’s law c. Mole’s law (also known as the ideal gas law) d. Fick’s law ANS: A Graham’s law states that when two gases are placed under the same temperature and pressure conditions, the rates of diffusion of the two gases are inversely proportional to the square root of their masses, or r1/r2 = M2/M1, where r1 and r2 represent the diffusion rates of the respective gases and M1 and M2 are the molar masses. PTS:

REF: Pages 15-16

83. Which of the following formula(s) best represent(s) Graham’s law? I. c p  s II. r1/r2 = d2/d1 III. D = S ÷ MW IV. r1/r2 = M2/M1 a. 1 b. 3

c. 2 and 4 d. 3 and 4 ANS: C Graham’s law states that when two gases are placed under the same temperature and pressure conditions, the rates of diffusion of the two gases are inversely proportional to the square root of their masses, or r1/r2 = M2/M1, where r1 and r2 represent the diffusion rates of the respective gases, and M1 and M2 are the molar masses. If the mass of a gas is considered directly proportional to its density at a constant temperature and pressure, then r1/r2 = d2/d1 where d1 and d2 are the densities of the gases in question. PTS:

REF: Pages 15-16

84. In the formula for Henry’s law, the c represents which of the following? a. Mass b. Density c. Solubility d. Partial pressure ANS: A c is the molar concentration (in mol/L) of the dissolved gas. PTS:

REF: Page 16

85. The law that describes the diffusion of a gas across a semipermeable membrane is law. a. Fick’s b. Henry’s c. Graham’s d. Charles’ ANS: A Fick’s law represents the flow of gases across semipermeable membranes. Henry’s law explains the relationship of a gas and a liquid in a combined space. Graham’s law involves the relationship of multiple gases placed under the same temperature and pressure, and Charles’ law states that the volume of gas varies directly with changes in temperature. PTS:

REF: Page 16

86. Fluid mechanics is a branch of physics that involves which of the following? 1. Hydrodynamics 2. Fluids in motion 3. Thermodynamics 4. Electrical properties of gases a. 2 b. 1 and 2 c. 1 and 4 d. 3 and 4 ANS: B

Fluid mechanics deals with the behavior of fluids in motion and involves fluid dynamics. Hydrodynamics is the study of fluids in motion. PTS:

REF: Page 16

87. Which of the following terms does not describe a pattern of flow? a. Tubular b. Laminar c. Turbulent d. Transitional ANS: A Tubular is the only word in the list that does not describe a pattern of flow. PTS:

REF: Page 17

88. When the movement of fluid molecules is streamlined, this flow is normally described as a. straight. b. laminar. c. turbulent. d. aerodynamic. ANS: B In laminar flow, the fluid flows in discrete cylindrical layers or streamlines. With turbulent flow, the movement of fluid becomes chaotic. Straight and aerodynamic are not terms that are used to describe the way fluid moves. PTS:

REF: Page 17

89. Fluid movement that is chaotic is known as a. random. b. turbulent. c. streamlined. d. transitional. ANS: B With turbulent flow, the movement of fluid molecules becomes chaotic and the orderly pattern of concentric layers seen with laminar flow is lost. Transitional flow is the mixture of laminar and turbulent flows. If the movement of fluid is said to be streamlined, it is laminar. Fluid mechanics does not describe the flow of fluids as being random. PTS:

REF: Page 17

90. When tubes have one or more branches, the flow becomes a. transitional. b. restricted. c. turbulent. d. laminar. ANS: A

Transitional flow is a mixture of laminar and turbulent flows that typically occur where tubes divide. See Fig. 1.15. Restricted flow occurs when narrowing or constrictions occur along the length of a tube. Laminar and turbulent flows can become restricted if an obstruction is encountered along the length of a tube. PTS:

REF: Page 17

91. The relationship between pressure, flow, and resistance for a liquid flowing through a tube represents a. Reynolds’ number. b. Poiseuille’s law. c. Venturi principle. d. Bernoulli principle. ANS: B When considering the flow of a liquid through a tube, you should take two factors into consideration: the driving pressure forcing the fluid and the resistance the liquid must overcome as it flows. Reynolds suggested that fluid flow becomes turbulent when velocity is increased or when there are changes in fluid density or viscosity and the radius of the tube. The Venturi and Bernoulli principles deal with the relationship between a liquid’s forward velocity and tubular lateral-wall pressure. PTS:

REF: Page 17

92. Applying the principles of Poiseuille’s law, which statement is true? a. The resistance offered by a tube is inversely proportional to its length. b. As the radius of a tubTeEdS ecTreBaA seNs,KthSeEpLreLsE suRre.gCraOdMient increases. c. The more viscous the fluid, the easier it is to move the fluid through a tube. d. The driving pressure of a gas is indirectly proportional with the length of the tube. ANS: B Poiseuille’s law can be rewritten as: P = Q  [(8nl)/(r4)]. According to this equation, the following statements can be made. The more viscous a fluid, the greater the pressure gradient required to cause it to move through a given tube. The resistance offered by a tube is directly proportional to its length. The pressure required to achieve a given flow through a tube must increase in direct proportion to the length of the tube. The resistance to flow is inversely proportional to the fourth power of the radius. Small changes in the radius of a tube will cause profound increases in the resistance to flow through that tube. PTS:

REF: Page 17

93. When you discuss the mechanics of breathing, which expression of Poiseuille’s law do you use? a. P =  R b. =P÷R c. =P÷R d. = 1/ ANS: C

Poiseuille’s law states that the pressure gradient required to cause a liquid to move through a tube is equal to the flow of the liquid through the tube multiplied by the resistance to flow. In a discussion of gases, the term flow of the liquid is replaced with flow of the gas. Therefore, the flow of the gas is equal to the pressure gradient divided by the resistance to flow. PTS:

REF: Page 17

94. Reynolds’ number is derived from which of the following components? a. Velocity of flow, radius of tube, density of gas, and velocity of gas b. Velocity of flow, length of tube, density of gas, and velocity of gas c. Velocity of gas, radius of tube, viscosity of flow, and density of gas d. Flow asymmetry, shape of tube, density of gas, and length of tube ANS: A The formula for Reynolds’ number is NR = v  d  (2r/), where v is the velocity of the flow; r is the radius of the tube, and d and η are the density and velocity of the gas, respectively. PTS:

REF: Pages 18-19

95. As a fluid flows through a tube of uniform diameter, pressure drops progressively over the length of the tube. This illustrates an application of which of the following? a. Coanda effect b. Venturi principle c. Bernoulli principle d. Reynolds’ number ANS: C Bernoulli stated that “As the forward velocity of a gas, or liquid, moving through a tube increases, the lateral wall pressure of the tube will decrease.” Venturi postulated that pressure drops of fluids moving through constriction along a tube can be reversed if there is gradual dilation in the tube distal to the constriction. The Coanda effect is also based on the Bernoulli principle and demonstrates that water or gas flow can be deflected through a full 180 degrees by careful placement of postconstriction extensions. Reynolds’ number is the result of this mathematical equation: NR = v  d  (2r/). The turbulent flow is greater when the Reynolds’ number exceeds 2000. PTS:

REF: Pages 18-19

96. Following the Bernoulli principle, when a fluid approaches a constriction in a tube, there will be a(n) in acceleration and a(n) in lateral pressure. a. decrease, decrease b. decrease, increase c. increase, decrease d. increase, increase ANS: C As fluid approaches a constriction in a tube, the flow of the liquid will accelerate (increase) as it enters the constriction, which in turn causes a decrease in lateral-wall pressure.

PTS:

REF: Pages 18-19

97. The pressure drop resulting from a constriction in a tube can be restored by which of the following? a. An increase in flow rate b. A postconstriction increase in radius c. The addition of another entrainment port d. A further decrease in the radius of the tube ANS: B This question involves the Venturi principle, which states that the pressure drop caused by fluid flowing through a tubular constriction can be restored to preconstriction values by allowing for a gradual dilation in the tube. PTS:

REF: Page 18

98. Placement of postconstriction extensions in a tube can deflect a flow 180 degrees along a new wall contour. This phenomenon illustrates the a. Coanda effect. b. Venturi principle. c. Bernoulli principle. d. Bernoulli–Coanda inversion. ANS: A Coanda was able to demonstrate that, with careful placement of the postconstriction extensions, he could deflT ecEt S aT stB reA am f aEirLtL hrEoR ug.hCaOfM ull 180-degree turn by extending the NKoS wall contour. PTS:

REF: Page 18

99. Electricity can be represented by the flow of which of the following? a. Negative ions through a nonconductive path b. Negative ions over a nonconductive circuit c. Electrons through a piece of copper wire d. Electrons in a bidirectional path ANS: C Electricity is produced by the flow of electrons through a conductive material such as copper. Electricity cannot flow through nonconductive material or simultaneously run bidirectionally along the same path. PTS:

REF: Page 19

100. An electrical current is influenced by which of the following? 1. Voltage 2. Resistance 3. Electromotive forces 4. The number of insulators a. 1 and 2

b. 2 and 4 c. 3 and 4 d. 3 and 4 ANS: A Electrical currents are influenced by voltage (the electromotive force pushing electrons forward) and the resistance electrons must overcome along the conductive pathway. An insulator is the material surrounding the conductive material and is usually made of plastic. PTS:

REF: Page 19

101. The standard unit of measure of an electrical current is which of the following? a. Milliampere b. Coulomb c. Ampere d. Volt ANS: C The standard unit of measurement of electrical current is the ampere (A), where 1 A is equivalent to 6.25  1018 electrons passing a point in 1 second. The term coulomb is used as a shorthand notation for 6.25  1018 electrons. The standard unit of measurement for voltage is the volt (V). A milliampere is equal to 0.001 A. PTS:

REF: Page 19

102. Which of the following correctly expresses Ohm’s law? a. R = I  V b. V = I  R c. I = V  R d. V = I/R ANS: B The relationships among current, voltage, and resistance can be explained with Ohm’s law: V = I  R. PTS:

REF: Page 19

103. According to Ohm’s law, assuming that the voltage is held constant, what will happen to the resistance if the current is doubled? a. It will remain the same. b. It will be doubled. c. It will quadruple. d. It will be halved. ANS: D Given the fact that when resistance is constant, there is a direct relationship between voltage and current; when voltage is constant, there is an indirect or inverse relationship between current and resistance. Therefore, if current is increased, resistance would have to decrease proportionately.

PTS:

REF: Page 19

104. A major disadvantage of a series circuit is which of the following? a. It is limited to one load. b. It can contain unlimited resistance. c. Electrical current will stop if a break occurs anywhere along the path. d. The circuit will remain up if a break occurs in one of the branches. ANS: C In a series circuit, there is only one path. If a break occurs anywhere in the path, the entire circuit will fail. PTS:

REF: Page 20

105. A series circuit contains a total resistance of 100 . If the circuit has three resistors and one of the resistors is 40 , what is the combined resistance of the last two resistors? a. 60  b. 2.5  c. 140  d. 0.04  ANS: A According to Kirchhoff’s laws regarding series circuits, total resistance is equal to the sum of all resistors in the circuit. If the circuit has three resistors, total resistance = A + B + C. Therefore, 100 = A + B + C. If one resistor is 40 , then 100 = 40 + B + C and the sum of B + C must equal 60 . PTS:

REF: Page 20

106. Which organ in the human body is most susceptible to electrical shock? a. Skin b. Heart c. Brain d. Lungs ANS: B Although all body tissues and organs are susceptible to electrical shock, the heart is the most vulnerable because it is governed by electricity. PTS:

REF: Pages 20-21

107. Electrical hazards can be prevented by which of the following? 1. Properly grounding the circuit 2. Using ground fault circuit interrupters (GFCIs) 3. Using only Underwriters Laboratories (UL)–approved electrical equipment 4. Using as many extension cords as necessary to keep the wires out of the way a. 1 and 2 b. 3 and 4 c. 2 and 3 d. 1, 2, and 3

ANS: D Grounding provides a path of least resistance that allows current to bypass the body in the event of a short circuit. GFCIs are circuit breakers that will trip when there is even a small difference between current flowing out through the device and current returning through the device. UL certifies devices that are plugged into current sources. PTS:

REF: Page 21

108. If 50% of the gas delivered to a patient is oxygen, its partial pressure at 1 atm is Hg. a. 265.0 b. 356.5 c. 380.0 d. 403.5

ANS: C The partial pressure of a gas in a mixture can be calculated by multiplying the total pressure of the mixture by the percentage of the mixture that the gas in question occupies. Therefore, 0.5  760 mm Hg = 380 mm Hg. PTS:

REF: Page 14

109. The standard unit of measurement for voltage is a. milliampere. b. coulomb. c. ampere. d. volt. ANS: D Voltage is measured using a voltmeter; the standard unit of measurement for voltage is the volt (V), which can be defined as the electrical potential required for 1A of electricity to move through 1ohm () of resistance. As with amperes, volts can be subdivided into smaller units, such as millivolts (mV) and microvolts (V). PTS:

REF: Page 20

110. Which of the following is a series-parallel circuit that consists of a direct current (DC) voltage source and a galvanometer that connects two parallel branches containing four resistors? a. Hunter Christie bridge b. Wheatstone bridge c. Transducer d. Circuit analysis ANS: B The Wheatstone bridge is a series-parallel circuit that consists of a DC voltage source (e.g., a battery) and a galvanometer that connects two parallel branches containing four resistors (R1, R2, R3, and RX). PTS:

REF: Page 20

111. Which of the following devices are used to measure atmospheric pressure? 1. Aneroid barometer 2. Wheatstone Bridge 3. Mercury barometer 4. Hygrometer a. 1 and 2 b. 1 and 3 c. 2 and 3 d. 3 and 4 ANS: B Atmospheric pressure can be measured with a barometer. The aneroid barometer (Fig. 1.5) measures atmospheric pressure by equilibrating the atmospheric gas pressure with a mechanical force, or the expansion force of an evacuated metal container. Atmospheric pressure can be measured with a barometer similar to the one shown in Fig. 1.4. The mercury barometer, which was invented by Evangelista Torricelli (c. 1608-1647), is the most commonly used device for measuring atmospheric pressure. (Torricelli was the first person to recognize the existence of atmospheric pressure; the pressure measurement torr is named in his honor.) PTS:

REF: Pages 9-10

Chapter 02: Principles of Infection Control Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. A 78-year-old man is being prepared for discharge following abdominal surgery, which he

underwent several days ago. The nurse notices that the patient has a temperature of 101.5F and has some tan secretions in his suture area. A specimen is sent to the laboratory. The results show the presence of Gram-positive cocci. The statement that might explain this condition is which of the following? a. The antibiotic was ineffective. b. The patient was not compliant with therapy. c. It is normal to have secretions at the suture site. d. A health care–associated infection should be considered. ANS: D

No antibiotic was mentioned in the scenario. There is no history of the patient receiving any medication for this problem, so compliance is not an issue with this situation. It is not normal to have secretions at a suture site. PTS: 1

REF: Page 25

2. A nosocomial infection is best defined as a a. respiratory system–borne pathogen. b. hospital-acquired pathogen. c. bacterial or viral organT isE mS . TBANKSELLER.COM d. blood-borne pathogen. ANS: B

A nosocomial infection is one that is acquired in a hospital setting. Respiratory system–borne pathogens and blood-borne pathogens can be acquired in the community. PTS: 1

REF: Page 25

3. Infectious diseases are typically caused by which of the following?

1. Ticks 2. Bacteria 3. Viruses 4. Algae a. 1 and 4 b. 2 and 3 c. 1, 2, and 4 d. 1, 2, and 3 ANS: D

Algae do not cause infectious diseases. Infectious diseases can be caused by ticks, bacteria, and viruses. PTS: 1

REF: Page 29, Table 2.3

4. Clinical microbiology is concerned with

the organism.

1. identifying 2. controlling 3. isolating 4. eradication of a. 1 and 4 b. 2 and 3 c. 1, 2, and 4 d. 1, 2, and 3 ANS: D

Clinical microbiology addresses the identification, isolation, and control of pathogens, not their eradication. PTS: 1

REF: Page 25

5. A prokaryotic, unicellular organism that ranges in size from 0.5 to 50 µm is usually classified

as which of the following? a. Virus b. Protozoan c. Bacterium d. Retrovirus ANS: C

This is the definition of a bacterium. PTS: 1

REF: Page 25

6. When speaking about the morphology of bacteria, one is referring to its a. size. b. shape. c. function. d. movement. ANS: B

There are three ways to classify bacteria: by its shape, by staining, and by its metabolic characteristics. Size, function, and movement are not characteristics used to classify bacteria. PTS: 1

REF: Page 25

7. Which of the following is a bacterium? a. Herpes simplex b. Pneumocystis jiroveci c. Pseudomonas aeruginosa d. Candida albicans ANS: C

Herpes is a virus; Pneumocystis carinii is a protozoan; and Candida albicans is a fungus. PTS: 1

REF: Page 26

8. A sputum specimen is received in the microbiology laboratory. Gram staining and a

microscopic examination reveal a paired, spherical, purple-stained organism. It can be reasonably assumed that this organism is which of the following? a. Gram-negative bacilli b. Gram-negative staphylococci c. Gram-positive diplococci d. Gram-positive bacilli ANS: C

Diplococci are spherically shaped bacteria that occur in pairs; Gram-positive organisms appear blue or violet. Gram-negative organisms have a red appearance from the counterstain. Staphylococci are cocci that occur in irregular clusters. Bacilli are rodlike organisms. PTS: 1

REF: Page 25

9. The word vibrio refers to a. the many shapes bacteria can assume. b. the erratic movement of bacteria. c. comma-shaped morphology. d. spirochete helical shape. ANS: C

Vibrio refers to comma-shaped bacteria. PTS: 1

REF: Page 25, Fig. 2.1

10. An organism that appears blue or violet after staining is usually called a. Gram negative. b. Gram positive. c. Ziehl–Neelsen. d. acid fast. ANS: B

Gram-positive organisms stain blue or violet, whereas Gram-negative organisms appear red from a counterstain of red dye safranin. Acid-fast stains (also called Ziehl–Neelsen stains) are different tests. PTS: 1

REF: Page 25

11. Which of the following is a Gram-negative pathogen? a. Bacillus anthracis b. Staphylococcus aureus c. Pseudomonas aeruginosa d. Clostridium botulinum ANS: C

Bacillus anthracis, Staphylococcus aureus, and Clostridium botulinum are Gram-positive pathogens. PTS: 1

REF: Page 26

12. Which of the following is spread by direct contact?

a. b. c. d.

Measles Hepatitis B Staphylococcus Histoplasmosis

ANS: C

Staphylococcus is spread by direct contact. Measles are spread by droplets; hepatitis B, by indirect contact; and histoplasmosis, by airborne dust. PTS: 1

REF: Page 29, Table 2.3

13. The Ziehl–Neelsen stain is useful in identifying which family of microorganisms? a. Streptococci b. Mycobacterium c. Staphylococci d. Pseudomonas ANS: B

The Ziehl–Neelsen stain is also called the acid-fast stain and is used to identify Mycobacterium species such as Mycobacterium tuberculosis. This stain is not used to identify streptococci, staphylococci, or Pseudomonas. PTS: 1

REF: Page 26

14. Which of the following is typically associated with tuberculosis (TB)? a. Mycobacterium b. Pseudomonas c. Clostridium d. Bordetella ANS: A

Mycobacterium tuberculosis is the organism responsible for pulmonary, spinal, and miliary TB. PTS: 1

REF: Page 26

15. Bacteria that require oxygen for growth are typically known as a. aerobes. b. airborne. c. anaerobes. d. autotrophs. ANS: A

Aerobes require oxygen for life. Airborne refers to the method of transmission of infectious diseases. Anaerobes can grow and live without oxygen, and autotrophs require simple inorganic nutrients to sustain themselves. PTS: 1

REF: Page 26

16. Which of the following is true concerning facultative anaerobes? a. They have limited oxygen tolerance. b. They require complex nutrients to exist.

c. They cannot live in oxygen environments. d. They require simple inorganic nutrients to exist. ANS: A

Facultative anaerobes have limited oxygen tolerance. Heterotrophs require complex nutrients to exist. Autotrophs require simple inorganic nutrients to exist. Only anaerobes cannot live in oxygen environments. PTS: 1

REF: Page 26

17. To survive adverse conditions, such as excessive heat and dryness, bacteria might do which of

the following? a. Store excess water in special spore-like structures. b. Form large colonies in a short period of time. c. Speed up their enzymatic processes. d. Form endospores. ANS: D

Certain bacteria form endospores under adverse conditions such as dryness, heat, and poor nutrition. Bacteria do not undergo any of the other processes mentioned. PTS: 1

REF: Page 26

18. Ventilator-associated pneumonia is commonly caused by which of the following? a. Escherichia coli b. Bacillus anthracis c. Enterobacteriaceae d. Corynebacterium diphtThE erS iaTeBANKSELLER.COM ANS: C

Ventilator-associated pneumonia is most commonly caused by Pseudomonas aeruginosa, Staphylococcus aureus, Enterobacteriaceae, Haemophilus influenzae, and Streptococcus spp. PTS: 1

REF: Page 28, Box 2.1

19. A virus can be described as a parasite with which of the following traits? a. Nucleic acid core b. Carbohydrate sheath c. Size of less than 20 nm d. Ability to produce spores ANS: A

Viruses have a nucleic acid core surrounded by a protein sheath; viruses range from 20 to 200 nm. They do not produce spores. PTS: 1

REF: Page 26

20. Viruses are usually described as nonliving because they a. do not have a cell wall. b. are unable to self-replicate. c. must create endospores to survive. d. cannot live without another living organism.

ANS: B

Viruses must invade a living organism to replicate. This is the reason that they are described as nonliving. They do have a wall-like structure that is made of protein. They do not create endospores and are able to live outside a host; however, they cannot replicate outside of a host. PTS: 1

REF: Page 26

21. Which of the following is a virus that has a respiratory route of transmission? a. Polio virus b. Hepatitis c. Coronavirus d. Herpes simplex virus ANS: C

Coronavirus has a respiratory route of transmission; for polio, the route of transmission is through the gut. Hepatitis is transmitted through body fluids and blood, and herpes simplex has several routes of transmission, including oral, genital, and ocular. PTS: 1

REF: Page 27, Table 2.2

22. Chlamydia species are classified as a. viruses. b. bacteria. c. protozoa. d. intracellular parasites. ANS: D

Chlamydia species have complex structures that resemble those of bacteria and they act like viruses in that they require a living host to replicate, but they are actually intracellular parasites. Protozoa are unicellular eukaryotes. PTS: 1

REF: Page 26

23. Which of the following is the type of organism that causes malaria and trypanosomiasis? a. Virus b. Parasite c. Protozoa d. Bacteria ANS: C

Protozoan infections include amebiasis, malaria, and trypanosomiasis. PTS: 1

REF: Page 26

24. Which of the following is the organism that is associated with pneumonia in

immune-compromised patients in the United States? a. Schistosoma b. Shigella c. Pneumocystis d. Rickettsiae

ANS: C

Pneumocystis pneumonia is common in immunocompromised patients—particularly those infected with human immunodeficiency virus. Pneumocystis is a fungal infection. Schistosoma is a blood fluke. Shigella is a Gram-negative, non–spore-forming, rod-shaped bacteria. Rickettsiae are intracellular parasites that resemble bacteria. PTS: 1

REF: Page 28

25. Airborne droplet nuclei are responsible for the transmission of a. legionellosis. b. histoplasmosis. c. staphylococcus. d. TB. ANS: D

TB is transmitted by droplet nuclei. Legionellosis is transmitted by airborne aerosols; histoplasmosis, by airborne dust; and staphylococcus, by direct contact. PTS: 1

REF: Page 29, Table 2.3

26. A budding unicellular organism revealed in the microscopic examination of sputum is most

likely a. yeast. b. Bacillus. c. Rickettsia. d. Clostridium. ANS: A

Yeast reproduces by budding. Bacteria reproduce either by binary fission or conjugation. Rickettsia reproduces by binary fission. PTS: 1

REF: Page 28

27. Which of the following organisms can be transmitted via the respiratory tract?

1. Hepatitis 2. Influenza 3. Varicella 4. Parainfluenza a. 1 and 4 b. 2, 3, and 4 c. 1 and 2 d. 2 and 3 ANS: B

Hepatitis is transmitted through blood and body fluids. PTS: 1

REF: Page 29, Table 2.3

28. Which of the following is the least likely mode of transmission for a nosocomial infection? a. Airborne b. Through fomites c. Vector-borne

d. Direct contact ANS: C

The transmission of infections by vectors is rarely associated with nosocomial infections. In the hospital, instruments and equipment (through fomites) are common sources of hospital-acquired infections. Direct contact is also a common way to transmit nosocomial infections. PTS: 1

REF: Page 29

29. The spread of diseases requires which of the following?

1. A pathogen source 2. Immunosuppression 3. Mode of transmission 4. A susceptible host a. 1 and 4 b. 1, 3, and 4 c. 2 and 3 d. 1, 2, and 4 ANS: B

Immunosuppression is not a requirement for the transmission of an infectious disease. However, a pathogen source, mode of transmission, and susceptible host must be present. A susceptible host does not have to be immunosuppressed to be considered susceptible. The host could have had surgery, be intubated, or have an indwelling catheter to be susceptible. PTS: 1

REF: Page 28

30. You are visiting a country that has been plagued by heavy rains and flooding. The population

is suffering from widespread disease. Which of the following is the most likely cause of the disease? a. Cholera b. Influenza c. Legionella d. Salmonellosis ANS: A

Cholera is a waterborne infectious disease. With excessive rains and flooding, this waterborne bacterium might flourish. Legionella is spread by aerosols. Salmonellosis is a foodborne infectious disease. Influenza is spread through the respiratory tract. PTS: 1

REF: Page 29, Table 2.3

31. The skin and mucosal tissue can prevent the spread of infectious agents by acting as

barriers. a. immunologic b. mechanical c. epidermal d. soft ANS: B

The skin and mucous membranes are mechanical barriers to infection, meaning that they physically prohibit the transfer of infectious organisms into a host. PTS: 1

REF: Page 28

32. Which of the following is a common pathogen that could cause a disruption of normal flora in

a patient receiving antibiotic therapy? a. Clostridium difficile b. Pneumocystis carinii c. Enterobacteriaceae spp. d. Pseudomonas aeruginosa ANS: A

Clostridium difficile are the bacteria that cause the disruption of normal flora in the gastrointestinal tract caused by antibiotic therapy. Pneumocystis carinii are the protozoa that cause pneumonia in immunocompromised patients with human immunodeficiency virus. Enterobacteriaceae spp. are the bacteria that can cause hypogammaglobulinemia in patients with multiple myeloma. PTS: 1

REF: Page 30, Table 2.4

33. Transmission of an infectious agent by flies would fall into which mode of disease transfer? a. Vector-borne b. Airborne c. Contact d. Indirect ANS: A

Insects are the transmission agents in vector-borne infectious diseases. Airborne, indirect, and contact transmission are not accomplished via insects. PTS: 1

REF: Page 29

34. Which of the following are the two primary human barriers to infection in the health care

setting? a. Disinfection and sterilization b. Immunologic and mechanical c. Disinfection and pasteurization d. Hand-washing and personal protective equipment ANS: B

Human barriers to infection include the mechanical barriers of the skin and mucous membranes and the person’s immune system. The others are preventative measures that reduce the spread of infection in health care settings. PTS: 1

REF: Page 28

35. An agent that destroys pathogenic microorganisms on inanimate objects only is best described

as a a. virucide. b. germicide. c. bactericide.

d. disinfectant. ANS: D

A disinfectant describes agents that destroy pathogenic microorganisms on inanimate objects only. Germicide is a general term used to describe agents that destroy pathogenic microorganisms on living tissue and inanimate objects. A bactericide destroys all pathogenic bacteria. A virucide destroys viruses only. PTS: 1

REF: Pages 30-31

36. Sterilization differs from pasteurization in that sterilization destroys a. bacteria and fungi only. b. only bacteria. c. all microbes. d. only viruses. ANS: C

Bactericides destroy only pathogenic bacteria. Fungicides kill fungi, and virucides kill viruses. Sterilization kills all microbes including spores, whereas pasteurization is a disinfection process that removes most pathogenic microorganisms except bacterial endospores. PTS: 1

REF: Page 35

37. Which of the following are factors that affect disinfection and sterilization?

1. Shape of the pathogen 2. Number of organisms 3. Resistance of the pathogen 4. Strength of the germicidTe ESTBANKSELLER.COM a. 2, 3, and 4 b. 3 and 4 c. 1 and 3 d. 2 and 3 ANS: A

The shape of the organism does not make a difference in how disinfection and sterilization work. The number, location, and innate resistance of the microorganisms; the concentration and potency of the germicide; the duration of exposure; and the physical and chemical environment in which the germicide is used are all factors that affect disinfection and sterilization. PTS: 1

REF: Page 35

38. Which of the following are true about the amount of time required to kill microbes?

1. Time decreases as the strength of the germicide decreases. 2. Time is directly proportional to the number of pathogens. 3. Time increases as the microbial population increases. 4. Time varies with the resistance of the organism. a. 2, 3, and 4 b. 3 and 4 c. 1 and 3 d. 2 and 3

ANS: A

The number of pathogens and their resistance affect the amount of time it takes to kill microbes. Increased strength of a germicide will decrease the amount of time to kill the microbes. PTS: 1

REF: Page 29

39. Which of the following medical states increase patient susceptibility to nosocomial infection? a. Hypoglycemia b. Altered B cells c. Hyperbilirubinemia d. Hypogammaglobulinemia ANS: D

Hypogammaglobulinemia is the only answer that describes a condition that increases susceptibility to nosocomial infections. PTS: 1

REF: Page 30, Table 2.4

40. A patient’s susceptibility to Pseudomonas aeruginosa is increased by a. organ transplantation. b. multiple myeloma. c. antibiotic therapy. d. chemotherapy. ANS: D

Oncochemotherapy increases a patient’s susceptibility to Pseudomonas aeruginosa and Candida. Organ transplantT atE ioS nTinBcA reN asKeS s aEpLaL tiE enRt’. sC suOsM ceptibility to toxoplasmosis. Multiple myeloma increases a patient’s susceptibility to Haemophilus influenzae. Antibiotic therapy increases a patient’s susceptibility to Clostridium difficile. PTS: 1

REF: Page 30, Table 2.4

41. After a ventilator is cleaned and ready for use, it should be stored in a. the hallway near the freight elevators. b. the back of the preparation area. c. the back of the clean-up area. d. a separate “clean room”. ANS: D

A separate “clean room” is necessary so that dirty and clean equipment remain separate. Hallways, prep areas, and clean-up areas are not ideal places to store clean equipment. PTS: 1

REF: Page 31

42. In general, germicides are most effective in which of the following environments? a. Lower acidity b. Lower alkalinity c. Lower temperatures d. Higher temperatures ANS: D

Higher temperatures increase the activity of most germicides. Higher alkalinity also improves the antimicrobial activity of some disinfectants. Lower temperatures and acidity do not improve the action of germicides. PTS: 1

REF: Page 35

43. Under normal conditions, high-level disinfectants can kill which of the following organisms?

1. Fungal buds 2. Bacterial spores 3. Gram-positive bacteria 4. Gram-negative bacteria a. 3 and 4 b. 1, 3, and 4 c. 1 and 2 d. 2 and 4 ANS: B

Bacterial spores are not killed by high-level disinfectants unless they are exposed to the disinfectant for an extended time. Fungi and all bacteria are killed by high-level disinfectants. PTS: 1

REF: Page 31

44. Flash pasteurization exposes equipment to which of the following? a. Water bath at 72C for 15 minutes b. Water bath at 63C for 30 minutes c. Moist heat at 72C for 15 minutes d. Moist heat at 72C for T 15ES seT coBnA dsNKSELLER.COM ANS: D

There are only two methods for pasteurization: the flash process and the batch process. The flash process requires moist heat at 72C for 15 seconds, and the batch process requires a water bath at 63C for 30 minutes. PTS: 1

REF: Page 33

45. Quaternary ammonium salts are routinely used to sanitize a. ventilator circuits. b. nebulizers. c. walls and furniture. d. critical respiratory care equipment. ANS: C

Quats are bactericidal, fungicidal, and virucidal toward lipophilic viruses. They are not sporicidal, tuberculocidal, or virucidal toward hydrophilic viruses. They are used to sanitize noncritical surfaces like walls and furniture. Most ventilator tubing is disposable and is therefore not cleaned and disinfected. PTS: 1

REF: Page 33

46. Alcohols such as ethyl and isopropyl are unable to kill a. fungi.

b. viruses. c. bacteria. d. bacterial spore. ANS: D

Ethyl and isopropyl alcohols are bactericides, fungicides, and virucides, but they do not kill bacterial spores. PTS: 1

REF: Page 33

47. The ability of alcohols to act as an effective disinfectant decreases significantly when their

concentration drops below a. 30%. b. 50%. c. 70%. d. 90%. ANS: B

Below 50% concentration, the ability of alcohols to disinfect decreases significantly. PTS: 1

REF: Page 33

48. The respiratory therapist is in a contact isolation room with a patient. The stethoscope for use

with this patient is located within the patient’s room. Which of the following is the most appropriate solution for disinfecting this stethoscope? a. Acetic acid b. Ethylene oxide c. Glutaraldehyde d. Isopropyl alcohol ANS: D

Alcohols are used to disinfect equipment such as thermometers, stethoscopes, and fiberoptic endoscopes; in addition, they are used to clean the surfaces of mechanical ventilators and preparation areas. Acetic acid is the disinfectant of choice with home respiratory care equipment and is not often used in the hospital setting. Glutaraldehyde is a respiratory irritant and would not be appropriate for use in patient care areas. Ethylene oxide cannot be used at the bedside because it requires specialized equipment and takes several steps to prepare it for disinfectant use. PTS: 1

REF: Page 33

49. Phenolic compounds are generally diluted to what concentration? a. 0.04% to 0.05% b. 0.4% to 5.0% c. 40% to 50% d. 4% to 5% ANS: B

Phenolic compounds are diluted to a 0.4% to 5% solution to provide a low to intermediate level of disinfection. PTS: 1

REF: Page 32, Table 2.5

50. Bacterial spores can be inactivated by exposure to a. 10 hours of iodophors. b. 8 hours of glutaraldehyde. c. 30 minutes of isopropyl alcohol. d. 6 hours of quaternary ammonium compounds. ANS: B

Glutaraldehyde is sporicidal and has an exposure time of 6 to 8 hours. Iodophors are bactericidal, tuberculocidal, fungicidal, and virucidal, but they are not effective against bacterial spores. Alcohols are bactericidal, fungicidal, and virucidal, but they do not kill bacterial spores. Quaternary ammonium compounds are not sporicidal. PTS: 1

REF: Page 34

51. A residue will remain on equipment exposed to a. formaldehyde. b. isopropyl alcohol. c. hydrogen peroxide. d. quaternary ammonium compounds. ANS: A

Formaldehyde will leave a residue on equipment. The other agents listed in these choices will not. PTS: 1

REF: Page 32, Table 2.5

52. Which of the following is tThE eS mT osBt A coNmKm ysR ic. alCm SoEnLpLhE OeMthod of disinfection? a. Quaternary ammonium compounds b. Alcohols c. Pasteurization d. Autoclaving ANS: C

Formaldehyde is a respiratory irritant. The other agents listed are not. PTS: 1

REF: Page 32, Table 2.5

53. A typical high-level disinfectant can kill organisms—but not spores—in what time period? a. 24 hours b. 1 to 2 hours c. 12 to 18 hours d. Less than 45 minutes ANS: D

High-level disinfectant agents are typically chemical sterilants that are used at reduced exposure times, usually less than 45 minutes. They kill bacteria, fungi, and viruses in this period of time. However, spores are not killed unless the chemical is used for an extended period of time. PTS: 1

REF: Page 34

54. In batch pasteurization, equipment is placed in a water bath heated to a. 63C b. 72C c. 163C d. 175C

_ for 30 minutes.

ANS: A

Batch pasteurization requires the equipment to be exposed to a water bath at 63C for 30 minutes. Flash pasteurization requires equipment to be exposed to moist heat at 72C for 15 seconds. PTS: 1

REF: Page 33

55. Acid glutaraldehyde is tuberculocidal with a minimum exposure time of _ a. 10 b. 20 c. 30 d. 40

minutes.

ANS: B

Acid glutaraldehyde is bactericidal, fungicidal, and virucidal with a 10-minute exposure time. However, exposure time must be extended to 20 minutes for it to become tuberculocidal. PTS: 1

REF: Page 34

56. The statement “A disinfectant’s potency increases as its concentration increases” is true for

which of the following? 1. Phenols 2. Alcohols 3. Iodophors 4. Glutaraldehydes a. 1 and 3 b. 2 and 4 c. 1, 2, and 4 d. 1, 3, and 4 ANS: C

Iodophors are the only exception to this statement. PTS: 1

REF: Page 34

57. During a home care visit, the respiratory therapist is instructing the patient and family member

on the use of the patient’s equipment. Which of the following household items should the respiratory therapist inform the patient to use to decontaminate the equipment? a. Alcohol b. Vinegar c. Bleach d. Lye ANS: B

White household vinegar is used extensively as a method for decontaminating home care respiratory equipment. One part 5% white household vinegar and three parts water should be used. Bleach and lye are too dangerous for the patient to use and are respiratory irritants. Prolonged and repeated use of alcohol can cause swelling and hardening of rubber and plastic tubes. PTS: 1

REF: Page 33

58. An oxygen atom can be added to acetic acid to form an excellent disinfectant with sterilization

capabilities. This disinfecting agent is a. peroxide. b. peroxidic acid. c. peracetic acid. d. acetic peroxide. ANS: C

Peracetic acid is an excellent disinfectant with sterilization capabilities. It kills microbes by denaturing proteins, disrupting cell wall permeability, and oxidizing cellular metabolites. Its shortcoming is that it can corrode brass, iron, copper, and steel. PTS: 1

REF: Page 34

59. Carbolic acid is a. an acetic acid derivative. b. a common disinfectant. c. the basis for phenol derivatives. d. the only form of acid glutaraldehyde. ANS: C

Carbolic acid is the prototype 6-carbon aromatic compound. It was first used as a germicide by Lister in his pioneering work on antiseptic surgery. It is no longer used. PTS: 1

REF: Page 33

60. The Centers for Disease Control and Prevention recommends that blood spills be cleaned with a. ethanol. b. peracetic acid. c. sodium hypochlorite. d. alkaline glutaraldehyde. ANS: C

The Centers for Disease Control and Prevention recommends that a 1:10 dilution of sodium hypochlorite be used to clean blood spills. PTS: 1

REF: Page 34

61. A 1.25% solution of acetic acid has been shown to be an effective bactericidal agent against a. Staphylococcus aureus. b. Pseudomonas aeruginosa. c. Mycobacterium tuberculosis. d. Streptococcus pneumoniae.

ANS: B

Pseudomonas aeruginosa is killed by 1.25% acetic acid or one part 5% white household vinegar and three parts water. Pseudomonas aeruginosa transmission is through indirect contact via fomites, such as those on clothing, surgical bandages, and especially equipment. It is the most common respiratory pathogen in patients with cystic fibrosis and is encountered in patients with chronic obstructive pulmonary disease (COPD). PTS: 1

REF: Page 33

62. Which of the following indicates the minimum time a tracheostomy inner cannula should be

soaked in 3% hydrogen peroxide to be an effective disinfectant during a patient’s tracheostomy care? a. 1 minute b. 5 minutes c. 10 minutes d. 15 minutes ANS: C

Commercially available 3% solutions of hydrogen peroxide are effective disinfectants of bacteria (including Mycobacteria sp.), fungi, and viruses and are active within 10 minutes at room temperature. To be effective against spores, the solution would need to be at 50C and the equipment would need to be soaked for at least 20 minutes. PTS: 1

REF: Page 35

63. The Centers for Disease Control and Prevention recommends a

dilution of bleach to

water to clean up blood spills. a. 1:1 b. 1:2 c. 1:10 d. 1:100 ANS: C

The Centers for Disease Control and Prevention recommends that a 1:10 dilution of sodium hypochlorite be used to clean up blood spills. PTS: 1

REF: Page 35

64. Which type of germicide requires activation with bicarbonate? a. 5% acetic acid b. 2% alkaline glutaraldehyde c. 3% hydrogen peroxide d. 10% sodium hypochlorite ANS: B

Only alkaline glutaraldehyde requires activation with a bicarbonate solution. This yields a solution with a pH of 7.5 to 8.5. PTS: 1

REF: Page 35

65. Commercial-grade hydrogen peroxide is an effective disinfectant at room temperature after

how many minutes?

a. b. c. d.

5 10 30 60

ANS: B

REF: Page 35

66. Which of the following physical properties are required for an autoclave to sterilize

biohazardous material? 1. Dry heat 2. A vacuum 3. 100% humidity 4. Increased air pressure a. 2 and 3 b. 1 and 3 c. 1, 2, and 4 d. 2, 3, and 4 ANS: D

Air is evacuated, moisture is added (100% humidity), and the pressure inside the autoclave is raised to 15 to 20 lb-force per square inch gauge (psig). Air is evacuated from the chamber because residual air prolongs the penetration time of steam, thus increasing the total autoclave EpLeL cycle time. Pressure is usedTE toSraTiB seAthNeKtS em raE tuRre.oCfOthMe steam, which is critical because the amount of time required to achieve sterilization depends on the temperature inside of the autoclave. Dry heat is not used during autoclaving. PTS: 1

REF: Page 35

67. Dry-heat sterilization involves a 1- to 2-hour exposure at approximately a. 100C. b. 132C. c. 170C. d. 200C. ANS: C

Dry heat is another effective method of heat sterilization. Its use is limited to items that are not heat-sensitive. Temperatures must be maintained between 160C and 180C for 1 to 2 hours for sterilization. PTS: 1

REF: Page 35

68. At high altitudes, sterilization by boiling must be prolonged primarily because of which of the

following? a. Increased oxygen content b. Reduced oxygen content c. Increased normal boiling point

d. Reduced normal boiling point ANS: D

Because water boils at a lower temperature at high altitudes, exposure time must be prolonged during this form of sterilization at high elevations. PTS: 1

REF: Page 35

69. Which of the following should routinely be used to ensure proper function and quality control

of an autoclave? 1. Pressure-sensitive tape 2. Biologic indicators 3. Chemical indicators 4. Heat-sensitive tape a. 2 and 3 b. 2 and 4 c. 1, 2, and 3 d. 1, 2, and 4 ANS: B

Because the process of autoclaving depends on several factors, heat-sensitive tape and biologic indicators are routinely used to ensure quality control during the process. Heat-sensitive tape that is used for packaging materials for autoclaving changes color when it is exposed to a given temperature for a prescribed amount of time. The most common biologic indicators for autoclaving are strips of paper that are impregnated with Bacillus stearothermophilus spores. These strips should be used weekly (at a minimum) to ensure that the autoclave is working properly. Biologic indicators are also used for ethylene oxide sterilization. PTS: 1

REF: Page 35

70. According to the classification of infection-risk devices described by Spaulding, ventilator

tubing is considered a. critical. b. noncritical. c. semicritical. d. highly critical. ANS: C

Ventilator tubing comes in contact with intact mucous membranes and is considered semicritical. Critical items are those that are introduced into sterile tissue or the vascular system. Noncritical items come in contact with intact skin. Noncritical items include face masks, ventilators, stethoscopes, and blood pressure cuffs. Highly critical is not a descriptor that Spaulding used. PTS: 1

REF: Page 37

71. According to the classification described by Spaulding, which of the following items of

medical equipment falls into the category of noncritical infection risk? a. Scalpels b. Ventilators

c. Ventilator tubing d. Manual resuscitators ANS: B

Noncritical items come in contact with intact skin. These items include face masks, ventilators, stethoscopes, and blood pressure cuffs. Scalpels are introduced into sterile tissue and are considered critical items. Ventilator tubing and manual resuscitators come in contact with intact mucous membranes and are considered semicritical. PTS: 1

REF: Page 37

72. Which of these precautions must be followed in the treatment of a patient with an influenza

infection? 1. Contact 2. Droplet 3. Airborne 4. Standard a. 1 and 3 b. 2 and 4 c. 1, 2, and 4 d. 2, 3, and 4 ANS: B

Standard precautions need to be used for all patients. Droplet precautions are used for patients known or suspected to have serious illnesses transmitted by large-particle droplets. Influenza is a serious viral infection spread by droplet transmission. Contact isolation is used for patients known or suspected to have serious illnesses easily transmitted by direct patient Ment. Airborne precautions should be contact or by contact with T iteEmSsTiB nA thN eK paStiEenLtL ’sEeR nv.irCoO nm used for patients who are known or suspected to have illnesses transmitted by airborne droplet nuclei, such as measles, varicella, or TB. PTS: 1

REF: Page 40, Box 2.6

73. Which of the following is the most important infection control procedure for anyone who has

direct patient contact? a. Sterile latex gloves b. Disposal of sharps c. Hand hygiene d. Face masks ANS: C

Handwashing is the most important prevention strategy to protect health care workers from being infected through contact with infected patients. It also reduces the risk of health care workers transmitting infectious microorganisms from one patient to another or from a contaminated site to a clean site on the same patient. Sterile gloves are worn during invasive procedures. Disposal of sharps is important when any sharps (e.g., needles) are used. Face masks need to be worn when there is a possibility of blood or body fluid being splashed or sprayed, such as during an arterial blood gas stick. PTS: 1

REF: Pages 42-43

74. Which of the following illnesses requires airborne precautions? a. Measles b. Clostridium difficile c. Herpes simplex virus d. Mycoplasma pneumoniae ANS: A

Airborne precautions should be used for patients who are known to have or who are suspected of having illnesses transmitted by airborne droplet nuclei, such as measles, varicella, or TB. Clostridium difficile and the herpes simplex virus require contact isolation, because they are transmitted by direct patient contact or by contact with items in the patient’s environment. Mycoplasma pneumoniae requires droplet precautions because it is spread by droplet transmission. PTS: 1

REF: Page 40, Box 2.6

75. Droplet isolation precautions call for all of the following, except a. face masks. b. latex gloves. c. protective eyewear. d. special air-handling. ANS: D

Droplet precautions include masks, gloves, and protective eyewear but not special air-handling. PTS: 1

REF: Page 43

76. Which isolation precaution requires the patient to be placed in a private isolation room? a. Droplet b. Contact c. Airborne d. Universal ANS: C

Airborne precautions have two major components: (1) placement of the infected patient in an area with appropriate air-handling and ventilation and (2) use of respiratory protective equipment by health care workers and visitors entering the patient’s room. In cases in which an infected patient must be transported, the patient should wear a surgical mask to minimize dispersal of droplet nuclei. Current standards require that infected patients be placed in a private, negative-pressure isolation room. Negative air pressure within the room should be monitored relative to other areas of the hospital. Severe acute respiratory syndrome, measles, chicken pox (primary varicella zoster virus), and TB are illnesses that require airborne precautions. PTS: 1

REF: Page 42

77. In preparation for an arterial blood gas puncture on a noninfectious patient in the pulmonary

laboratory, which of the following items of protective apparel should be used? 1. Gown 2. Gloves

3. Shoe covers 4. Eye protection a. 1 and 2 b. 2 and 4 c. 2, 3, and 4 d. 1, 2, 3, and 4 ANS: B

The least amount of protective apparel that should be worn when drawing an arterial blood gas includes gloves and eye protection. In the case of a patient in isolation, a gown should be worn if there is a chance of splashing blood. Shoe covers are not necessary in areas outside of the operating rooms. PTS: 1

REF: Page 42

78. The below figure represents which of the following bacteria?

a. b. c. d.

Bacillus Diplococcus Streptococcus Staphylococcus

TESTBANKSELLER.COM

ANS: D

Cocci that occur in irregular clusters are called staphylococci. A bacillus is rod-shaped; a diplococcus is paired, sphere-shaped bacteria; and a streptococcus is a chain of cocci. PTS: 1

REF: Page 25

79. Which of the following figure represents a spirochete?

a. b. c. d.

A B C D

ANS: C

Bacteria that are spiral are called spirochetes. The others are designated as follows: (A) streptococci, (B) diplococci, and (D) vibrio. PTS: 1

REF: Page 25

80. A Gram stain leaves the following organism violet. Which pathogen could this be?

a. b. c. d.

Escherichia coli Bacillus anthracis Staphylococcus aureus Streptococcus pneumoniae

ANS: D

Streptococcus pneumoniae are Gram-negative spheres that occur in chains. Escherichia coli are Gram-negative and rod-shaped. Bacillus anthracis are Gram-positive and rod-shaped. Staphylococus aureus are Gram-positive spheres that occur in irregular clusters. PTS: 1

REF: Page 25

81. Which of the following is a commonly encountered Gram-negative, facultative anaerobic

bacillus bacterium? a. Escherichia coli b. Clostridium tetani c. Neisseria meningitidis d. Haemophilus parainfluenzae ANS: A

Escherichia coli are Gram-negative, rod-shaped facultative anaerobes. Clostridium are Gram-positive, rod-shaped anaerobes. Neisseria meningitidis are Gram-positive aerobes that occur in chains. Haemophilus parainfluenzae are Gram-negative, rod-shaped aerobes. PTS: 1

REF: Page 26, Table 2.1

82. Which of the following viruses will cause bronchiolitis? a. Influenza b. Rhinovirus c. Herpes zoster d. Respiratory syncytial ANS: D

Respiratory syncytial virus causes bronchiolitis. Influenza virus can cause tracheobronchitis and pneumonia. Rhinovirus causes rhinitis and pharyngitis. Herpes zoster causes vesicles on ectodermal tissues.

PTS: 1

REF: Page 27, Table 2.2

83. What is the route of transmission for hepatitis? a. Gut b. Genitalia c. Body fluids d. Respiratory tract ANS: C

The transmission route for hepatitis is blood and body fluids. The transmission route for coxsackievirus and polio is the gut. Herpes simplex can be transmitted through the genitals. The respiratory tract is the transmission route for influenza, mumps, measles, parainfluenza, respiratory syncytial virus, adenoviruses, rhinoviruses, varicella, and rubella. PTS: 1

REF: Page 27, Table 2.2

84. The definition “an aerobic, Gram-negative, rodlike bacteria” describes a. Bacillus anthracis. b. Bordetella pertussis. c. Clostridium botulinum. d. Mycobacterium tuberculosis. ANS: B

Bordetella pertussis is Gram-negative, aerobic, and rod-shaped. Bacillus anthracis is Gram-positive, aerobic, and rod-shaped. Clostridium botulinum is Gram-positive, anaerobic, and rodlike. Mycobacterium tuberculosis is Gram-positive, aerobic, and rodlike. PTS: 1

REF: Page 27, Table 2.2

85. Legionellosis is transmitted by which of the following mode? a. Mosquitoes b. Airborne dust c. Airborne aerosol d. Waterborne vehicle ANS: C

The transmission mode for legionellosis is through airborne aerosols. Mosquitoes transmit malaria. Airborne dust transmits histoplasmosis. Water transmits shigellosis and cholera. PTS: 1

REF: Page 27

86. Hepatitis B is spread by which type of transmission? a. Droplet nuclei b. Direct contact c. Indirect contact d. Foodborne vehicle ANS: C

Hepatitis B is spread by indirect contact. TB and diphtheria are spread by droplet nuclei. Hepatitis A, venereal disease, human immunodeficiency virus, staphylococcus, and enteric bacteria are spread by direct contact. Salmonellosis and hepatitis A are spread through food.

PTS: 1

REF: Page 29, Table 2.3

87. Opportunistic fungal infections are typically caused by which of the following? a. Pneumocystis carinii b. Aspergillus fumigatus c. Histoplasma capsulatum d. Haemophilus haemolyticus ANS: B

Aspergillus fumigatus causes opportunistic fungal infections. Pneumocystis carinii is an opportunistic protozoan that causes pneumonia in immunocompromised patients. Histoplasma capsulatum can cause fungal infections in otherwise healthy individuals. Haemophilus haemolyticus is usually nonpathogenic, but on rare occasions it can cause subacute endocarditis. PTS: 1

REF: Page 28

88. Human immunodeficiency virus is transmitted by which of the following routes? a. Direct contact b. Droplet contact c. Indirect contact d. Airborne aerosol ANS: A

Human immunodeficiency virus is transmitted by direct contact. TB and diphtheria are spread by droplet nuclei. Hepatitis B is spread by indirect contact. Legionellosis is spread by airborne aerosols. PTS: 1

REF: Page 29, Table 2.3

89. Safe needle practice calls for which of the following? a. Needles should not be recapped. b. Recap the needle with two hands. c. Sterile glove are necessary when drawing blood. d. Dispose of the needle in a hazardous waste bag. ANS: A

Needles should not be recapped. When it is necessary to recap a syringe, both hands should never be used; instead, use the one-hand “scoop” technique or a mechanical device to recap syringe needles safely. Gloves should always be worn when using a needle to draw blood. Needles must be disposed of in a biohazard sharps (i.e., hard plastic) container. PTS: 1

REF: Page 42

90. Endotracheal intubation increases a patient’s susceptibility to which of the following common

pathogens? a. Pneumocystis carinii b. Neisseria meningitidis c. Staphylococcus aureus d. Streptococcus pneumoniae

ANS: C

Endotracheal intubation increases a patient’s susceptibility to Staphylococcus aureus, as well as Pseudomonas aeruginosa, Enterobacteriaceae species, and Candida. Pneumocystis carinii is common in patients with acquired immunodeficiency syndrome. Patients with systemic lupus erythematosus, liver failure, or vasculitis are susceptible to Neisseria meningitidis and Streptococcus pneumoniae. PTS: 1

REF: Page 30, Table 2.4

91. Patients undergoing corticosteroid therapy have an increased risk of nosocomial infection

from which of the following common pathogens? a. Candida albicans b. Enterobacteriaceae sp. c. Streptococcus pneumoniae d. Staphylococcus epidermidis ANS: A

Corticosteroid therapy disrupts the normal flora of the oral cavity, leaving the patient at risk for the development of Candida albicans, which is otherwise known as thrush. PTS: 1

REF: Page 30, Table 2.4

92. An adult is brought to the emergency department with third-degree burns over 40% of his

body. This patient now has an increased susceptibility to which of the following organisms? a. Streptococcus pneumoniae b. Pseudomonas aeruginosa c. Candida albicans d. Clostridium difficile ANS: B

The skin and mucosal barrier have been disrupted by the burns; therefore, this patient is susceptible to Pseudomonas aeruginosa. Pseudomonas aeruginosa is one of several pathogens that can affect hospitalized patients. Patients with systemic lupus erythematosus, liver failure, or vasculitis are susceptible to Streptococcus pneumoniae. Oncochemotherapy and antibiotic therapy increase a patient’s susceptibility to Candida albicans and Clostridium difficile. PTS: 1

REF: Page 30, Table 2.4

93. A 65-year-old male is intubated and placed on a mechanical ventilator after a motor vehicle

accident. Thirty-six hours later he develops infiltrates on the chest radiograph. Which of the following actions may have been able to prevent this from occurring? 1. Elevation of the head of the bed 20 to 30 degrees 2. Changing ventilator circuit every 24 hours 3. Stress ulcer prophylaxis 4. Avoid the use of sedatives. a. 1 and 2 b. 1, 2, and 3 c. 1, 3, and 4 d. 3 and 4

ANS: C

The information indicates that the patient has ventilator-associated pneumonia; ventilator-associated pneumonia must be suspected anytime intubation develops shortly after endotracheal intubation. There are many actions that can be taken to prevent its development. Current standards state that the ventilator circuit should be changed only when it is grossly contaminated. PTS: 1

REF: Page 38

94. A home care patient with COPD is being instructed on the use of a hand-held nebulizer.

Which of the following would be the recommended method of disinfection for the nebulizer? a. Alkaline glutaraldehyde b. One part household vinegar and three parts water c. Pasteurization d. Autoclave ANS: B

Acetic acid is the agent of choice to disinfect home care equipment due to its low cost and effectiveness. Alkaline glutaraldehyde requires a use of a hood for protection from fumes. Pasteurization and autoclave both require specialized equipment. PTS: 1

REF: Page 38, Box 2.4

95. Which of the following conditions require the use of National Institute for Occupational

Safety and Health (NIOSH)-approved respiratory protective devices? 1. Pneumocystis jiroveci 2. TB 3. Influenza 4. Smallpox a. 1 only b. 1 and 3 c. 1, 2, and 4 d. 2, 3, and 4 ANS: D

These conditions, TB, Influenza, and smallpox are all associated with droplet nuclei and require the use of an N-95 respirator. PTS: 1

REF: Page 40

96. Intermediate-level disinfection methods kill which of the following organisms?

1. Fungi 2. Tubercle bacteria 3. Spores 4. Viruses a. 1, 2, and 4 b. 2 and 3 c. 1, 3, and 4 d. 2 and 4 ANS: A

Intermediate-level disinfectants kill most vegetative bacteria, some fungi, and some viruses. PTS: 1

REF: Page 31

Chapter 03: Manufacture, Storage, and Transport of Medical Gases Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. Which of the following gases support combustion?

1. Air 2. Oxygen 3. Helium 4. Carbon dioxide a. 2 only b. 1 and 2 c. 2 and 3 d. 1, 3, and 4 ANS: B

Oxygen and air support combustion. Helium and carbon dioxide are not flammable. PTS: 1

REF: Page 53, Table 3.2

2. Which of the following gases is the least dense? a. Carbon dioxide b. Nitrous oxide c. Helium d. Air ANS: C

Helium is the second-lightest element, with a density of 0.165 kg/m3 at 21.1C and 1 atmospheric pressure (atm). Oxygen is slightly heavier than air, with a density of 1.326 kg/m3 at 21.1C and 760 mm Hg. PTS: 1

REF: Page 57, Table 3.3

3. Which gas has been used successfully in the treatment of pulmonary hypertension of the

newborn? a. Oxygen b. Nitric oxide c. Nitrous oxide d. Helium–oxygen mixture ANS: B

At very low concentrations (2 to 80 parts per million) combined with oxygen, nitric oxide has been used to successfully treat persistent pulmonary hypertension of the newborn. Nitrous oxide is used as a central nervous system depressant (anesthetic). Helium–oxygen mixtures decrease the work of breathing by decreasing turbulent airflow. PTS: 1

REF: Page 50

4. In high concentrations, which of the following gases is a potent anesthetic? a. Nitric oxide

b. Nitrous oxide c. Carbon dioxide d. Helium–oxygen mixture ANS: B

The major use for nitrous oxide is a central nervous system depressant. As such, it is a potent anesthetic when administered in high concentrations. At very low concentrations (2 to 80 parts per million) combined with oxygen, nitric oxide has been used successfully to treat persistent pulmonary hypertension of the newborn. Carbon dioxide is nonflammable, but it supports combustion. Helium–oxygen mixtures decrease the work of breathing by decreasing turbulent airflow. PTS: 1

REF: Page 50

5. Which of the following gases is used to decrease the work of breathing associated with severe

airway obstruction? a. Nitric oxide b. Nitrous oxide c. Helium–oxygen mixture d. Carbon dioxide–oxygen mixture ANS: C

A helium–oxygen mixture decreases the work of breathing by decreasing turbulent airflow. PTS: 1

REF: Page 52

6. Which of the following can cause chemical pneumonitis and pulmonary edema? a. Nitrous oxide b. Carbon dioxide c. Excess amounts of nitric oxide d. A combination of nitric oxide and nitrogen dioxide ANS: D

Nitric oxide and nitrogen dioxide combine to form a potent irritant that can cause chemical pneumonitis and pulmonary edema. Nitrous oxide, which is nicknamed laughing gas, can cause brain damage or death if inhaled without a sufficient oxygen supply. PTS: 1

REF: Page 50

7. Which of the following method can be used to obtain carbon dioxide? a. Heating uranium ore b. Combustion of natural gas c. Fractional distillation of liquid air d. Oxidizing ammonia at high temperatures ANS: B

Unrefined carbon dioxide can be obtained from the combustion of coal, natural gas, or other carbonaceous fuels. Helium can be obtained by heating uranium ore. The two methods most commonly used to prepare oxygen are the fractional distillation of liquid air and the physical separation of atmospheric air. Nitric oxide can be prepared by oxidizing ammonia at high temperatures (i.e., 500C and above).

PTS: 1

REF: Page 51

8. Which agency is responsible for the regulations that govern the manufacture, storage, and

transport of compressed gases? a. Bureau of Medical Devices b. Compressed Gas Association (CGA) c. US Department of Transportation (DOT) d. US Food and Drug Administration (FDA) ANS: C

Metal cylinders have been used for storing compressed gases since 1888. Federal regulations issued by the DOT require that all cylinders used to store and transport compressed gases conform to specifications. The FDA sets purity standards for medical gas. The CGA provides standards and safety systems for compressed-gas systems. PTS: 1

REF: Page 53

9. Which agency sets purity standards for medical gases? a. CGA b. DOT c. FDA d. ISO ANS: C

The FDA sets purity standards for medical gas. The DOT governs the manufacture, storage, and transport of compressed gases. The CGA sets standards and provides safety systems for compressed-gas systems. The ISO is an international agency that sets standards for technology. PTS: 1

REF: Page 54, Box 3.2

10. Safety systems for medical gases are recommended and provided by a. DOT. b. CGA. c. FDA. d. National Fire Protection Association (NFPA). ANS: B

The CGA sets standards and provides safety systems for compressed-gas systems. The FDA sets purity standards for medical gas. The DOT regulates the manufacture, storage, and transport of compressed gases. The NFPA is an independent agency that provides information on fire protection and safety. PTS: 1

REF: Page 54, Box 3.2

11. A cylinder has “DOT 3AA 2015” stamped on it. What does the 3AA stand for? a. Ownership mark b. Manufacturer’s mark c. Non–heat-treated carbon-steel d. Heat-treated, high-strength steel ANS: D

3AA stands for heat-treated, high-strength steel. Type 3A cylinders are made of carbon-steel (non–heat-treated). PTS: 1

REF: Page 53

12. A cylinder has “DOT 3AL 2015” stamped on it. What does the 3AL stand for? a. Manufacturer’s initials b. Constructed of heat-treated, high-strength steel c. Required to undergo hydrostatic testing every 3 years d. Constructed of specially prescribed seamless aluminum alloys ANS: D

3AL means that the cylinder is constructed of specially prescribed seamless aluminum alloys and must be examined every 5 years to test its expansion characteristics. Type 3AA is constructed of heat-treated, high-strength steel. PTS: 1

REF: Page 53

13. Which type of cylinder is produced from non–heat-treated carbon-steel? a. 3 b. 3A c. 3AA d. 3AAA ANS: B

Type 3AA cylinders are produced from heat-treated, high-strength steel; type 3A cylinders are made of carbon-steel (non–heat treated). Type 3AL cylinders are constructed of specially prescribed seamless aluminTuEmSaTllB oyAsN .T in. deCrsO, M which are made of low-carbon steel, KySpEe L3LcyElR are no longer produced. PTS: 1

REF: Page 53

14. If the maximum filling pressure is marked as 2050 lb-force per square inch gauge (psig), this

cylinder is capable of holding a. 1845 b. 2050 c. 2255 d. 2460

psig.

ANS: C

Compressed-gas cylinders should be capable of holding up to 10% more than the maximum filling pressure as marked. 10%  2050 = 205 + 2050 = 2255 psig. PTS: 1

REF: Page 54

15. An asterisk following the reexamination date on a cylinder indicates that the cylinder a. has passed the test. b. must be retested every 5 years. c. must be retested every 10 years. d. has been sold to another company. ANS: C

An asterisk after the reexamination date on the cylinder markings (see Fig. 3.4) indicates that the cylinder must be retested every 10 years. PTS: 1

REF: Page 54

16. Which size cylinder would be most appropriate for use during patient transport? a. H b. G c. M d. E ANS: D

Size “E” cylinders are used for emergencies and for transport. The other cylinders are too large to be used for transport. PTS: 1

REF: Page 56

17. Which of the following are marked on a cylinder?

1. Ownership marks 2. Method of production 3. Serial number of the cylinder 4. Type of material used to construct the cylinder a. 3 only b. 1 and 2 c. 2 and 3 d. 1, 3, and 4 ANS: D

The method of production is not required to be on the cylinder. All the other options are a requirement. PTS: 1

REF: Pages 53-54

18. A plus sign after an examination date indicates that the cylinder a. may be retested in 5 years. b. may be retested in 10 years. c. has been sold to another company. d. has complied with the requirements of the test. ANS: D

The plus sign means that the cylinder has complied with the requirements of the test. An asterisk following the reexamination date on the cylinder markings indicates that the cylinder must be retested every 10 years. PTS: 1

REF: Page 54

19. The color codes for cylinders are prescribed by the a. US National Formulary. b. CGA. c. FDA. d. American Standards Association.

ANS: A

The US National Formulary sets the color-code standards. PTS: 1

REF: Page 54

20. What is the cylinder color for nitrous oxide? a. Red b. Black and white c. Brown d. Light blue ANS: D

Nitrous oxide is light blue. Ethylene is red. Compressed air is black and white. Helium is brown. See Table 3.4. PTS: 1

REF: Page 57, Table 3.4

21. What is the international color code for compressed air? a. Gray b. Black c. Yellow d. Black and white ANS: D

The international color code for compressed air is black and white. Yellow is the color set by the US National Formulary. PTS: 1

REF: TPE agSe T 58BANKSELLER.COM

22. Which of the following appears on the labels of gas cylinders?

1. Chemical symbol of the contents 2. Precautionary measures for the gas 3. Specific hazards related to use of the gas 4. Volume of the cylinder marked in liters at 70F a. 2 and 3 b. 1 and 4 c. 1, 2, and 3 d. 1, 2, 3, and 4 ANS: D

The CGA and the American Standards Association specify that all labels should include the chemical symbol of the contents, precautionary measures, specific hazards related to the gas, and the volume of the cylinder marked in liters at 70F. PTS: 1

REF: Page 57

23. Which agency sets standards for the purity of medical gases? a. US National Formulary b. CGA c. FDA d. American Standards Association

ANS: C

Only the FDA sets the purity standards for medical gases. PTS: 1

REF: Page 51

24. A 97% purity standard is required for which of the following gases? a. Ethylene b. Nitrogen c. Nitric oxide d. Nitrous oxide ANS: D

See Table 3.4. PTS: 1

REF: Page 57, Table 3.4

25. What is the purity standard for oxygen? a. 99% b. 98% c. 97% d. 95% ANS: A

See Table 3.4. PTS: 1

REF: Page 58, Table 3.5

26. Which of the following staT teE mSeT ntB (sA ) is ylinder valves? NK(aSreE)LtrLueEaRb.out COcM

1. Diaphragm valves can withstand pressure greater than 1500 psig. 2. Direct-acting valves are used for pressure less than 1500 psig. 3. Diaphragm valves should be used with flammable gases. 4. Leakage cannot occur with direct-acting valves. a. 3 only b. 1 only c. 2 and 3 d. 1 and 4 ANS: A

Diaphragm valves can withstand pressures less than 1500 psig and should be used with flammable gases because they do not allow leaks. A direct-acting valve contains two washers and a Teflon packing to prevent gas leakage around the threads. PTS: 1 27.

REF: Page 53

Which of the following statement(s) is (are) true about cylinder valves? 1. Diaphragm valves cannot withstand pressure greater than 1500 psig. 2. Direct-acting valves are used for pressure greater than 1500 psig. 3. Diaphragm valves should not be used with anesthetic gases. 4. Stem leakage can occur with direct-acting valves. a. 3 b. 2 and 4 c. 1 and 4

d. 1, 2, and 4 ANS: D

Diaphragm valves are ideal for situations in which no gas leaks can be allowed, such as with flammable anesthetics. PTS: 1

REF: Page 53

28. Which of the following statements are true about diaphragm type of valves?

1. A partial rotation of a diaphragm type of valve will not open the stem. 2. The valve seat in a diaphragm type of valve does not turn. 3. The diaphragm type of valve contains two fiber washers. 4. The diaphragm type of valve uses a threaded stem. a. 1 and 2 b. 1 and 3 c. 3 and 4 d. 2 and 4 ANS: D

The valve seat does not turn and is therefore resistant to scoring; it also uses a threaded stem in place of the packing found on the direct-acting valves. The direct-acting valve has two fiber washers. PTS: 1

REF: Page 53

29. The diaphragms of a diaphragm type of valve can be made of which of the following?

1. Steel 2. Copper 3. Aluminum 4. Chrome-molybdenum a. 2 b. 2 and 3 c. 3 and 4 d. 1 and 2 ANS: D

The diaphragm type of valve has two diaphragms, one made of steel and one made of copper. Aluminum and chrome-molybdenum are metals that are used in the construction of cylinders. PTS: 1

REF: Page 53

30. Wood’s metal is used to make a. gas cylinders. b. fusible-plug pressure-relief valves. c. rupture-disk pressure-relief valves. d. spring-loaded pressure-relief devices. ANS: B

Fusible-plug pressure-relief valves are made of a metal alloy that melts when the temperature of the gas in the tank exceeds a predetermined temperature. This is called Wood’s metal. PTS: 1

REF: Page 53

31. Which type of valve operates on the principle that as the pressure in a cylinder increases, the

temperature of the gas increases? a. Direct-acting valves b. Fusible-plug pressure-relief valves c. Rupture-disk pressure-relief valves d. Spring-loaded pressure-relief valves ANS: B

Fusible-plug pressure-relief valves operate on the principle that as the pressure in a tank increases, the temperature of the gas increases, causing the plug to melt. Spring-loaded devices are designed to release excessive cylinder pressure and reseal, preventing further release of gas from the cylinder after the cause of the excessive pressure is removed. The rupture-disk will buckle when the pressure inside the cylinder exceeds a certain predetermined limit. Direct-acting valves are not pressure-relief valves; instead, they are controlling devices that seal the contents of a compressed cylinder until it is ready for use. PTS: 1

REF: Page 54, Box 3.2

32. Which agency designed the safety systems for outlet connections of cylinder valves? a. Z-79 Committee b. CGA c. FDA d. American National Standards Institute (ANSI) ANS: B

The CGA designed the safety systems for outlet connections of cylinders. The Z-79 Committee establishes stanTdE arSdT s fBoA r aNnK esSthEeL tiL cE anRd.vC enOtiMlatory devices. The FDA sets purity standards. ANSI is a private nonprofit organization that coordinates the voluntary development of national standards in the United States. PTS: 1

REF: Page 53

33. Medical gas cylinder valve outlets always have connections that are a. right; external b. right; internal c. left; external d. left; internal

-handed and

ANS: A

External and right-handed is the standard for medical gas cylinder valve outlets. PTS: 1

REF: Page 53

34. Which safety system is used with small cylinders, sizes “A” through “E”? a. Pin Index Safety System b. Diameter Index Safety System (DISS) c. Direct-Acting Valve Safety System d. American Standard Index Safety System ANS: A

Small cylinders (i.e., sizes “A” to “E”) with post type of valves use a different American Standard indexing system called the Pin Index Safety System. PTS: 1

REF: Page 62, Fig. 3.8

35. The cylinder outlet diameter for a “G” size oxygen cylinder is a. 0.830 b. 0.903 c. 0.960 d. 0.965

inches.

ANS: B

See Fig. 3.8. PTS: 1

REF: Page 62, Fig. 3.8

36. A nitrous oxide “H” size cylinder cannot be attached to oxygen equipment because the nitrous

oxide cylinder has which of the following? 1. A different outlet size 2. A different thread type 3. An outer threading system 4. Internal threading; and oxygen has an external threading a. 1, 2, 3, and 4 b. 2, 3, and 4 c. 2 and 3 d. 1 and 2 ANS: D

See Fig. 3.8. PTS: 1

REF: Page 62, Fig. 3.8

37. Which of the following types of threading does a compressed-air cylinder have?

1. Right-handed 2. Left-handed 3. Internal 4. External a. 2 and 3 b. 1 and 4 c. 2 and 4 d. 1 and 3 ANS: B

See Fig. 3.8. PTS: 1

REF: Page 63, Fig. 3.9

38. What are the pin positions for an “E” size oxygen cylinder? a. 2 and 4 b. 2 and 5 c. 2 and 6 d. 3 and 5

ANS: B

See Fig. 3.9. PTS: 1

REF: Page 63, Fig. 3.9

39. What are the pin positions for an “E” size compressed-air cylinder? a. 1 and 5 b. 1 and 6 c. 2 and 5 d. 3 and 5 ANS: A

See Fig. 3.9. PTS: 1

REF: Page 61, Box 3.4

40. Which of the following procedures should be followed in setting up a compressed-gas

cylinder at a patient’s bedside? 1. Inspect the cylinder and valve for dirt, debris, and oil. 2. Make sure the cylinder is properly secured. 3. Tighten the regulator with a pipe wrench. 4. Open the cylinder valve completely. a. 3 and 4 b. 1 and 2 c. 2, 3, and 4 d. 1, 2, and 4 ANS: B

See Box 3.4. PTS: 1

REF: Page 61, Box 3.4

41. The best position for the cylinder valve when it is being used is a. completely open. b. two turns toward the left. c. one turn, open toward the right. d. one-half-turn back from completely open. ANS: D

See Box 3.4. PTS: 1

REF: Page 61

42. After connecting an oxygen regulator to an “H” cylinder and turning the direct-acting valve

on, the respiratory therapist attempts to turn on the flow of oxygen. The desired gas flow is not achieved. Which of the following are the most likely problems? 1. The therapist is using the wrong regulator. 2. The pressure in the cylinder is inadequate. 3. The regulator outlet is obstructed. 4. There is a leak in the connection between the cylinder outlet and the regulator. a. 1 and 3

b. 2 and 4 c. 2 and 3 d. 1, 2, and 4 ANS: C

Failure to achieve a desired gas flow from a cylinder regulator can result from inadequate pressure or from an obstruction at the regulator outlet. There would be a hissing noise if there was a leak. Safety systems prevent the wrong regulator from fitting an oxygen cylinder. PTS: 1

REF: Page 61

43. An “E” size cylinder is turned on, and the flowmeter is off. Which of the following is (are) the

most likely causes of a hissing sound? 1. A cracked flowmeter 2. Inadequate pressure in the cylinder 3. An obstruction at the regulator outlet 4. A leak in the connection between the yoke and the cylinder opening a. 2 and 4 b. 1 and 2 c. 1 and 3 d. 1 and 4 ANS: D

A hissing noise means that there is a leak somewhere in the system. Typically, that will occur between the yoke and the cylinder opening or if there is a crack in the flowmeter. Inadequate pressure or an obstruction would not cause a hissing sound. PTS: 1

REF: TPE agSe T 61BANKSELLER.COM

44. A full “H” size cylinder is used to provide oxygen to an air-entrainment mask at 6 L/min. If

the cylinder is replaced at 500 psig, how long will it last? a. 5 hours b. 10 hours 20 minutes c. 10 hours 50 minutes d. 15 hours 23 minutes ANS: D

Amount of time left in cylinder = (cylinder pressure  cylinder factor)/flow rate of gas (liters/min). H cylinder factor = 3.14. Full-size “H” cylinder = 2265 psig. If the cylinder is changed at 500 psi, then 2265 – 500 = 1765 (1765 psi will be used). (3.14  1765)/6 L/min = 923.7 minutes/60 = 15 hours (0.39  60) = 15 hours 23 minutes. PTS: 1

REF: Page 63, Box 3.5

45. An “E” size cylinder with 1600 psig is used to provide oxygen to a simple mask running at 5

L/min during a transport. The cylinder will last a. 8 hours. b. 56 minutes. c. 68 minutes. d. 89 minutes. ANS: D

Amount of time left in cylinder = (cylinder pressure  cylinder factor)/flow rate of gas (liters/min). “E” size factor = 0.28. A simple mask should run at a minimum of 5 L/min. Therefore, (1600  0.28)/5 L/min = 448/5 = 89.6 minutes. PTS: 1

REF: Page 63, Box 3.5

46. An “E” size oxygen cylinder with 2000 psig in it is being used at 4 L/min. How much will be

used in 45 minutes? a. 26.2 psig b. 140 psig c. 180 psig d. 643 psig ANS: D

Amount of time left in cylinder = (cylinder pressure  cylinder factor)/flow rate of gas (liters/min). (2000  0.28)/4 = 140 minutes to use up 2000 psig. Therefore, 2000 psig/140 min = X psig/1 minute X = 14.3 psig/min  45 minutes = 642.8 psig. PTS: 1

REF: Page 63, Box 3.5

47. A “G” size oxygen cylinder with 1450 psig is being used at 5 L/min. This cylinder will be

empty in approximately a. 1; 30 b. 2; 39 c. 11; 30 d. 15; 16

hour(s) and

minutes.

ANS: C

Amount of time left in cylinder = (cylinder pressure  cylinder factor)/flow rate of gas (liters/min). “G” size cylinder factor = 2.41. Amount of time = (1450  2.41)/5 = 698.9 minutes/60 = 11 hours 39 minutes. PTS: 1

REF: Page 63, Box 3.5

48. The K cylinder at a patient’s bedside contains 1300 psig and is using 7 L/min. It will take

approximately a. 3.7 b. 9.7 c. 6 d. 4

hours to use 800 psig.

ANS: C

Amount of time left in cylinder = (cylinder pressure  cylinder factor)/flow rate of gas (liters/min). K factor = 3.14. Time to use 800 psi = (800  3.14)/7 = 358.8 min/60 = 5 hours 59 minutes. PTS: 1

REF: Page 63, Box 3.5

49. The E cylinder on a crash cart contains 900 psig. How long would the cylinder last if used at

10 L/min? a. 1 hour

b. 25 minutes c. 3 hours 36 minutes d. 4 hours 42 minutes ANS: B

Amount of time left in cylinder = (cylinder pressure  cylinder factor)/flow rate of gas (liters/min). E factor = 0.28. Time to use 900 psig = (900  0.28)/10 = 25 minutes. PTS: 1

REF: Page 63, Box 3.5

50. A “G” size cylinder with 2000 psig is used for 6 hours at 5 L/min. How much gas was used

during this time? a. 2000 psig b. 750 psig c. 573 psig d. 107 psig ANS: B

Amount of time left in cylinder = (cylinder pressure  cylinder factor)/flow rate of gas (liters/min). G factor = 2.41. Time to use 2000 psig = (2000  2.42)/5 = 964 minutes/60 = 16 hours. 2000 psig/16 hours = X psig/6 hours. X = 750 psig will be used in 6 hours at 5 L/min. PTS: 1

REF: Page 63, Box 3.5

51. Which of the following statements are true with regard to liquid bulk systems?

1. Liquefied oxygen occupies a fraction of the space required for the storage of gaseous oxygen. 2. The CGA regulates the cToE nsStrTuB ctA ioN nKoS f lE iqLuL idEoR x. ygCeO nM systems. 3. A bulk oxygen system contains more than 40,000 ft of oxygen. 4. The working pressure of a liquid bulk oxygen system is 50 psig. a. 2 and 4 b. 3 and 4 c. 1 and 3 d. 1 and 4 ANS: D

See Box 3.6. PTS: 1

REF: Page 64, Box 3.6

52. The function of the vaporizer of a liquid bulk oxygen system is to a. act as a pressure release. b. reduce the pressure to 50 psig. c. convert liquid oxygen to gaseous oxygen. d. allow heat to be released into the environment. ANS: C

The reservoir stores a mixture of liquid and gaseous oxygen. The vaporizer acts as a heat exchanger where heat is absorbed from the environment and used to warm the liquid oxygen to room temperature, thus forming gaseous oxygen. PTS: 1

REF: Page 63

53. The gas above liquid oxygen is maintained a. between its freezing point and its critical temperature. b. between its boiling point and its critical temperature. c. at its critical pressure. d. at its boiling point. ANS: B

The pressure-release valve allows some of the gas on top of the liquid to escape if the contents are warmed too much. This release of gas allows the gas within the container to expand, thus lowering the temperature. This maintains the gas under pressure between its boiling point and its critical temperature so that the majority of the reservoir’s contents will be maintained in the liquid state. PTS: 1

REF: Page 63

54. The application of Gay-Lussac’s law in a bulk liquid oxygen system a. accounts for the conversion of the liquid oxygen to gaseous oxygen. b. allows the reservoir contents to be maintained in the liquid state. c. keeps the liquid oxygen above its critical temperature. d. allows the gas to be maintained at 50 psig. ANS: B

According to Gay-Lussac’s law, if the volume of a gas remains constant, there is a direct relationship between the absolute pressure of a gas and its temperature. This release of gas allows the gas within the container to expand, thus lowering the temperature. PTS: 1

REF: TPE agSe T 63BANKSELLER.COM

55. Which of the following are components of a bulk liquid oxygen system?

1. 3AA container 2. Insulated reservoir 3. Pressure-release valve 4. A heater for the liquid oxygen a. 2 and 3 b. 1 and 3 c. 2 and 4 d. 1 and 4 ANS: A

A bulk liquid oxygen system consists of an insulated reservoir, a vaporizer with associated tubing attached to the reservoir, a pressure-reducing valve, and an appropriate pressure-release valve. PTS: 1

REF: Page 63

56. The NFPA requires bulk oxygen systems to be located

1. 10 ft from flammable gas storage. 2. 10 ft from public sidewalks. 3. 5 ft from the property line. 4. 5 ft from congested areas.

a. 1 and 4 b. 2 and 3 c. 2, 3, and 4 d. 1, 2, 3, and 4 ANS: B

See Box 3.6. PTS: 1

REF: Page 65, Box 3.6

57. According to the NFPA, for a nonambulatory patient, the minimum distance from a bulk

oxygen supply is a. 5 b. 10 c. 25 d. 50

ft.

ANS: D

See Fig. 3.11. PTS: 1

REF: Page 66, Fig. 3.11

58. One liter of liquid oxygen weighs a. 25 b. 40 c. 86 d. 860

oz.

ANS: B

One liter of oxygen weighs 2.5 lb. 2.5 lb  16 oz/lb = 40 oz. PTS: 1

REF: Page 67

59. A home care patient inquires about how long her portable liquid oxygen system, currently

weighing 30 lb, will last if she uses 3 L/min. The manufacturer says the weight of an empty container is 8 lb. Her system will last for day(s) and hours. a. 1; 18 b. 2; 9 c. 4; 21 d. 8; 12 ANS: A

First subtract 8 lb from 30 lb = 22 lb. Convert 22 lb/2.5 lb/L = 8.8 L. 8.8 L  860 (liter of liquid oxygen multiplied by 860 equals the liters of gaseous oxygen) = 7568 L. Then divide by liter flow. 7568/3 L/min = 2522 min = 1 day 18 hours. PTS: 1

REF: Page 67, Box 3.7

60. If a portable liquid oxygen reservoir is set to deliver 6 L/min and the current reservoir weight

is 38 lb, it will take is 10 lb. a. 5

hours for the reservoir to empty if the weight of an empty container

b. 23 c. 27 d. 36 ANS: C

Subtract 10 lb from 38 lb = 28 lb. Convert 28 lb/2.5 lb/L = 11.2 lb. 11.2 lb  860 = 9632 L. Then divide by liter flow: 9632 L/6 L/min = 1605 minutes, or 27 hours. PTS: 1

REF: Page 67, Box 3.7

61. Approximately how long will a liquid oxygen reservoir last when supplying 3 L/min to your

patient? The current reservoir weight is 20 lb, and the weight of an empty reservoir is 10 lb. a. 19 hours b. 38 hours c. 46 hours d. 119 hours ANS: A

Subtract 10 lb from 20 lb = 10 lb. Convert 10 lb/2.5 lb/L= 4 L. 4  860 = 3440 L. Then divide by the flow 3440 L/3 L/min = 1146 minutes, or 19 hours. PTS: 1

REF: Page 67

62. During your home care visit on Monday morning, you weigh the patient’s portable liquid

oxygen reservoir. The liquid oxygen weighs 18 lb, and the patient is using 2 L/min. When should you schedule a visit to fill up the reservoir? a. The next Monday b. Wednesday morning c. Thursday afternoon d. Friday afternoon ANS: B

18 lb/2.5 lb/L = 7.2 L. 7.2 L  860 = 6192 L/2 L/min = 3096 minutes, or 51 hours 36 minutes, which is 2 days 3 hours 36 minutes. So it would have to be filled on Wednesday. PTS: 1

REF: Page 67, Box 3.7

63. Which of the following types of compressor can accommodate a mechanical ventilator?

1. Diaphragm 2. Liquid air 3. Rotary 4. Piston a. 1 only b. 2 and 4 c. 3 and 4 d. 1, 3, and 4 ANS: C

Rotary compressors use a rotating vane to compress air from an intake valve. As the rotating vane turns, gas is drawn into the cylinder through a one-way valve (Fig. 3.16). The rotor turns, which causes the gas to be compressed as the oval-shaped cylinder becomes smaller. The compressed gas is then forced out of the compressor through another one-way outflow valve. Low-pressure rotary compressors are used in ventilators such as the Bennett MA-1. Piston compressors use the action of a motor-driven piston to compress atmospheric air. The piston is seated within a cylinder casing and is sealed to it with a carbon or Teflon ring. Fig. 3.14 illustrates the operational principle of a typical piston air compressor used to power a mechanical ventilator. PTS: 1

REF: Page 67

64. Which of the following is (are) a small nebulizer compressor(s)?

1. Diaphragm 2. Liquid air 3. Rotary 4. Piston a. 4 only b. 1 only c. 1 and 2 d. 1, 3, and 4 ANS: B

A flexible diaphragm is attached to a piston to compress gas. As the piston moves down, the diaphragm is bent outward and gas is drawn through a one-way valve into the cylinder. Upward movement of the piston forces the gas out of the cylinder through a separate one-way outflow valve. Examples oT fE diS apThB raAgN mKcS om prL esEsoRr. sC arO eM the Air Shields Diapump and the EL DeVilbiss small nebulizer compressor. PTS: 1

REF: Page 67

65. Which of the following agencies makes recommendations for medical air supply? a. ISO b. NFPA c. CGA d. Bureau of Medical Devices ANS: B

See Box 3.8. PTS: 1

REF: Page 68, Box 3.8

66. Which of the following statements about medical air supplies are false?

1. The air intake port must be located indoors. 2. The source of medical air must be from the outside atmosphere. 3. Most hospital bulk air supply systems use two compressors. 4. Backflow through the compressors that are cycled off must be prevented manually. a. 1 and 4 b. 1, 2, and 3 c. 2 and 3 d. 3 and 4

ANS: A

See Box 3.8. PTS: 1

REF: Page 68, Box 3.8

67. Which of the following types of air compressors are used in bulk supply systems?

1. Piston 2. Rotary 3. Liquid air 4. Diaphragm a. 1 and 4 b. 1 and 3 c. 1 and 2 d. 2 and 4 ANS: C

To power a bulk air supply, either a piston or a rotary compressor is necessary. Liquid air is not used as a source for bulk supply. A diaphragm air compressor could not keep up with the requirements of a bulk system. PTS: 1

REF: Page 54, Box 3.2

68. The NFPA requires that bulk oxygen systems be at least how many feet from parked vehicles? a. 5 b. 10 c. 15 d. 20 ANS: B

See Fig. 3.11. PTS: 1

REF: Page 66, Fig. 3.11

69. If the working pressure of a bulk oxygen system is 45 psig, all pressure-relief valves should be

set at a. 45 b. 50 c. 67 d. 80

psig.

ANS: C

All pressure-relief valves are set 50% higher than the system working pressure (e.g., set at 75 psi for a 50-psi system pressure). PTS: 1

REF: Page 58

70. In the event of a fire in a hospital, which of the following might be necessary?

1. Provide supplemental oxygen to patients who require it. 2. Shut off oxygen zone valves to the affected area. 3. Shut off the main oxygen valve. 4. Check oxygen line pressure.

a. b. c. d.

1 and 3 1 and 2 2 and 4 3 and 4

ANS: B

In case of fire, affected zones can be isolated, thus preventing the problem from spreading to other areas of the hospital. And always remember patient safety in terms of applying the appropriate oxygen to each patient. PTS: 1

REF: Page 59

71. Which of the following are safety features incorporated into a medical gas piping system?

1. Zone valves 2. Riser valves 3. Pressure-relief valves 4. In-line oxygen analyzers a. 3 and 4 b. 1 and 3 c. 1 and 4 d. 1, 2, and 3 ANS: D

See Fig. 3.17. PTS: 1

REF: Page 59

oE unSdTaB t sAtaNtiKoS nE ouLtlLetEs R of.aCm 72. Which safety systems are fT OeMdical gas piping system? 1. DISS 2. American Standard Safety System (ASSS) 3. Pin Index Safety System 4. Quick Connect a. 1 and 3 b. 1 and 4 c. 2 and 3 d. 2 and 4 ANS: B

Station outlets are designed with safety systems that prevent the connection of incompatible devices. Two safety systems are currently available: the DISS and Quick-Connect adapters. PTS: 1

REF: Page 59

73. The type of station outlet connection that uses noninterchangeable thread fittings to connect

gas-powered devices to station outlets is known as a. Regulator. b. Quick-connect adapter. c. Pin Index Safety System. d. DISS. ANS: D

Fig. 3.20 shows an outlet that uses DISS. This system, which was designed by the CGA, uses noninterchangeable thread fittings to connect gas-powered devices to station outlets. PTS: 1

REF: Page 59

74. Which of the following statements are true concerning station outlets?

1. Check valves are safety valves that close automatically when an adapter is disengaged from the outlet. 2. Station outlets do not have ASSS connections. 3. Quick-connect adapters use noninterchangeable thread fittings. 4. Check valves must hold a minimum of 200 psig. a. 3 and 4 b. 1, 3, and 4 c. 2 and 4 d. 1 and 2 ANS: D

Station outlets have safety valves that close automatically when an adapter is disengaged from the outlet (i.e., quick-connect adapters). The quick-connect adapters and the DISS are the two safety systems that can be at a station outlet. PTS: 1

REF: Page 72

75. What percentage of oxygen does a typical molecular sieve concentrator provide when it is

running at 2 L/min? a. 100% b. 90% c. 85% d. 40% ANS: B

The concentration of oxygen leaving the system depends on the flow rate set. For example, at flows less than 6 L/min, the gas contains approximately 92% to 97% oxygen. PTS: 1

REF: Page 73

76. Which is true about the process of fractional distillation of liquid air? a. Compressed air is a by-product. b. It produces pure liquid oxygen. c. Liquid nitrous oxide is produced. d. Concentrators use it to produce oxygen. ANS: B

The fractional distillation of liquid air creates pure liquid oxygen. Oxygen concentrators take in room air and separate oxygen from nitrogen. PTS: 1

REF: Page 50, Box 3.1

77. One liter of liquid oxygen is equivalent to a. 2.5 b. 328 c. 348

liters of gaseous oxygen.

d. 860 ANS: D

Oxygen expands to 860 times its liquid volume at 25C and 1 atm; therefore, the total volume of gaseous oxygen available can be calculated by multiplying the number of liters of liquid oxygen by 860. PTS: 1

REF: Page 67

78. Which of the following statements are true given that, on one side of a medical gas cylinder,

the only markings to appear are 3 (tw) 84 + *. 1. The cylinder passed the hydrostatic test 2. The cylinder must be retested after 5 years 3. The cylinder must be retested after 10 years 4. The cylinder was manufactured in March 1984 a. 2, 3, and 4 b. 1 and 3 c. 1 and 4 d. 1, 2, and 4 ANS: D

See Fig. 3.4. PTS: 1

REF: Page 57

79. Which of the following statements reflects the recommendations of the NFPA and CGA for

storing cylinders outdoors? 1. Cylinders should not beTstE orSeT dB inAaN nKarSeE aL wL heEreRt.hC eO teM mperature exceeds 125F. 2. Cylinders must be protected from the weather. 3. Full and empty cylinders should be kept separate. 4. Cylinders should not be stored outside. a. 1 and 4 b. 1 and 2 c. 2 and 3 d. 1, 2, and 3 ANS: D

See Box 3.3. PTS: 1

REF: Page 55, Box 3.3

80. Which of the following large-cylinder safety recommendations is appropriate?

1. Protective caps are not necessary during storage. 2. Cylinders should be transported with protective caps. 3. Cylinder carts used in the operating room must be grounded. 4. Transportation must occur on an appropriate cart, onto which the cylinder is secured by a chain. a. 1 and 4 b. 1 and 2 c. 2 and 3 d. 2, 3, and 4

ANS: D

Large cylinders have a protective cap that fits over the valve stem. This cap should be kept on cylinders when moving or storing them. PTS: 1

REF: Page 55, Box 3.3

81. Which of the following types of oxygen storage device are appropriate for home care?

1. Compressor 2. Concentrator 3. Bulk oxygen system 4. Liquid oxygen cylinder a. 1 and 3 b. 2 and 4 c. 2, 3, and 4 d. 1, 2, and 4 ANS: B

Concentrators are used in the home care setting for patients who require low-flow oxygen. Liquid oxygen cylinders can allow the patient more time outside of the home during travel. Manifolds and bulk oxygen systems are not appropriate for home care. Compressors provide medical air, not oxygen. PTS: 1

REF: Page 73

82. Which of the following have the fastest diffusion rate through the semipermeable membrane

of an oxygen concentrator? 1. Carbon dioxide 2. Water vapor 3. Nitrogen 4. Oxygen a. 1 and 2 b. 1 and 3 c. 3 and 4 d. 2 and 4 ANS: D

Oxygen concentrators are devices that produce enriched oxygen from atmospheric air. Thus, oxygen and water vapor diffuse through these membranes faster than nitrogen. PTS: 1

REF: Page 73

83. The concentration of oxygen leaving an oxygen concentrator depends on the a. number of sieves in the unit. b. number of compressors used. c. set flow rate of the gas exiting. d. size of the sodium-aluminum silicate pellets. ANS: C

Atmospheric gases diffuse through the membrane at different rates. The rate at which a gas diffuses depends on its diffusion constant and solubility for the plastic membrane and the pressure gradient for the gas across the membrane.

PTS: 1

REF: Page 73

84. Bulk oxygen is produced through which of the following? a. Molecular sieves b. Fractional distillation c. Semipermeable membranes d. Combustion of natural gas ANS: B

Fractional distillation generates bulk oxygen. Molecular sieves and semipermeable membranes are used in oxygen concentrators. The combustion of natural gas produces carbon dioxide. PTS: 1

REF: Page 50

85. Which of the following gases is used to treat singultus? a. Air b. Oxygen c. Nitrous oxide d. Carbon dioxide ANS: D

Carbon dioxide is used for the treatment of singultus (hiccups) and as a stimulant/depressant of the central nervous system. PTS: 1

REF: Page 51

86. At –183C, which of the following gases exists as a pale, bluish liquid that is slightly heavier

than water? a. Air b. Oxygen c. Nitrous oxide d. Carbon dioxide ANS: B

Oxygen is an elemental gas that is colorless, odorless, and tasteless at normal temperatures and pressures. It makes up 20.9% of the Earth’s atmosphere by volume and 23.2% by weight. It constitutes approximately 50% of the Earth’s crust by weight. Oxygen is slightly heavier than air, having a density of 1.326 kg/m3 at 21.1C and 760 mm Hg (specific gravity = 1.105). At temperatures less than –183C (–300F), oxygen exists as a pale, bluish liquid that is slightly heavier than water. PTS: 1

REF: Page 50

87. Which of the following gases may be used as a refrigerant? a. Oxygen b. Nitric oxide c. Carbon dioxide d. Carbon monoxide ANS: C

Solid carbon dioxide is used to refrigerate perishable materials during transport (e.g., food and laboratory specimens). Liquid carbon dioxide can be used as an expendable refrigerant and is used extensively as a fire-extinguishing agent in portable and stationary fire-extinguishing systems. PTS: 1

REF: Page 51

88. Which of the letters points to the manufacturer’s mark?

a. b. c. d.

A B C D

ANS: B

See Fig. 3.4. PTS: 1

REF: Page 57

89. Which size cylinder is currently used for the storage of nitric oxide? a. 61.4 cubic ft b. 82 cubic ft c. 110 cubic ft d. 152 cubic ft ANS: B

Before 1997, nitric oxide was supplied in cylinders with a volume capacity of 152 cubic ft. It is now supplied in smaller cylinders (82 cubic ft) with 626 CGA valve outlets. PTS: 1

REF: Page 57

90. The cylinder color for nitric oxide is a. red. b. light blue. c. teal and black. d. brown and green.

ANS: C

See Table 3.4. PTS: 1

REF: Page 58

91. Which gas law is applied in a fusible-plug pressure-relief valve? a. Boyle’s b. Charles’ c. Dalton’s d. Gay-Lussac’s ANS: D

REF: Page 59

92. The American Standard System connections for all life support gases are _ a. b. c. d.

-handed and

. Left; internal Left; external Right; internal Right; external

ANS: D

Note that the connections for oxygen and other life-support gases are right-handed and external. PTS: 1

REF: Page 59

93. Which of the following is the Pin Index Safety System pin position for oxygen?

a. b. c. d.

A B C D

ANS: A

Recall that in this system, indexing is accomplished by the exact placement of two pins into holes in the post valve. PTS: 1

REF: Page 63, Fig. 3.9

94. An “E” size oxygen cylinder with 2200 psig has a set flow rate of 2 L/min. It will take

hours and a. 5; 30 b. 5; 6 c. 4; 30 d. 4; 12

minutes until the gauge pressure reaches 400 psig.

ANS: D

Amount of time left in cylinder = (cylinder pressure  cylinder factor)/flow rate of gas (liters/min). 2200 – 400 = 1800 psig (the amount of gas that will be used). (1800  0.28)/2 = 252 minutes/60 = 4 hours 12 minutes. PTS: 1

REF: Page 63, Box 3.5

95. Which of the following “E” size oxygen cylinders will last the longest?

Pressure (psig)

Flow (L/min)

a. 1600 b. 1400 c. 800 d. 400

3 2.5 2 1

ANS: B

This answer was derived from the following formula: 1400  0.28 = 392/2.5 L/min = 156.8 minutes. 1400 psig at 2.5 L/min will last the longest compared with the other three. PTS: 1

REF: Page 63, Box 3.5

96. An “H” size oxygen cylinder with 1600 psig has a set flow rate of 3 L/min. It will take

hours and a. 17; 24 b. 21; 25 c. 22; 40 d. 27; 54

minutes to reach 300 psig.

ANS: C

The same formula as described in the previous question is used here; however, you first have to subtract 300 psig from 1600 psig to get the exact duration for 1300 psig. (1300  3.14)/3 = 1360.7 minutes/60 = approximately 22 hours 40 minutes. PTS: 1

REF: Page 63, Box 3.5

97. The following figure represents the components of which of the following?

a. Hydrostatic testing system b. Bulk liquid oxygen system

c. Fractional distillation apparatus d. Alternating oxygen supply system ANS: B

Recall also Fig. 3.10. PTS: 1

REF: Page 64, Box 3.6

98. Which of the following “G” size oxygen cylinders will run out of oxygen first?

Pressure (psig) a. 700 b. 900 c. 1100 d. 1600

Flow (L/min) 1.5 1.0 2.5 3.0

ANS: C

This answer was derived from the following formula:

The cylinder factor is 3.14. 1100 psig has the shortest duration at 1382 minutes, or 23 hours. PTS: 1

REF: Page 63, Box 3.5

99. According to the NFPA, the minimum distance for a place of public assembly from a bulk

oxygen storage system is how many feet? a. 10 b. 15 c. 25 d. 50 ANS: D

See Fig. 3.11. PTS: 1

REF: Page 66

100. Storage of a portable liquid oxygen system adjacent to a heat source will

the

the oxygen. a. increase; pressure b. increase; venting c. decrease; pressure d. decrease; venting ANS: B

Liquid oxygen units should not be located adjacent to heat sources, which can accelerate the venting of oxygen. PTS: 1

REF: Page 68, Box 3.8

101. A stationary liquid oxygen system contains 80 lb of oxygen when full. A home care patient is

using it 8 hours each day, during sleep, at a rate of 3 L/min. At this usage, how many days will the liquid oxygen last? a. 6 b. 8 c. 19 d. 27 ANS: C

Use the liquid oxygen duration formula as given previously. A liter of liquid oxygen weighs 2.5 lb, so: 80 lb/2.5 = 32 L. Gaseous oxygen occupies a volume that is 860 times the volume of liquid oxygen, so: liters of liquid  860 = liters of gas. Duration of supply (minutes) = gas supply remaining (in liters) ÷ flow (liters/minute). Once you get the answer in minutes, you divide by 60 to obtain the number of hours. Then divide the number of hours by the usage, which is 8 hour/day; that gives you 19 days. PTS: 1

REF: Page 67, Box 3.7

Chapter 04: Administering Medical Gases: Regulators, Flowmeters, and Controlling Devices Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. What device helps reduce high-pressure gases from cylinders or bulk storage units to a lower working pressure? a. Regulator b. Flow restrictor c. Bourdon gauge d. Thorpe tube ANS: A The regulator is the only device in which pressure is regulated. The other devices relate to flow. PTS:

REF: Page 81

2. The chamber located above the diaphragm of a single-stage regulator is which of the following? a. Lower chamber b. Pressure-relief valve c. High-pressure chamber d. Adjustable regulator ANS: C The high-pressure chamber is located above the diaphragm and contains a valve stem that will close the inlet when the pressure reaches its setting. PTS:

REF: Page 81

3. The gas flow into the high-pressure side regulator is dependent on what two opposing forces? 1. Gas pressure above the diaphragm 2. Gas pressure at the diaphragm 3. Spring tension below the diaphragm 4. Spring tension above the diaphragm a. 1 and 3 b. 2 and 3 c. 2 and 4 d. 1 and 4 ANS: A When the force offered by the high-pressure gas above the diaphragm equals the force offered by spring tension, the diaphragm is straight and the inlet valve is closed. PTS:

REF: Page 81

4. Delivered pressures on common adjustable regulators are between per square inch gauge (psig). a. 0; 50 b. 0; 100 c. 50; 100 d. 50; 200

and

pounds

ANS: B Most adjustable regulators can be set to deliver pressure between 0 and 100 psig. PTS:

REF: Page 81

5. Which regulator supports the theory that gas pressure is gradually reduced as gas flows from a high-pressure source through a series of stages to the outlet? a. Single-stage regulator b. Flowmeter c. Preset regulator d. Multistage regulator ANS: D Gas from a compressed cylinder (e.g., 2200 psig) enters the first stage of a two-stage regulator, and the gas pressure is reduced to an intermediate pressure (e.g., 700 psig). This lower pressure gas then enters into the second stage of the regulator, where the gas pressure is further reduced to the desired working pressure (e.g., 50 psig) before the gas reaches the outlet. PTS:

RETFE: ST PaBgA eN 81KSELLER.COM

6. Which device is more precise in terms of controlling gas pressure? a. Bourdon flowmeter b. Thorpe tube flowmeter c. Multistage regulator d. Flow restrictors ANS: C Multistage regulators can control gas pressure with more precision than single-stage regulators because the pressure is gradually reduced. PTS:

REF: Page 81

7. The most commonly used flowmeter in respiratory care is which of the following? a. Thorpe tube flowmeter b. Bourdon gauge c. Flow restrictor d. Reducing valve ANS: A Thorpe tubes are the most commonly used flowmeters in respiratory care. PTS:

REF: Page 83

8. The problem most often encountered with a Thorpe tube flowmeter is a. patient outlet becomes occluded b. gas leaks caused by faulty valve seats c. a cracked tube d. prolonged heat exposure ANS: B This problem is usually detected when the flowmeter is turned off completely, but gas can be heard continuing to flow from the flowmeter outlet; in this case, the flowmeter should be replaced. This problem can also occur because of constant wear and tear. PTS:

REF: Page 83

9. Pressure-compensated flowmeters provide which of the following? a. Accurate estimates of pressure b. Accurate estimates of flow c. Back pressure d. A means to estimate leaks ANS: B On pressure-compensated flowmeters, the needle valve controlling gas flow out of the flowmeter is located distal to the Thorpe tube. This arrangement allows the pressure in the indicator tube to be maintained at the source gas pressure, which ensures an accurate estimate of flow. PTS:

REF: Page 83

10. A float that jumps and is closed and is attached to a bulk falls to zero when the needle valve system is indicative of a flowmeter. a. crack in the b. Bourdon c. noncompensated d. pressure-compensated ANS: D This floating movement occurs because the source gas must pass through the indicator tube before it reaches the needle valve. PTS:

REF: Page 83

11. Which device uses the following principle? As the driving pressure is increased, the flow from the flowmeter outlet increases. a. Compensated Thorpe tube flowmeter b. Fixed-orifice flowmeter c. Bourdon flowmeter d. Noncompensated pressure flowmeter ANS: C A Bourdon flowmeter is actually a reducing valve that controls the pressure gradient across an outlet with a fixed orifice.

PTS:

REF: Page 84

12. What are the types of flow restrictors? 1. Fixed-orifice 2. Adjustable, multiple-orifices 3. Compensated orifice 4. Noncompensated orifice a. 1 and 4 b. 2 and 3 c. 3 and 4 d. 1 and 2 ANS: D There are two types of flow restrictors: fixed-orifice and adjustable, multiple-orifice models. The adjustable, multiple-orifice flow restrictor uses a series of calibrated openings in a disk that can be adjusted to deliver different flows. PTS:

REF: Page 86

13. The characteristics of low-flow devices are 1. fractional inspired oxygen (FIO2) from 0.22 to 0.60. 2. make use of a nasal cannula. 3. make use of a Venturi mask. 4. make use of a transtracheal catheter. a. 1, 2, and 4 b. 1 and 4 c. 1 and 3 d. 1, 2, 3, and 4 ANS: A All of the choices are low-flow devices except for a Venturi mask. A Venturi mask is an air-entrainment device, all of which are considered to be high-flow devices. Therefore, Venturi masks deliver a precise FIO2. PTS:

REF: Page 95

14. A patient with chronic bronchitis comes to your emergency department; she is discovered to have a pulse oximetry oxygen saturation (SpO2) of 78% with room air. On the basis of these data, which oxygen-delivery device would you use with the patient? a. 6-L nasal cannula b. Transtracheal catheter c. Simple mask d. Venturi mask ANS: D A patient with chronic obstructive pulmonary disease requires a precise FIO2 because of carbon dioxide (CO2) retention issues. The only precise FIO2 device is a Venturi mask, which is considered a high-flow device. PTS:

REF: Page 95

15. High-flow devices include which of the following? 1. Nasal cannula 2. Venturi mask 3. Mask with reservoir bag 4. Oxygen hoods a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 2 and 4 ANS: D High-flow devices are also called fixed-performance devices because they provide oxygen at flow rates high enough to completely satisfy a patient’s inspiratory demands. These high-flow oxygen-delivery devices include air-entrainment masks (Venturi masks), incubators, oxygen tents, oxygen hoods, and high-volume aerosol devices. PTS:

REF: Page 93

16. Which of the following are disadvantages of the nasal cannula? 1. Pressure necrosis 2. Drying nasal mucosa 3. FIO2 not precise 4. Claustrophobia a. 1 and 4 b. 1 and 2 c. 1, 2, and 3 d. 2 and 3 ANS: C With straight prongs, oxygen flow is directed toward the superior aspects of the nasal cavity, thus promoting turbulent flow; with curved prongs, oxygen entering the nose is directed across the nasal turbinate, thus enhancing laminar flow as the gas flows through the nasal cavity. Thus, both types of prongs can cause the aforementioned disadvantages. PTS:

REF: Page 87

17. If the air-entrainment port on a Venturi mask is occluded, which of the following will happen? 1. A decrease in flow 2. A decrease in FIO2 3. An increase in flow 4. An increase in FIO2 a. 1 and 2 b. 1 and 3 c. 1 and 4 d. 2 only ANS: C

Partial obstruction of oxygen flow downstream of the jet orifice or partial obstruction of the entrainment ports will decrease the amount of room air entrained, thus raising the FIO2 of the delivered gas. PTS:

REF: Page 93 | Page 95

18. In theory, a nasal cannula can deliver what amount of FIO2 to a patient? a. 0.24 to 0.60 b. 0.24 to 0.36 c. 0.24 to 1.00 d. 0.24 to 0.44 ANS: D The FIO2 levels delivered by a nasal cannula vary with the flow rate setting. Generally, the FIO2 increases by about 4% for each liter of flow increase beginning with 1 L/min delivering approximately 24% oxygen. PTS:

REF: Page 90, Table 4.1

19. O2-induced hypoventilation is more likely to occur with which oxygen-delivery device? a. Simple mask b. Nasal cannula c. Venturi mask d. Large-volume nebulizer ANS: A Excessive amounts of oxT ygEeSnTcB anAcNauKsS eE aL paLtiEent R.wCitOhMchronically elevated CO2 levels to hypoventilate because the oxygen can knock out the patient’s hypoxic drive. The oxygen concentration delivered can vary significantly and may cause ventilatory depression in patients with chronically elevated partial pressure of arterial CO2 (PaCO2) levels. PTS:

REF: Page 86, Clinical Practice Guideline 4.1

20. A nasal cannula that delivers 5 L/min translates to what approximate FIO2? a. 36% b. 28% c. 40% d. 44% ANS: C The FIO2 increases approximately 4% for each liter of flow increase. If we begin with 20%, then 5 L/min  4 = 20. And 20% + 20% = 40%. PTS:

REF: Page 90, Table 4.1

21. What liter flow is approximately 32% on a nasal cannula? a. 2 b. 3 c. 4 d. 5

ANS: B For this calculation, zero flow is 20%. Therefore, 32% represents 4% oxygen, then 12/4 = 3 L/min. PTS:

20% = 12%. If each liter

REF: Page 90, Table 4.1

22. If a Venturi mask is set at 28% and the liter flow is set above the set liter flow prescribed on the device, what FIO2 is being delivered? a. 28% b. 32% c. 100% d. 80% ANS: A For most commercially available masks, the oxygen concentration is varied by changing the size of the nozzle outlet or the entrainment ports. The flow of oxygen to the nozzle is constant and set to a minimum value, usually 2 to 10 L/min. PTS:

REF: Page 95, Table 4.2

23. Which of the following influences the FIO2 delivered to the patient by nasal cannula? 1. Work of breathing 2. Tidal volume 3. Respiratory rate 4. Humidification a. 2 and 4 b. 1, 2, and 3 c. 1 and 3 d. 1, 2, 3, and 4 ANS: B All physiologic aspects play a role in the amount of FIO2 delivered to a patient regardless of whether breathing is predominantly occurring through the nose or the mouth. PTS:

REF: Page 87

24. Upon arrival to the emergency department, a patient is found to have an SpO2 of 75% on a nonrebreathing mask. You notice that the nonrebreathing mask is hooked to a bubble humidifier. The humidifier bottle is whistling and is expanded. What is your next action as the respiratory therapist? a. Change the bubble humidifier; it is defective b. Check for kinks in tubing c. Remove the nonrebreathing mask from the humidifier and run off of O2 d. Place a Venturi mask on the patient ANS: C The humidity bottle is not designed for high flows. When it is set to a high flow, the humidity bottle expands and whistles; in turn there is a greater likelihood that the oxygen flowmeter will pop off from the pressure source.

PTS:

REF: Page 93

25. A patient with pulmonary fibrosis comes to the emergency department with an SpO2 of 87% and a respiratory rate of 28 breaths/min. The patient is unsure whether her transtracheal catheter is working properly; what is your first action? a. Intubate her. b. Examine her for a mucus plug. c. Place a nasal cannula on her. d. Place a lavage catheter. ANS: C The therapist should think to place the patient on O2 to maintain her oxygenation status. Once the oxygen is running and the patient is breathing well, the therapist can examine the catheter for obstructions. PTS:

REF: Page 87

26. The benefits of a transtracheal catheter include which of the following? 1. Lower flows are needed to obtain higher SpO2 2. The ability for the patient to eventually wean off of O2 3. Improved self-image of the patient 4. Oxygen cost savings of up to 20% a. 2 and 4 b. 1 and 3 c. 1, 3, and 4 d. 1, 2, and 3 ANS: C The guiding principle for transtracheal oxygen is that the oxygen is delivered directly into the trachea, which provides the patient with adequate oxygen while reducing the amount of oxygen used. This reduces dilution with room air on inspiration. Consequently, lower oxygen flows from the source gas are required to achieve the desired arterial oxygen saturation (SaO2) with a cost savings of up to 60%. PTS:

REF: Page 93

27. Complications of transtracheal oxygen catheters are 1. subcutaneous emphysema 2. mucus-plugging 3. infection 4. air-trapping a. 2 and 3 b. 1 and 4 c. 2, 3, and 4 d. 1, 2, and 3 ANS: D These risks can be minimized with proper care, including saline instillation and periodic clearing of the catheter lumen with a guidewire or cleaning rod.

PTS:

REF: Page 93

28. Patients exposed to FIO2 greater than or equal to 50% are at risk for which of the following? 1. Chronic obstructive pulmonary disease 2. O2 toxicity 3. Permanent lung damage 4. Atelectasis a. 1 and 2 b. 2 and 4 c. 2, 3, and 4 d. 1 and 3 ANS: C Oxygen is considered a type of medication. If a patient is exposed to large amounts for a long period of time, all of the aforementioned can occur except for chronic obstructive pulmonary disease, which is considered a disease process not a complication. PTS:

REF: Page 86, Clinical Practice Guideline 4.1

29. In a pulse-demand oxygen-delivery system, the a. pendant b. demand valve c. pressure-relief valve d. flow valve

replaces the flowmeter.

ANS: B The demand valve conneTctEs S diTreBcA tlyNtKoSthEeLoL xyEgRe. nC soOuM rce (50 psig), therefore replacing the flowmeter that is used with continuous-flow cannulas. Note that demand systems can function as pulsed or continuous-flow sources of oxygen. Settings allow the operator to select the equivalent of 1 to 5 L/min of oxygen flow from a conventional flowmeter. PTS:

REF: Page 91

30. Types of reservoir cannulas include which of the following? 1. Mustache 2. Pulse demand 3. Pendant 4. High flow a. 1 and 2 b. 2 and 3 c. 1, 3, and 4 d. 2, 3, and 4 ANS: C The two types of reservoir nasal cannulas are the mustache and the pendant. The high-flow nasal cannula can provide heated, humidified oxygen at flows varying between 5 and 40 L/min. PTS:

REF: Page 91

31. Partial rebreathing masks deliver what FIO2 at what liter flow? a. 0.35 to 0.50 at 4 to 5 L/min b. 0.40 to 0.70 at 6 to 10 L/min c. 0.50 to 0.80 at 6 to 8 L/min d. 0 50 to 1.00 at 12 to 15 L/min ANS: B A partial rebreathing mask can deliver an FIO2 of 0.40 to 0.70 with oxygen flows of 6 to 10 L/min. The actual percentage of oxygen delivered is also influenced by the patient’s ventilatory pattern. PTS:

REF: Page 91

32. Which of the following are O2-conserving devices? 1. Transtracheal oxygen catheters 2. Reservoir cannulas 3. Pulse-demand oxygen-delivery systems 4. E size cylinder O2 tanks a. 1, 2, and 4 b. 1, 2, and 3 c. 1, 3, and 4 d. 1, 2, 3, and 4 ANS: B Transtracheal oxygen catheters, reservoir cannulas, and pulse-demand oxygen-delivery systems are recent developments that have significantly improved the delivery of oxygen therapy, especially with rTeE gaSrdTtBoAcN onKsS erE viL ngLE oxRy. geCnOsM upplies during long-term oxygen therapy. PTS:

REF: Page 87, Clinical Practice Guideline 4.2

33. A typical adult oxygen mask has a volume of approximately how much? a. 25 to 50 mL b. 50 to 75 mL c. 75 to 100 mL d. 100 to 200 mL ANS: D A typical adult oxygen mask has a volume of approximately 100 to 200 mL and may be thought of as an extension of the anatomic reservoir, because the patient inhales its contents during the early part of inspiration. As such, simple oxygen masks can deliver higher FIO2 levels than nasal cannulas because of a “reservoir effect.” Note that the oxygen flow into the mask must be sufficient to wash out exhaled carbon dioxide, which can accumulate in this potential reservoir. PTS:

REF: Page 92

34. Which of the following are advantages of transtracheal catheters? 1. Increase patient mobility. 2. Improve patient compliance because of an enhanced cosmetic appearance.

3. Increase the amounts of nasal irritation. 4. Heighten the risk for mucus plugging. a. 1, 2, and 3 b. 2 and 3 c. 1 and 2 d. 1, 3, and 4 ANS: C Not only do transtracheal catheters produce an overall oxygen savings, they improve patient compliance with oxygen therapy because of cosmetic appearance. Transtracheal catheters are relatively inconspicuous. It is also found that patients with transtracheal catheters have increased mobility. PTS:

REF: Page 93

35. The statement that is true concerning reservoir cannulas is which of the following? a. The mustache cannula can hold about 40 mL of gas. b. The pendant cannula can reduce oxygen supply use by 75%. c. Patients prefer the mustache cannula to the pendant cannula. d. The patient’s clothing can conceal pendant cannulas. ANS: D Studies indicate that mustache and pendant systems may reduce oxygen supply use by 50%. Many patients feel that mustache cannulas are heavier, larger, and more obvious. Pendant cannulas can be concealed by the patient’s clothing. PTS:

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36. The main goal of a pulse-demand oxygen-delivery system is which of the following? 1. To provide oxygen only during expiration 2. To provide oxygen only during inspiration 3. To deliver oxygen to the patient only after a sufficient inspiratory effort is made and the demand valve opens 4. To deliver oxygen at a preset flow rate and close during inspiration to conserve oxygen a. 1 and 3 b. 2 and 4 c. 2 and 3 d. 1 and 4 ANS: C Pulse-demand oxygen-delivery systems deliver oxygen to the patient on demand only during inspiration. Oxygen is delivered to the patient only after a sufficient inspiratory effort is made and the demand valve opens. The demand valve closes during exhalation to conserve oxygen. PTS:

REF: Page 91

37. A simple mask can deliver what percentage of FIO2 at how many liters/minute? a. 0.24 to 0.44 at 1 to 6 L/min b. 0.35 to 0.50 at 5 to 10 L/min

c. 0.40 to 0.60 at 10 to 15 L/min d. 0.50 to 0.80 at 5 to 10 L/min ANS: B The simple mask can deliver a higher concentration than a nasal cannula because of the volume of the mask itself. That volume serves as an extension of the anatomic reservoir. The simple mask is generally said to be able to deliver 0.35 to 0.50 at oxygen flows of 5 to 10 L/min. PTS:

REF: Page 92

38. The FIO2 that is actually delivered to the patient through an oxygen mask depends on which of the following? 1. Flow of the oxygen to the mask 2. Presence of a reservoir bag 3. Humidity of the gas 4. Density of the gas a. 1 and 2 b. 2 and 3 c. 1 and 4 d. 3 and 4 ANS: A The flow of oxygen to a reservoir mask determines the FIO2, as do the patient’s breathing pattern and the presence or absence of a reservoir bag. Those masks with a reservoir bag will have a higher FIO2 than those without a reservoir bag. PTS:

REF: Page 86

39. Which of the following devices could cause CO2 retention? 1. Simple mask 2. Aerosol face mask 3. Nonrebreathing mask 4. Air-entrainment mask a. 1 and 3 b. 1 and 2 c. 2 and 3 d. 3 and 4 ANS: A Carbon dioxide rebreathing can occur if the oxygen flow to a simple or nonrebreathing mask is not sufficient to wash out the patient’s exhaled gases. The flow of oxygen to a reservoir mask determines the FIO2, as do the patient’s breathing pattern and the presence or absence of a reservoir bag. Those masks with a reservoir bag will have a higher FIO2 than those without a reservoir bag. PTS:

REF: Page 88

40. In a typical adult partial rebreathing mask, the reservoir bag has an approximate volume capacity of mL?

a. b. c. d.

150 to 300 300 to 500 400 to 600 500 to 700

ANS: B A typical partial rebreathing mask has a reservoir bag with a volume capacity of 300 to 500 mL. PTS:

REF: Page 92

41. Which of the following O2 devices has 2 one-way valves and the second valve is at the exhalation ports, which prevents room air from entering the mask during inhalation? a. Nonrebreathing mask b. Partial rebreathing mask c. Aerosol tracheostomy collar mask d. Simple mask ANS: A The first set of valves is a one-way valve located between the reservoir bag and the base of the mask. This valve allows gas flow to enter the mask from the reservoir bag when the patient inhales and prevents gas flow from the mask flowing back into the reservoir bag during the patient’s exhalation. The second set of valves is at the exhalation ports. The one-way valves placed there prevent room air from entering the mask during inhalation. They also allow the patient’s exhaled gases to exit the mask during exhalation. PTS:

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42. Theoretically, a nonrebreathing mask can deliver 100% oxygen, assuming that the mask fits appropriately on the patient’s face and is the only source of gas being inhaled by the patient. However, in actual practice, the disposable nonrebreathing mask can deliver what FIO2? a. 0.30 to 0.50 b. 0.40 to 0.60 c. 0.60 to 0.80 d. 0.24 to 0.50 ANS: C The discrepancy between disposable nonrebreathing masks and the original Boothby-Lovelace-Bulbulian masks is primarily related to the fact that manufacturers usually supply disposable masks with one of the exhalation valves removed. PTS:

REF: Page 93

43. The concentration of oxygen delivered to the patient with an air-entrainment mask depends on which of the following? 1. Flow of the oxygen to the nozzle 2. Size of the jet nozzle outlet 3. Size of the entrainment port 4. Size of the Venturi mask a. 1, 2, and 3

b. 2, 3, and 4 c. 1, 2, and 4 d. 3 and 4 ANS: A Oxygen flowing through the jet nozzle of an air-entrainment device “drags” in room air through the entrainment ports as a result of viscous, shearing forces between the gas exiting the jet nozzle outlet and the surrounding ambient air. The concentration of oxygen delivered to the patient, therefore, depends on the flow of oxygen exiting the jet nozzle, the size of the jet nozzle outlet, and the size of the entrainment ports. PTS:

REF: Pages 93-94

44. The total flow for a 35% air-entrainment mask running at 10 L/min is a. 43 b. 53 c. 60 d. 65

L/min.

ANS: B 100% O2 35% FIO2 = 65%. 20% air 35% FIO2 = 15. Ratio: 15:65 = 1:4.3. For every 1 L/min of O2, there is 4.3 L/min of air being entrained. 1 + 4.3 = 5.3  10 = 53 L/min total flow. PTS:

REF: Page 95, Table 4.2

45. How many liters/minute T ofEaSirTiB s bAeNinKgSeE ntL raLinEeR d. foCr O aM 35% air-entrainment mask running at 10 L/min? a. 43 L/min b. 53 L/min c. 60 L/min d. 65 L/min ANS: A Refer to question 44. Air: 4.3  10 L/min = 43 L/min of air being entrained. PTS:

REF: Page 95, Table 4.2

46. The oxygen/air ratio for the 35% air-entrainment mask is a. 1:4.3. b. 1:5.3. c. 1:6.0. d. 1:6.5. ANS: A Refer to question 44. PTS:

REF: Page 95, Table 4.2

47. The total flow for a 50% air-entrainment mask running at 8 L/min is a. 18

L/min.

b. 22 c. 25 d. 30 ANS: B 100% O2 50% = 50%. 20% air 50% FIO2 = 30. 30:50 = 1:1.7. For every 1 L/min of O2, there is 1.7 L/min of air being entrained. 1 + 1.7 = 2.7  8 = 21.6 L/min total flow. PTS:

REF: Page 95, Table 4.2

48. How many liters/minute of air is being entrained for a 50% air-entrainment mask running at 8 L/min? a. 10 b. 12 c. 14 d. 20 ANS: C Refer to question 47. 1.7  8 = 13.6 L/min of air being entrained. PTS:

REF: Page 95, Table 4.2

49. A 22-year-old with asthma comes to the emergency department in respiratory distress. The patient has acute shortness of breath (SOB); is febrile, tachypneic, and tachycardic; and has an SpO2 of 88% on a nasal cannula that delivers 2 L/min. Which of the following actions should the respiratory therapist take at this time? a. Teach the patient to bTrea hE puLrL seE dRli. psC. OM ESthTeBthAroNuKgS b. Place a simple mask on the patient. c. Remove the cannula and place a 0.35 air-entrainment mask on the patient. d. Place a high-flow cannula at 15 L/min on the patient. ANS: C A patient with asthma benefits from a precise preset FIO2. With a simple mask, there is a greater likelihood of the patient retaining CO2, which is not helpful for those with asthma. Breathing through pursed lips is beneficial to people with asthma; however, it is not the first course of action. Finally, a high-flow cannula at 15 L/min is too much FIO2 for the patient at this time. PTS:

REF: Pages 93-94

50. Which of the following O2 devices is appropriate for patients with chronic obstructive pulmonary disease who are hypoxemic? a. Simple mask b. Nasal cannula c. Partial rebreathing mask d. Air-entrainment mask ANS: D

Air-entrainment masks are excellent for providing oxygen therapy to hypoxemic patients with chronic obstructive pulmonary disease who typically require a fixed FIO2 between 0.24 and 0.35. The total flow of gas delivered (oxygen plus air) by such masks for lower FIO2 levels is usually sufficient to meet the peak inspiratory flow requirements for these patients. PTS:

REF: Pages 93-94

51. With oxygen hoods, FIO2 must be measured by using what type of device? a. Incubator b. Pulse oximeter c. Heater d. Analyzer ANS: D Oxygen hoods must be measured intermittently or monitored continuously with an oxygen analyzer. PTS:

REF: Pages 96-97

52. Current incubators are designed to allow which of the following? 1. Variable control of environmental temperature 2. Variable control of environmental humidity 3. Control of FIO2 concentration 4. Control of barometric pressure a. 1, 2, and 3 b. 1 and 2 c. 3 and 4 d. 2 and 3 ANS: A The temperature and humidity of the gas within the incubator are regulated by a servo-controlled mechanism connected to a fan that circulates environmental gas over heating coils and a blow-by humidifier. Supplemental oxygen can be provided by connecting a heated humidifier directly to the incubator. PTS:

REF: Page 97

53. An oxygen allows compressed air and oxygen from a high-pressure source to enter into a chamber where the pressure of the two gases is equalized, usually at 50 psi. a. blender b. tent c. hood d. delivery devices ANS: A An oxygen blender is attached to both a high-pressure compressed air source and a high-pressure oxygen source of equal pressure (approximately 50 psig). PTS:

REF: Page 98

54. It is important to filter the gas before it enters the blender housing; otherwise, a malfunction will occur. Which of the following can cause a malfunction? 1. Moisture 2. Particulate matter 3. High amounts of FIO2 4. Low amounts of FIO2 a. 1 and 3 b. 1 and 2 c. 1 and 4 d. 2 and 3 ANS: B Because moisture and particulate matter introduced into the blender by the source gases can cause the blender to malfunction, it is important to filter the gas before it enters the blender housing. PTS: 55.

REF: Page 98

therapy exposes patients to a pressure greater than atmospheric pressure while they breathe 100% oxygen, either continuously or intermittently. a. Aerosol oxygen b. Hyperbaric oxygen c. Bronchial hygiene d. Nitric oxide ANS: B Hyperbaric oxygen theraT pyES exTpB osAesNpKaS tiE enLtsLtE oR a. prCesOsM ure greater than atmospheric pressure while they breathe 100% oxygen, either continuously or intermittently. PTS:

REF: Page 98

56. What types of patients are treated with hyperbaric oxygen therapy? 1. Deep sea diving patients with decompression sickness 2. Those with thermal injuries 3. Patients with carbon monoxide poisoning 4. Those with refractory osteomyelitis a. 1, 2, and 3 b. 1, 2, and 4 c. 2, 3, and 4 d. 1, 2, 3, and 4 ANS: D

Decompression sickness arises from the generation of nitrogen bubbles in the vascular system and tissues in volumes sufficient to interfere with the function of an organ. The cause of gas bubble formation is the rapid decompression during ascent from diving when the speed of decompression exceeds the ability of the gas-saturated tissues to vent the gases by simple diffusion. For this type of patient, hyperbaric oxygen will reduce the size of the bubbles. For thermal injuries, hyperbaric oxygen limits the progression of the burn injury, reduces swelling, and may reduce the need for surgical intervention. For CO poisoning, hyperbaric oxygen promotes the dissociation of carboxyhemoglobin more than just oxygen alone. For refractory osteomyelitis, hyperbaric oxygen provides periodic elevation of bone and tissue oxygen tension from hypoxic levels to normal or supranormal levels, which promotes collagen production by fibroblasts. PTS:

REF: Page 98

57. Exposure to elevated barometric pressure during hyperbaric oxygen therapy can directly affect a number of physiologic parameters, including which of the following? 1. Arterial and alveolar partial pressure for oxygen 2. Temperature of the gases being breathed 3. Work of breathing 4. Lung volumes a. 1 and 2 b. 1 and 4 c. 2, 3, and 4 d. 1, 2, 3, and 4 ANS: D The effect of increased aT mE biSenTtBpA reN ssKuS reEoL nLthEeRp. arC tiO alMpressure of alveolar oxygen (PAO2) can be explained by Dalton’s law, which states that the total pressure of a gas mixture, such as air, equals the sum of the partial pressures of each of the constituent gases in the mixture. According to Gay-Lussac’s law, if the volume of a gas remains constant, there is a direct relationship between the absolute pressure of a gas and its temperature. It is reasonable to suggest that if the volume of a hyperbaric chamber remains constant, then increasing the pressure would raise the temperature inside of the chamber. PTS: 58.

REF: Page 98

law states that if the temperature of a gas remains constant, the volume of a gas is inversely related to its pressure. a. Henry’s b. Boyle’s c. Dalton’s d. Laplace’s ANS: B Boyle’s law states that if the temperature of a gas remains constant, the volume of a gas is inversely related to its pressure. Therefore, as pressure is exerted on a container, the gas volume within the container decreases. PTS:

REF: Page 99

59. Dalton’s law states that a. the total pressure of a gas mixture equals the sum of the partial pressure of each constituent gas in the mixture. b. the pressure within a liquid sphere is influenced by the surface tension forces of the liquid and the size of the sphere. c. there is a direct relationship between the absolute pressure of a gas and its temperature. d. the volume of a gas is inversely related to its pressure. ANS: A Dalton’s law states that the sum of the partial pressures of a gas mixture equals the total pressure of the system. Laplace’s law states that the pressure within a liquid sphere is influenced by the surface tension forces of the liquid and the size of the sphere. Gay-Lussac demonstrated that if the volume of a gas is held constant, the gas pressure rises as the absolute temperature of the gas increases. Boyle’s law states that when the temperature is held constant, the volume that a gas occupies is inversely proportional to the absolute pressure exerted on it. PTS:

REF: Page 99

60. A patient is receiving 0.30 FIO2 with a barometric pressure at 750 mm Hg. The partial pressure of carbon dioxide (PCO2) for this patient is 70 mm Hg; the partial pressure of arterial oxygen (PaO2) is 60 mm Hg. The PAO2 for this patient is mm Hg. a. 100.2 b. 123.4 c. 160.0 d. 181.7 ANS: B Formula: PAO2 = (barometric pressure [PB] – pressure of water vapor [PH2O]) FIO2 – PaCO2 (1.25). PAO2 = (750 mm Hg – 47) 0.30 – 70 (1.25). PAO2 = 210.9 – 87.5. PAO2 = 123.4 mm Hg. PTS:

REF: Page 99

61. A patient is receiving 0.60 FIO2 with a barometric pressure of 755 mm Hg. PCO2 is 56 mm Hg and PaO2 65 mm Hg. The PAO2 for this patient is mm Hg. a. 265.6 b. 300.9 c. 354.8 d. 404.0 ANS: C Formula: PAO2 = (PB – PH2O) FIO2 – PaCO2 (1.25). PAO2 = (755 – 47) 0.60 – 56 (1.25). PAO2 = 424.8 – 70. PAO2 = 354.8 mm Hg.

PTS:

REF: Page 99

62. A patient is receiving 0.80 FIO2 with a barometric pressure at 760 mm Hg. PCO2 is at 68; PaO2 is 55. The PAO2 for this patient is mm Hg. a. 395.6 b. 485.4 c. 510.9 d. 550.0 ANS: B Formula: PAO2 = (PB – PH2O) FIO2 – PaCO2 (1.25). PAO2 = (760 – 47) 0.80 – 68 (1.25). PAO2 = 570.4 – 85. PAO2 = 485.4 mm Hg. PTS:

REF: Page 99

63. As the barometric pressure increases, there is an increase in the density of the gas being breathed. The increase in gas density in turn causes a(n) a. decrease in work of breathing. b. increase in FIO2. c. increase in work of breathing. d. decrease in FIO2. ANS: C The increase in gas density results in increased work of breathing, which is not noticeable and can easily be accomm odSaT teB dA inNhKeaSlth yL suEbR je. ctC s.OInMpatients with reduced lung reserves, TE EL however, this increased work can present problems and necessitate ventilatory support. PTS:

REF: Page 99

64. Intermittent air-breathing is used in hyperbaric chambers to prevent which of the following? a. Hyperventilation b. Oxygen toxicity c. Hypoventilation d. Hypertension ANS: B Hyperbaric oxygenation is achieved by having the patient breathe oxygen by mask or through a specially designed hood while being exposed to elevated barometric pressures in the compressed-air chamber. Treatment schedules are tailored to the specific needs of the patient. Generally, patients are placed on schedules in which intermittent air-breathing periods of 5 minutes or more are programmed approximately every 20 minutes to prevent oxygen toxicity to the patient. PTS:

REF: Page 98

65. Which types of devices/techniques should be used to monitor the oxygenation status of patients undergoing hyperbaric oxygen therapy? 1. Transcutaneous monitoring

2. Arterial blood gas monitoring 3. End-tidal CO2 monitoring 4. Spirometer a. 1 and 2 b. 1 and 4 c. 2 and 3 d. 3 and 4 ANS: A Transcutaneous monitoring has proven to be valuable in the assessment of the overall oxygenation status of a patient undergoing hyperbaric therapy. Arterial blood gas monitoring can provide information on the oxygenation status of patients receiving hyperbaric therapy and can also give an indication of their ventilatory status. PTS:

REF: Page 100

66. Contraindications for hyperbaric oxygen therapy consist of which of the following? 1. Pneumothorax 2. Obstructive bronchial diseases 3. Upper respiratory infection 4. Skin grafting a. 1 and 2 b. 1, 3, and 4 c. 1, 2, and 3 d. 3 and 4 ANS: C If pneumothorax occurs during hyperbaric treatment, chest tubes should be immediately inserted; failure to treat pneumothorax can have dire consequences. Gas-trapping can result in barotraumas for those with obstructive bronchial diseases. Similarly, patients who have upper respiratory infections and nasal congestion are usually unable to clear their ears during compression and decompression and thus are prone to eardrum rupture during treatment. PTS:

REF: Page 101, Box 4.2

67. Which type of therapy has been used to successfully treat persistent pulmonary hypertension in newborns? a. Helium-oxygen (heliox) b. Nitric oxide c. Bronchial hygiene d. Carbon dioxide–nitrogen (carbogen) ANS: B Nitric oxide has been shown to be a potent pulmonary vasodilator. PTS:

REF: Page 101

68. The therapeutic dose of nitric oxide is a. 2 to 80

ppm.

b. 25 to 115 c. 40 to 150 d. 30 to 60 ANS: A The therapeutic dose of nitric oxide is 2 to 80 ppm. PTS:

REF: Page 101

69. Heliox has been used on a limited basis to treat patients with which of the following? a. Hyperventilation b. Thermal burns c. Airway obstructions d. Upper respiratory infections ANS: C Specifically, heliox has been used to manage asthmatic patients with acute respiratory failure, to treat postextubation stridor in pediatric trauma patients, as an adjunct in the treatment of pediatric patients with refractory croup, to administer anesthetic gases to patients via small-diameter endotracheal tubes, and to provide ventilatory support for patients with severe airway obstruction caused by chronic bronchitis and emphysema. PTS:

REF: Page 91

70. An 18-year-old with severe asthma is brought into the emergency department on an nonrebreathing mask; he is in acute respiratory distress. He has been given multiple rounds of bronchodilators and coTrE ticSoT stB erAoN idK sS anEdLisLsEtiR ll .inCdOisMtress, with an SpO2 of 85% on the nonrebreathing mask. What therapy should the respiratory care practitioner suggest to the physician at this time? a. Nitric oxide therapy b. Heliox therapy c. Carbogen therapy d. Hyperbaric therapy ANS: B Heliox mixtures have been used on a limited basis to treat patients with airway obstruction, specifically in the management of asthmatic patients with acute respiratory failure. PTS:

REF: Page 91

71. A patient is placed on a 70:30 heliox mixture using an oxygen flowmeter set at 8 L/min. The actual flow rate going to the patient is L/min. a. 11.2 b. 12.8 c. 14.4 d. 16.2 ANS: B Conversion for 70:30 = 1.6  8 L/min = 12.8 L/min. PTS:

REF: Page 103, Table 4.3

72. A pediatric patient with refractory croup is placed on heliox 80:20 at a flow of 10 L/min. The actual flow going to the patient is L/min. a. 14 b. 16 c. 18 d. 20 ANS: C Conversion for 80:20 = 1.8  10 L/min = 18 L/min. PTS:

REF: Page 103, Table 4.3

73. The benefits of breathing heliox are related to its lower density in comparison with pure oxygen or air. The lower density does which of the following? 1. Promotes laminar flow 2. Increases the amount of turbulent flow 3. Reduces the amount of turbulent flow 4. Decreases the laminar flow a. 1 and 2 b. 1 and 3 c. 2 and 4 d. 3 and 4 ANS: B This relationship is important to remember when administering heliox because the actual flow rate of gas deliveredTw illTbB eA grNeK atS erEthLaLnEthRe.sC etOflMow. ES PTS:

REF: Page 91

74. What type of oxygen device is used to administer heliox to a nonintubated patient? a. Nasal cannula b. High-flow cannula c. Simple mask d. Nonrebreathing mask ANS: D For nonintubated patients, a well-fitted nonrebreathing mask attached to a reservoir bag should be used. The flow rate of gas should be high enough to prevent the reservoir bag from collapsing during inspiration. Nasal cannulas are ineffective for delivering heliox because of leakage; instead, nonrebreathing masks are the most effective. PTS:

REF: Page 91

75. A 55-year-old man comes to the emergency department on a nonrebreathing mask with an SpO2 of 88%. The patient was found unconscious in a running car in the garage. Carbon monoxide poisoning is a concern at this time. What should the respiratory care practitioner recommend to the physician at this time? a. Place a nasal cannula at 6 L/min on the patient b. Begin the patient on heliox therapy 80%:20%

c. Place the patient on carbogen therapy 5%:95% d. Set the patient up on an air-entrainment device at 0.50 FIO2 ANS: C Carbogen is used to treat hiccups and carbon monoxide poisoning; furthermore, it is used as a stimulant/depressant of ventilation and to prevent the complete washout of CO2 during cardiopulmonary bypass. PTS:

REF: Page 103, Table 4.3

76. To prevent an adverse reaction, it is essential to monitor which of the following when administering carbogen to a patient? 1. Heart rate 2. Blood pressure 3. Respirations 4. The patient’s mental status a. 1, 2, and 3 b. 1, 2, and 4 c. 2, 3, and 4 d. 1, 2, 3, and 4 ANS: D Pulse, arterial blood pressure, and minute volume normally increase as the patient breathes carbogen, but the rapidity and level of these changes depend on the concentration of the mixture. PTS:

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77. According to the American Association for Respiratory Care (AARC) Clinical Practice Guideline, which of the following are considered precautions or complications of oxygen therapy? 1. A PaO2 >60 mm Hg in spontaneously breathing patients with chronic PaCO2 levels 2. With FIO2 >0.50 and the risk of oxygen toxicity or absorption atelectasis occurring 3. During laser bronchoscopy and high levels of oxygen 4. Acute myocardial infarction a. 1, 2, and 4 b. 1, 2, and 3 c. 2, 3, and 4 d. 1, 2, 3, and 4 ANS: B See the AARC Clinical Practice Guideline: Oxygen Therapy for Adults in the Acute Care Facility—2002 Revision and Update, Clinical Practice Guideline 4.1. PTS:

REF: Page 86, Clinical Practice Guideline 4.1

78. All oxygen-delivery systems should be checked how often according to the AARC Clinical Practice Guideline? a. At least once a day b. Twice a week

c. Every 48 hours d. Once a month ANS: A See the AARC Clinical Practice Guideline: Oxygen Therapy for Adults in the Acute Care Facility—2002 Revision and Update, Clinical Practice Guideline 4.1. PTS:

REF: Page 86, Clinical Practice Guideline 4.1

79. What criteria must a patient meet for home oxygen therapy, according to AARC Clinical Practice Guidelines? 1. PaO2 <55 mm Hg 2. SpO2 <88% room air at rest 3. SpO2 <88% room air with exertion 4. PaO2 >60 mm Hg a. 1, 2, and 4 b. 2, 3, and 4 c. 1, 2, and 3 d. 2 and 3 ANS: C See the AARC Clinical Practice Guideline: Oxygen Therapy for Adults in the Acute Care Facility—2002 Revision and Update, Clinical Practice Guideline 4.1. PTS:

REF: Page 86, Clinical Practice Guideline 4.1

80. Retinopathy of prematurT ityEoSfT teB nA ocNcK urSs E inLnLeE onRa. teC sO beMcause of which of the following? Increased amounts of F O a. I 2 b. Low amounts of FIO2 c. Improper placement of the oxygen-delivery device d. Hyperventilation ANS: A The origin of retinopathy of prematurity, especially with regard to the role of oxygen, is controversial. Nonetheless, care should be taken when supplemental oxygen is provided to preterm infants (<37 weeks’ gestation). It is suggested that oxygen supplementation should not result in a PaO2 >80 mm Hg. PTS:

REF: Page 88, Clinical Practice Guideline 4.3

81. For a neonate on an oxygen hood, where is the best placement of an oxygen analyzer to measure the correct FIO2? a. Above the patient’s head b. At the nose and mouth c. On the side near either arm d. The rear of the hood ANS: B Neonates are obligate nose-breathers, so the mouth and nose are the most accurate location, because it is the area closest to the nares.

PTS:

REF: Pages 96-97

82. What is the estimated percentage of FIO2 for a patient on 3 L/min delivered through a nasal cannula? a. 32% b. 40% c. 44% d. 50% ANS: A 3 L/min  4 = 12 L/min + 20 = 32% FIO2. The flow is multiplied by 4 because for every 1 L/min of oxygen flowing to a nasal cannula the FIO2 increases by 4%. The 20 is the number that the flow multiplied by 4 is added to, in order to get the approximate FIO2. PTS:

REF: Page 90, Table 4.1

83. Which of the following are disadvantages of delivering oxygen by reservoir masks? 1. Rebreathing N2 2. The patient cannot eat 3. Increased risk of aspirations 4. Claustrophobia/discomfort a. 2 and 3 b. 3, and 4 c. 1, 3, and 4 d. 2, 3, and 4 ANS: D Oxygen masks are confining and may not be well-tolerated by some patients. Furthermore, they must be removed during eating, drinking, and facial and airway care. Patients often report that these oxygen masks cause skin irritation, especially when they are tightly fitted. Finally, both aspiration of vomitus and rebreathing of CO2 are more likely when a mask is being used. PTS:

REF: Page 88

84. Which of the following are advantages of nasal cannula use? 1. They are cost-effective. 2. They deliver precise FIO2. 3. The patient can eat, speak, and drink with the cannula in place. 4. Pressure necrosis will not occur. a. 1 and 2 b. 1 and 3 c. 2 and 3 d. 3 and 4 ANS: B Nasal cannulas are inexpensive and allow the patient to eat, drink, and speak while receiving oxygen. Nasal cannulas cannot deliver precise oxygen concentrations, and pressure necrosis is possible because of the pressure points where the tubing holds the cannula in place touch the patient’s face and ears.

PTS:

REF: Page 87

85. Which of the following are the potential harmful effects of excessive amounts of oxygen therapy? 1. Persistent pulmonary hypertension 2. Oxygen-induced hypoventilation 3. Absorption atelectasis 4. Retinopathy or prematurity a. 1, 2, and 3 b. 1, 2, and 4 c. 2, 3, and 4 d. 3 and 4 ANS: C Oxygen is considered a type of medication. If exposed to large amounts of oxygen for a long period of time, a patient can experience lung damage because oxygen can be toxic if given in high doses. PTS:

REF: Page 86, Clinical Practice Guideline 4.1

86. When a closed Thorpe tube flowmeter is attached to a 50-psi oxygen source, the indicator float jumps up then quickly falls to zero. This flowmeter is a. broken. b. a Bourdon gauge flowmeter. c. compensated for back pressure. d. uncompensated for bT acEkSpT reB ssAuN reK . SELLER.COM ANS: C A flowmeter can be determined to be pressure-compensated if the following test is performed: With the needle valve closed, the flowmeter is plugged into a high-pressure gas source. If the float in the indicator tube jumps and then falls to zero, the flowmeter is pressure-compensated. The float movement occurs because the source gas must pass through the indicator tube before it reaches the needle valve. PTS:

REF: Page 83

87. What type of oxygen-delivery device does the following image illustrate?

a. b. c. d.

Simple mask Nonrebreathing mask Air-entrainment mask Aerosol mask

ANS: B See also Fig. 4.19. PTS:

REF: Page 93

88. What type of oxygen-delivery device does the following image illustrate?

a. b. c. d.

Simple mask Nonrebreathing mask Air-entrainment mask Partial rebreathing mask

ANS: C

See Fig. 4.20. PTS: 89.

REF: Page 94, Fig. 4.19

law states that the degree to which a gas enters into a physical solution in body fluids is directly proportional to the partial pressure of gas to which the fluid is exposed? a. Dalton’s b. Henry’s c. Gay-Lussac’s d. Boyle’s ANS: B Henry’s law is used to explain the changes in the PaO2 that occur with exposure to elevated ambient pressure. The law states that the degree to which a gas enters into physical solution in body fluids is directly proportional to the partial pressure of gas to which the fluid is exposed. PTS:

REF: Page 99

90. A 6-year-old patient with asthma has a sudden onset of SOB and wheezing. He presents to the emergency department with a heart rate of 82 beats/min, respiratory rate of 28 breaths/min, and an SpO2 of 87% on room air. Which of the following actions should the respiratory care practitioner take at this time? 1. Place the patient on oxygen therapy. 2. Intubate the patient. 3. Administer a bronchodilator. 4. Administer nitric oxidT eE thS erTapByA. NKSELLER.COM a. 1 and 3 b. 1 and 2 c. 2 and 4 d. 3 and 4 ANS: A Immediate relief for the patient at this time can be provided by a bronchodilator to help open up the airways and by oxygen to improve the patient’s oxygenation status. Intubation and nitric oxide therapy can both be administered to people with asthma; however, these approaches are taken when the others do not work for the patient and depend on the severity of the patient’s condition. PTS:

REF: Page 88

91. A 60-year-old man with a 90 pack-years smoking history arrives in the emergency department on a nonrebreathing mask with an SpO2 of 88%. The arterial blood gas results at this time indicate a pH of 7.38, PCO2 of 58, and partial pressure of oxygen (PO2) of 54. Which action should the respiratory therapist take at this time? a. Keep the nonrebreathing mask on the patient. b. Administer an 80:20 heliox concentration. c. Place a nasal cannula set at 6 L/min. d. Place an air-entrainment mask on the patient that delivers 0.40 FIO2.

ANS: D An air-entrainment device is the best delivery device for a patient with chronic obstructive pulmonary disease because of its ability to provide a precise FIO2. The other choices have a greater likelihood of causing CO2 retention and knocking out the patient’s hypoxic drive. PTS:

REF: Page 93 | Page 95

92. A home care patient calls to inform the respiratory therapist that his transtracheal catheter accidentally fell out last night and that he was unable to reinsert it. The patient should be told to a. insert a dilating or stenting device. b. continue attempts to reinsert the catheter. c. use a nasal cannula and call his physician as soon as possible. d. use a nasal cannula until another transtracheal catheter is delivered to the home. ANS: C Without the transtracheal catheter in place, this patient is not receiving any supplemental oxygen. To avoid hypoxemia, the patient must use a back-up delivery device. The most appropriate device in this situation would be a nasal cannula. The patient must call the physician for follow-up immediately. PTS:

REF: Page 87

93. The PAO2 when the atmospheric pressure is 3 atm, the PACO2 is 40 mm Hg, and the FIO2 is 0.80 is mm Hg. a. 2280 b. 1784 c. 1736 d. 1500 ANS: C PAO2 = (Pbar PH2O) FIO2 PaCO2 ÷ 0.8; Pbar = 3 atm  760 = 2280 mm Hg. PAO2 = (2280 47)0.8 40 ÷ 0.8. PAO2 = 1786.4 50 = 1736.4 mm Hg. PTS:

REF: Page 99

94. A 45-year-old man had a deep sea diving accident recently and developed air emboli. Which type of therapy should the therapist recommend at this time? a. Nitric oxide therapy b. Heliox therapy c. Hyperbaric therapy d. Aerosol therapy ANS: C

Hyperbaric oxygen therapy exposes patients to a pressure greater than atmospheric pressure while they breathe 100% oxygen either continuously or intermittently. The effects on lung volume can be explained by Boyle’s law, which states that if the temperature of a gas remains constant, the volume of a gas is inversely related to its pressure. That is, as the pressure exerted on the container increase, the gas volume decreases. Thus when a person is exposed to elevated pressures, the gas volume contained in any body cavity tends to be compressed. PTS:

REF: Page 98

95. A patient has a 0.40 air-entrainment mask on and is not tolerating it well at this time because of claustrophobia. A nasal cannula is placed on the patient. What liter flow should be set to match the appropriate FIO2? a. 2 b. 3 c. 4 d. 5 ANS: D 5 L/min  4 = 20. 20 + 20 = 0.40 FIO2. PTS:

REF: Page 93 | Page 95

96. A patient is receiving supplemental oxygen via a 30% air-entrainment mask set at 8 L/min. The respiratory therapist must increase the supplemental oxygen to 40%. To maintain the same total output, the flow rate must be increased to L/min. a. 10 b. 14 c. 16 d. 18 ANS: D The output for the 30% air-entrainment mask set at 8 L/min is 72 L/min, because 30% has nine total parts multiplied by 8 L/min, which equals 72 L/min. The total output for 40% should, therefore, be 72 L/min. There are four total parts in 40% multiplied by an unknown flow that equals 72 L/min. 4X = 72. X is equal to 18 L/min. PTS:

REF: Page 93 | Page 95

Chapter 05: Airway Management Devices and Advanced Cardiac Life Support Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. “Elevating the head and extending the neck” describes which of the following? a. The position for transtracheal invasive airway insertion b. The position for a nasopharyngeal airway insertion c. A maneuver called the jaw thrust or chin lift d. A maneuver called the sniffing position ANS: D

Transtracheal invasive airway insertion is a procedure that involves the surgical placement of a catheter through the airway and does not require extension of the neck. For nasopharyngeal airway insertion, the head and neck do not need to be adjusted. The jaw thrust or chin lift is used if the neck is not able to be extended because of cervical spine injuries. PTS: 1

REF: Page 111, Table 5.1

2. Which of the following statements is true concerning the sniffing position? a. It is the best position for oral intubation. b. It is indicated when a patient is vomiting. c. It is used for an unstable cervical spine injury. d. It is contraindicated for temporomandibular joint disease. ANS: A

The jaw thrust is the maneT uvEeS r uTsB edAtNoKinStuEbLatLeEaRp. atC ieO ntMwith an unstable cervical spine injury. The presence of temporomandibular joint disease can be an indication of a difficult intubation, but it is not a contraindication for the sniffing position. When a patient is vomiting, his head should be turned to one side to prevent aspiration. PTS: 1

REF: Page 111, Table 5.1

3. An accident victim with an unstable cervical spine injury needs to be intubated. Which of the

following will facilitate this type of intubation? a. Chin lift b. Fowler position c. Neck extension d. Sniffing position ANS: A

The neck extension and sniffing position are both contraindicated for an unstable cervical spine injury. The head is elevated too high in the Fowler position to facilitate intubation. PTS: 1

REF: Page 111, Table 5.1

4. The most appropriate method for opening the airway of an awake patient with a fractured

mandible is which of the following? a. Chin lift b. Jaw thrust

c. Guedel airway d. Sniffing position ANS: D

The chin lift and jaw thrust are contraindicated in the case of a fractured mandible. Use of any of the oropharyngeal airways might cause gagging or vomiting in patients who are awake. PTS: 1

REF: Page 111, Table 5.1

5. Which of the following is the most common cause of an obstructed airway? a. Tongue falling backward b. Bleeding from the nose c. Mucus production d. Cardiac arrest ANS: A

It can be assumed that the tongue is the most common cause of airway obstruction, because many devices have been developed to displace the tongue and create a passage for air. Bleeding from the nose and mucus production can cause airway obstruction but are not the most common causes. Cardiac arrest is not the cause of an obstructed airway; rather, it is the tongue that will obstruct the airway during a cardiac arrest. PTS: 1

REF: Page 114

6. Which of the following are complications associated with the placement of an oropharyngeal

airway? 1. Gagging 2. Vomiting 3. Esophageal injury 4. Dissection of the posterior pharyngeal wall a. 1 and 4 b. 1 and 2 c. 2, 3, and 4 d. 1, 2, and 3 ANS: B

The oropharyngeal airways are not placed deep enough in the airway to create esophageal or pharyngeal wall damage. PTS: 1

REF: Page 111, Table 5.1

7. The airway examination of a patient reveals Mallampati airway class II and a thyromental

distance of 7 cm. The statement that is most appropriate about the intubation of this patient is which of the following? a. An oral intubation should be attempted first. b. Routine intubation of this patient may be impossible. c. This patient will have an airway management problem. d. This patient may require invasive airway management in the future. ANS: A

A Mallampati airway class III and a thyromental distance of less than 6 cm are predictors of a difficult airway. Because this airway examination demonstrates an airway that is not difficult, the initial attempts to establish an airway should be by means of oral intubation. PTS: 1

REF: Page 113, Table 5.3

8. Which of the following is true of a Guedel airway? a. There is no protected central channel. b. It consists of a hollow central channel. c. Its length is measured in centimeters. d. It is identical to a Berman airway. ANS: B

The Guedel airway has a central channel, is measured in millimeters, and differs from the Berman airway in its cross-sectional profile. PTS: 1

REF: Pages 121-122

9. Which of the following is true about a Berman airway? a. It has a central channel. b. It is smaller than a Guedel airway. c. It must be inserted upside down. d. Its shape is similar to that of a Guedel airway. ANS: D

A Berman airway has a shape similar to that of the Guedel airway, but it has a different cross-sectional profile without a protected central channel. It can be inserted in several ways (see page 120). PTS: 1

REF: Page 122

10. After inserting an oropharyngeal airway, the respiratory therapist notices that the flange is

protruding excessively from the patient’s mouth. Attempts to push the airway back cause it to bounce forward. Which of the following is the most appropriate action? a. Remove and replace the airway immediately. b. Turn the airway to the side, and try to catch the tongue in the curve. c. Take no action; the airway should protrude excessively from the mouth. d. Turn the airway upside down, and attempt to advance it farther into the mouth. ANS: A

An important sign that the distal airway tip may not have passed the back of the tongue is if the flange protrudes excessively from the patient’s mouth. If attempts to push the airway farther in just bounce it back out, it is probably catching on the back of the tongue and should be removed and replaced immediately by using one of the previously described methods of insertion. PTS: 1

REF: Pages 121-122

11. Insertion of a laryngeal mask airway a. is superior to the insertion of a nasopharyngeal device. b. requires airway manipulation. c. usually requires a special device.

d. protects the lungs from aspiration. ANS: A

The placement of a laryngeal mask airway does not necessitate airway manipulation or a special device. It does not protect the lungs from aspiration because it does not reliably seal the esophageal inlet. It is, however, superior to a nasopharyngeal airway. PTS: 1

REF: Pages 125-126

12. A respiratory therapist notices that a semiconscious patient is not moving enough air and has a

problem coughing up mucus. An attempt to insert an oropharyngeal airway is unsuccessful because the patient is struggling. Which of the following is the most appropriate action? a. Perform a tracheostomy. b. Insert a Berman airway. c. Use a nasopharyngeal airway. d. Sedate the patient, and insert the oropharyngeal airway. ANS: C

If the patient struggles to expel an oropharyngeal airway, attempts at insertion should be abandoned and an improved head position or a nasopharyngeal airway should be used to open the upper airway. The nasopharyngeal airway will also facilitate nasotracheal suction to evacuate excess mucus in the airways. A tracheostomy is not appropriate in this situation because it is too invasive. A Berman airway is another type of oropharyngeal airway that this kind of patient will not be able to tolerate. Sedation of the patient is not appropriate at this time. PTS: 1

REF: Page 124

13. Which of the following is the method for the insertion of a nasopharyngeal airway? a. Upside-down and then turned b. Parallel to the nasal pharynx floor c. Parallel to the long axis of the nose d. Perpendicular to the floor of the nasal pharynx ANS: B

Insertion of an oropharyngeal airway is done upside-down and then turned. Inserting the nasopharyngeal airway parallel to the long axis of the nose is inserting it “up the nose” and is likely to cause bleeding. It is impossible to insert the nasopharyngeal airway perpendicular to the nasal pharynx floor. PTS: 1

REF: Page 124

14. Insertion of a nasopharyngeal airway is accomplished by using which of the following? a. A tongue blade b. Intermittent pressure c. An Endotrol tube d. Gentle, continuous pressure ANS: D

A tongue blade can be used during the insertion of an oropharyngeal airway to move the tongue to one side. Intermittent pressure might cause damage and bleeding to the inside of the nasal cavity. An Endotrol tube is an endotracheal tube that allows for the manipulation of the tip of the tube. It does not facilitate insertion of a nasal airway. PTS: 1

REF: Page 124, Fig. 5.22

15. Which of the following is considered a long-term risk of nasopharyngeal tube placement? a. Penetration of the brain by the airway b. Nasal bleeding c. Sinus infection d. Hypoxia ANS: C

Insertion of a nasal airway when there is a basilar skull fracture does increase the risk of penetrating the brain with the nasal airway, but it is not a long-term complication. Nasal bleeding is a complication of the insertion of the airway. Hypoxia is a risk factor when an airway is not able to be established or is compromised. A nasal airway can introduce organisms into the nasal cavity and the sinuses; therefore, when long-term nasal tube use is required, the risk to the patient increases. PTS: 1

REF: Page 124

16. The airway device that has a cuff that rests against the upper esophageal sphincter when in

place is a. a laryngeal mask airway. b. a tracheostomy tube (TT). c. an endotracheal tube. d. a Guedel airway. ANS: A

The laryngeal mask airway is the only airway that has a cuff that rests in the posterior pharynx, with its tip on the upper esophageal sphincter. PTS: 1

REF: Page 111, Table 5.1

17. Laryngeal mask airways are useful in emergency situations because a. an appropriate size is easy to choose. b. placement does not have to be checked. c. they protect the lungs from aspiration. d. minimum head and neck movement is required. ANS: D

The size of the laryngeal mask airway is based on the patient’s weight and may not be easy to choose. The placement of a laryngeal mask airway must be checked by using measurements of end-tidal carbon dioxide (CO2) and breath sounds. Laryngeal mask airways do not protect the lungs from aspiration because they are noninvasive. Laryngeal mask airways are useful in emergencies because they do not require airway manipulation or extreme head positioning, which minimizes flexion and extension of the cervical spine for proper placement. PTS: 1

REF: Page 125

18. The maximum laryngeal mask airway cuff pressure is a. 15 b. 30 c. 45 d. 60

cm H2O.

ANS: D

The laryngeal mask airway is designed to form a low-pressure seal in the laryngeal inlet by means of an inflated cuff. The cuff pressures should not exceed 60 cm H2O. PTS: 1

REF: Page 125

19. Which of the following is the most appropriate type of airway for ventilation needs of a

semiconscious patient for whom intubation with an endotracheal tube is unsuccessful? a. Berman airway b. TT c. Laryngeal mask airway d. Nasopharyngeal airway ANS: C

According to “Difficult Airway Algorithm” set forth by the American Society of Anesthesiologists, because the patient is unable to be invasively intubated and remains awake, the noninvasive airway approach with a laryngeal mask airway is necessary. PTS: 1

REF: Page 124, Fig. 5.22

20. The most effective type of emergency airway to manually ventilate a patient in her 36th week

of pregnancy is a. a laryngeal mask airway. b. a nasopharyngeal airway. c. an oropharyngeal airway. d. a TT. ANS: A

Pregnant patients predictably have improved ventilation with a laryngeal mask airway when compared with other mask techniques. The tracheostomy is too invasive for this situation. The nasal and oropharyngeal airways do not facilitate manual ventilation better than the laryngeal mask airway. PTS: 1

REF: Pages 125-126

21. The airway of choice for an obese patient with a known difficult airway is a a. Guedel airway. b. Berman airway. c. laryngeal mask airway. d. nasopharyngeal airway. ANS: C

The laryngeal mask airway is of particular benefit in patients with a known or anticipated difficult airway. PTS: 1

REF: Page 125

22. Which of the following is considered a secure airway device? a. Combitube b. Berman airway c. Endotracheal tube d. Laryngeal mask airway ANS: C

Because the endotracheal tube is inserted into the trachea and sealed with a cuff, it is considered to be a secure airway. The esophageal cuff affords some protection from regurgitation, but, as with the laryngeal mask airway, the Combitube is not considered a secure airway device; neither is the Berman airway. PTS: 1

REF: Page 111, Table 5.1

23. A nondisposable laryngeal mask airway should be checked for a. ability of the cuff to hold water. b. number of times it was sterilized. c. discoloration and integrity of the cuff. d. resilience of the self-inflating foam cuff. ANS: C

Laryngeal mask airways can be re-sterilized 100 to 200 times, but marked discoloration and failure of the pilot tube and cuff to hold pressure are indications that the tube should be discarded. The cuff should not be filled with water, and laryngeal mask airways do not have foam cuffs. PTS: 1

REF: TPE agSe T 12B8ANKSELLER.COM

24. Laryngeal mask airway placement includes the use of which of the following? a. Stylet b. Finger c. Lighted stylet d. Miller laryngoscope ANS: B

A finger is used to guide the deflated cuff past the tongue and pharynx. The tube is held in place with the other hand while the guiding finger is withdrawn. A stylet and Miller laryngoscope are used in the placement of an endotracheal tube. A lighted stylet is used in the blind placement of an endotracheal tube. PTS: 1

REF: Page 127, Fig. 5.26

25. After several unsuccessful attempts at endotracheal intubation and an inability to adequately

ventilate a patient with a face mask, the most appropriate method to ensure ventilation is with the placement of which of the following? a. Guedel airway b. Berman airway c. Nasopharyngeal airway d. Laryngeal mask airway ANS: D

According to the “Difficult Airway Algorithm,” when face mask ventilation is inadequate and intubation attempts are unsuccessful, an attempt to place a laryngeal mask airway should be made. PTS: 1

REF: Page 127, Fig. 5.26

26. Two cuffs are incorporated into which of the following artificial airways? a. Combitube b. Berman airway c. Endotracheal tube d. Laryngeal mask airway ANS: A

The Combitube has two cuffs; one is proximal and the other distal. They are designed to seal the esophagus and the pharynx. PTS: 1

REF: Page 129, Fig. 5.32

27. If the esophageal lumen of the Combitube enters the trachea, the Combitube a. will not secure the airway. b. must be removed immediately. c. can be used as an endotracheal tube. d. must be pulled back to rest in the pharynx. ANS: C

The small distal lumen of the Combitube usually advances into the esophagus, but in the case of a tracheal entry of the distal lumen, the Combitube can be used as a conventional endotracheal tube. This wiT ll E seScT urB eA thNeKaiSrw EaLyL. ER.COM PTS: 1

REF: Page 131

28. High positive airway pressure can be maintained with which of the following airways? a. Guedel airway b. Laryngeal mask airway c. Nasopharyngeal airway d. Endotracheal tube airway ANS: D

Endotracheal tubes allow ventilation with high levels of positive pressure; provide direct access to the lower airway for secretion removal and drug delivery; prevent aspiration of foreign material into the lung; and permit bronchoscopic examination of the peripheral airways. None of the other airways mentioned are able to maintain ventilation with high pressures without leaking or allowing gastric distention. PTS: 1

REF: Page 131

29. A blind nasotracheal intubation may be aided by a. a Combitube. b. an Endotrol tube. c. a foil-wrapped tube. d. a Cole endotracheal tube.

ANS: B

The endotracheal tube tip can be controlled with an Endotrol tube. With this device, an implanted string with a pull-ring turns the tip anterior when pulled (Fig. 5.35). This device is particularly well-suited for blind nasotracheal intubation. PTS: 1

REF: Page 131

30. Which of the following statements concerning endotracheal tubes and their insertion is true? a. The straight blade gives better tongue control than the curved blade. b. The Macintosh blade must be inserted along the left side of the tongue. c. The Miller blade is inserted along the right side of the tongue. d. The epiglottis must be hooked with the tip of the Macintosh blade. ANS: C

The curved blade gives better tongue control than the straight blade. Both types of blades must be inserted along the right side of the tongue. The Macintosh blade lifts the epiglottis indirectly by being placed in the vallecula, not directly on the epiglottis. PTS: 1

REF: Page 132

31. The position that best facilitates the insertion of an oral endotracheal tube is the

position. a. chin lift b. sniffing c. neutral head d. jaw thrust ANS: B

The sniffing position is ideal for opening up the upper airway and aligning the trachea for intubation. The chin lift or jaw thrust should be used to open the airway of a patient with cervical spine injuries. The neutral head position is most appropriate for blind nasal intubation. PTS: 1

REF: Page 135

32. During intubation, the intubator should stand in which of the following positions? a. As close as possible to the patient b. Approximately 2 feet away from the patient’s mouth c. As far away from the patient’s mouth as possible d. Far enough away from the mouth to allow binocular vision ANS: D

Manipulation of the endotracheal tube into the trachea can be facilitated by the proper position of the intubator with respect to the patient. The intubator’s head should be far enough away from the patient’s mouth to allow binocular vision, as seen in Fig. 5.34, A. When the intubator is too close, the clinician’s depth perception is compromised. PTS: 1

REF: Page 135, Fig. 5.41A and B

33. A blind nasal intubation is facilitated by which of the following patient positions? a. Chin lift b. Jaw thrust

c. Neutral head d. Extreme head ANS: C

Instead of the sniffing position, a neutral or slightly flexed head position is optimal for blind nasal intubation. Jaw thrust and chin lift are used for patients with cervical spine injuries. An extreme head position would not facilitate either a nasal intubation or an oral intubation. PTS: 1

REF: Page 136

34. A patient’s endotracheal tube cuff pressure is measured at 35 mm Hg. The most appropriate

immediate action to take is a. extubate the patient immediately. b. do nothing; this pressure is acceptable. c. add more volume to the cuff, and recheck pressure. d. remove some volume from the cuff, and recheck pressure. ANS: D

Because of tracheal mucosal blood pressure-flow characteristics, cuff pressure should be below 25 mm Hg to prevent tracheal ischemic damage. High cuff pressure is not an indication for extubation. Adding more volume would increase the cuff pressure even more, creating more of a blockage to blood and lymph circulation in the area surrounding the cuff. PTS: 1

REF: Page 136

35. Blood flow to the tracheal mucosa will become compromised if endotracheal tube cuff

pressures are greater than a. 15 b. 20 c. 25 d. 30

mm Hg.

ANS: C

Because of the flow characteristics of tracheal mucosal blood pressure, cuff pressure should be below 25 mm Hg to prevent tracheal ischemic damage. The acceptable range for cuff pressures is 20 to 25 mm Hg or 25 to 35 cm H2O. PTS: 1

REF: Page 131

36. When a Macintosh type of laryngoscope blade is used, which of the following actions is most

appropriate? a. Insert the blade along the left side of the tongue. b. Insert the tip of the blade below the level of the vallecula. c. Identify the epiglottis, and hook it with the tip of the blade. d. Lift the laryngoscope forward and upward to visualize the larynx. ANS: D

A curved blade enables identification of the epiglottis; the blade tip should be inserted above the epiglottis into the vallecula, which is the space between the tongue base and the epiglottis. With a forward and upward lift, the larynx is illuminated and the endotracheal tube can be passed into the trachea. The blade is inserted along the right side of the tongue. The tip of the blade needs to be in the vallecula. The epiglottis should not be hooked with the tip of the blade. PTS: 1

REF: Page 133

37. Rapid feedback to confirm the correct placement of an endotracheal tube immediately after

intubation is achieved by which of the following? a. Capnography b. Chest radiography c. CAT Scan d. Fiberoptic bronchoscopy ANS: A

The most sensitive and rapid way to confirm correct placement is to detect expired carbon dioxide by means of a capnograph or a color-change capnometric device. A chest radiograph is used to determine proper position with respect to the carina. Chest auscultation is subjective, and referred sounds from the stomach might be confused with breath sounds. Fiberoptic bronchoscopy is another way to confirm placement, but this procedure may take time for preparation. PTS: 1

REF: Page 138 | Page 140

38. A newly intubated patient is assessed with a color-changing CO2 detection device. The

presence of CO2 is confirmTeE d,SaT sB isAmNoK isS tuEreLoLnEeR xh.aC laO tiM on. However, auscultation reveals decreased breath sounds on the right side. This problem can be corrected by doing which of the following? a. Extubate and use a laryngeal mask airway. b. Order a chest radiograph to determine what is happening. c. Reposition the endotracheal tube, and auscultate again. d. Push the tube in farther, and listen for bilateral breath sounds. ANS: C

This problem is caused by intubation of the right mainstem airway. The patient’s endotracheal tube must be repositioned by suctioning the pharynx, deflating the cuff, pulling the endotracheal tube back slightly, reinflating the cuff, then auscultating for bilateral breath sounds. PTS: 1

REF: Page 110

39. If breath sounds are not heard over the left lung after intubation, the most likely cause is

which of the following? a. An endotracheal tube that is not inserted far enough b. Cuff not inflated enough c. Left mainstem intubation d. Right mainstem intubation ANS: D

A common problem with endotracheal tubes is that they are either inserted too far or migrate too far into the trachea, so the cuff might obstruct a bronchus or only one lung might be ventilated. Right mainstem intubation is most common, especially in children, because not only is the angle of take-off of the right main bronchus less than that of the left, but the distance between the glottis and the carina is quite small. PTS: 1

REF: Page 110

40. Both the respiratory therapist and the physician have made several attempts to intubate a

patient. The patient is becoming more and more cyanotic. Face mask ventilation is inadequate. The most appropriate action to take is which of the following? a. Administer a paralyzing agent. b. Make another attempt at oral intubation. c. Establish an airway with a tracheostomy. d. Attempt to establish a nasopharyngeal airway. ANS: C

According to the “Difficult Airway Algorithm,” in this type of situation, emergency invasive airway access should be initiated. This includes either surgical or percutaneous tracheostomy or cricothyrotomy. PTS: 1

REF: Page 124, Fig. 5.22

41. The proper location for transtracheal needle insertion is a. into the cricoid cartilage. b. through the cricothyroid membrane. c. between the first and the second tracheal cartilage rings. d. under the hyoid bone, tT hE roS ugThBtA heNtK hySrE ohLyL oiEdRli. gaCmOeMnt. ANS: B

The simplest invasive airway device is a large-bore intravenous catheter inserted percutaneously through the cricothyroid membrane, a procedure called needle cricothyroidotomy. This easily identified space is located between the thyroid cartilage and the cricoid ring. PTS: 1

REF: Page 146

42. Complications of a cricothyroidotomy include which of the following? a. Tracheal stenosis b. Laryngeal stenosis c. Ruptured epiglottis d. Vocal cord paralysis ANS: B

Subglottic or laryngeal stenosis can be a long-term problem after cricothyroidotomy. PTS: 1

REF: Page 144

43. Complications from manual resuscitation ventilation with a bag-mask-valve device include

1. injury to the surrounding soft tissues 2. insufflation of the stomach 3. inability to ventilation

4. subglottic stenosis a. 2, and 3 b. 1, 3, and 4 c. 1 and 2 d. 2, 3, and 4 ANS: C

Although manual resuscitation ventilation with a bag-mask-valve device is one of the mainstays of airway management, it is not without complications. Common problems include injury to the surrounding soft tissues and nerves, such as the mandibular branch of the facial nerve and the mental nerves. Attention must be taken to avoid placing pressure on the eyes as corneal abrasions or other eye injury may occur. Using the minimal ventilatory pressures needed to adequately ventilate the patient helps to avoid insufflation of the stomach leading to gastric distention and regurgitation. An inability to ventilate the patient adequately is the most serious complication associated with mask ventilation and unfortunately inadequate ventilation may go unrecognized by the provider. PTS: 1

REF: Page 121

44. Complications from an emergency cricothyroidotomy can be prevented by doing which of the

following? a. Using a small scalpel b. Using a large-gauge needle c. Orally intubating the patient d. Converting to a tracheostomy ANS: D

Most authorities suggest elTecEtiSvT eB coAnN veKrsSioEnLoLf E anRe.mCeOrgMency cricothyroidotomy to a formal tracheostomy within 24 hours to reduce the likelihood of severe problems. PTS: 1

REF: Page 144

45. After reinsertion of a TT, manual ventilation is difficult. What immediate action should be

taken? a. Reattempt insertion. b. Perform a cricothyroidotomy. c. Remove the tube, and insert another TT. d. Manually ventilate the patient through the upper airway. ANS: D

If ventilation is difficult after urgent replacement of a dislodged TT, it might not lie in the trachea and manual ventilation through the upper airway should be initiated without delay. PTS: 1

REF: Pages 146-147

46. The appropriate device for maintaining a small stoma to facilitate tracheal suctioning is which

of the following? a. Tracheal button b. Luer-Lok system c. Transtracheal needle d. Silastic TT

ANS: A

A tracheal button can be used to maintain a small stoma and may be removed for suctioning. PTS: 1

REF: Page 147, Fig. 5.62

47. A patient with an Olympic button arrives in the emergency department via ambulance and has

a respiratory arrest in the hospital. To establish a secure airway that could be attached to a mechanical ventilator, the respiratory therapist should a. insert an laryngeal mask airway. b. place a nasopharyngeal airway in the nose. c. intubate the patient with an uncuffed endotracheal tube. d. replace the Olympic button with a cuffed TT. ANS: D

The tracheal button must be changed to a cuffed TT in order to maintain positive-pressure ventilation. PTS: 1

REF: Page 147

48. The function of a double-lumen endotracheal tube is to a. facilitate speaking. b. independent lung ventilation. c. maintain a tracheostomy stoma. d. assist in weaning a patient from a TT. ANS: B

A double-lumen endotracheal tube is used outside the operating room to protect the “good,” or healthy, lung from blood cT onEtaSmTiB naAtiN onKS inEpL atL ieE ntRs .wCitO hM massive hemoptysis or infection from an empyema. PTS: 1

REF: Page 142

49. The size of a suction catheter should be a. a 12-French catheter. b. the same as the internal diameter (ID) of the endotracheal tube. c. two-thirds the size of the outer diameter (OD) of the endotracheal tube. d. less than half of the ID of the artificial airway. ANS: D

The general recommendation is that the catheter diameter should be no more than half the ID of the artificial airway. PTS: 1

REF: Page 148

50. The maximum size catheter that can be used for a size 9.0 (ID) TT is a. 6 b. 11 c. 12 d. 13

French.

ANS: D

(9  3)/2 = 13.5 French. Therefore, out of the choices given the maximum size is a 13 French.

PTS: 1

REF: Page 148

51. The appropriate size of suction catheter for a size 5.0 TT is a. 3.5 b. 7.5 c. 12 d. 15

French.

ANS: B

(5  3)/2 = 7.5 French. PTS: 1

REF: Page 148

52. Endotracheal tube suctioning should be preceded by a. pulse oximetry. b. instillation of 15 mL of sterile saline solution. c. preoxygenation for 30 seconds. d. hyperinflation for 60 seconds. ANS: C

Preoxygenation of the patient with 100% oxygen for a minimum of 30 to 60 seconds before suctioning is required to avoid the hazards of hypoxemia. PTS: 1

REF: Page 148

53. Failure to secure an appropriately placed endotracheal tube with the addition of air into the

cuff might be due to whichToEf S thTeBfoAllNoK wS inE g?LLER.COM a. Herniation of the cuff b. Malfunction of the pilot valve c. Pilot tubing that is too long d. An endotracheal tube that is too small ANS: B

A malfunction of the pilot valve will cause a leak. This will not allow the endotracheal cuff to maintain appropriate pressure to seal the airway. PTS: 1

REF: Page 148

54. The American Society for Testing and Materials (ASTM) and the International Standards

Organization (ISO) recommend that manual resuscitators be capable of delivering a minimum fractional inspired oxygen (FIO2) of with an oxygen flow of L/min. a. 1.00; 12 b. 0.95; 20 c. 0.85; 15 d. 0.50; 10 ANS: C

The ASTM and the ISO recommend that manual resuscitators be capable of delivering a FIO2 of 0.85 with an oxygen flow of 15 L/min. PTS: 1

REF: Page 120, Box 5.1

55. The patient connectors of a resuscitator valve must have which of the following ID to OD? a. 15:22 mm (ID:OD) b. 20:25 mm (ID:OD) c. 12:20 mm (ID:OD) d. 18:24 mm (ID:OD) ANS: A

According to the ASTM and the ISO patient connectors of the resuscitator valve must have a 15:22-mm ID:OD. PTS: 1

REF: Page 120, Box 5.1

56. Oxygen-powered resuscitators are classified as which of the following?

1. Volume-limited 2. Pressure-limited 3. Patient-triggered 4. Operator-triggered a. 1 and 3 b. 2 and 3 c. 2 and 4 d. 1 and 4 ANS: B

Oxygen-powered resuscitators are pressure-limited devices that work similarly to reducing valves. A typical oxygen-powered resuscitator consists of a demand valve that can be manually operated or patient triggered. PTS: 1

REF: Page 120

57. When resuscitating a newborn, which of the following devices is most appropriate? a. Manual resuscitator bag with a minimum volume of 600 mL b. Oxygen-powered resuscitator with a 60-cm H2O pressure-release valve c. Oxygen-powered resuscitator with a 50-cm H2O pressure-release valve d. Manual resuscitator bag with a 35- to 45-cm H2O pressure-release valve ANS: D

According to the ASTM and ISO devices used for infants may incorporate a pressure-release valve that limits peak inspiratory pressure to 40  5 cm H2O. PTS: 1

REF: Page 120, Box 5.1

58. Inability to maintain an adequate mask seal during manual ventilation will cause a. gastric distention. b. pressures to exceed 40 cm H2O. c. lower tidal volumes to be delivered. d. tidal volumes to exceed 800 mL. ANS: C

Failure to maintain an adequate seal between the mask and the patient’s face can lead to the delivery of low tidal volumes.

PTS: 1

REF: Page 119

59. The ventilation patterns specified by the American Heart Association require that a. infant resuscitator bags deliver 20 mL at a rate of 60 breaths/min. b. adult resuscitation bags deliver 600 mL at a rate of 20 breaths/min. c. infant resuscitator bags deliver 6 to 8 mL/kg at a rate of 40 breaths/min. d. child resuscitator bags deliver at least 300 mL at a rate of 20 breaths/min. ANS: C

The American Heart Association recommends 6 to 8 mL/kg at a rate of 40 breaths/min for infants. PTS: 1

REF: Page 121, Table 5.4

60. An ideal manual resuscitator should be able to deliver a minimum of

FIO2 when

oxygen is available. a. 0.35 b. 0.40 c. 0.45 d. 0.50 ANS: B

One feature of an ideal manual resuscitator is to be able to deliver oxygen concentrations of 0.40 when oxygen is available. PTS: 1

REF: Page 120, Box 5.1

61. A reservoir on a manual reT suEsS ciT taB toA rN doKeS sE wL hiL chEoRf.thCeOfoMllowing? a. Accumulate exhaled tidal volume with high oxygen concentrations. b. Allow for higher oxygen concentrations to be delivered. c. Increase the amount of volume being delivered. d. Collect exhaled volume for measurement. ANS: B

The presence of reservoirs allows for oxygen accumulation and the potential delivery of 100% oxygen. PTS: 1

REF: Page 118

62. With a manual resuscitator bag, the use of rapid rates causes which of the following?

1. An increase in fractional delivered oxygen concentration (FDO2) 2. A decrease in FDO2 3. An increase in tidal volume delivered 4. A decrease in tidal volume delivered a. 1 and 4 b. 2 and 4 c. 1 and 3 d. 2 and 3 ANS: B

Rapid rates with a manual resuscitator will decrease the amount of time the bag has to refill with the appropriate amount of volume and will also decrease the amount of oxygen accumulating in the reservoir thereby decreasing the delivered oxygen concentration and decreasing the tidal volume delivered. PTS: 1

REF: Page 121

63. Properties of an ideal adult manual resuscitator bag include which of the following? a. Dead space volume greater than 30 mL b. Bag volume of at least 800 mL c. Bag construction allowing for slow refill d. Low inspiratory and expiratory airflow resistance ANS: D

A manual resuscitator bag should have low inspiratory and expiratory airflow resistance to ensure ease of use. PTS: 1

REF: Page 120

64. The minimum volume of a child manual resuscitator bag should be a. 800 b. 500 c. 300 d. 200

mL.

ANS: B

Resuscitation bags used for children should have a volume of at least 500 mL to ventilate children appropriately. PTS: 1

REF: Page 120

65. Compression of a 2.0-L manual resuscitator bag is not moving the patient’s chest. Possible

causes include which of the following? 1. The diaphragm valve is missing. 2. The mask seal is inadequate. 3. The oxygen level is too low. 4. The bag volume is too small. a. 2 and 3 b. 3 and 4 c. 1 and 2 d. 1 and 4 ANS: C

If the mask seal is inadequate the volume necessary to ventilate the patient will be inadequate, which will result in lack of chest movement. If the resuscitator bag is too small there is not enough volume to adequately ventilate the patient and the chest will not rise appropriately. If the leaf valve is missing the gas from the bag will not be directed to the patient and will therefore result in inadequate chest movement. PTS: 1

REF: Page 120

66. The following diagram represents which artificial airways?

a. b. c. d.

Combitube Endotrol tube Guedel airway Laryngeal mask airway

ANS: A

This figure depicts a Combitube. This tube has a double-lumen and two cuffs and can be inserted blindly in comatose patients with airway difficulty. It can function with either the esophagus intubated or the trachea intubated. PTS: 1

REF: Page 129, Fig. 5.32

67. The safety air inlet is represented in this diagram by which of the following letters?

a. b. c. d.

A B C D

ANS: C

If the reservoir bag’s inlet valve malfunctions, then the safety air inlet allows room air to enter the resuscitator bag. PTS: 1

REF: Page 118, Fig. 5.11

68. In this diagram, where does the part labeled A-1 fit into this TT?

a. b. c. d.

A B C D

ANS: C

A-1 is the cap that fits into the fenestrated TT when the inner cannula is removed. PTS: 1

REF: Page 147

69. When performing endotracheal intubation the respiratory care practitioner is unable to

successfully intubate the patient. He or she is unable to visualize the uvula or the soft palate; only the hard palate is visible. Which of the following statements best describe this situation? a. The patient has increased neck circumference. b. The epiglottis shows evidence of inflammation. c. The data indicates a Mallampati classification of IV. d. The data indicates that a smaller endotracheal tube is necessary. ANS: C

A Mallampati classification of IV is indicated by an inability to visualize the uvula or soft palate; only the hard palate will be visible. PTS: 1

REF: Page 113, Table 5.3

70. A 30-year-old male is admitted to the emergency room after a severe motor vehicle accident.

Assessment reveals he had a full stomach with significant reflux. His effective static compliance is measured at 20 mL/cm H2O. Which of the following types of airways would be appropriate to provide ventilatory support for this patient? a. Nasopharyngeal airway b. Laryngeal mask airway c. Endotracheal tube d. Endobronchial tube ANS: C

A laryngeal mask airway is contraindicated for three reasons; there was evidence he had a full stomach, there was evidence of gastroesophageal reflux, and his lung compliance is decreased. This would require an endotracheal tube to support ventilation. There is no evidence that a double lumen endotracheal tube is necessary. PTS: 1

REF: Page 114, Fig. 5.3

71. Airway ultrasound is used a. as a way to evaluate and airway. b. to visualize the posterior pharynx, posterior commissure, and posterior wall of the

trachea. c. by an ultrasound technologist to help the respiratory therapist place a tube. d. only during elective intubations. ANS: A

Ultrasound of the airway is emerging as a means in which one can evaluate an airway as well as a tool in assisting with intubation and predicting difficult intubation as above. While the tongue, oropharynx, epiglottis, larynx, true and false vocal cords, cricoid cartilage, cricothyroid membrane, and anterior trachea may be easily visualized, the posterior pharynx, posterior commissure, and posterior wall of the trachea are difficult to see due to artifacts from intra-tracheal air. PTS: 1

REF: Page 141

Chapter 06: Humidity and Aerosol Therapy Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. Which of the following statements is true? a. Water that exists in the form of individual molecules in a gaseous state is humidity. b. Water that exists in the form of individual molecules is an aerosol. c. Water that exists in the form of particulate matter is relative humidity (RH). d. Water that exerts no pressure is a vapor. ANS: A

Humidity is water that exists in the form of individual molecules in the vaporous or gaseous state. An aerosol is a suspension of solid or liquid particles in a gas. Water vapor does exert pressure, although the pressure may vary. PTS: 1

REF: Page 157

2. Which of the following statements is true? a. Fog and mist are considered water vapor. b. Medical aerosols are much smaller than molecules of water. c. Medical aerosols range from 0.2 to 50 m. d. As the temperature of a gas increases, water vapor pressure decreases. ANS: C

Medical aerosol must deposit anywhere from the upper airways to the lower airways; therefore, it must be the apT prEoS prTiaBteAsNizKeSfoErLthLeEtaRrg.eCt O siM te, with a range of 0.2 to 50 m. Fog and mist are considered aerosols, not water vapor. Medical aerosols need to be larger than water vapor molecules—otherwise they would be too stable to deposit at their target site. As the temperature of a gas increases, water vapor pressure also increases because gas molecules move faster, resulting in a greater number of molecular collisions. PTS: 1

REF: Page 157

3. How often should a spacer or valved holding chamber (VHC) be washed? a. Once a day b. Once a week c. Once a month d. There is no need to wash a spacer or VHC ANS: B

Manufacturers’ recommend washing spacers/VHCs with soap and water once a week. However, previous research suggests cleaning spacers after each use due to bacterial contamination found with spacers by patients at home. The concentration of soap or detergent is not important as it does not influence aerosol drug delivery to patients; therefore, only a few drops is enough for cleaning spacers/VHCs and detergent concentration. Although previous recommended not to rinse off spacers to protect them against electrostatic charge, not rinsing the detergent off may cause contact dermatitis. Therefore, clinicians should consider using spacers and VHCs that are made of nonelectrostatic material.

PTS: 1

REF: Page 183

4. Which of the following is true concerning water vapor? a. It is a true gas. b. It has a constant pressure. c. It exerts a partial pressure. d. It exists above its critical temperature. ANS: C

Water vapor exerts a pressure (PH2O) that results from the continuous, random movement of water molecules. It is not a true gas and does not have a constant pressure. As the temperature of a gas increases, water vapor pressure increases and water molecules leave the liquid state through evaporation. PTS: 1

REF: Page 157

5. A water molecule at the surface contains enough kinetic activity to enter the vapor state. This

is the definition of which of the following? a. Evaporation b. Vaporization c. The boiling point d. The critical point ANS: A

Evaporation occurs when liquid molecules near the surface contain enough kinetic energy to break free and enter a vapor state without the addition of heat. Vaporization is the energy required to vaporize a liquid. The boiling point is when the water is heated to a point at which molecules leave the liquid T stE atS eT anBdApNroKdS ucEeLwLaE teR r. vaCpO orM. PTS: 1

REF: Page 157

6. When absolute humidity (AH) is constant and the temperature of the gas increases, the a. gas is saturated. b. capacity decreases. c. water content increases. d. RH decreases. ANS: D

RH decreases when the AH is held constant and the temperature of the gas is increased because the warmer gas has a higher capacity. Mathematically, when the denominator of a ratio is increased, the whole number will decrease. PTS: 1

REF: Page 157

7. What is the RH when the AH is 15 mg H2O/L and the capacity of a gas is 20.6 mg H2O/L? a. 15% b. 20% c. 30% d. 72% ANS: D

RH = (AH/capacity)  100%. (15 mg/L/20.6 mg/L)  100% = 72%.

PTS: 1

REF: Page 157, Box 6.1

8. The RH is 40% and the capacity is 32 mg H2O/L. The AH of this gas is a. 1.3 b. 12.8 c. 60 d. 128

mm Hg.

ANS: B

RH = (AH/capacity)  100%. [40% = 0.4]. 0.4 = x/32. 32  0.4 = 12.8 mg H2O/L. PTS: 1

REF: Page 157, Box 6.1

9. At 20C, water vapor pressure is measured as 15 mm Hg. If the maximum partial pressure at

this temperature is 17.5 mm Hg, the RH is a. 30%. b. 50%. c. 75%. d. 85%. ANS: D

15/17.5  100% = 85%. PTS: 1

REF: Page 157, Box 6.1

10. If its RH is 50% and its AH is 16 mg H2O/L, the water vapor capacity of a gas is

H2O/L. a. 0.8 b. 3.2 c. 8 d. 32 ANS: D

0.5 = 16/X. 0.5X = 16. X = 16/0.5. X = 32 mg/L. PTS: 1

REF: Page 157, Box 6.1

11. At 37C, water vapor exerts a partial pressure of a. 43.9; 47 b. 47; 43.9 c. 44; 44 d. 100; 100

mm Hg and contains

mg H2O/L.

ANS: B

At sea level, a gas at body temperature (37C), at a pressure of 47 mm Hg, and at a saturation of 100% will contain 43.9 mg of water per liter of gas.

PTS: 1

REF: Page 157, Box 6.1

12. Condensation will form in large-bore corrugated tubing during the delivery of bland aerosol

because the a. gas is warmed by ambient air. b. corrugated tubing is too short. c. gas is cooled by ambient air. d. particles are susceptible to gravity. ANS: D

The liquid particles suspended in gas grow larger and heavier, condense, and then fall out because large particles are more susceptible to gravity than small particles. If the ambient air is warmer than the gas carrying the aerosol, the gas will warm, increasing its capacity to hold water, thereby preventing rainout in the tubing. The shorter the tubing, the less time there is for the rainout to occur before the aerosol reaches the patient. The ambient air in the hospital setting is usually at or warmer than the temperature of the gas carrying the aerosol. So, the gas will not cool off as it flows to the patient unless it is a heated aerosol. PTS: 1

REF: Page 162

13. A pulse oximeter on a patient with a tracheostomy shows 89% saturation. The patient has a

heated humidifier with a 40% air-entrainment tracheostomy collar. A rapid assessment shows no secretion production and equal breath sounds. Which of the following is the most appropriate first step? a. Increase the oxygen delivered through the flowmeter. b. Increase the air-entrainment device to 60%. c. Apply positive pressure with bag-valve ventilation. TESTBANKSELLER.COM d. Check to see whether water is collected in the gas-delivery tube. ANS: D

The condensation collected in the gas-delivery tube must be removed because it becomes an obstruction that disrupts gas and humidity delivery to the patient. The other choices disregard the simplest step, which should be taken first. PTS: 1

REF: Page 162

14. Which of the following is true about the physiologic control of heat and moisture exchange by

the body? a. The nose, oropharynx, and hypopharynx add heat and humidity during exhalation. b. The nose, oropharynx, and hypopharynx cool gas and reclaim water during inhalation. c. The inability of the nasal mucosa to reabsorb excessive amounts of exhaled condensation in cold weather causes a “runny nose.” d. The mouth is more efficient at reclaiming heat and water during exhalation than is the nose. ANS: C

A runny nose in a cold environment is caused by the inability of the nasal mucosa to reabsorb excessive amounts of exhaled gas condensed in water. The upper airways add heat and humidity to inspired gases during inhalation, and cool and reclaim water during exhalation. During exhalation, the mouth is much less efficient than the nose in reclaiming heat and water. PTS: 1

REF: Page 158

15. The isothermic saturation boundary is located just below the a. carina. b. nasopharynx. c. lobar bronchi. d. mainstem bronchi. ANS: A

The isothermic saturation boundary is the point, typically 5 cm below the carina, at which body temperature and pressure, saturated with water vapor (BTPS) is reached. The nasopharynx is above the carina. PTS: 1 16.

REF: Page 159, Fig. 6.1

Which of the following statements about the isothermic saturation boundary is true? a. Exercise causes the isothermic saturation boundary to shift higher in the trachea. b. At 2 cm above the carina, inhaled gas reaches BTPS. c. Inhalation through the mouth shifts the isothermic saturation boundary downward. d. Below the isothermic saturation boundary, temperature and RH are variables. ANS: C

At the isothermic saturation boundary inhaled gas reaches BTPS, which is below the carina. The temperature and RH are constant after that point. Because exercise causes an increase in the volume, rate, and type of breathing (i.e., breathing through the mouth), the isothermic saturation boundary would shift downward. PTS: 1

REF: Page 159

17. Which of the following are true about the function of the upper airways?

1. They cool inspired air. 2. They filter out secretions. 3. They humidify inspired air. 4. They keep the nasal mucosa moist. a. 1, 2, and 3 b. 1 and 3 c. 2 and 4 d. 3 and 4 ANS: D

The upper airway is responsible for humidifying inspired air. The upper airways add heat and humidity to inspired gases during inhalation. The nasal mucosa is kept moist by secretions from the mucous glands. Humidity and warmth are captured by the nasal mucosa, and exhaled air is cooled.

PTS: 1

REF: Page 158

18. A large humidity deficit will cause a. a nonproductive cough. b. increased cilia function. c. increased movement of mucus. d. decreased airway resistance. ANS: A

When the airways are exposed to dry, cold air, ciliary motility is reduced; the airways become more irritable; and because mucous production is increased, pulmonary secretions become thick and inspissated, with increased airway resistance and a nonproductive cough. PTS: 1

REF: Page 159

19. The structure that has a large surface area and therefore increases contact between inspired air

and mucosa is the a. nose. b. carina. c. larynx. d. epiglottis. ANS: A

In the nose, the tortuous path of the turbinates increases contact between the inspired air and the mucosa. PTS: 1

REF: Page 158

20. Inspired air is humidified and warmed through what two physical processes?

1. Condensation 2. Evaporation 3. Convection 4. Conduction a. 1 and 2 b. 1 and 4 c. 2 and 3 d. 3 and 4 ANS: C

As the inspired air enters the nose, it is warmed by convection, not by conduction, and picks up water vapor from the moist mucosal lining by evaporation, not by condensation. PTS: 1

REF: Page 158

21. A high-flow nasal cannula set at 15 L has been running for a while without humidification.

Which of the following could have happened? a. The cilia function increases. b. Turbulent convection stops. c. Airway resistance decreases. d. The isothermic saturation boundary shifts. ANS: D

The isothermic saturation boundary shifts deeper into the lungs when a person inhales through cold, dry air. In this case, the cilia function decreases and secretions are produced, increasing airway resistance. The turbulent convection increases contact between the inspired air and the mucosa. PTS: 1

REF: Page 158

22. The RH of an inspired gas is greater than 60% of BTPS. Which of the following statements is

true? a. Production of mucus in the airways will increase. b. The work of breathing will increase. c. The airways will function normally. d. Secretions will become thick and dehydrated. ANS: C

When the RH of inspired gas is greater than 60% of BTPS conditions, no injury is believed to occur in normal lungs. The production of mucus will increase, work of breathing will increase, and secretions will become thick and dehydrated when the RH is less than 60% of BTPS. PTS: 1

REF: Page 158

23. Indications for the use of warm, humidified gas are which of the following?

1. Patients with hypothermia 2. Patients with croup 3. Patients with bronchospasm 4. Patients with postextubation edema a. b. c. d.

1, 2, and 3 1 and 3 2 and 4 2, 3, and 4

ANS: B

Warm, humidified gases are used to raise core temperatures of patients with hypothermia to prevent intraoperative hypothermia, and to alleviate bronchospasm in patients with reactive airways, in addition to maintaining normal humidity levels in the airway. Cool, humidified gas is often used in conjunction with a bland aerosol delivery to treat upper airway inflammation resulting from croup, epiglottitis, and postextubation edema. PTS: 1

REF: Page 159

24. A patient with a nasal cannula set to deliver 8 L/min of oxygen would be expected to report

which of the following? 1. Dry, nonproductive cough 2. Increased work of breathing 3. Abdominal pain 4. Thick, dehydrated secretions a. 1, 2, and 4 b. 1 and 3 c. 2 and 4 d. 2, 3, and 4

ANS: A

Dry, nonproductive cough; increased work of breathing; substernal pain; and thick, dehydrated secretions are symptoms of inadequate airway humidification. See Box 4.2. PTS: 1

REF: Page 159, Box 6.2

25. Which of the following statements about humidifiers is appropriate? a. The warmer the gas, the less water vapor it can hold. b. Evaporation occurs more rapidly with a large water-to-gas surface area. c. High peak flows improve the efficacy of a humidifier. d. The mass of the water is inversely proportional to its capacity to transfer heat. ANS: B

Larger surface areas will increase the amount of evaporation that will occur. The warmer the gas, the more water it can hold. High flows through a humidifier decrease its efficiency, because there is less time for contact between the gas and water. According to the principles of thermodynamics, the mass of the water is directly proportional to its capacity to transfer heat. See also Box 6.4. PTS: 1

REF: Page 159, Box 6.4

26. Which of the following humidifiers is classified as passive? a. Bubble humidifier b. Large-volume nebulizer (LVN) c. Passover humidifier d. Heat and moisture exchanger ANS: D

A heat and moisture exchanger is a passive humidifier. All the others are active humidifiers. PTS: 1

REF: Page 161

27. When the temperature is 37C and the RH is 35%, the AH is a. 11.9 b. 15.4 c. 16.5 d. 79.5

mg H2O/L.

ANS: B

RH = [content (AH)/capacity]  100%. (35% = 0.35). 0.35 = x/44 = 15.4 mg H2O/L. PTS: 1

REF: Page 157, Box 6.1

28. If the RH of a gas is 55% and the capacity is 18 mg/L, the AH is a. 10 b. 12 c. 22.5 d. 25.2 ANS: A

RH = (content [AH)/capacity].

mg H2O/L.

0.55 = x/18 mg H2O/L. x = 10 mg H2O/L. PTS: 1

REF: Page 157, Box 6.1

29. What is the RH of air at 37C if the actual water vapor pressure is 33 mm Hg? a. 89% b. 75% c. 70% d. 25% ANS: C

RH = [content(AH)/capacity]  100%. (33 mm Hg/47 mm Hg [water vapor pressure at body temperature])  100% = 70%. PTS: 1

REF: Page 157, Box 6.1

30. The actual water vapor pressure at 37C when the RH is 50% is a. 18.5 b. 23.5 c. 22 d. 45

mm Hg.

ANS: B

RH = [content (AH)/capacity]  100%. 0.5 = x/44 mm Hg = 23.5 mm Hg. PTS: 1

NoKxS6E agSe T 15B7A ,B .1LLER.COM REF: TPE

31. If the actual water vapor pressure is 40 mm Hg and the capacity is 55 mm Hg, the RH is a. 88% b. 85% c. 80% d. 35% ANS: C

RH = [content (AH)/capacity]  100%. (44/55)  100% = 80%. PTS: 1

REF: Page 157, Box 6.1

32. The efficiency of a bubble humidifier is affected by which of the following? a. Gas flow rate b. Operating pressure c. Aerosol production d. Oxygen concentration ANS: A

As gas flow increases, the reservoir cools by as much as 10C, thus limiting its effectiveness to provide humidity at flow rates higher than 10 L/min. An increased gas flow rate decreases the amount of contact time between the gas and the water. Increasing the height of the water column above the gas outlet increases the humidity content of the bubbles by allowing for the longer contact time. PTS: 1

REF: Page 161

33. A patient reports a dry nose and throat. He is receiving 6 L of O2 through a nasal cannula.

Which of the following is most appropriate to address the patient’s dry nose and throat? a. Decrease the oxygen flow rate to 3 L. b. Add a low-flow bubble humidifier. c. Suggest an aerosol treatment with a mucolytic agent. d. Take no action. ANS: B

If a nasal cannula is set to deliver more than 5 L/min, humidification will be necessary. A low-flow bubble humidifier humidifies the gas traveling to the patient through a nasal cannula with approximately 40% to 50% of the RH at standard room temperatures. See Fig. 6.4. The other options are not applicable. PTS: 1

REF: Page 162, Fig. 6.4

34. A low-flow bubble humidifier is running at 4 L/min and is not whistling. Which action should

be taken at this time? a. No action should be taken because this is normal. b. Increase the flow to make it whistle. c. Replace the spring-loaded valve. d. Change the unit because there is a leak. ANS: A

The humidifier is functioning normally. The pressure-relief valve releases high pressure (>2 psi) to prevent bursting of the humidifier bottle when there is an obstruction creating a whistling sound. Leaks are not detected by the pressure-relief valve. PTS: 1

REF: Pages 161-162

35. Which of the following is a true statement about the delivery of warm, humidified gas to the

lungs? a. The gas delivered to the nose or mouth contains 95% RH and has an AH of 28 to 34 mg/L at 29C to 32C. b. The gas delivered to the hypopharynx contains 50% RH and has an AH level of 10 mg/L at 22C. c. The gas delivered to the midtrachea contains 50% RH and has an AH level of 36 to 40 mg/L at 31C to 35C. d. The gas delivered to the midtrachea contains 100% RH and has an AH level of 36 to 40 mg/L at 31C to 35C. ANS: D

The gas delivered to the midtrachea contains 100% RH and has an AH level of 36 to 40 mg/L at 31C to 35C. The gas delivered to the hypopharynx contains 95% RH and has an AH level of 28 to 34 mg/L at 29C to 32C. The gas delivered to the nose or mouth contains 50% RH and has an AH level of 10 mg/L at 22C. See Box 6.3. PTS: 1

REF: Page 159, Box 6.3

36. The efficiency of a bubble humidifier depends on which of the following?

1. Temperature 2. Length of the oxygen tubing being used 3. Surface area between the gas and water 4. Size of water particles a. 1 and 2 b. 1 and 3 c. 3 and 4 d. 2 and 4 ANS: B

The effectiveness of bubble humidifiers depends of the presence of a diffuser, the water level in the humidifier, and the surface area between the gas and water. The length of the oxygen tubing being used will not affect the efficiency of the bubble humidifier. PTS: 1

REF: Page 159, Box 6.4

37. A nonrebreathing mask has been replaced by a high-flow nasal cannula humidifier set at 15

L/min. The benefit of this device to a patient is that it a. decreases airway resistT anEcS e.TBANKSELLER.COM b. delivers medication to the airways. c. prevents an increased humidity deficit. d. dilutes thick secretions for easy removal. ANS: C

The high-flow nasal cannula humidifier will prevent an increase in humidity deficit because it uses a special bubble humidifier that can accommodate the rapid flow rates and still humidify the gas. PTS: 1

REF: Page 163

38. The respiratory therapist has been called because the nasal cannula with humidifier delivering

4 L/min is making a high-pitched whistle. The most probable cause of the problem is that the a. humidifier is leaking. b. oxygen tubing is kinked. c. oxygen tubing is too long. d. nasal prong is not in place. ANS: B

Humidifier pop-off valves typically provide both an audible alarm and a visible alarm; the humidifier automatically resumes normal operation once the excess pressure is vented. PTS: 1

REF: Page 200

39. Which of the following statements is true concerning bland aerosols? a. Bland aerosols should not be delivered to patients with tracheostomies. b. Ultrasonic nebulizers are inefficient at producing bland aerosols. c. Sterile water and hypotonic, isotonic, and hypertonic solutions can be used. d. Humidifiers must be heated to deliver bland aerosols. ANS: C

Sterile water and hypotonic, hypertonic, and isotonic solutions can all be used to create bland aerosols. If the patient has a tracheostomy, this requires the addition of a device that can produce high humidity. In most cases, this device would be the LVN, which produces bland aerosols. Ultrasonic nebulizers are very efficient at producing bland aerosols. LVNs do not need heat to produce bland aerosols. PTS: 1

REF: Page 198, Clinical Practice Guideline 6-2

40. Appropriate use of an ultrasonic nebulizer will aid which of the following? a. Ribavirin delivery b. Sputum induction c. Croup tent use d. Pentamidine aerosolization ANS: B

Ultrasonic nebulizers generate bland aerosols and aid the delivery of sterile water and hypotonic, isotonic, or hypertonic saline aerosols. They are very effective when used to induce sputum production for laboratory testing. Ribavirin is aerosolized in the small-particle aerosol generator model 2 (SPAG-2). Pentamidine is aerosolized in the Circulaire or Respirgard type of nebulizers that have filters to remove the aerosol before it is emitted into the environment. PTS: 1

REF: Page 202

41. A respiratory therapist needs to deliver hypotonic solution to a patient through a large-volume

jet nebulizer. The gas flow setting should be a. 2; 4 b. 4; 6 c. 6; 8 d. 6; 15

L/min.

ANS: D

Jet nebulizers typically operate at a flow of 6 to 15 L/min. PTS: 1

REF: Page 193

42. Which of the following statements regarding large-volume jet nebulizers is true? a. Gas is brought down the siphon tube into the liquid. b. Lateral pressure increases around the air-entrainment ports. c. Baffling removes the larger particles from the generated aerosol. d. Closing the air-entrainment ports can increase inspiratory flow. ANS: C

The resulting low pressure generated at the jet draws fluid from the reservoir up to the top of a siphon tube, where it is sheared off and is carried in the gas stream. Inspiratory flows decrease as the air-entrainment port is closed. PTS: 1

REF: Page 193

43. A patient wants to use a spinning disk nebulizer at home. The patient should be aware that it a. increases the ambient RH. b. is a mechanical aerosol generator. c. can be a source of bacterial contamination to the environment. d. can deliver 20 mL/min. ANS: C

The room nebulizers are not commonly recommended because they can be a source of bacterial contamination to the environment. See also Fig. 6.11. PTS: 1

REF: Page 193

44. The respiratory therapist needs to deliver a bland aerosol to a 24-month-old child through a

spinning disk device. The appropriate flow setting is a. 3; 5 b. 6; 8 c. 10; 15 d. 20; 22

L/min.

ANS: D

Larger versions of these devices (with 2- to 3-L reservoirs) are used to deliver bland aerosols into mist tents. These encloTsE urSeTsyBsA teN mKs S caEnLgL enEeR ra.teCfO loMw rates greater than 20 L/min, with water outputs as high as 5 mL/min (300 mL/h). Because heat buildup in enclosures is a problem, these systems are always unheated. PTS: 1

REF: Page 193 | Page 199

45. A sputum induction is needed for a 55-year-old female patient. Which of the following

devices will be most appropriate? a. Spinning disk nebulizer b. Wick humidifier c. Ultrasonic nebulizer d. Large-volume jet nebulizer ANS: C

Ultrasonic nebulizers are valued clinical tools for inducing sputum production so that specimens can be used for diagnostic analysis. Ultrasonic nebulizers yield a higher quantity and quality of sputum specimens for analysis than other nebulizers but at some cost of increased airway reactivity. PTS: 1

REF: Page 202

46. The device that presents the least risk of cross-contamination as a room humidifier is which of

the following? a. Bubble humidifier b. LVN

c. Wick humidifier d. Ultrasonic nebulizer ANS: C

Passover and wick type of humidifiers present less risk of cross-contamination than does the ultrasonic nebulizer as a room humidifier, which can easily become contaminated, resulting in airborne transmission of pathogens. PTS: 1

REF: Page 166

47. You have to set up a continuous heated aerosol to a patient with a tracheostomy. Which of the

following pieces of equipment will be needed? 1. Aerosol mask 2. Tracheostomy collar 3. Thermometer 4. Drain bag 5. Oxygen tubing 6. Corrugated tubing 7. LVN 8. Ultrasonic nebulizer 9. Heating unit 10. Bubble humidifier a. 1, 5, and 10 b. 2, 4, 6, and 8 c. 1, 4, 6, 7, and 9 d. 2, 3, 4, 6, 7, and 9 ANS: D

The appropriate pieces of equipment needed to deliver a continuous heated aerosol are listed in Box 6.5. An ultrasonic nebulizer should not be used because it has an increased risk of causing bronchospasm with continuous use. PTS: 1

REF: Page 166, Box 6.5

48. A patient has a heated air-entrainment large-volume jet nebulizer. The aerosol disappears

completely during each inspiration. The most appropriate action to take is to a. decrease the oxygen flow to the LVN. b. increase the oxygen flow to the LVN. c. decrease the heat level. d. remove the corrugated reservoir tubing. ANS: B

The aerosol should not completely disappear during inspiration. This means that the device is not meeting the needs of the patient. The oxygen flow can be increased without worry that the fractional inspired oxygen will increase, because the device uses air entrainment to set the oxygen concentration. This is the only answer that will increase the output of the device to meet the patient’s inspiratory needs. PTS: 1

REF: Page 166, Box 6.5

49. You have been called because of an audible alarm from a heated air-entrainment large-volume

jet nebulizer. The most-appropriate immediate action is to a. decrease the oxygen flow. b. change the device to an injection nebulizer. c. change the device to a high-flow heated humidifier. d. turn off the heater power to prevent overheating. ANS: D

Audible and visual alarms should indicate when remote temperature sensors are disconnected, absent, or defective; in these cases, power to the heater should be interrupted to prevent overheating. See Box 6.7. PTS: 1

REF: Page 160

50. A heated air-entrainment large-volume jet nebulizer needs to be set up for a patient. In

addition to the nebulizer, which of the following pieces of equipment are needed? 1. Heating device 2. Tracheostomy collar 3. Thermometer 4. Aerosol mask 5. Drain bag 6. Oxygen tubing 7. Corrugated tubing a. 1, 2, 5, and 7 b. 4 and 7 c. 3, 4, 5, and 6 d. 1, 3, 4, 5, and 7 ANS: D

Because the patient is not intubated, an aerosol mask needs to be used with a nebulizer that has a heating device. Corrugated tubing with a thermometer and a drain bag in-line to collect the rain out are also needed. Oxygen tubing is not used with LVNs. PTS: 1

REF: Page 166, Box 6.5

51. Which of the following is a complication from bland aerosol therapy?

1. Infection 2. Overhydration 3. Bronchospasm 4. Upper airway edema a. 3 and 4 b. 1 and 2 c. 2, 3, and 4 d. 1, 2, and 3 ANS: D

The most common problems with bland aerosol delivery systems involve infection control, environmental safety, inadequate mist production, overhydration, bronchospasm, and noise. PTS: 1

REF: Page 198, Clinical Practice Guideline 6-2

52. Which of the following presents the greatest risk for an infant being treated with a heated jet

nebulizer? a. Infection b. Bronchospasm c. Overhydration d. Tachycardia ANS: C

Overhydration is a potentially serious problem for patients being treated with heated jet nebulizers and ultrasonic nebulizers. The risk of overhydration is greatest for infants, young children, and those with preexisting fluid or electrolyte imbalances. PTS: 1

REF: Page 168

53. An ultrasonic nebulizer is being used to deliver a hypotonic solution. The patient suddenly

reports shortness of breath. The respiratory therapist auscultates, which reveals wheezing over both lung fields. Which of the following actions should be taken first? a. Observe the patient. b. Give the patient oxygen. c. Add a bronchodilator to the treatment. d. Immediately stop the treatment. ANS: D

If bronchospasm occurs during therapy, treatment must be stopped immediately, oxygen must be provided, and appropriate bronchodilator therapy should be initiated as soon as possible. PTS: 1

REF: Page 168

54. A hypotonic solution with an ultrasonic nebulizer is ordered for a patient who has a history of

hyperreactive airways. In such a situation, the respiratory therapist should recommend which of the following? 1. Refuse to give the treatment. 2. Suggest giving a bronchodilator before the hypotonic solution. 3. Suggest that an isotonic solution be used instead. 4. Administer oxygen before the hypotonic solution. a. 1 b. 2 and 3 c. 3 and 4 d. 4 ANS: B

If the physician still requests bland aerosol therapy for this patient, pretreatment with a bronchodilator might be required. In addition, isotonic solutions (0.9% saline) might also be better tolerated by these patients than water. Administered oxygen will not prevent bronchospasm—even if an isotonic solution is used in a patient with hyperreactive airways. PTS: 1

REF: Page 163 | Page 168

55. An individual’s humidity deficit will be the smallest when breathing a. oxygen through a heated-wick humidifier. b. room air through a heat and moisture exchanger.

c. room air at 30C and 50% RH. d. by nasal cannula (6 L/min) with a bubble humidifier. ANS: A

A wick humidifier can deliver 44 mg/L of water vapor as compared with 10 to 31 mg/L from a heat and moisture exchanger, 15 mg/L from room air at 30C and 50% RH, and 10 to 20 mg/L from a bubble humidifier. PTS: 1

REF: Page 157, Table 6.1

56. Which of the following devices would be the least effective in reducing a patient’s humidity

deficit while intubated? a. A heat and moisture exchanger b. An unheated bubble humidifier c. A wick humidifier set at 35C d. Heated air-entrainment nebulizer ANS: B

The unheated bubble humidifier has a water vapor output of 10 to 20 mg H2O/L compared with the heat and moisture exchanger, with approximately 30 mg H2O/L; the wick humidifier, with 44 mg H2O/L; and the heated air-entrainment nebulizer, with 33 to 55 mg H2O/L. PTS: 1

REF: Page 161

57. Which of the following is true concerning heat and moisture exchangers? a. They are passover type A humidifiers. b. They might reduce the incidence of nosocomial infections. c. They are best-suited foT rE loS ngT-B teA rmNK usSe E oL nL mE ecRh. anCicOaM l ventilators. d. They are able to provide a humidity output of 10 to 44 mg/L at 35C. ANS: B

Heat and moisture exchangers might reduce the incidence of nosocomial infections. Passive humidifier heat and moisture exchangers have been successfully used to meet the short-term humidification needs of spontaneously breathing and mechanically ventilated patients with endotracheal and tracheostomy tubes. However, a heat and moisture exchanger is not a passover humidifier. The passover humidifier directs gas over a liquid or liquid-saturated surface. Heat and moisture exchanging filters have an increased internal surface area and are capable of providing moisture output in the range of 18 to 28 mg H2O/L. According to the American Association for Respiratory Care’s Clinical Practice Guideline, heat and moisture exchangers should not be used for long-term humidification of patients who are receiving invasive mechanical ventilation. PTS: 1

REF: Page 172

58. Creation of aerosol particles within a small-volume nebulizer is based on a. Stokes’ law. b. Brownian motion. c. the Bernoulli principle. d. Reynolds’ number. ANS: C

A typical small-volume nebulizer is powered by a high-pressure stream of gas directed through a restricted orifice (the jet). The gas stream leaving the jet passes the opening of a capillary tube immersed in solution. Because it produces low lateral pressure at the outlet, the high jet velocity draws the liquid up the capillary tube and into the gas stream, where it is sheared and broken up into droplets. This is known as the Bernoulli principle. PTS: 1

REF: Page 163

59. Driving a small-volume nebulizer with heliox, instead of air or oxygen, has what effect on the

aerosol produced? a. Increases upper airway impaction b. Creates larger particles c. Decreases the aerosol output d. Increases the turbulence of the aerosol ANS: A

The density of the driving gas affects both aerosol generation and the delivery of aerosols to the lungs. Lowering the density of the carrier gas reduces the amount of turbulent flow, which results in less aerosol impaction in the upper airways. When heliox is used to drive a jet nebulizer at standard flow rates, aerosol output is substantially less than with air or oxygen, and aerosol particles are considerably smaller. PTS: 1

REF: Pages 191-192

60. To produce clinically useful aerosol particles through a small-volume nebulizer, the gas flow

rate should be set at a. 12; 15 b. 10; 12 c. 6; 10 d. 3; 6

L/min.

ANS: C

Set flow to the manufacturer’s recommendations; often this is 6 to 10 L/min. See Box 4.11. PTS: 1 61.

REF: Page 191

Which of the following is the optimal technique for use of a metered-dose inhaler? 1. Actuating the inhaler with the mouthpiece 4 cm from the patient’s opened mouth 2. Placing the inhaler in the mouth and closing the lips tightly 3. Holding breath for 5 to 10 seconds after inhalation 4. Inhaling the aerosol quickly a. 1 and 3 b. 1, 3, and 4 c. 1, 2, and 3 d. 2 and 4 ANS: A

If an adult patient positions the outlet of the pressurized metered-dose inhaler approximately 4 cm (two finger widths) in front of an opened mouth and has a low inspiratory flow rate, this technique can increase the dose delivered to the lower respiratory tract from a range of approximately 7% to 10% to 14% to 20% and can decrease the impact on the oropharyngeal region. PTS: 1

REF: Page 201, Box 6.14

62. Which of the following are true about the use of a metered-dose inhaler?

1. Inertial impaction can be reduced if the patient holds the inhaler in the mouth. 2. Larger particles will be produced in a cold environment. 3. The optimum temperature for an inhaler canister is 37C. 4. The inhaler needs to be shaken before actuation. a. 1 and 4 b. 1 and 3 c. 2 and 3 d. 2, 3, and 4 ANS: D

If an adult patient positions the outlet of the pressure metered-dose inhaler approximately 4 cm (two finger widths) in front of an opened mouth with a low inspiratory flow rate, this practice can increase the dose delivered to the lower respiratory tract from a range of approximately 7% to 10% to 14% to 20% and decrease oropharyngeal impaction. A cold ambient temperature (i.e., a temperature of less than 10C) dramatically decreases the output of chlorofluorocarbon pressure metered-dose inhalers. PTS: 1

REF: TPE agSe T 20B1A ,B .1L 4 LER.COM NoKxS6E

63. One criterion for the use of a dry-powder inhaler is the patient’s ability to a. coordinate inspiration with actuation. b. hold the dry-powder inhaler 4 cm from the mouth. c. empty the powder into the dry-powder inhaler. d. inspire at flows greater than 40 L/min. ANS: D

The most critical factor in passive dry-powder inhaler use is the need for high inspiratory flow. Patients must generate inspiratory flows of at least 40 to 60 L/min to produce a respirable powder aerosol. PTS: 1

REF: Page 188 | Page 186

64. Which of the following devices can be used to administer a continuous bland aerosol?

1. Face tent 2. Simple mask 3. Nonrebreathing mask 4. Tracheostomy collar a. 1 b. 1 and 4 c. 2 and 3 d. 2, 3, and 4

ANS: B

The face tent and tracheostomy collar are patient interface appliances used to deliver bland aerosol therapy. The others are not. PTS: 1

REF: Page 165

65. A patient with subglottic edema might benefit from what type of humidity or aerosol therapy? a. Continuous heated bland aerosol b. Humidity from a bubble humidifier c. Continuous cold-nebulized bland aerosol d. Dry-powder inhaler with a bronchodilator ANS: C

A continuous cold-nebulized bland aerosol will produce vasoconstriction and reduce edema. Continuous heated bland aerosol is used for patients with hypothermia. A dry-powder inhaler with a bronchodilator is used to relieve a bronchospasm. Humidity from a bubble humidifier will not reduce subglottic edema. PTS: 1

REF: Page 197, Clinical Practice Guideline 6-1

66. Which of the following offers the best method for delivering ribavirin? a. A small-volume nebulizer and an aerosol mask b. An LVN, large-bore tubing, and a Briggs adapter c. SPAG-2, large-bore tubing, and an oxygen hood d. SPAG-2, large-bore tubing, and an aerosol mask ANS: C

The SPAG was manufactuT reE d SbT yB ICANNPKhSaE rmLaL ceEuR ti. caClsOsM pecifically for the administration of ribavirin (Virazole) to infants with respiratory syncytial virus infection. PTS: 1

REF: Page 193

67. Continuous bland aerosol administration can be hazardous when administered to patients with

1. asthma. 2. pneumonia. 3. cystic fibrosis. 4. ineffective cough mechanisms. a. 1 and 3 b. 1 and 4 c. 2 and 4 d. 2, 3, and 4 ANS: B

Continuous bland aerosols should not be used for patients with asthma because of bronchospasm. For patients who have ineffective cough mechanisms, continuous aerosol use can cause overhydration. PTS: 1

REF: Page 198, Clinical Practice Guideline 6-2

68. Continuous bland aerosol is being delivered to an intubated patient through a LVN and a

Briggs adapter. A clinical assessment reveals bronchoconstriction. Which of the following is the most appropriate recommendation?

a. b. c. d.

Switch to an ultrasonic nebulizer. Change to a heated-wick humidifier. Add a heater to the LVN. Decrease the flow rate to the LVN.

ANS: B

Change to a heated-wick humidifier, which is a heated humidifier that is appropriate when airways are hyperreactive. Ultrasonic nebulizers and LVNs will worsen bronchospasms because they also create bland aerosol. PTS: 1

REF: Page 176, Fig. 6.28

69. A metered-dose inhaler should be held away from the mouth during actuation to a. decrease the effect of inertial impaction on the particles. b. decrease the effect of gravity on the particles. c. ensure deposition in the oropharynx. d. prevent cross-contamination. ANS: A

This technique will decrease the effect of inertial impaction on the particles in the oropharynx. PTS: 1

REF: Page 181

70. Which of the following will correct the problem of tubing condensation within the ventilator

circuit? a. Water traps b. Increase the room temperature c. Hot wire circuit d. Both A and C ANS: D

Hot wire circuits are quite common in the intensive care unit. The placement of wire-heating elements into the ventilator circuit allows the gas delivered to the patient to remain at a constant temperature. PTS: 1

REF: Page 162

71. Which of the following are contraindications for heat moisture exchanger (HME) use?

1. Hypothermia 2. Uncuffed endotracheal tubes 3. With heated humidification 4. Decrease volume of secretions a. 1, 2, and 3 b. 1 and 3 c. 2 and 3 d. 2 and 4 ANS: A

Contraindications of heat and moisture exchanger use are hypothermia, the presence of uncuffed endotracheal tubes, use with heated humidification, and an increase in the volume of secretions.

PTS: 1

REF: Page 163, Fig. 6.7

72. Which of the following are valid reasons for using a heat and moisture exchanger in infants? a. Heat and moisture exchangers add 30 to 90 mL of mechanical dead space. b. Heat and moisture exchangers are effective with uncuffed endotracheal tubes. c. Heat and moisture exchangers might cause an obstruction in endotracheal tubes in

infants. d. Heat and moisture exchangers are an inexpensive alternative to humidifiers. ANS: D

Heat and moisture exchangers are not recommended for use in infants for several reasons. Heat and moisture exchangers add 30 to 90 mL of mechanical dead space, often exceeding the tidal volume of a 5-kg infant (i.e., 25 mL). Uncuffed endotracheal tubes used in infants allow a portion of exhaled gas to leak around the tube, bypassing the heat and moisture exchanger and reducing its ability to capture exhaled heat and humidity. Providing heated humidity at less than 35C has been associated with narrowing and obstruction of endotracheal tubes in infants. The advantages of heat and moisture exchangers are that they are inexpensive alternatives to humidifiers and they are the best choice for adult patients. PTS: 1

REF: Page 173

73. A heat and moisture exchanger is best placed where in the ventilator circuit? a. Directly at the patient Y-connector b. Twenty centimeters away from the endotracheal tube c. At the ventilator outlet d. At the ventilator inlet ANS: A

Heat and moisture exchangers should be placed directly at the airway or patient Y-connector. Other heat and moisture exchanger locations that might also prove effective are 10 cm away from the endotracheal tube. PTS: 1

REF: Page 173

74. Approximately how much of a patient’s heat and humidity is returned when using an HME? a. 40% b. 50% c. 60% d. 70% ANS: D

The HME, or artificial nose, is classified as a passive humidifier. Like the nose, an HME captures and returns up to 70% of exhaled heat and humidifies to the patient in order to heat and humidifies the next inspiration. PTS: 1

REF: Pages 173-174

75. Which of the following offers the most accurate and reliable method for measuring the

temperature and humidity level within a ventilator circuit? a. Humidity control of hot wire humidification system b. Oxygen analyzer

c. Hygrometer–thermometer d. Not able to measure humidity level ANS: C

The most accurate and reliable way to ensure that patients are receiving gas at the expected temperature and humidity level is to measure these parameters with the portable battery-operated digital hygrometer–thermometer system. Humidity control on a hot wire humidification system will not provide a measurement of AH or RH; instead, it will enable the measurement of only the temperature differential between the humidifier and the airway sensor. PTS: 1

REF: Page 175

76. It is appropriate to suggest which of the following to provide humidification for an intubated

patient with a cuffed endotracheal tube, no secretions, and a tidal volume of 500 mL? a. A heat and moisture exchanger b. Heated aerosol or humidifier c. Heated aerosol with humidifier d. Systemic hydration ANS: A

If there are no secretions, an HME would be suitable. Use the algorithm for selecting the correct humidity and bland aerosol therapy located in the text. PTS: 1

REF: Page 176, Fig. 6.28

77. Which of the following devices or methods would be appropriate to provide sufficient

humidity for an intubated pTaE tieSnTt B wA ithNaKnSuEnL cuLffEeR d. enCdO otMracheal tube who has thick, bloody secretions? a. Heat and moisture exchanger b. Heated humidifier c. Heated humidifier with a heat and moisture exchanger d. Systemic hydration ANS: B

According to the algorithm for selecting the correct humidity and bland aerosol therapy, a heated humidifier is appropriate for this patient. Both the use of an uncuffed endotracheal tube and the presence of thick, bloody secretions are contraindications for the use of a heat and moisture exchanger. Heat and moisture exchangers cannot be used with heated humidification. Systemic hydration does not adequately humidify inhaled gas. PTS: 1

REF: Page 181, Box 6.7

78. Which of the following treatments would provide sufficient humidity to a conscious patient

with a core temperature less than 36C who had nearly drowned? a. Heat and moisture exchanger b. Heated aerosol or humidifier c. Heated aerosol with humidifier d. Systemic hydration ANS: B

Because the patient is hypothermic, a heated aerosol or heated humidifier needs to be used. Hypothermia is a contraindication for the use of a heat and moisture exchanger. Heated aerosol generators are not used in conjunction with humidifiers, and systemic hydration will not help warm the patient’s core temperature. PTS: 1

REF: Page 176, Fig. 6.28

79. Which of the following are the Gram-negative bacilli that are responsible for nosocomial

infections when aerosol generators are in use? a. Pseudomonas aeruginosa and Streptococcus pneumoniae b. Legionella pneumophila and Streptococcus pneumoniae c. Pseudomonas aeruginosa and Legionella pneumophila d. Legionella pneumophila and Streptococcus viridans ANS: C

The Gram-negative bacilli are Pseudomonas aeruginosa and Legionella pneumophila. All the other choices are Gram-positive cocci. PTS: 1

REF: Page 178

80. Which of the following is appropriate to provide humidity to a patient with cold air reactive

airways? a. HME b. Heated aerosol c. Heated humidifier d. Systemic hydration ANS: C

A patient with cold air reactive airways would be best suited with a heated humidifier according to the algorithm for selecting the correct humidity and bland aerosol therapy. PTS: 1

REF: Page 176, Fig. 6.28

81. Reactive bronchospasm and increased airway resistance are most likely to be caused by a. warm humidity. b. warm aerosol. c. aerosolized normal saline. d. cold high-density aerosol. ANS: D

The administration of cold high-density aerosols increases the risk of developing reactive bronchospasm and increased airway resistance. PTS: 1

REF: Page 179

82. Which of the following represent the immediate signs and symptoms of a patient experiencing

bronchospasm during the administration of a bland aerosol? 1. Percentage of forced expiratory volume in 1 second (%FEV1) <75% 2. Vesicular breath sounds 3. Increased work of breathing 4. Change of breathing pattern a. 1, 2, and 3

b. 1, 3, and 4 c. 2 and 3 d. 3 and 4 ANS: B

Monitoring for reactive bronchospasm should consist of peak flow measurements or %FEV1 before and after therapy; auscultation for adventitious breath sounds; observation of the patient’s breathing pattern and overall appearance; and, most essentially, communication with the patient during therapy to determine the perceived work of breathing. PTS: 1

REF: Page 179

83. Which of the following statements about breath-actuated nebulizers is true?

1. They can be used during the entire respiratory cycle. 2. They do not require good hand-breath coordination. 3. They decrease aerosol medication waste. 4. They are not appropriate for some patients with severe airway obstruction. a. 1, 2, and 3 b. 2, 3, and 4 c. 2 and 3 d. 3 and 4 ANS: B

Breath-actuated nebulizers generate aerosol only during inspiration. It is true that breath-actuated pressure metered-dose inhalers do not require good hand-breath coordination, and because of that they decrease aerosol medication waste. Patients with severe airway obstruction may not have the capability of generating enough flow to trigger the breath actuator. PTS: 1

REF: Pages 181-182

84. Which of the following statements is true about the use of a pressure metered-dose inhaler

with a VHC? a. This chamber cannot be used with infants. b. Infants can take up to 10 breaths. c. Shake the pressure metered-dose inhaler and chamber separately. d. This device is only for adults and children over the age of 12. ANS: B

A pressure metered-dose inhaler with a VHC can be used by adults and infants. Adults will take 1 to 3 breaths, and infants can take up to 10 breaths. Shake the pressure metered-dose inhaler with the chamber. PTS: 1

REF: Page 183, Box 6.8

85. Which of the following statements is true concerning the use of dry-powder inhalers? a. Propellants are used to help deliver the drug. b. The carrier substance is usually lactose or glucose. c. Laminar flow is necessary to create the aerosol. d. Patients must breathe slowly and deeply during administration. ANS: B

The carrier substance is usually lactose or glucose. Turbulent flow is a function of the ability of the patient to inhale the powder with a sufficiently high inspiratory flow rate. Propellants are not used in dry-powder inhalers. PTS: 1

REF: Pages 185-186

86. A respiratory therapist needs to deliver a bronchodilator with a small-volume nebulizer. To

ensure that 70% of the medication is available for nebulization, the nebulizer. a. 3 b. 5 c. 3.5 d. 4

mL of fluid should fill

ANS: B

Filling the nebulizer with 5 mL would make 3.5 mL, or 70% of the medication, available for nebulization. PTS: 1

REF: Pages 188-189

87. Which of the following statements is true concerning vibrating mesh nebulizers? a. They require at least 3 mL of solution to produce an aerosol. b. The exit velocity of the aerosol from vibrating mesh nebulizers is rapid. c. They add no gas to the aerosol stream. d. They can produce a particle size range of 1 to 2 m. ANS: C

Vibrating mesh nebulizersTaE ddSnToBgA asNtK oS thEeLaL erE osRo. l sCtrOeaMm. They can generate aerosol from a single drop of liquid, so they require very little solution to produce an aerosol. The exit velocity of the aerosol is slow (less than 4 m/s), and the particle can range from 2 to 5 m (mass median aerodynamic diameter). PTS: 1

REF: Page 192

88. Which of the following statements about vibrating mesh nebulizers is false? a. They have no residual volume. b. They reduce the contamination of medication in the reservoir. c. They are capable of generating aerosol from a single drop of liquid. d. They can be used in closed systems during mechanical ventilation. ANS: A

Vibrating mesh nebulizers do have residual drug volumes that range from 0.1 to 1.2 mL. As is not the case with jet nebulizers and ultrasonic nebulizers, the mesh acts as a physical barrier between the drug in the medication reservoir and the body of the nebulizer in which the aerosol output is collected. This reduces the risk that exhaled pathogens will contaminate the medication in the reservoir. They can generate an aerosol from a single drop of liquid. PTS: 1

REF: Page 192

89. A patient who requires mechanical ventilation has a core body temperature of 32o C; humidity

is being provided with a HME. Which of the following statements is accurate?

a. b. c. d.

The RH at BTPS will be increased. Higher inspiratory flow rates will be required. Humidification will be inadequate due to the decreased body temperature. The minute volume will be increased due to the hypothermia.

ANS: C

Prolonged and severe shifts in the isothermic saturation boundary can damage the airways and compromise the body’s normal heat and moisture exchange mechanisms. PTS: 1

REF: Page 173

90. What should the patient do if they have not used their pMDI in 5 days? a. The patient should call their doctor because they may not need it anymore. b. Make sure it is not empty. c. Prime it by shaking the device and releasing two sprays into the air. d. Shake it for at least 30 to 60 seconds. ANS: C

When the pMDI is new or has not been used for 24 hours or more, it needs to be primed by shaking the device and releasing two or more sprays into the air. Through priming the drug inside, the canister was mixed with the propellant and an adequate dose is given to the patient during therapy. Also, it must be noted that manufacturers recommend 30 seconds to 1 minute between actuations. PTS: 1

REF: Pages 180-181

Chapter 07: Lung Expansion Therapy and Airway Clearance Devices Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. The primary indication for lung expansion therapy is a. asthma. b. atelectasis. c. chronic bronchitis. d. respiratory distress. ANS: B

Lung expansion therapy is used to either prevent or treat atelectasis. PTS: 1

REF: Page 212

2. Factors that increase the risk of atelectasis include a. productive cough. b. lower extremity paralysis. c. decreased intraabdominal pressure. d. chronic obstructive pulmonary disease. ANS: D

Factors that contribute to the development of atelectasis include retained secretions, altered breathing patterns, pain associated with surgery and trauma, chronic obstructive pulmonary disease, prolonged immobilization in a supine position, and increased intraabdominal pressure. PTS: 1

REF: Page 212

3. Untreated atelectasis can result in which of the following?

1. Decreased shunting 2. Increased shunting 3. Hypercapnia 4. Hypocapnia a. 1 and 3 b. 2 and 3 c. 1 and 4 d. 2 and 4 ANS: B

If atelectasis goes untreated, it can lead to pulmonary shunting, hypoxemia, hypercapnia, and ultimately respiratory failure. PTS: 1

REF: Page 212

4. Contraindications for incentive spirometry include a. postthoracic surgery. b. vital capacity less than 10 mL/kg. c. restrictive pulmonary disease.

d. inspiratory capacity greater than predicted value. ANS: B

A vital capacity of less than 10 mL/kg demonstrates that the patient is unable to breathe deeply, effectively rendering the patient unable to perform the maneuver that is necessary to achieve positive results. Incentive spirometry is indicated for postthoracic surgery and restrictive pulmonary disease. If a patient has an inspiratory capacity greater than predicted, that patient would be able to perform incentive spirometry. PTS: 1

REF: Page 213

5. Indications for incentive spirometry include a. postabdominal surgery. b. respiratory muscle weakness. c. optimization of bronchodilator therapy. d. inability to effectively deep breathe. ANS: A

Abdominal surgery predisposes a patient to the development of pulmonary atelectasis. Patients with respiratory muscle weakness or the inability to effectively deep breathe will not be able to perform incentive spirometry and therefore will not benefit from its use. Incentive spirometry is not used to optimize bronchodilator therapy. PTS: 1

REF: Page 213

6. Complications from incentive spirometry include a. barotrauma. b. hypoventilation. c. pulmonary edema. d. subcutaneous emphysema. ANS: A

Pulmonary barotrauma is a complication of incentive spirometry that usually occurs in patients with emphysematous lungs. Hypoventilation, pulmonary edema, and subcutaneous emphysema are not complications of incentive spirometry. PTS: 1

REF: Page 214, Clinical Practice Guideline 7.2

7. When instructing patients on the use of a volume-displacement incentive spirometer, the

respiratory therapist should inform the patients to do which of the following? a. Inhale deeply and hold for 3 to 5 seconds. b. Exhale as fast as possible into the mouthpiece. c. Inhale and exhale rapidly through the mouthpiece. d. Perform 30 sustained maximum inspirations every 15 minutes. ANS: A

After patients have achieved the maximum volume, they should be instructed to hold this volume constant for 3 to 5 seconds. The other choices are not techniques for use with incentive spirometry. PTS: 1

REF: Page 214

8. A patient has undergone surgery and is receiving continuous supplemental oxygen via a 30%

air-entrainment mask. He becomes pale and short of breath during incentive spirometry. Pulse oximetry reveals a significant drop in oxygen saturation during incentive spirometry. The respiratory therapist should do which of the following for subsequent incentive spirometry therapy? a. Switch to a different type of incentive spirometer. b. Request that incentive spirometry be discontinued. c. Cut a hole in the mask for the incentive spirometer’s mouthpiece. d. Use a 3 L/min nasal cannula during incentive spirometry. ANS: D

The drop in oxygen saturation during incentive spirometry is due to the interruption of oxygen therapy. For this patient it is necessary to maintain oxygen therapy during incentive spirometry. Because the use of a mask is difficult during incentive spirometry, a nasal cannula with a flow rate of 3 L/min will approximate the air-entrainment mask’s 30% supplemental oxygen. PTS: 1

REF: Page 214, Clinical Practice Guideline 7.2

9. Which of the following is true concerning flow-dependent incentive spirometry devices? a. The volume capacity for a child should be approximately 3 L. b. The patient must perform a sustained maximum inspiration. c. They are available as multiuse electrically powered devices. d. Positive pressure within the device causes the flexible plastic bellows to rise. ANS: B

The performance of a sustained maximum inspiration is necessary to perform incentive spirometry with a flow-depTeE ndSeT ntBiA ncNeK ntS ivEe L spLirEoR m. etC erO(M or any incentive spirometry device). PTS: 1

REF: Page 214

10. During an incentive spirometry treatment, a patient holds the 600 mL/s ball up for 1.5

seconds; the patient inhaled a volume of a. 0.15 b. 0.45 c. 0.60 d. 0.90

ANS: D

Flow = Tidal volume ÷ Inspiratory time. Tidal volume = Flow  Inspiratory time. Tidal volume = 600 mL/s  1.5 s = 900 mL, or 0.90 L. PTS: 1

REF: Page 213

11. A patient reports that during incentive spirometry she becomes dizzy and must stop the

maneuver when this happens. The most probable cause of this situation is a. hypoventilation. b. hyperventilation. c. patient fatigue. d. bronchospasm.

ANS: B

The patient’s light-headedness is caused by hyperventilation. This is a common complication of incentive spirometry. PTS: 1

REF: Page 214, Clinical Practice Guideline 7.2

12. After abdominal surgery, a young, otherwise healthy patient is unable to meet the volume set

for his volume-oriented incentive spirometer. This situation is most likely due to a. exacerbation of bronchospasm. b. inadequate pain control. c. major lung collapse. d. hyperventilation. ANS: B

Patients who are recovering from abdominal or thoracic surgery might find it difficult to achieve incentive spirometry volume goals when their pain is not under control. An exacerbation of bronchospasm would most likely cause a patient to wheeze. Major lung collapse would cause respiratory failure, and hyperventilation would cause dizziness. PTS: 1

REF: Page 214, Clinical Practice Guideline 7.2

13. A patient undergoing incentive spirometry should be monitored for outcome by assessing

which of the following? 1. Forced expiratory volume at 1 second (FEV1) 2. Peak expiratory flow 3. Partial pressure of arterial oxygen (PaO2) 4. Blood pressure a. 1 and 2 b. 2 and 3 c. 1 and 4 d. 3 and 4 ANS: B

When assessing for outcome from incentive spirometry, the respiratory therapist is looking for the absence of or an improvement in signs of atelectasis. These signs are decreased respiratory rate, resolution of fever, normal pulse rate, improved breath sounds, a normal chest radiograph, improved arterial oxygenation, increased vital capacity and peak expiratory flows, return of functional residual capacity or vital capacity to preoperative values, and improved inspiratory muscle performance. PTS: 1

REF: Page 214, Clinical Practice Guideline 7.2

14. A patient is able to sustain a flow of 900 cc/s to hold the ball of a flow-oriented incentive

spirometer aloft for 2 seconds. Her inspired volume is a. 0.18 b. 0.90 c. 1.45 d. 1.80 ANS: D

Flow = Tidal volume ÷ Inspiratory time.

Tidal volume = Flow  Inspiratory time. Tidal volume = 900 mL/s  2 s = 1800 mL, or 1.80 L. PTS: 1

REF: Page 213

15. To determine outcome for a patient undergoing intermittent positive-pressure breathing

(IPPB) therapy, the respiratory therapist should assess which of the following? 1. Peak expiratory flow 2. Breath sounds 3. Clearance of secretions 4. Maximum inspiratory pressure a. 1 and 2 b. 3 and 4 c. 1, 2, and 3 d. 2, 3, and 4 ANS: C

Assessment of outcomes for IPPB include tidal volume measurement, FEV1, peak expiratory flows, cough assessment, chest radiograph review, and subjective patient response. Improved cough with treatment, leading to better clearance of secretions. The color of the patient’s sputum is not a determining factor in the outcome of IPPB; it is an outcome assessment for the use of antibiotics. Maximum inspiratory pressure is not used in the determination of the effectiveness of IPPB. PTS: 1

REF: Page 216, Clinical Practice Guideline 7.3

16. Myasthenia gravis is causing a patient to have respiratory muscle weakness. He has a vital

capacity of 5 mL/kg and is unable to cough effectively. What therapy would you recommend to help prevent pulmonary complications? a. Incentive spirometry b. Deep-breathing exercises c. Positive expiratory pressure (PEP) d. IPPB ANS: D

The patient’s vital capacity of 5 mL/kg is a contraindication for the use of incentive spirometry, and coupled with the fact that he is unable to cough effectively, this makes the use of deep-breathing exercises inappropriate. The patient’s respiratory weakness plus the fact that there is no mention of excessive sputum make PEP therapy inappropriate. IPPB is appropriate because of the patient’s low vital capacity and inability to cough effectively. PTS: 1

REF: Page 216, Clinical Practice Guideline 7.3

17. A 60-year-old female patient with a diagnosis of bilateral lower lobe pneumonia is brought to

the emergency department. An assessment reveals a temperature of 38.5C (101.3F), a respiratory rate of 25 breaths/min, a pulse of 115 beats/min, and decreased breath sounds in both lower lobes; furthermore, she is not alert. What type of therapy should the respiratory therapist suggest? a. Incentive spirometry b. Deep-breathing exercises c. PEP

d. IPPB ANS: D

The patient’s ability to ventilate and cough effectively is compromised because she is not alert. Because of this, incentive spirometry, deep-breathing exercises, and PEP are not appropriate therapies. IPPB is appropriate because she is not alert. PTS: 1

REF: Page 216, Clinical Practice Guideline 7.3

18. A patient who is receiving IPPB therapy for atelectasis now exhibits improved breath sounds

and an increased ability to clear secretions. Chest radiography reveals improvement, but not total resolution, of atelectasis. The IPPB therapy is discontinued. What is the most appropriate action at this time? a. Flutter valve b. Incentive spirometry c. Continuous positive airway pressure (CPAP) d. Intrapulmonary percussive ventilation (IPV) ANS: B

The patient’s increased ability to clear secretions, improved breath sounds, and improved chest radiograph demonstrate an improvement in his atelectasis and overall condition. At this time, “stepping-down” therapy would be appropriate. The most appropriate physiologic therapy that targets atelectasis is incentive spirometry. Flutter valve and IPV are therapies for mobilizing retained secretions, and CPAP should be used when atelectasis fails to respond to incentive spirometry and IPPB. PTS: 1

REF: Page 214 | Page 216, Clinical Practice Guideline 7.2 and 7.3

19. All IPPB machines are required to have an operating gas pressure source of

lb force per

square inch gauge (psig). a. 25 to 35 b. 35 to 45 c. 45 to 55 d. 55 to 65 ANS: C

Regardless of the manufacturer, all IPPB machines require a 45- to 55-psig gas pressure source, such as a compressed-gas cylinder, a bulk air or oxygen system, or an air compressor. PTS: 1

REF: Page 217

20. The variable that ends inspiration during IPPB therapy with a Bird Mark 7 is a. time. b. flow. c. volume. d. pressure. ANS: D

The Bird Mark 7 is a pneumatically powered ventilator that will pressure-cycle during IPPB therapy. If used for short-term mechanical ventilation, it could be time-cycled. PTS: 1

REF: Page 218

21. Which of the following is a compact, inexpensive, single-patient IPPB device? a. Bird Mark 7 b. Puritan Bennett AP-4 c. Puritan Bennett PR-1 d. Vortran IPPB device ANS: D

The Vortran IPPB device provides short-term, pressure-triggered, pressure-cycled, constant-flow ventilatory support in combination with aerosol therapy. The primary advantage of these devices is that they are relatively compact and inexpensive compared with conventional IPPB devices. In addition, the Vortran IPPB units are single-patient, multiple-use devices, a situation that reduces the incidence of nosocomial infections caused by cross-contamination. PTS: 1

REF: Page 218

22. The therapy that mobilizes retained secretions by using devices similar to, but less

cumbersome than, CPAP is known as which of the following? a. Expiratory positive airway pressure b. IPPB c. IPV d. PEP ANS: D

The rationale for the use of PEP therapy is similar to that for the use of CPAP, except that PEP seems to be less cumbersome and more manageable for patients. Expiratory positive KbSeErsLom LE airway pressure and IPV aT reEjuSsT t aBsAcN um eR as.CCPOAMP. IPPB is lung expansion therapy, not bronchial hygiene therapy. PTS: 1

REF: Page 218

23. Why is the Vortran IPPB device unsuitable for patients with endotracheal or tracheostomy

tubes? a. It is unable to nebulize medications b. It is not equipped with a redundant pop-off valve c. It utilizes continuous flow of gas greater than 40 L/min d. Peak pressures cannot be adjusted ANS: B

The unit runs on a continuous flow of gas of up to 40 L/min. (Flows of 40 L/min are automatically achieved when the unit is connected to a 50-psig source gas; flows of 15 to 40 L/min can be achieved by connecting the system to a 50-psig source gas using a standard hospital flowmeter.) Peak inspiratory pressures can be adjusted between 20 and 50 cm H2O, and the device can produce a positive end-expiratory pressure (PEEP) of 2 to 5 cm H2O (the manufacturer reports that the set PEEP typically is one-tenth of the peak pressure). The device’s nebulizer, which provides the continuous flow of gas and a patient demand valve, can hold 20 mL of solution for nebulization. The nebulizer is also equipped with an air entrainment valve, which allows the patient to entrain additional air through the nebulizer.

The device is not equipped with a redundant pop-off valve and should not be used with patients with endotracheal or tracheostomy tubes. It should be cautiously used when IPPB is administered with a mask. PTS: 1

REF: Page 218

24. Patients undergoing PEP therapy must have a high enough expiratory flow to generate

pressure in the range of a. 5 to 10 b. 10 to 20 c. 20 to 25 d. 25 to 30

cm H2O.

ANS: B

A patient undergoing PEP therapy must be able to generate expiratory flows high enough to maintain expiratory pressure at 10 to 20 cm H2O. PTS: 1 25.

REF: Page 221, Box 7.1

With an underwater seal resistor, how is the level of CPAP determined? a. A spring is used to hold a diaphragm down over the expiratory port b. A bar magnet that attracts a ferromagnetic disk seated on the expiratory port of the circuit c. By the height of the column d. A specially milled steel ball is placed over a calibrated orifice ANS: C

With underwater seal resisT toE rsS ,T tuB biA ngNK atS taE chLeL dE toRth.eCeOxM piratory port of the circuit is submerged under a column of water. The level of CPAP is determined by the height of the column. PTS: 1

REF: Page 218

26. During a PEP therapy session, a patient should be told to a. stop after 20 to 30 breaths. b. place lips into the mouthpiece. c. take a deep breath, and then actively exhale. d. breathe normally through the mouthpiece. ANS: C

Patients should be instructed to inspire through the one-way valve of the PEP device to a volume that is greater than the normal tidal volume—but not to the total lung capacity. At the end of inspiration, patients are encouraged to actively, but not forcefully, exhale to functional residual capacity. PTS: 1

REF: Page 221, Box 7.1

27. During a PEP therapy session, a patient should be a. told to perform 20 to 30 breaths. b. encouraged to complete 30- to 40-minute sessions. c. self-administer therapy. d. reaching an I:E ratio of 1:2.

ANS: C

The level of resistance chosen should allow the patient to achieve the therapeutic goal of generating PEP of 10 to 20 cm H2O with an inspiratory-to-expiratory ratio (I:E) of 1:3 or 1:4. The patient should perform 10 to 20 breaths through the device, then perform a series of two or three huff coughs to clear loosened secretions. This cycle should be repeated 5 to 10 times during a 15- to 20-minute session. Finally, the patient should be encouraged to learn to self-administer this therapy, although more than one session may be required to ensure patient proficiency in the use of these devices. PTS: 1

REF: Page 221, Box 7.1

28. An assessment of a patient with newly diagnosed chronic bronchitis reveals an alert,

cooperative, and oriented patient. Low-pitched wheezes are heard bilaterally on auscultation. The patient has a productive cough, producing copious amounts of sputum; no fever; a pulse of 85 beats/min; respirations of 18 breaths/min; and blood pressure of 145/90. The most appropriate lung expansion therapy for this patient is which of the following? a. Incentive spirometry b. IPPB c. PEP d. Flutter valve ANS: C

Because he is alert, cooperative, and oriented, IPPB is not appropriate for him. Incentive spirometry might be an alternative; however, it will not help this patient to mobilize the copious amounts of sputum being produced. PEP not only acts as an enhancement to the movement of mucus, but it also reverses atelectasis and optimizes delivery of bronchodilators to patients with chronic broTnEcS hiT tisB. A TN heKfS luEttL erLvEalRv. eC wO illMserve only as bronchial hygiene therapy. PTS: 1

REF: Page 219

29. Air trapping in patients with asthma or chronic obstructive pulmonary disease can be reduced

by which of the following? a. IPV b. IPPB c. PEP d. Incentive spirometry ANS: C

Positive airway pressure with PEP is indicated to reduce air trapping in patients with asthma or chronic obstructive pulmonary disease. IPV is a bronchial hygiene therapy only. IPPB is a lung expansion therapy that should be used only if another lung expansion therapy, such as incentive spirometry, is not appropriate. PTS: 1

REF: Page 216, Clinical Practice Guideline 7.3

30. A female patient’s chest radiograph shows bilateral lower lobe atelectasis. She is alert and

oriented. Arterial blood gas analysis reveals mild hypoxemia and respiratory alkalemia; her vital signs are within normal limits. Which of the following is most appropriate at this time? a. Chest physiotherapy every 4 hours

b. CPAP +5 cm H2O c. IPV every 2 hours d. IPPB 35 cm H2O Q4 ANS: B

This patient requires lung expansion therapy to reverse the atelectasis. Chest physiotherapy and IPV are both bronchial hygiene therapy. IPPB is lung expansion therapy, but it is not appropriate for this patient because she is alert and oriented. CPAP will help to reverse her mild hypoxemia and atelectasis. PTS: 1

REF: Pages 216-219, Clinical Practice Guidelines 7.3 and 7.4

31. An assessment of outcome for a patient receiving mask CPAP +8 cm H2O should include

which of the following? a. Cardiac output testing b. Pulse oximetry c. Intracranial pressure measurement d. Pulmonary function testing ANS: B

Oxygen saturation should improve as atelectasis resolves. Pulse oximetry is an easy, quick, noninvasive, and cheap way of assessing patients undergoing positive airway pressure therapy. PTS: 1

REF: Page 219, Clinical Practice Guideline 7.4

32. Which of the following therapies can be used as an alternative to endotracheal intubation and

continuous ventilation for T paEtiS enTtsBrAeqNuKirS inEgLshLoErtR-t. erC mOvMentilatory support? a. CPAP b. Expiratory positive airway pressure c. IPPB d. IPV ANS: C

Since its introduction in 1947, IPPB has been used for a variety of reasons, including short-term ventilatory support, lung expansion therapy, and as an aid in delivering aerosolized medications. PTS: 1

REF: Pages 217-218

33. Which of the following is a type of adjunctive therapy that aids in the mobilization of airway

secretions through high-frequency percussive breaths applied inside the patient’s airways? a. IPV b. CPAP c. Expiratory positive airway pressure d. PEP ANS: A

IPV involves the delivery of high-frequency percussive breaths into the patient’s airways instead of applying percussions to the outside of the chest wall as in standard chest physiotherapy techniques.

PTS: 1

REF: Pages 222-223

34. How much pressure is the Percussionaire IPV-1 able to deliver with each cycle? a. 5 to 15 cm H2O b. 10 to 35 cm H2O c. 15 to 50 cm H2O d. 25 to 40 cm H2O ANS: D

The Percussionaire IPV-1 can deliver percussive pressure of 25 to 40 cm H2O. PTS: 1

REF: Pages 222-223

35. The maximum frequency of percussive breaths that a Percussionaire IPV-1 can deliver to a

patient’s airways is a. 1.3 b. 1.7 c. 3 d. 5

Hz.

ANS: D

The rate for the Percussionaire is 100 to 300 cycles/min, or 1.7 to 5 Hz. PTS: 1

REF: Pages 222-223

36. IPV mobilizes airway secretions by which of the following methods? a. Generating a subatmospheric pressure on inspiration, then an expiratory resistance b. Applying a positive preTsE suSreTtB oA aN paKtS ieE ntL ’sLaE irR w. ayCsOthMroughout the respiratory cycle c. Delivering high-frequency percussive breaths into the patient’s airways d. Applying an expiratory resistance to exhaled flow from the patient ANS: C

The Percussionaire IPV provides a form of oscillator therapy that delivers high-frequency percussive breaths into the patient’s airways. It is used as an adjunct for mobilizing airway secretions. PTS: 1

REF: Pages 222-223

37. What is one major component of a pneumatically powered percussor? a. Force control b. Vibration control c. Amplitude control d. Convex applicator ANS: A

Each pneumatically powered percussor usually has a high-pressure hose, a body with controls for varying the frequency and the force of percussive strokes, and a remote head with a concave applicator. PTS: 1

REF: Pages 222-223

38. One type of threshold resistor used to create CPAP is which of the following?

a. b. c. d.

Bennett valve Sliding Venturi Underwater seal Oscillator cartridge

ANS: C

The underwater seal resistor has tubing attached to the expiratory port of the circuit and is submerged under a column of water. The level of CPAP is determined by the height of the column. PTS: 1

REF: Page 218

39. To apply positive airway pressure to a manual resuscitator bag during patient transport, which

of the following are most appropriate? 1. Spring-loaded valve 2. Underwater seal 3. Magnetic valve 4. Weighted ball a. 1 and 2 b. 1 and 3 c. 2 and 4 d. 3 and 4 ANS: B

The spring-loaded valve and the magnetic valve are the only valves that are able to be used during patient transport. The water column would be subject to leaks and possible breakage of the cylinder. The weighted ball must always be held upright and is impractical for transport. PTS: 1

REF: Page 218

40. Bronchial hygiene therapy for patients with Duchenne muscular dystrophy or spinal muscular

atrophy is most appropriate with which of the following? a. IPPB b. Incentive spirometry c. Mechanical insufflation–exsufflation d. PEP ANS: C

The purpose of a mechanical insufflation–exsufflation device is to replace or augment cough clearance in individuals with respiratory muscle weakness or paralysis (e.g., neuromuscular disease). PTS: 1

REF: Pages 226-227

41. Which of the following bronchial hygiene therapy devices can be used to ventilate a patient? a. Hayek Oscillator b. The Vest c. Percussionaire IPV-1 d. PEP ANS: A

The Hayek Oscillator is technically classified as an electrically powered noninvasive ventilator. This device consists of a flexible chest cuirass that is applied over the chest wall. The device delivers both negative and positive pressure to the chest wall during the respiratory cycle. The negative pressure creates inspiration, and the positive pressure produces a forced exhalation. PTS: 1

REF: Pages 231-232

42. A patient with chronic bronchitis is being discharged from the hospital. The simplest, most

cost-efficient device to aid this patient with bronchial hygiene therapy is which of the following? a. Percussionaire IPV-1 b. Flutter therapy c. Bird Mark 8 d. Pneumatic percussor ANS: B

Flutter therapy is relatively easy for patients to use and is less expensive than the other devices listed in the answer choices. PTS: 1

REF: Page 222

43. Contraindications to positive airway pressure adjuncts to bronchial hygiene therapy include

which of the following? a. Hiccups b. Air swallowing c. Esophageal surgery d. Subcutaneous emphysema ANS: C

Esophageal surgery is listed in Clinical Practice Guideline 7.4 as a contraindication to the use of positive airway pressure adjuncts to bronchial hygiene therapy. PTS: 1

REF: Page 216, Clinical Practice Guideline 7.3

44. What is the function of the counterweight plug and magnet in the Acapella Flutter type of

device? a. Creates positive and negative pressure in the chest b. Provides high-frequency external chest wall oscillations c. Creates oscillations that are transmitted into the lungs d. Creates positive pressure throughout the respiratory cycle ANS: C

Acapella is a flutter type of valve that creates a series of high-frequency oscillations that are transmitted into the lungs through the airway opening. PTS: 1

REF: Page 219

45. The device that will prevent early airway closure is a. incentive spirometry. b. IPPB. c. flutter valve therapy.

d. high-frequency chest wall oscillation. ANS: C

The steel ball of the flutter valve or the counterweighted plug and magnet help to prevent early airway closure. PTS: 1

REF: Page 219

Chapter 08: Assessment of Pulmonary Function Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. The accuracy of an instrument depends on which of the following?

1. The standard deviation of repeated measurements 2. The instrument’s linearity and frequency response 3. The instrument’s ability to reproduce a measurement 4. The instrument’s sensitivity to environmental conditions a. 1 and 2 b. 1 and 3 c. 2 and 3 d. 2 and 4 ANS: D

Accuracy can be explained as how closely a measured value is related to the correct value of the quantity measured. The accuracy of any instrument depends on its linearity and frequency response, its sensitivity to environmental conditions, and how well it is calibrated. PTS: 1

REF: Page 232

2. The precision of an instrument depends on a. linearity. b. calibration. c. repeatability. d. frequency of response. ANS: C

An instrument’s precision can be quantified by calculating the standard deviation of repeated measurements. Precision is the expression of an instrument’s ability to reproduce a measurement. PTS: 1

REF: Page 232

3. Which of the following is a volume-collecting device? a. Turbine flowmeter b. Thermal anemometer c. Dry rolling seal spirometer d. Pressure pneumotachograph ANS: C

A typical example of a volume-collecting device is a dry rolling seal spirometer. The other devices are flow-sensing devices. PTS: 1

REF: Page 232

4. Which of the following can be used to measure airflow? a. “Hot wire” anemometer b. Bellows spirometer

c. Water-sealed spirometer d. Dry rolling seal spirometer ANS: A

A typical example of a flow-sensing device is a hot-wire, or thermal, anemometer. The other devices are volume-collecting devices. PTS: 1

REF: Page 232

5. The rotating motor-driven drum used to document the bell movement of a water-sealed

spirometer is known as which of the following? a. Spirograph b. Kymograph c. Anemometer d. Pneumotachograph ANS: B

This is the definition of a kymograph. PTS: 1

REF: Page 233

6. “An aluminum bell suspended by a chain-and-pulley mechanism with a weight that

counterbalances the weight of the bell” describes which of the following? a. Dry rolling spirometer b. Water-sealed spirometer c. Bellows spirometer d. Pneumotachograph ANS: B

This is the description of a water-sealed spirometer. PTS: 1

REF: Page 233

7. The visual picture of volume and flow measurements is known as which of the following? a. Spirogram b. Spirometer c. Kymograph d. Turbine flowmeter ANS: A

As a patient exhales into a water-sealed spirometer, the bell moves upward and the attached pen moves proportionately downward on graph paper, creating a spirogram. PTS: 1

REF: Page 233

8. When a patient inhales while connected to a water-sealed spirometer, the bell moves

and the pen moves a. up; up b. up; down c. down; up d. down; down ANS: C

Inhalation causes the bell to move downward and the pen to move upward. PTS: 1

REF: Page 233

9. What speed should be used for the rotating drum of a water-sealed spirometer to measure

volume changes during a forced vital capacity (VC) maneuver? a. 16 mm/min b. 32 mm/min c. 160 mm/min d. 1920 mm/min ANS: D

The fastest speed (1920 mm/min) is used for recording volume changes during forced VC maneuvers. PTS: 1

REF: Page 233

10. Speed settings of 32 and 160 mm/min on a water-sealed spirometer can be used to measure

which of the following? 1. Minute ventilation 2. Peak expiratory flows 3. Maximum voluntary ventilation 4. Forced VC maneuvers a. 1 and 2 b. 1 and 3 c. 2 and 4 d. 3 and 4 ANS: B

The slower speeds (32 and 160 mm/min) are used for measuring tidal volume, minute ventilation, and maximum voluntary ventilation. PTS: 1

REF: Page 233

11. The bell factor for a 9-L water-sealed spirometer bell is a. 13.5 b. 29.3 c. 20.93 d. 41.73

mL/mm.

ANS: C

The bell factor is the number of milliliters of gas that must be displaced to cause the kymographic pen to move 1 mm. The bell factor for a 9-L bell is 20.93 mL/mm. PTS: 1

REF: Page 233

12. What is the tidal volume measurement when the pen of a 9-L water-sealed spirometer moves

25 mm? a. 0.338 L b. 0.523 L c. 0.843 L d. 1.043 L

ANS: B

The bell factor for a 9-L water-sealed spirometer is 20.93 mL/mm. Therefore, 20.93 mL/1 mm = X mL/25 mm; X = 523 mL, or 0.523 L. PTS: 1

REF: Page 233

13. What is the volume displacement when the pen of a 13.5-L water-sealed spirometer moves 28

mm? a. 0.378 L b. 0.563 L c. 0.586 L d. 1.168 L ANS: D

The bell factor for a 13.5-L water-sealed spirometer is 41.73 mL/mm. Therefore, 41.73 mL/1 mm = X mL/28 mm; X = 1168 mL, or 1.168 L. PTS: 1

REF: Page 233

14. Which of the following is true concerning the Stead-Wells spirometer? a. Counterweights are necessary. b. The pen and bell move in opposite directions. c. The pen recorder is attached directly to the bell. d. On exhalation, the bell and pen move downward. ANS: C

The pen recorder for the Stead-Wells spirometer is attached directly to the bell, so as the bell moves upward during exhalation, the pen also moves upward. PTS: 1 15.

REF: Page 233

is used to measure lung-volume changes by collecting exhaled gas into an expandable wedge-shaped device. a. A bellows spirometer b. A water-sealed spirometer c. A vortex pneumotachometer d. A screen pneumotachometer ANS: A

The expandable wedge-shaped device is a bellows, making this a bellows spirometer. PTS: 1

REF: Page 234

16. Which statement is true concerning thermal flowmeters? a. Gas flow can be measured bidirectionally b. Gas velocity affects the amount of cooling c. Cooling increases the resistance of a heated wire d. Cooling decreases the resistance of a thermistor bead ANS: B

Gas flow is calculated by the amount of power needed to maintain the temperature of the heating element. A high gas velocity will cool the heating element, requiring more power to maintain the temperature of the thermistor. PTS: 1

REF: Page 234

17. Which of the following devices is bidirectional? a. Turbine flowmeter b. Screen pneumotachograph c. Vortex ultrasonic flowmeter d. Variable-orifice pneumotachograph ANS: D

The variable-orifice pneumotachograph is a disposable, bidirectional, flow-measuring device that uses a flexible obstruction with a variable area for measuring flow as a function of the pressure differential generated by the obstruction. Turbine flowmeters, thermal anemometers, and vortex ultrasonic flowmeters are all unidirectional. PTS: 1

REF: Pages 236-238

18. Peak flowmeters are calibrated in which of the following units? a. Liters/second b. Liters/minute c. Milliliters/second d. Millimeters/minute ANS: B

Peak flowmeters operate bT yE mSeaTsB urAinNgKthSeEgLasLfEloRw.aCgO aiM nst a rotating vane. Peak flowmeters are usually calibrated in liters per minute. PTS: 1

REF: Page 236

19. Which of the following devices uses the principle that gas flow is proportional to the pressure

drop across a known resistance? a. Turbine flowmeter b. Thermal flowmeter c. Fleisch pneumotachograph d. Ultrasonic pneumotachograph ANS: C

All pneumotachographs, except the ultrasonic pneumotachograph, operate on the principle that gas flow through them is proportional to the pressure drop that occurs as the gas flows across a known resistance. PTS: 1

REF: Page 236

20. Which type of flow-measuring device uses struts to create a partial obstruction to gas flow,

causing whirlpools to be produced when gas flows through it? a. Monel pneumotachograph b. Ceramic pneumotachograph c. Vortex ultrasonic flowmeter d. Variable-orifice pneumotachograph

ANS: C

The vortex ultrasonic flowmeter uses struts to create a partial obstruction to gas flow. As gases flow past these struts, whirlpools (or vortices) are produced. The frequency at which these whirlpools are produced is related to gas flow through the struts. PTS: 1

REF: Page 236

21. Which type of pneumotachograph uses the Doppler effect to measure airflow velocity? a. Fleisch b. Screen type c. Nonvortex d. Variable-orifice ANS: C

The nonvortex ultrasonic pneumotachograph estimates airflow by projecting pulsed sound waves along the longitudinal axis of the flowmeter. The theory is that the speed of the ultrasonic wave transmission is influenced by the rate of gas flow through the device, which is the Doppler effect. PTS: 1

REF: Page 236

22. A screen pneumotachograph is a. built with metal struts. b. expensive and nondisposable. c. bidirectional and very accurate. d. heated to prevent condensation. ANS: D

The screen pneumotachograph is similar to Fleisch-type devices in that a heating element is incorporated to prevent water condensation on the metal screens. PTS: 1

REF: Page 236

23. The standard for repeatability for forced expiratory volume in 1 second (FEV1) is a. 100 b. 150 c. 200 d. 250 ANS: B

The repeatability standard for FEV1 is 150 mL. PTS: 1

REF: Page 241

24. The best method for accurately measuring the thoracic gas volume of a patient with

emphysema is a. helium dilution. b. nitrogen washout. c. pressure plethysmography. d. chemiluminescence monitoring. ANS: C

mL.

Inert gas techniques, such as helium dilution and nitrogen washout, can measure gas volumes only in communicating airways. Body plethysmography measures all of the volume in the thorax. Therefore, inert gas measurements of functional residual capacity (FRC) for a patient with chronic obstructive pulmonary disease and severe air trapping will be lower than FRC measurements obtained during body plethysmography. PTS: 1

REF: Pages 238-239

25. Which of the following represents the relationship used by body plethysmography to calculate

FRC? a. VFRC = △V ÷ △P  (PB − PH2O) b. VFRC = △P ÷ △V  (PB − PH2O) c. VFRC = △V ÷ △T  (PB − PH2O) d. VFRC = (PB − PH2O)  △V ANS: A

VFRC = △V ÷ △P  (PB − PH2O), where △V and △P are the box volume and alveolar pressure changes measured during the panting maneuver, PB is the ambient barometric pressure, and PH2O is the water vapor pressure (assume 47 mm Hg for 37C). PTS: 1

REF: Page 239

26. The end point of a helium dilution test occurs when a. nitrogen is washed out. b. there is no more helium. c. the change in pressure remains steady. d. the helium percentage T reE mS aiTnB s sAteNaK dySfEoL r 2LE mR in. utCesO. M ANS: D

The end point of the helium dilution test is reached when the helium percentage remains steady for 2 minutes, indicating that the helium is equilibrated between the spirometer and the patient’s lungs. PTS: 1

REF: Page 240

27. One type of ventilatory pattern necessary for calculating FRC through the use of a body

plethysmograph is a. deep breathing with a breath hold. b. rapid, shallow breathing. c. deep, rapid breathing. d. slow, deep breathing. ANS: B

Mouth pressure and box pressure changes are measured during tidal breathing and panting maneuvers. PTS: 1

REF: Page 240

28. Which of the following equipment is necessary to perform a nitrogen washout test? a. Pneumotachometer b. Carbon dioxide (CO2) absorber

c. Drying column d. Pressure transducer ANS: A

See Fig. 8.10, which shows the breathing circuit for performing a nitrogen washout test. PTS: 1

REF: Page 241, Fig. 8.11

29. Body plethysmography is based on which of the following gas laws? a. Boyle’s b. Charles’ c. Dalton’s d. Gay-Lussac’s ANS: A

Body plethysmography measures mouth pressure and box pressure changes during tidal volume and panting. The microprocessor unit calculates the FRC from empirically derived pressure–volume relationships. It is Boyle’s law that explains the relationship between gas volume and pressure when temperature is held constant. PTS: 1

REF: Page 239

30. A comparison of FRC measured by body plethysmography with that measured by nitrogen

washout reveals that the measurement obtained during the nitrogen washout test is less than that during body plethysmography. This discrepancy is most likely caused by which of the following? a. Poor technique b. Severe air-trapping c. Restrictive lung disease d. Directional valve malfunction ANS: B

Severe air-trapping will produce lower FRC results than body plethysmography because the nitrogen washout test measures gas volumes only in communicating airways. PTS: 1

REF: Page 239

31. Which of the following do aneroid manometers use to measure pressure? a. A vacuum chamber with a flexible diaphragm b. Capacitance and changes in output voltage c. Changes in inductance of two coils d. A Wheatstone bridge circuit ANS: A

An aneroid manometer consists of a vacuum chamber with a flexible cover or diaphragm that flexes when pressure is applied to it. Electromechanical transducers use variable capacitance; strain gauge pressure transducers use Wheatstone bridge circuits; and variable inductance transducers use the magnetic flux between two coils to measure pressure. PTS: 1

REF: Pages 244-245

32. Which type of pressure-measurement device is best suited to measure arterial blood pressure

through an arterial catheter? a. Bourdon gauge b. Aneroid manometer c. Variable inductance d. Variable capacitance ANS: C

Variable inductance and strain gauge pressure transducers are commonly used for measuring respiratory and cardiovascular pressures because they respond quickly to pressure changes. PTS: 1

REF: Pages 244-245

33. Which type of pressure-measurement device is used to measure a patient’s maximum

inspiratory pressure? a. Variable inductance b. Aneroid manometer c. Plethysmograph d. Strain gauge ANS: B

Aneroid manometers are used as independent units for instantaneous pressure measurements, such as maximum inspiratory and expiratory pressures. PTS: 1

REF: Pages 244-245

34. Which of the following is true concerning the triple-lumen esophageal catheter used with the

BICORE CP-100 PulmonaTryEM onBitAoN rinKgSSEyL stL em ST E?R.COM a. It can measure intrapleural pressure indirectly. b. Its ideal position is the upper third of the esophagus. c. When the catheter enters the stomach, a negative pressure is recorded. d. The catheter can be positioned by observing the markings on its side. ANS: A

Esophageal pressure is used clinically to estimate intrapleural pressure. PTS: 1

REF: Pages 244-245

35. The bedside respiratory mechanics of mechanically ventilated patients can be measured with

which of the following standalone units? a. VenTrak system b. Tissot spirometer c. BICORE CP-100 system d. Stead-Wells spirometer ANS: C

Current mechanical ventilators have microprocessor units incorporated into their designs for measuring bedside respiratory mechanics, especially during mechanical ventilation. “Standalone” units, like the BICORE CP-100 Pulmonary Monitoring System. PTS: 1

REF: Pages 244-245

36. “Opposition to the flow of an alternating current” is the definition of a. electrical resistance. b. variable capacitance. c. electrical impedance. d. variable inductance. ANS: C

Electrical impedance, which is opposition to the flow of an alternating current, is determined by the resistance and capacitance of the circuit through which the current must pass. PTS: 1

REF: Page 242

37. Impedance plethysmographs operate by using

__-frequency,

-amplitude electrical

current. a. low; low b. high; low c. low; high d. high; high ANS: B

A constant high-frequency, low-amplitude electrical current is passed between the two electrodes, and the return voltage is used to calculate the impedance. PTS: 1

REF: Page 242

38. Which of the following might cause an apnea monitor to fail to alert the clinician to the

presence of apnea? a. Tachycardia b. Changes in blood volume c. Upper airway obstruction d. Inadequate sensitivity settings ANS: C

Recent evidence suggests that bradycardia and upper airway obstruction might cause apnea monitors to fail to signal apnea. PTS: 1

REF: Page 242

39. The parents of a newborn sent home with an apnea monitor call the respiratory therapist to

report several periods of apnea as noted by the monitor’s alarm system. The respiratory therapist should check which of the following to ensure that the baby’s movement was not the cause of these alarms? a. Sensitivity of the monitor b. Placement of the electrodes c. Amount of electrical current d. Frequency of the vibrations ANS: A

The sensitivity of the impedance pneumograph can be adjusted by the operator to prevent false alarms because of changes in impedance caused by movement instead of by changes in respiration.

PTS: 1

REF: Page 242

40. Which of the following are factors that influence the partial pressure of alveolar carbon

dioxide (PACO2)? 1. Diffusion 2. Ventilation 3. CO2 production 4. Perfusion of the lungs a. 1 and 2 b. 2 and 3 c. 1, 3, and 4 d. 1, 2, 3, and 4 ANS: D

Four major factors influence the PACO2—CO2 production, perfusion of the lungs, diffusion, and ventilation. The balance of these four components represents the total transport and elimination of CO2. PTS: 1

REF: Page 259

41. What following conditions may cause an apnea monitor to fail to signal apnea?

1. Tachypnea 2. Bradycardia 3. Excessive movement 4. Airway obstruction a. 1 and 2 b. 2 and 4 c. 1 and 3 d. 3 and 4 ANS: B

Bradycardia and upper airway obstruction can cause apnea monitors to fail to signal apnea, because with bradycardia, cardiac oscillations and intrathoracic blood-volume changes cause an increase in impedance, which is sensed as part of the respiratory cycle. Continued respiratory efforts in the presence of upper airway obstruction are sensed as normal respiratory efforts. PTS: 1

REF: Page 242

42. What type of device is used in an ICU to detect respiratory muscle fatigue? a. Aneroid manometer b. Pressure plethysmograph c. Inductive plethysmograph d. Electromechanical transducer ANS: C

Respiratory inductive plethysmography has been used clinically as a means of monitoring the breathing patterns of patients in ICUs. In the ICU, it has been used primarily to identify uncoordinated thoracoabdominal movements that are associated with respiratory muscle fatigue or failure.

PTS: 1

REF: Page 244

43. The principle that the respiratory system moves with 2 degrees of freedom describes the basis

for which of the following? a. Inductive plethysmography b. Volume plethysmography c. Strain gauge transducer d. Nitrogen washout ANS: A

Inductive plethysmography is based on the principle that the respiratory system moves with 2 degrees of freedom. That is, it consists of two moving parts: the rib cage and the abdomen. During inspiration, the rib cage moves outward as the lungs expand in the thorax. Simultaneously, the abdomen is displaced outward by the downward movement of the diaphragm. PTS: 1

REF: Page 244

44. As measured by inductive plethysmography, rib cage movement plus abdominal movement

equals a. tidal volume. b. inspiratory capacity. c. expiratory reserve volume. d. FRC. ANS: A

Because the two moving parts in the respiratory system, the rib cage and the abdomen, are arranged in a series, the suT mEoS fT thB eA twNoKdSisEpL laL ceEmRe. ntC sO caMn be used to calculate the air volume inspired. PTS: 1

REF: Page 244

45. Which device would be appropriate for monitoring respiratory rate and tidal volume during a

sleep study? a. Capnograph b. Mass spectrometer c. Pneumotachograph d. Inductive plethysmograph ANS: D

Respiratory inductive plethysmography has been used extensively in research on respiratory muscle function. It has been used as a means of monitoring breathing patterns of patients in sleep laboratories. PTS: 1

REF: Page 244

46. Which of the following values are measured directly?

1. FEV1 2. Airway resistance (Raw) 3. Peak expiratory flows 4. Maximum inspiratory pressures

a. b. c. d.

1 and 2 2 and 4 1, 3, and 4 3 and 4

ANS: C

FEV1 and peak expiratory flows are routine measurements during spirometry. Maximum inspiratory pressure is a common airway pressure measurement made on spontaneously breathing patients. Raw is calculated by subtracting plateau pressure (Pplateau) from peak inspiratory pressure and dividing the resultant pressure by the airflow. PTS: 1

REF: Page 246 | Page 248

47. Which of the following variables can be measured directly? a. Lung compliance b. Work of breathing c. Raw d. Pplateau ANS: D

Pplateau is measured during mechanical ventilation and represents the amount of pressure needed to maintain the tidal volume within the patient’s lungs during a period of no gas flow. PTS: 1

REF: Page 246 | Page 248

48. To set up a pulmonary function laboratory that can measure all standard and dynamic lung

volumes, which of the following equipment is necessary? a. Screen pneumotachogrT apEhSaT ndBA inN duKcS tiE veLpLleEthRy. sm CoOgMraph b. Fleisch pneumotachograph and peak flowmeter c. Vortex ultrasonic flowmeter and inductive plethysmograph d. Stead-Wells spirometer and constant-volume plethysmograph ANS: D

The Stead-Wells spirometer measures volumes and flows, whereas the constant-volume plethysmograph (the most common plethysmograph used) measures FRC. These two devices are able to measure all the volumes and flows necessary for full pulmonary function studies. The screen, Fleisch, and vortex ultrasonic pneumotachographs are unidirectional and are not able to measure inspiratory and expiratory flow simultaneously. Inductive plethysmography will provide respiratory rate and volume only, and is used in sleep laboratories. PTS: 1

REF: Page 233

49. Which of the following is the most appropriate lung volume to measure for a mechanically

ventilated patient? a. Minute volume b. Residual volume c. Expiratory reserve volume d. Inspiratory reserve volume ANS: A

At the bedside, the most commonly measured lung volume is the expired minute volume.

PTS: 1

REF: Page 248

50. Newer ventilators can make tidal volume and minute volume measurements by incorporating

which of the following? a. Capnograph b. Anemometer c. Flow transducer d. Pressure transducer ANS: C

In most new ventilators, a flow transducer is incorporated into the system design to give continual updates on the tidal volume and minute volume. PTS: 1

REF: Page 248

51. If a patient’s minute volume is 8.5 L/min and his respiratory rate is 15 breaths/min, what is

their average tidal volume? a. 0.125 L b. 0.570 L c. 0.060 L d. 5.700 L ANS: B

Minute volume = tidal volume  respiratory rate. Tidal volume = minute volume ÷ respiratory rate. Tidal volume = 8.5 L/min ÷ 15 breaths/min. Tidal volume = 0.570 L. PTS: 1

REF: Page 248

52. What is the minute volume of a patient if her respiratory rate is 12 breaths/min and her tidal

volume is 750 mL? a. 0.06 L b. 9.00 L c. 6.25 L d. 0.9 L ANS: D

Minute volume = tidal volume  respiratory rate. Minute volume = 0.75 L  12 breaths/min. Minute volume = 9 L. PTS: 1

REF: Page 248

53. Increased alveolar ventilation is associated with which of the following? a. Hyperthermia b. Bronchospasm c. Decreased metabolic rate d. Respiratory muscle fatigue ANS: A

Hyperthermia increases the metabolic demands of the tissues and increases alveolar ventilation. PTS: 1

REF: Page 249

54. Which of the following devices can a patient with asthma use in the home to monitor daily

variations in Raw? a. Thermal flowmeter b. Fleisch pneumotachograph c. Screen pneumotachograph d. Vortex ultrasonic flowmeter ANS: C

Screen pneumotachographs are inexpensive, disposable, operate at ambient temperature, and do not require a heating element. The Fleisch pneumotachograph is affected by turbulent airflow, making accurate peak flow readings difficult. PTS: 1

REF: Page 236

55. Which of the following could indicate secretions in the airway of a mechanically ventilated

patient? a. Increase in inspiratory capacity b. Increase in breathing frequency c. Increase in peak inspiratory pressure d. Decrease in forced expiratory flow rates ANS: C

An increase in airway resisTtaEnS ceT, B asAwNiK thSsE ecLreLtiE oR ns.iC nO thM e airway, will cause an elevation in the peak inspiratory pressure. PTS: 1

REF: Pages 245-246

56. VC is the sum of which of the following?

1. Residual volume 2. Inspiratory capacity 3. Expiratory reserve volume 4. Inspiratory reserve volume a. 2 and 3 b. 1 and 4 c. 1 and 2 d. 3 and 4 ANS: A

The VC is equal to the sum of the inspiratory capacity plus the expiratory residual volume. PTS: 1

REF: Page 248, Fig. 8.19

57. Expiratory residual volume plus residual volume equals a. FRC. b. inspiratory capacity. c. total lung capacity. d. VC.

ANS: A

Expiratory residual volume plus residual volume equals FRC. PTS: 1

REF: Page 248, Fig. 8.19

58. Total lung capacity is a result of a. VC plus residual volume. b. inspiratory capacity plus residual volume. c. inspiratory capacity plus expiratory residual volume. d. inspiratory reserve volume plus FRC. ANS: A

The total lung capacity is the sum of the VC and the residual volume. PTS: 1

REF: Page 248, Fig. 8.19

59. Patients with restrictive pulmonary disease demonstrate a decrease in which of the following

measurements? 1. VC 2. Total lung capacity 3. Forced expiratory flow from 25% to 75% of the VC (FEF25%-75%) 4. Ratio of forced expiratory volume in 1 second to vital capacity (FEV1/VC) a. 1 and 2 b. 2 and 3 c. 1 and 4 d. 3 and 4 ANS: A

Patients with restrictive pulmonary disease can have decreases in VC and total lung capacity. PTS: 1

REF: Page 249

60. The results of pulmonary function testing show a normal total lung capacity and decreased,

but reversible, FEV1 and FEV25%-75%. The patient is a 22-year-old, nonsmoking man with a history of intermittent “noisy breathing.” Which of the following is most likely the cause of his problem? a. Asthma b. Emphysema c. Pulmonary fibrosis d. Severe restrictive pulmonary disease ANS: A

Asthma is a disease that shows reversibility in the FEV1 and FEV25%-75%. This reversibility, coupled with the fact that he is an otherwise healthy, nonsmoking, 22-year-old with a history of intermittent noisy breathing, makes asthma the best choice as the most likely cause of the problem. PTS: 1

REF: Page 249

61. If the chest wall compliance of a mechanically ventilated patient decreases, which of the

following will occur?

a. b. c. d.

Maximum inspiratory pressure will decrease. Peak inspiratory pressure will decrease. Pplateau will increase. Tidal volume will increase.

ANS: C

When chest wall compliance decreases, there will be an increase in maximum inspiratory pressure and Pplateau. PTS: 1

REF: Page 249

62. Which device can be incorporated into a ventilator to provide continuous recordings of airway

pressure during the breathing cycle? a. Variable capacitance transducer b. Inductive plethysmograph c. Strain gauge transducer d. Aneroid manometer ANS: C

Peak inspiratory pressure can be derived from continuous recordings of airway pressure that can be made during the breathing cycle by using a strain gauge transducer. PTS: 1

REF: Page 245

63. The amount of pressure required by a ventilator to maintain tidal volume when there is no gas

flow is known as a. Pplateau. b. peak inspiratory pressuT reE. STBANKSELLER.COM c. peak expiratory pressure. d. maximum inspiratory pressure. ANS: A

Pplateau represents the amount of pressure needed to maintain the tidal volume within the patient’s lungs during static conditions and is the total pressure required to overcome only elastic forces. PTS: 1

REF: Page 249

64. Which device is appropriate for assessing a patient’s response to bronchodilator therapy at the

bedside? a. Stead-Wells spirometer b. Mainstream capnograph c. Inductive plethysmograph d. Peak flowmeter ANS: D

Rotating-vane flowmeters are used as handheld peak flowmeters and at the bedside to assess patient response to bronchodilator therapy. PTS: 1

REF: Page 249

65. Which of the following is a complication of performing peak expiratory flow maneuvers?

a. b. c. d.

Increased static pressure Increased airway resistance Decreased chest compliance Decreased mean airway pressure

ANS: B

Increased airway resistance, due to bronchoconstriction or airway collapse, is a complication of forced exhalation required to perform peak expiratory flow maneuvers. PTS: 1

REF: Page 250, Clinical Practice Guideline 8.1

66. Occlusion of the expiratory valve of the ventilator at the end of a tidal inspiration enables

measurement of which of the following? a. Pplateau b. Peak airway pressure c. Maximum inspiratory pressure d. Maximum expiratory pressure ANS: A

Pplateau is measured during mechanical ventilation by temporarily occluding the expiratory valve of the ventilator at the end of a tidal inspiration and noting the new pressure level. PTS: 1

REF: Page 249

67. What term is used to describe the pressure reading on the anemometer of a ventilator during

an inspiratory hold maneuver? a. Pplateau. b. Peak inspiratory pressuTreESTBANKSELLER.COM c. Mean inspiratory pressure d. Maximum inspiratory pressure ANS: A

The inspiratory hold maneuver shows the pressure to maintain the tidal volume within the patient’s lungs during a period of no gas flow; this is the Pplateau. PTS: 1

REF: Page 249

68. Which gas law is applicable when considering Raw? a. Boyle’s b. Charles’ c. Poiseuille’s d. Avogadro’s ANS: C

Poiseuille’s law states that a twofold decrease in airway diameter results in a 16-fold increase in Raw. Boyle’s law and Charles’ law address the relationships among pressure, volume, and temperature. Avogadro’s law is concerned with the number of molecules in a volume of gas. PTS: 1

REF: Page 250

69. Which of the following is normal Raw of the respiratory system? a. 1 to 3 cm H2O/L/s

b. 2 to 5 cm H2O/L/s c. 4 to 8 cm H2O/L/s d. 6 to 10 cm H2O/L/s ANS: B

Raw averages 2 to 5 cm H2O/L/s. PTS: 1

REF: Page 250

70. Which of the following variables in the formula describing Poiseuille’s law can be altered in

the clinical setting to improve Raw? 1. Radius of the airways 2. Viscosity of the inspired gas 3. Flow rate of the inspired gas 4. Temperature of the inspired gas a. 1 and 3 b. 1, 2, and 4 c. 2 and 4 d. 1, 2, and 3 ANS: D

Poiseuille’s law is represented by the formula Raw = [8  gas flow  gas viscosity  airway length] ÷ [  radius4]. Bronchospasm causes a decrease in the radius of the airways. Bronchodilators can reverse that process, thereby decreasing the Raw. High flow rates cause more turbulence and increased Raw. During mechanical ventilation, the flow rate of the gas being delivered can be changed by the respiratory therapist. Helium-oxygen (heliox) is used in respiratory care, not because of its viscosity, but because of its low density. An 80:20 mix of heliox is the least-dense gaTs E avSaT ilB abAleNfK orShEuL mLanER us. e,CbOuM t it has a viscosity higher than room air. So, heliox does not improve Raw. It does, however, make its way around any airway obstruction. PTS: 1

REF: Page 250

71. Which of the following pathophysiologic conditions can increase the peak inspiratory pressure

without increasing the Plateau of a ventilated patient? a. Asthma b. Atelectasis c. Kyphoscoliosis d. Pulmonary interstitial fibrosis ANS: A

An asthma exacerbation causes bronchospasm, which increases Raw, thereby triggering an increase in peak inspiratory pressure without an increase in Pplateau. PTS: 1

REF: Page 250, Clinical Practice Guideline 8.1

72. The respiratory system compliance of a patient receiving mechanical ventilation when the

returned tidal volume is 650 mL, the static pressure is 35 cm H2O, and the positive end-expiratory pressure is 8 cm H2O is mL/cm H2O. a. 0.04 b. 18.6

c. 53.9 d. 24 ANS: D

Respiratory system compliance can be determined by dividing the tidal volume by the Pplateau − baseline Cstat = 650 ÷ (35 − 8) = 650 ÷ 27 = 24 mL/cm H2O. PTS: 1

REF: Page 251, Table 8.4

73. Which of the following is an oxygen analyzer that uses paramagnetism to measure oxygen

concentration? a. Galvanic b. Electrical c. Paramagnetic d. Polarographic ANS: C

The paramagnetic analyzer uses the physical principle of paramagnetism to measure oxygen concentration. Galvanic and polarographic analyzers use chemical reactions to measure oxygen concentration, and electrical analyzers use thermal conductivity. PTS: 1

REF: Pages 250-251

74. Which of the following is an oxygen analyzer that can display both the partial pressure (in

millimeters of mercury) and the percentage of oxygen concentration? a. Paramagnetic b. Galvanic c. Electrical d. Polarographic ANS: A

The scale on a paramagnetic oxygen analyzer is calibrated to display both the partial pressure (in millimeters of mercury) and the percentage of oxygen concentration. PTS: 1

REF: Pages 251-252

75. Which type of oxygen analyzer can be used in the presence of anesthetic gases?

1. Polarographic 2. Paramagnetic 3. Electrical 4. Galvanic a. 3 and 4 b. 2 and 3 c. 1, 2, and 4 d. 1 and 2 ANS: C

An electrical analyzer uses a Wheatstone bridge setup and monitors the changes in current flow as it relates to oxygen concentrations. The Wheatstone bridge can generate a significant amount of heat and therefore is dangerous to use in the presence of flammable gases, such as anesthetic gases.

PTS: 1

REF: Pages 251-252

76. Which type of oxygen analyzer will give erroneous concentration levels in the presence of

contaminant gases? a. Polarographic b. Electrical c. Galvanic d. Physical ANS: B

Electrical analyzers use changes in current flow through wires to measure the concentration of oxygen. Contaminant gases can dissipate heat at different rates than oxygen and nitrogen, so, if gases other than oxygen and nitrogen are present, this can lead to erroneous fractional inspired oxygen (FIO2) levels. PTS: 1

REF: Pages 251-252

77. Which of the following is used to measure nitrogen oxides? a. Paramagnetic analyzer b. A Wheatstone bridge c. Polargraphic analyzer d. Chemiluminescence monitoring ANS: D

Two types of monitoring systems are routinely used when nitric oxide (NO) is administered: chemiluminescence monitoring and electrochemical monitoring. PTS: 1

REF: TPE agSesT2B5A 1-N 25K2SELLER.COM

78. Which oxygen analyzer uses a semipermeable polytetrafluoroethylene membrane to separate

oxygen from a potassium hydroxide bath containing a gold cathode and a lead anode? a. Paramagnetic b. Galvanic c. Electrical d. Polarographic ANS: B

Within the galvanic cell there is a semipermeable membrane that separates the gas sample from a hydroxide solution with a gold cathode and a lead anode. The polarographic cell uses a platinum cathode and a silver anode immersed in a potassium hydroxide bath. PTS: 1

REF: Pages 251-252

79. Electrical analyzers operate by using which of the following? a. Clark electrodes b. Pauling’s principle c. Thermal conductivity d. Oxygen-mediated chemical reaction ANS: C

Electrical analyzers operate on the principle of thermal conductivity and use an electronic device called a Wheatstone bridge. The Clark electrode is used by the polarographic analyzer. Pauling’s principle is used in paramagnetic analyzers, and electrical analyzers use thermal conductivity to analyze oxygen concentration. PTS: 1

REF: Pages 251-252

80. Which of the following happen to the wire within a Wheatstone bridge when it is exposed to

oxygen concentrations higher than room air? 1. Its resistance decreases 2. Its resistance increases 3. It cools down 4. It heats up a. 1 and 2 b. 2 and 3 c. 1 and 4 d. 1 and 3 ANS: D

The Wheatstone bridge contains two parallel wires that receive current flow from an external power source, usually a battery. One of these wires, which serves as the reference, is exposed to room air. The other wire is located in the sample chamber and is exposed to the gas being analyzed. If the sample gas contains a higher oxygen-to-nitrogen ratio than is present in room air, the sample wire cools and its resistance decreases, because oxygen is a better conductor of heat than nitrogen. PTS: 1

REF: Pages 251-252

TESTBANKSELLER.COM

81. Which analyzer would be most appropriate to use during an airlift transport of a patient? a. Galvanic b. Electrical c. Clark electrode d. Polarographic ANS: B

Electrical oxygen analyzers are unaffected by changes in pressure that occur with altitude changes. PTS: 1

REF: Pages 251-252

82. Which of the following types of oxygen analyzer can be placed in a ventilator circuit to

continuously monitor oxygen concentration? 1. Polarographic 2. Paramagnetic 3. Galvanic 4. Physical a. 1 and 4 b. 1 and 3 c. 2 and 3 d. 2 and 4

ANS: B

Galvanic and polarographic analyzers can be used for continuous monitoring of oxygen concentrations during mechanical ventilation. PTS: 1

REF: Pages 251-252

83. NO is effective in the treatment of pulmonary hypertension in neonates because it causes

which of the following? a. Peripheral vasoconstriction b. Macrophage cytotoxicity c. Platelet adhesion d. Vasodilatation ANS: D

NO is used for the treatment of pulmonary hypertension in neonates because it promotes pulmonary vasodilatation. Other effects of NO include macrophage cytotoxicity and platelet adhesion. PTS: 1

REF: Page 253

84. Two gases that can be falsely identified as nitrogen dioxide (NO2) are a. NH2 and HNO3. b. NH3 and HNO3. c. NO3 and HNO3. d. NH2 and nitrous oxide (N2O). ANS: D

NH2 and N2O are two gaseTs E thSatTcBanAN beKfS alE seLlyLiEdR en.tiC fiO edMas NO2. PTS: 1

REF: Page 253

85. A device that can measure NO2 uses which of the following? a. A Wheatstone bridge b. A catalytic converter c. Potassium hydroxide d. An infrared (IR) spectroscope ANS: B

NO2 levels can be measured indirectly by converting NO2 to NO with a catalytic or chemical converter, and then measuring the NO concentration. PTS: 1

REF: Page 253

86. Which reactions take place near the sensing electrode of an electrochemical NO analyzer? a. 2H2O → 4H+ + 4e− + O2 b. O2 + 4H+ + 4e− → 2H2O c. 4NO + 2H2O + 2O2 → 4HNO3 d. NO + 2H2O → HNO3 + 3H+ + 3e− ANS: D

An electrochemical NO analyzer consists of three electrodes immersed in an electrolyte solution that contains a highly conductive concentrated acid or alkali solution. The electrodes are separated from the gas sample to be analyzed by a semipermeable membrane. NO and NO2, from the unknown gas sample, diffuse across a semipermeable membrane and react with the electrolyte solution near the sensing electrode. This generates electrons in the oxidation reaction: NO + 2H2O → HNO3 + 3H+ + 3e−. PTS: 1

REF: Page 255

87. Which of the following gases affect the accuracy of NO/NO2 electrochemical monitors?

1. NH2 2. N2O 3. CO2 4. CO a. 1, 2, and 4 b. 1, 3, and 4 c. 2 and 3 d. 3 and 4 ANS: B

The accuracy of NO/NO2 electrochemical monitors can be altered by the presence of background gases—such as CO2, CO, and NH2—that have lower oxidation potentials than the sensor potential. PTS: 1

REF: Pages 255-256

r is most appropriate for a critical care setting? 88. Which type of CO2 monitoT ESTBANKSELLER.COM a. IR spectroscopy b. Raman spectroscopy c. Mass spectroscopy d. Clark electrode ANS: A

IR spectroscopy is currently the method of choice in critical care settings, and mass spectroscopy is most often used in surgical suites. PTS: 1

REF: Page 257

89. Which of the following are associated with sidestream capnographs?

1. Delayed reporting times 2. Addition of dead space to the airway 3. Increased risk of inappropriate extubation 4. Increased risk of plugging of the sample tubing a. 1 and 2 b. 1 and 3 c. 2 and 4 d. 3 and 4 ANS: B

Sidestream capnographs show a slight delay between sampling and reporting times because of the time required to transport the sample from the airway to the sample chamber. The plastic tube that transports sample gas from the airway to the analyzer is prone to plugging by water and secretions, and therefore can lead to erroneous readings. PTS: 1

REF: Page 258

90. The gases that have the same molecular weight and cannot be separated on the basis of weight

alone during mass spectroscopy include which of the following? a. N2 and O2 b. N2O and O2 c. CO2 and N2 d. N2O and CO2 ANS: D

CO2 and N2O have the same molecular weight and are not able to be separated on the basis of molecular weight, which can lead to erroneous readings. This problem is overcome by ionizing N2O to N2O+ and CO2 to C+. PTS: 1

REF: Page 259

91. A normal capnogram contains the most CO2 during which of the following phases? a. 1 b. 2 c. 3 d. 4 ANS: C

During phase 1, there is essentially no CO2 because the gas is from the patient’s dead space. In phase 2, CO2 from the alveoli mixes with gas from the smaller airways, causing the CO2 concentration to rise. During phase 3, the CO2 concentration curve remains at its highest level as alveolar gas is exhaled. Inspiration causes the measured exhaled CO2 level to fall to 0; this is phase 4. PTS: 1

REF: Page 258

92. End-tidal CO2 is measured with a capnograph during the a. end; 3 b. end; 4 c. middle; 2 d. beginning; 3

of phase

ANS: A

The end of phase 3 has the highest amount of exhaled CO2. PTS: 1

REF: Page 258

93. What is the normal relationship between the partial pressure of arterial carbon dioxide

(PaCO2) and partial pressure of end-tidal CO2 (PETCO2)? a. PaCO2 and PETCO2 are equal b. PaCO2 is 10 mm Hg more than PETCO2 c. PaCO2 is 4 to 6 mm Hg less than PETCO2

d. PaCO2 is 4 to 6 mm Hg more than PETCO2 ANS: D

Although the PETCO2 should equal the PaCO2, the PETCO2 is actually 4 to 6 mm Hg lower than the PaCO2. PTS: 1

REF: Page 258

94. At the alveolar level, when ventilation occurs with reduced or no perfusion, this condition is

known as which of the following? a. Alveolar shunt b. Anatomic shunt c. Anatomic dead space d. Functional dead space ANS: D

Ventilation with little or no perfusion at the level of the alveoli is known as functional dead space. An alveolar shunt occurs when alveoli are perfused but not ventilated. An anatomic shunt is the percentage of cardiac output that does not participate in gas exchange in the lung because of normal anatomy: Unoxygenated blood from the bronchopulmonary vein (lungs) and the thebesian veins (heart) empty directly into the left heart. Anatomic dead space includes all the conducting airways where no gas exchange occurs. PTS: 1

REF: Page 258

95. A 24-year-old skier with a broken femur has been in the postanesthesia care unit for 24 hours

and is 12 hours postextubation with no supplemental oxygen. He is awake, alert, and oriented, and he reports shortness ofTbEreSaT thB .A ANcaKpSnoEgLraLpEh Rsh.oCwOs Mdecreased PETCO 2. Which of the following could cause this patient’s current status? a. Respiratory center depression b. Pulmonary embolism c. Muscular paralysis d. Alveolar shunt ANS: B

Long-bone fractures put a patient at risk for the development of pulmonary emboli. The decreased PETCO2 is showing that physiologic dead space has increased because of the blockage of pulmonary arterioles. PTS: 1

REF: Page 259

96. Which of the following PETCO2 readings is consistent with a drug overdose? a. 0.3% b. 2.5% c. 5.3% d. 10.0% ANS: D

Normal expired air contains approximately 4% to 6% CO2. A drug overdose depresses the respiratory center, leading to a higher than normal PETCO2. PTS: 1

REF: Page 260

97. Capnography is widely used to determine a. hemodynamic status. b. adequacy of cerebral blood flow. c. placement of an endotracheal tube. d. response to bronchodilator therapy. ANS: C

Capnography is an excellent method to determine tracheal, rather than esophageal, intubation because only the lungs produce CO2. PTS: 1

REF: Page 261, Clinical Practice Guideline 8.2

98. Measuring the energy needs of patients is known as which of the following? a. Oximetry b. Calorimetry c. Capnography d. Spectroscopy ANS: B

Calorimetry is a method of determining energy expenditure by using the measurements of the amount of heat radiated and absorbed by an organism. PTS: 1

REF: Page 265

99. Which type of calorimeter is best suited to measure the energy expenditure of a mechanically

ventilated patient with a heated humidifier? a. IR b. Open-circuit c. Closed-circuit d. Double-circuit ANS: C

Closed-circuit calorimeters can be used for both spontaneously breathing and mechanically ventilated patients. Open-circuit devices can also be used for both spontaneously breathing and mechanically ventilated patients. However, special problems can arise when systems are used with mechanically ventilated patients. Some of these problems include fluctuations in FIO2, separation of the patient’s inspired and expired gases from the continuous gas flow provided by the ventilator, and handling of water vapor. PTS: 1

REF: Page 266

100. Most calorimeters are unreliable when the oxygen concentration is above 50% to 60%

because of which of the following? a. Boyle’s law b. Charles’ law c. The Hamburger effect d. The Haldane transformation ANS: D

Beyond FIO2s of 0.50 to 0.60, most systems are unreliable because of the Haldane transformation; therefore, any data derived from their use should accordingly be viewed skeptically. PTS: 1

REF: Page 267

101. Which of the following factors will cause inaccurate calorimetry measurements on a

mechanically ventilated patient? a. FIO2 > 0.5 b. Varying pressure c. Room temperature = 23C d. Heat and moisture exchanger ANS: A

Clinical studies have demonstrated that currently available systems cannot provide accurate and reproducible oxygenation consumption per minute ( O2) measurements for patients breathing FIO2s greater than 0.5. PTS: 1

REF: Page 268

102. Proteins contribute significantly to energy expenditure during which of the following states? a. Severe sepsis b. Hyperthermia c. Prolonged starvation d. Long-bone fractures ANS: C

.C Under normal conditions, pTrE otS eiT nsBcAoN ntKriS buEtL eL onElyRm inO orMamounts to energy metabolism. Note that the percentage of protein used represents the normal turnover rate for replenishing structural and functional proteins in the body. Proteins might contribute significantly to energy expenditure, however, in cases of starvation. PTS: 1

REF: Page 269

103. What percent change in metabolic rate would you expect if a patient has a fever of 103F? a. 10% increase b. 20% increase c. 44% increase d. 25% decrease ANS: C

An increase in body temperature of 1F will cause a 10% increase in metabolic rate. If the patient has a fever of 103F, subtracting 98.6F from the 103F yields 4.4F. A 1F increase causes a 10% rise in metabolic rate, so 4.4  10% will equal a 44% increase. PTS: 1

REF: Page 269

104. The expected respiratory quotient of a patient with severe sepsis is a. 0.7. b. 0.8. c. 1.0.

d. >1.0. ANS: A

Several studies have shown that patients with severe sepsis have respiratory quotients of approximately 0.7 because of their reliance on lipid metabolism for energy and an inability to use carbohydrates. PTS: 1

REF: Pages 269-270

105. In the below figure, A represents which of the following?

a. b. c. d.

VC Inspiratory capacity Total lung capacity FRC

ANS: C

Total lung capacity is the sum of all the lung volumes. PTS: 1

REF: Page 248, Fig. 8.19

106. In the below figure, B represents which of the following?

a. b. c. d.

VC Inspiratory capacity Inspiratory reserve volume Expiratory residual volume

ANS: A

VC is the total amount of air that can be exhaled after a maximum inspiration. It is the sum of the inspiratory reserve volume, the tidal volume, and the expiratory residual volume. PTS: 1

REF: Page 248, Fig. 8.19

107. In the below figure, C represents which of the following?

a. b. c. d.

VC Inspiratory capacity FRC Expiratory residual volume

ANS: B

Inspiratory capacity is the amount of air that can be inhaled after a normal exhalation. PTS: 1

REF: Page 248, Fig. 8.19

108. Which of the measurements shown in the figure is obtained by using body plethysmography?

a. b. c. d.

B C D E

ANS: C

D represents the FRC and can be measured only by using either body plethysmography or inert gas techniques.

PTS: 1

REF: Page 248, Fig. 8.19

109. In the below figure, A is pointing to which of the following components?

a. b. c. d.

Dry seal Water seal CO2 absorber Linear potentiometer

ANS: C

A is pointing to the CO2 absorber. PTS: 1

REF: Page 233, Fig. 8.2

110. The device shown in the figure can measure which of the following?

a. b. c. d.

FEV1 Minute volume Forced VC Maximum expiratory flow

ANS: B

The figure shows a turbine flowmeter, handheld respirometer, which is used to measure tidal volume and minute volume. PTS: 1

agSe T 23B5A , FNigK. S 8.E 6 LLER.COM REF: TPE

111. The figure represents which type of pneumotachograph?

a. b. c. d.

Fleisch Variable-orifice Vortex ultrasonic Nonvortex ultrasonic

ANS: C

The figure represents a vortex ultrasonic pneumotachograph. PTS: 1

REF: Page 237, Fig. 8.8

112. In the figure, the amount of pressure required to overcome elastic forces is represented by

which of the letters?

a. b. c. d.

A B C D

ANS: C

Point C represents the Pplateau, which represents the total force that must be applied to overcome elastic forces only. PTS: 1

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REF: Page 250, Fig. 8.20

113. The arrow points to which of the following lung volumes in the figure?

a. b. c. d.

Tidal volume Residual volume Inspiratory reserve volume Expiratory residual volume

ANS: D

The arrow is pointing to expiratory residual volume, which is the total amount of gas that can be exhaled from the lung after a quiet exhalation. PTS: 1

REF: Page 248, Fig. 8.19

114. The capnogram seen in the figure shows which of the following?

a. b. c. d.

Excessive phase 4 Deep “curare cleft” Indistinguishable phase 3 Slow cardiac oscillation

ANS: C

The figure shows an indistinguishable phase 3 caused by increase in physiologic dead space. This is a sign of chronic obstructive pulmonary disease. PTS: 1

REF: Page 262, Fig. 8.31A

115. The capnogram seen in theTfE igS urTeBshAoNwKsSwEhL icL hE ofRt. heCfOoM llowing?

a. b. c. d.

Chronic obstructive pulmonary disease Cardiac oscillations Rebreathing exhaled gases Cheyne-Stokes breathing

ANS: A

Physiologic dead space increases with chronic obstructive pulmonary disease, which causes phase 3 to become indistinguishable, as shown in the figure. PTS: 1

REF: Page 262, Fig. 8.31E

116. A decrease in perfusion of the alveoli will lead to which of the following? a. Alveolar shunt b. Extra-alveolar shunt c. Anatomic dead space d. Physiologic dead space ANS: D

A decrease of perfusion to the alveoli causes an increase in ventilation without perfusion, which is physiologic dead space. A shunt is perfusion without ventilation. Anatomic dead space is the normal amount of dead space in the body due to the conducting airways. PTS: 1

REF: Page 260, Fig. 8.30

117. The arterial-to-end-tidal CO2 and the arterial-to-maximum expiratory partial pressure of

carbon dioxide (PCO2) gradients are both elevated and equal to each other. This finding is consistent with a. chronic obstructive pulmonary disease. b. left-sided heart failure. c. esophageal intubation. d. pulmonary embolism. ANS: D

Normally, the difference between the PCO2 measured at the end of a maximum exhalation and the PaCO2 is minimal. Patients with chronic obstructive pulmonary disease or left-sided heart failure do not show an increase in this difference. However, patients with pulmonary embolism show an increased gradient. PTS: 1

REF: Page 263, Fig. 8.32

118. Phase 1 of a single-breath CO2 (SBCO2) curve represents which of the following? a. Anatomic dead space b. Physiologic dead space c. Transition between airway and alveolar exhaled gas d. Anatomic shunt ANS: A

Anatomic dead space has no CO2; the mixed expired CO2 (FECO2) = 0 during that phase. PTS: 1

REF: Pages 263-264

119. In the figure, what does area X represent?

a. b. c. d.

Amount of CO2 not eliminated because of alveolar dead space Amount of CO2 not eliminated due to anatomic dead space Amount of CO2 in a single breath Amount of CO2 rebreathed

ANS: C

Area X represents the actual amount of CO2 exhaled in the breath, assuming that no exhaled air is rebreathed. This is the volume of CO2 in a single breath. PTS: 1

REF: Page 263, Fig. 8.34

120. Which of the following statements is true if metabolism increases? a. PaCO2 will rise even if ventilation increases. b. The SBCO2 curve increases if ventilation does not. c. The volumetric CO2 tracing will not change even if ventilation increases. d. CO2 production decreases proportionally. ANS: B

If metabolism increases and ventilation does not, PaCO2 rises and the amount of CO2 exhaled during the SBCO2 increases. PTS: 1

REF: Pages 263-264

Chapter 09: Assessment of Cardiovascular Function Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. The ability of certain specialized cells of the heart to depolarize spontaneously is known as

which of the following? a. Rhythmicity b. Excitability c. Automaticity d. Conductivity ANS: C

Automaticity describes the ability of certain specialized cells of the heart to depolarize. Diastasis refers to the long period of reduced ventricular filling that follows the rapid-filling period. Excitability is defined as the ability of a cell to respond to an electrical stimulus. Conductivity is defined as the ability of cardiac tissue to propagate an action potential. PTS: 1

REF: Page 274

2. Which of the following is defined as the ability of a cell to respond to an electrical stimulus? a. Conductivity b. Rhythmicity c. Excitability d. Automaticity ANS: C

Excitability is defined as the ability of a cell to respond to an electrical stimulus. Conductivity refers to the ability of cardiac tissue to propagate an action potential. Automaticity describes the ability of certain specialized cells of the heart to depolarize. Rhythmicity refers to the heart’s pacemaker action potential. PTS: 1

REF: Page 274

3. The ability of cardiac tissue to propagate an action potential is the definition of a. excitability. b. automaticity. c. conductivity. d. depolarization. ANS: C

Conductivity is defined as the ability of cardiac tissue to propagate an action potential. Excitability refers to the ability of a cell to respond to an electrical stimulus. Automaticity describes the ability of certain specialized cells of the heart to depolarize. Polarization occurs when a cell becomes electrically activated. PTS: 1

REF: Page 274

4. When a cell membrane of an excitable cell is exposed to a depolarizing current, which of the

following occurs?

a. b. c. d.

Increased influx of calcium into the cell Rapid influx of sodium ions into the cell Increased efflux of potassium out of the cell Rapid efflux of protein molecules out of the cell

ANS: B

An action potential begins when the cell membrane of the excitable cell is exposed to a depolarizing current and eventually reaches its excitation threshold potential. The initial phase of this type of action potential consists of a rapid upstroke or depolarization. This change in membrane potential to a more positive value occurs because of a rapid influx of sodium ions into the cell. PTS: 1

REF: Page 274

5. A muscle cell cannot be depolarized again during which phases of an action potential? a. End of 0 to the beginning of 2 b. Beginning of 1 to the end of 3 c. End of 1 to the beginning of 4 d. Beginning of 0 to the middle of 3 ANS: D

The period from the beginning of phase 0 to the middle of phase 3 is referred to as the absolute refractory period or effective refractory period, because regardless of the strength of the stimulus, the myocyte cannot be depolarized again. PTS: 1

REF: Pages 274-275

iaS cT ceBllA sN haKsSthEeLsL loE wR es.t C acOtiM on potential? 6. Which of the following carTdE a. Atrial b. Ventricular c. Purkinje fiber d. Sinoatrial node ANS: D

The slope of phase 0 of the sinoatrial node (pacemaker) is less than those of the atrial, ventricular, and Purkinje fiber action potentials, and the former often is referred to as a slow action potential, whereas the latter are called fast action potentials. PTS: 1

REF: Pages 274-275

7. Automatic electrical discharges in the myocardium normally begin within which of the

following? a. Bundle of His b. Sinoatrial node c. Bachmann bundle d. Atrioventricular node ANS: B

The sinoatrial node, as well as the atrioventricular node, normally has action potentials that differ from those of other excitable cells of the heart. Depolarization of the sinoatrial node initiates the heartbeat by triggering a wave of excitation that spreads through the right and left atria as it moves toward the atrioventricular node.

PTS: 1

REF: Pages 274-275

8. Electrical stimulation of a cardiac muscle cell is the definition of which of the following? a. Contraction b. Refraction c. Polarization d. Depolarization ANS: D

The action potential begins when the cell membrane of the excitable cell is exposed to a depolarizing current and eventually reaches its excitation threshold potential. This is known as depolarization. PTS: 1

REF: Pages 274-275

9. Which letter in the figure identifies the anterior internodal pathway?

TESTBANKSELLER.COM

a. b. c. d.

A C E F

ANS: B

See Fig. 9.2 in the text. PTS: 1

REF: Page 276, Fig. 9.2

10. Which letter in the figure identifies the cardiac cells through which there is a 100-ms delay?

a. b. c. d.

A B C D

ANS: D

As the electrical impulse travels through the atrioventricular node, there is a 100-ms delay in the conduction. This allows the atria to become fully depolarized and contract before ShTisBaAllNow KS ventricular excitation beginTsE .T s tEhL eL atE riaRl . coCnOtrM action and emptying to contribute optimally to ventricular filling. PTS: 1

REF: Page 276, Fig. 9.2

11. Which letter indicates the path impulses travel to the left atrium?

a. A

b. C c. D d. E ANS: D

AV nodes occur through a series of high-speed internodal conduction pathways, referred to as the anterior, middle, and posterior internodal pathways. Impulses travel to the left atrium via a branch of the anterior internodal pathway, which is called the Bachmann bundle. PTS: 1

REF: Page 276, Fig. 9.2

12. The fourth intercostal space at the left sternal margin is the site for which of the following

electrocardiogram leads? a. V1 b. V2 c. V3 d. V4 ANS: B

V2 is placed in the fourth intercostal space, at the right sterna margin. PTS: 1

REF: Page 278, Fig. 9.5C

13. The fifth intercostal space on the anterior axillary line is the site for which of the following

electrocardiogram leads? a. V3 b. V4 c. V5 d. V6 ANS: C

V5 is located at the same level as V4 (fifth intercostal space) on the anterior axillary line. PTS: 1

REF: Page 278, Fig. 9.5

14. The paper speed of an electrocardiographic machine should be set at a speed of a. 10 b. 15 c. 20 d. 25 ANS: D

When an electrocardiogram (ECG) is recorded, the paper speed is set at 25 mm/s, the equivalent of 1500 mm/min. PTS: 1

REF: Page 280

15. Each millimeter on electrocardiographic recording paper represents a. 0.02 b. 0.04 c. 0.20 d. 0.40

seconds.

mm/s.

ANS: B

Time is recorded on the x-axis, with each millimeter representing 0.04 second. PTS: 1

REF: Page 280

16. How many millimeters are between each heavy vertical line on electrocardiographic paper? a. 1.0 b. 2.0 c. 4.0 d. 5.0 ANS: D

The area between the heavy vertical lines on the electrocardiographic paper represents 5.0 mm. PTS: 1

REF: Page 280

17. The time required for the atrial impulse to travel through the atrioventricular node is defined

as which of the following? a. P–R segment b. P–R interval c. QRS interval d. ST segment ANS: B

The P–R interval ranges from 0.12 to 0.2 second and is the time it takes for the impulse initiated in the atria to travel through the atrioventricular node. The P–R segment occurs between the end of the P wTaE veSaTnB dA thN eK beSgEinLnL inE gRo. f tC hO eM QRS interval, corresponds to the 0.1-second delay that occurs within the atrioventricular node. The P–R segment is included in the P–R interval. The QRS interval represents ventricular depolarization, and the ST segment represents ventricular depolarization. PTS: 1

REF: Page 281

18. On an electrocardiogram, the time between atrial and ventricular contraction is known as the a. P–R segment. b. ST segment. c. QRS interval. d. Q–T interval. ANS: A

The P–R segment represents the time delay that occurs within the atrioventricular node and therefore represents the time between atrial and ventricular contractions. The ST segment occurs during ventricular depolarization, the QRS interval represents ventricular polarization, and the Q–T interval represents the time required for ventricular depolarization and repolarization to occur. PTS: 1

REF: Page 281

19. The QRS complex represents which of the following? a. Atrial depolarization

b. Ventricular depolarization c. Ventricular repolarization d. Threshold potential ANS: B

Ventricular depolarization is represented on the electrocardiogram as the QRS complex. The P wave represents atrial depolarization. The T wave represents ventricular repolarization. Threshold potential is the critical level of electrical excitation reached by any cell, causing an action potential to occur. PTS: 1

REF: Page 281

20. The QRS vector appears downward in which of the following electrocardiogram leads? a. II b. V5 c. aVL d. aVR ANS: D

The QRS vector will normally be upward in leads I, II, aVL, and V5 and is usually downward in leads aVR and V1. PTS: 1

REF: Page 281

21. On an electrocardiogram, which of the following represents ventricular repolarization? a. T wave b. P–R interval c. ST segment d. QRS complex ANS: A

Repolarization of the ventricles is represented by the T wave. The P–R interval is the time it takes for the impulse initiated in the atria to travel through the atrioventricular node. The ST segment occurs during ventricular depolarization, and the QRS complex represents ventricular depolarization. PTS: 1

REF: Page 281

22. On an electrocardiogram, which of the following represents ventricular depolarization and

repolarization? a. P–R interval b. Q–T interval c. ST segment d. QRS complex ANS: B

The Q–T interval is measured from the beginning of the QRS complex to the end of the T wave. It represents the time required for ventricular depolarization and repolarization to occur and also approximates the time of ventricular systole. PTS: 1

REF: Page 282

23. Repolarization of the papillary muscles or remnants of ventricular repolarization appears on

an electrocardiogram as a a. P wave. b. T wave. c. U wave. d. J point. ANS: C

The U wave follows the T wave and precedes the successive P wave. It is thought to represent remnants of ventricular repolarization or repolarization of the papillary muscles. PTS: 1

REF: Page 282

24. What is the heart rate shown on the following electrocardiogram?

a. b. c. d.

150 200 250 300

ANS: D

Isolate 3 seconds out of the strip. There are 15 cardiac cycles in a 3-second period. Multiply 15 by 20. The heart rate is 300 beats/min. PTS: 1

REF: Pages 282-283

25. What is the heart rate shown on the following ECG?

a. b. c. d.

60 78 90 100

ANS: D

Isolate 3 seconds out of the strip. There are 5 cardiac cycles in a 3-second period. Multiply 5 by 20. The heart rate is 100 beats/min. PTS: 1

REF: Pages 282-283

26. What is the heart rate depicted on the following electrocardiogram?

a. b. c. d.

60 80 100 120

ANS: B

Isolating 3 seconds out of the strip shows that there are 4 cardiac cycles in the 3-second period. Multiply 4 by 20. The heart rate is 80 beats/min. PTS: 1

REF: Page 285

27. Which of the following might cause sinus tachycardia? a. Vomiting b. Hypothermia c. Thyrotoxicosis d. Mediastinal tumors ANS: C

Thyrotoxicosis, which refers to the hypermetabolic clinical syndrome that results from serum elevations in thyroid hormone, can cause sinus tachycardia. Vomiting, hypothermia, and mediastinal tumors can cause sinus bradycardia. PTS: 1

REF: Page 285

28. Ingestion of large quantities of coffee may cause which of the following? a. Sinus bradycardia b. Junctional rhythms c. Bundle-branch blocks d. Premature ventricular beats ANS: D

Ingestion of large quantities of coffee, which contains caffeine, can cause a healthy person to have premature ventricular beats. PTS: 1

REF: Page 288

29. -Adrenergic blocking agents, such as propranolol, can cause a. sinoatrial block. b. sinus tachycardia. c. sinus bradycardia. d. premature atrial beats. ANS: C

-Adrenergic blocking agents block stimulation by the sympathetic nervous system, causing the heart to slow down its rate. This can lead to sinus bradycardia. PTS: 1

REF: Page 285

30. What is the cardiac rhythm depicted on the following electrocardiogram?

a. b. c. d.

Atrial fibrillation Premature atrial beats Paroxysmal atrial tachycardia Premature ventricular contractions

ANS: A

Atrial fibrillation is characterized by gross irregularities in both atrial and ventricular depolarization. The P waves have been replaced by fibrillatory waves, which have caused an undulation of the baseline. Not every atrial depolarization has been transmitted by the atrioventricular node. PTS: 1

REF: Page 288

31. What is the name of the following cardiac arrhythmia?

a. b. c. d.

Paroxysmal atrial tachycardia Atrial premature depolarization Premature ventricular contractions Wolff-Parkinson-White syndrome

ANS: C

The two premature ventricular contractions shown are characterized by the absence of a P wave, wide QRS complexes, and a lack of T waves. PTS: 1

REF: Page 288

32. A prolonged R–R interval indicates which of the following kinds of cardiac arrhythmia? a. Atrial fibrillation b. Sinoatrial block c. Premature ventricular beats d. Paroxysmal atrial tachycardia

ANS: B

Sinoatrial blocks occur when the impulse generated at the sinoatrial node is blocked before it can enter the atrial muscle. On the electrocardiogram this is demonstrated by a sudden loss of P waves resulting from the absence of atrial depolarization. The contour of the QRS complex is normal, but the R–R intervals are usually prolonged, indicating the presence of a junctional escape rhythm. PTS: 1

REF: Page 289

33. The heart block that causes “dropped” beats and that is often the result of increased

parasympathetic tone is called a. sinoatrial b. Mobitz type I c. first-degree atrioventricular d. left bundle branch

block.

ANS: B

Dropped beats are characteristic of second-degree atrioventricular blocks, which consist of Mobitz type I and Mobitz type II blocks. These dropped beats are a result of the atrioventricular node’s inability to conduct impulses from the sinoatrial node. Sinoatrial blocks are indicated by a sudden loss of P waves. First-degree atrioventricular blocks are indicated by a prolongation of the P–R interval. Left bundle-branch blocks are indicated by the absence of Q waves in the left limb leads. PTS: 1

REF: Page 289

34. Which of the following is the most characteristic electrocardiographic finding in myocardial

infarction? a. T wave inversion b. ST segment elevation c. ST segment depression d. Downward-deflected Q waves ANS: D

When cardiac tissue fed by the left anterior descending and circumflex branches of the left coronary artery infarct, Q waves become abnormal most noticeably on the left precordial leads. As a result, the Q waves deflect downward instead of upward because of a lack of counterbalancing electrical forces on the affected side. PTS: 1

REF: Page 289

35. What are the atrial and ventricular rates for lead I in the following electrocardiogram?

Atrial Rate a. 75 b. 180 c. 300 d. 135

Ventricular Rate 225 90 75 45

ANS: C

The strip is 2.4 seconds long, so 60 ÷ 2.4 = 25, making 25 the multiplication factor. Because there are 3 ventricular beats, the ventricular rate is 3 times 25, or 75 beats/min. There are 12 P waves, making the atrial rate 12 times 25, or 300 beats/min. PTS: 1

REF: Page 289

36. The aVL lead shows the electrocardiogram in the below figure. This is indicative of the

occlusion of which of the following coronary arteries?

a. b. c. d.

Left coronary artery Circumflex artery Right coronary artery Anterior interventricular branch of the left coronary artery

ANS: B

The electrocardiogram strip shows ST segment elevation. This occurs in leads II, III, and aVL with the occlusion of the circumflex artery. Left coronary artery occlusion will cause an ST segment elevation in lead I and a depression in lead III. Right coronary occlusion will cause ST segment depression in precordial leads V3 and V4. An occlusion of the anterior interventricular branch of the left coronary artery will cause an ST segment elevation in lead I and an ST segment depression in lead III. PTS: 1

REF: Page 291, Table 9.2

37. Isovolumetric contraction of the ventricles follows which electrocardiographic event?

a. b. c. d.

P wave R wave S wave T wave

ANS: B

Ventricular systole begins with a period of isovolumetric contraction, which follows the peak of the R wave. Atrial systole follows the P wave. The S wave is followed by ventricular ejection. Isometric relaxation of the ventricles follows the T wave. PTS: 1

REF: Pages 291-292, Fig. 9.23

38. Pressure rising in the ventricles but no blood being ejected is the definition of a. ventricular systole. b. ventricular diastole. c. isovolumetric relaxation. d. isovolumetric contraction. ANS: D

During isovolumetric contraction, the ventricular muscle fibers shorten, but the volume of blood in the ventricle remains constant because the mitral valve, tricuspid valve, aortic valve, and the pulmonary valve remain closed. PTS: 1

REF: Pages 291-292

39. During diastasis, which of the following occurs within the ventricles? a. Pressure increases. b. Blood enters slowly. c. Pressure falls dramatically. d. Blood pushes against the semilunar valves. ANS: B

Rapid ventricular filling occurs when the atrioventricular valves open and lasts for approximately one-third of the diastole. Two-thirds of diastole consists of reduced filling, or diastasis. PTS: 1

REF: Pages 291-292

40. The right ventricle peak systolic pressure is represented by a. 15 b. 25 c. 80 d. 120

millimeters of mercury.

ANS: B

The systolic pressure of the right ventricle is 25 mm Hg. This pressure is higher than the pressure in the pulmonary artery (15 mm Hg). PTS: 1

REF: Pages 291-292

41. At what point in the figure do the semilunar valves close?

a. b. c. d.

A B C D

ANS: B

In the semilunar valves and aortic and pulmonic valves, closure is associated with the dicrotic notch on the aortic pressure tracing. See Fig. 9.22. PTS: 1

REF: Page 287, Fig. 9.22

42. At what point in the figure do the atrioventricular valves close?

a. b. c. d.

B D E F

ANS: C

The atrioventricular valves close at the beginning of ventricular systole. See Fig. 9.22.

PTS: 1

REF: Page 287, Fig. 9.22

43. When does the atrial kick begin? a. Just before atrial systole b. During atrial repolarization c. During the impulse delay in the atrioventricular node d. Simultaneously with ventricular excitation ANS: C

As the impulse travels through the atrioventricular node, there is a 100-ms delay in conduction. This delay is important because it allows the atria to become fully depolarized and contract before ventricular excitation begins. This allows the atria to contract and empty, which has been dubbed atrial kick, contributing to optimal ventricular filling. PTS: 1

REF: Page 276

44. Which of the following is true concerning junctional rhythms? a. They produce no P waves b. They can produce inverted P waves c. They are only generated high in the atrioventricular node d. Their rates can vary from 60 to 80 beats/min ANS: B

Junctional rhythms are impulses that originate in or near the atrioventricular node. The P wave may precede, coincide with, or follow the QRS, depending on the relative conduction times from the impulse’s site of origin in the atrioventricular node to the atria and ventricles. Impulses generated high in the atrioventricular node are likely to be associated with a P wave EpRu.lsCesOgMenerated low in the atrioventricular that occurs before the QRSTcEoS mT plBexA,NwKhS erE eaLsLim node result in a P wave that follows the QRS complex. Because of retrograde transmission of the impulse into the atria, the P wave appears inverted in the electrocardiogram leads that face the left side of the heart: leads II, III, and aVF. PTS: 1

REF: Page 288

45. The a wave on an arterial pressure tracing is a result of which of the following during a

cardiac cycle? a. Atrial systole b. Atrial diastole c. Ventricular systole d. Ventricular diastole ANS: A

Atrial systole is indicated on the atrial pressure tracing as an a wave. PTS: 1

REF: Page 293

46. The atrial kick becomes important to ventricular filling during which of the following? a. Atrial flutter b. Atrial fibrillation c. Ventricular asystole d. Ventricular tachycardia

ANS: D

The atrial kick occurs just before the beginning of ventricular systole. Contraction of the atria normally contributes only a small amount of blood to ventricular filling. However, it can contribute a significant amount of blood to ventricular filling if the heart rate is increased and the period of diastasis is reduced. This occurs during ventricular tachycardia, because the higher heart rate results in a reduction in the volume of blood that passively enters the ventricle during atrial diastole. PTS: 1

REF: Page 292

47. On an atrial pressure tracing, which wave corresponds to atrial diastole? a. a wave b. c wave c. R wave d. P wave ANS: B

The c wave occurs at the beginning of atrial diastole and coincides with the period of ventricular systole and is associated with a transient increase in atrial pressure as the pressure in the ventricle increases and forces the closed atrioventricular valves backward into the atrial chamber. PTS: 1

REF: Page 292

48. Closure of the semilunar valves and opening of the atrioventricular valves is associated with

which heart sound? a. S1 b. S2 c. S3 d. S4 ANS: B

The second heart sound occurs at the beginning of ventricular relaxation and is associated with closure of the semilunar valves and opening of the atrioventricular valves. The first heart sound occurs at the onset of ventricular contraction and is associated with closure of the atrioventricular valves and opening of the semilunar valves. The third heart sound occurs during early ventricular filling, and the fourth heart sound occurs during atrial contraction. PTS: 1

REF: Page 293

49. A phonocardiogram is used to detect which of the following heart sounds? a. S1 and S2 b. S2 and S3 c. S3 and S4 d. S1 and S4 ANS: C

S3 and S4 are not typically heard with a stethoscope, but these sounds can be amplified and recorded graphically with a phonocardiogram. PTS: 1

REF: Page 293

50. The cuff of a sphygmomanometer should be inflated to

mm Hg above the point when

the radial pulse disappears. a. 10 b. 20 c. 30 d. 40 ANS: C

The examiner should inflate the cuff to a pressure approximately 30 mm Hg above the pressure at which the radial pulse disappears. PTS: 1

REF: Page 293

51. The first sound heard, by stethoscope, when deflating a sphygmomanometer cuff is known as

which of the following? a. Atrial systole b. Systolic pressure c. First heart sound d. Diastolic pressure ANS: B

The pressure at which a tapping sound is first heard as the cuff is deflated is the systolic pressure. PTS: 1

REF: Page 294

52. Falsely elevated systolic and diastolic blood pressure readings can occur when using either a

manual or an automatic syT steEmST beBcA auNseKoSfEwLhL icE hRo. f tC hO e fMollowing? a. Improper positioning b. Motion artifacts c. Undersized cuff d. Improper inflation ANS: C

An undersized cuff can falsely elevate readings in both manual sphygmomanometers and automated blood pressure monitoring systems. PTS: 1

REF: Page 294

53. The proximal opening on a pulmonary artery catheter is used to measure a. cardiac output (CO). b. central venous pressure. c. pulmonary artery pressure. d. pulmonary capillary wedge pressure. ANS: B

In standard balloon rotation catheters, one lumen connects to a balloon at the tip of the catheter. A second lumen runs the length of the catheter and terminates at a port at the distal end of the catheter. The second lumen’s distal port can be used to monitor pulmonary artery systolic and diastolic pressures, as well as pulmonary artery occlusion pressure (PAOP); this pressure is also often referred to as the pulmonary artery wedge pressure). It can also be used to obtain mixed venous blood samples when the catheter’s distal end is positioned in the pulmonary artery. PTS: 1

REF: Page 294

54. The thermistor is located a. 2 b. 10 c. 30 d. 50

cm back from the tip of a pulmonary artery catheter.

ANS: A

The fourth lumen of a specially designed thermodilution catheter contains electrical wires, known as the thermistor, that is located approximately 2 cm from the tip of the catheter. PTS: 1

REF: Page 296

55. Which port on a Swan-Ganz catheter is used to measure CO? a. Distal b. Inflation c. Proximal d. Thermistor ANS: D

The thermistor is used to perform a thermodilution CO measurement. The distal port is used to measure pulmonary pressure and when the balloon is inflated it is used to measure pulmonary capillary wedge pressure. The balloon is inflated from the inflation port. The most proximal port is used to measure central venous pressure. PTS: 1

REF: Page 298

56. Which of the following lumens will appear on a cross-sectional view of a triple-lumen

pulmonary artery catheter at 20 cm back from the tip? 1. Distal 2. Inflation 3. Proximal 4. Thermistory a. 1 and 3 b. 2 and 4 c. 1, 2, and 4 d. 2, 3, and 4 ANS: C

The proximal port of a triple-lumen pulmonary catheter is located 30 cm back from the tip of the catheter.

PTS: 1

REF: Page 298

57. Other than air, the gas that is commonly used to inflate the balloon on a pulmonary artery

catheter is a. helium. b. nitrogen. c. oxygen. d. carbon dioxide. ANS: D

CO2 is sometimes used to inflate the balloon because if the balloon should rupture, the CO2 is absorbed by the tissues rather than causing an air embolism. PTS: 1

REF: Page 298

58. The right-heart catheterization waveform in the figure that represents pressure in the right

ventricle is which of the following?

a. b. c. d.

A B C D

ANS: B

The pressure tracing from a right-heart catheterization will first show the right atrial pressure tracing, followed by the right ventricle. PTS: 1

REF: Page 299, Fig. 9.28

59. Pulmonary artery occlusion pressure can be used to estimate a. left-atrial preload. b. left-atrial afterload. c. left-ventricular end-diastolic pressure. d. right-ventricular end-diastolic pressure. ANS: C

Pulmonary artery wedge pressure, or pulmonary artery occlusion pressure, is used as an estimate of left atrial pressure and thus preload of the left ventricle, or left-ventricular end-diastolic pressure. PTS: 1

REF: Page 298

60. A pulmonary artery catheter introduced via the antecubital route is currently at the 50-cm

mark and is showing the tracing below. Is there a problem with this catheter?

a. b. c. d.

Yes; the balloon has ruptured. No; it is in the pulmonary artery. Yes; it is knotted in the right ventricle. No; it is wedged in a pulmonary capillary.

ANS: C

When a pulmonary artery catheter is introduced through the antecubital route, the distance required to enter the pulmonary artery is between 40 and 50 cm. A catheter in at the 50-cm mark should be showing a pulmonary artery tracing. This waveform is a right ventricular waveform. Therefore, the cTaE thS etTerBm t bSeEkLnL otE teR d. inCtO heMright ventricle. AuNsK PTS: 1

REF: Page 299, Fig. 9.28

61. Rupture of the pulmonary artery catheter balloon can cause which of the following? a. Atrial flutter b. Air embolism c. Pneumothorax d. Pulmonary infarction ANS: B

If air is used to inflate the balloon and the balloon ruptures, an air embolism is possible. PTS: 1

REF: Pages 297-298

62. Which of the following is a type of pressure transducer that uses a metal bellows and a

Wheatstone bridge? a. Resistive (or resistance) b. Strain gauge c. Variable inductance d. Variable capacitance ANS: A

A resistive (or resistance) transducer consists of a thin metal bellows attached to four wires, forming a Wheatstone bridge. The variable capacitance transducer has a flexible diaphragm to sense pressure changes, but it is linked to an electrode. A variable inductance transducer consists of a stainless steel diaphragm attached to a soft iron core positioned between two coils. PTS: 1

REF: Page 300

63. What is the CO when oxygen (O2) consumption = 200 mL/min, arterial O2 content = 21 vol%,

and mixed venous O2 content = 15 vol%? a. 3.3 mL/min b. 4.3 mL/min c. 5.3 mL/min d. 6.3 mL/min ANS: A

CO = oxygen consumption ÷ (arterial O2 content − mixed venous O2 content). 21 vol% = 21 mL/100 mL and 15 vol% = 15 mL/100 mL. Therefore, 200 mL/min ÷ (21 mL/100 mL − 15 mL/100 mL) 10 = 3.3 mL/min. PTS: 1

REF: Pages 300-301

64. What is the CO when O2 consumption = 180 mL/min, arterial O2 content = 18.4 vol%, and

mixed venous O2 content = 14.4 vol%? a. 4.5 mL/min b. 5.5 mL/min c. 6.5 mL/min d. 7.5 mL/min ANS: A

CO = oxygen consumption ÷ (arterial O2 content − mixed venous O2 content). 18.4 vol% = 18.4 mL/100 mL and 14.4 vol% = 14.4 mL/100 mL. Therefore, 180 mL/min ÷ (18.4 mL/100 mL − 14.4 mL/100 mL) 10 = 4.5 mL/min. PTS: 1

REF: Pages 300-301

65. What is the CO, by using the direct Fick method, for a patient with the following

hemodynamic values? PaO2 = 80 mm Hg SaO2 = 90% Hb = 14 gm% = 35 mm Hg = 65% PB = 760 mm Hg a. b. c. d.

= 210 mL/min 3.5 mL/min 4.36 mL/min 5.83 mL/min 6.15 mL/min

ANS: B

CaO2 = (Hb  1.34) SaO2 + (SaO2  0.003). CaO2 = (14 gm%  1.34) 0.90 + (80 mm Hg  0.003). CaO2 = 17.12 vol%.

= (Hb  1.34) +(  0.003). = (14 gm%  1.34) 0.65 + (35  0.003). = 12.3 vol%. Q= ÷ (CaO2 – ) 10. Q = 210 mL/min ÷ (17.12 mL/100 mL − 12.3 mL/100 mL) 10. Q = 4.36 mL/min. PTS: 1

REF: Pages 300-301

66. What is the cardiac index (CI) when CO = 5.0 mL/min and body surface area (BSA) = 2.9

m2 ? a. 1.72 L/min/m2 b. 1.67 L/min/m2 c. 2.10 L/min/m2 d. 12.5 L/min/m2 ANS: A

CI = /BSA. CI = 5.0 mL/min ÷ 2.9 m2. CI = 1.72 mL/min/m2. PTS: 1

REF: Page 304

67. Which of the following formulas represents CO? a. CO = CI  BSA b. CO = stroke volume  T STBANKSELLER.COM BE SA c. CO = heart rate  stroke volume d. CO = oxygen consumption  (CAO2 − CaO2) ANS: C

CO can be calculated by multiplying the heart rate by the stroke volume. PTS: 1

REF: Pages 300-301

68. Right-ventricular afterload can be estimated by using which equation? a. (MAP)  (SV)  (0.00136) b. (MPAP)  (SV)  (0.00136) c. (MAP − MRAP/CO)  80 d. (MPAP − MLAP/CO)  80 ANS: D

The right-ventricular afterload is the resistance the right ventricle must overcome to eject blood and is estimated from calculations of pulmonary vascular resistance, which is expressed as mean pulmonary artery pressure (MPAP) minus mean left atrial pressure (MLAP) divided by CO or pulmonary blood flow multiplied by a factor of 80. PTS: 1

REF: Page 305

69. Systemic vascular resistance is 1700 dynes cm−5. Which of the following is consistent with

this value? a. Elevated left-ventricular afterload b. Elevated right-ventricular afterload c. Decreased left-ventricular preload d. Decreased right-ventricular preload ANS: A

The normal range for systemic vascular resistance is 900 to 1500 dynes cm−5. Preload is defined as the filling pressure of the ventricles at the end of ventricular diastole. Afterload represents the resistance the ventricles must overcome to eject blood. Therefore, an elevated systemic vascular resistance would cause an elevated left-ventricular afterload. PTS: 1

REF: Page 305

70. Which of the following represents the port on a pulmonary artery catheter used to take

measurements that estimate right-ventricular end-diastolic pressure? a. Distal b. Balloon c. Proximal d. Thermistor ANS: C

The proximal port of a pulmonary artery catheter rests in the right atrium and is used to obtain central venous pressure. Central venous pressure is used to estimate the right-ventricular end-diastolic pressure. The distal port is used to measure pulmonary artery pressure. The distal port is also used to measure the pulmonary artery wedge pressure, which is an ChOeMthermistor is used to measure CO. estimation of left-ventriculT arEeSnT d-B diAasNtoKlS icEpL reL ssEuR re. .T PTS: 1

REF: Page 301

71. How long are adult pulmonary artery catheters? a. 60 cm b. 80 cm c. 100 cm d. 110 cm ANS: D

The standard balloon flotation catheter is 110 cm long. The pediatric catheter is 60 cm long. PTS: 1

REF: Page 296

72. The display from the proximal port of a pulmonary artery catheter reads 12 cm H2O. This

measurement is which of the following? a. Stroke work index b. Central venous pressure c. Pulmonary artery pressure d. Pulmonary capillary wedge pressure ANS: B

The measurement made at the proximal port of a pulmonary artery catheter is the central venous pressure.

PTS: 1

REF: Page 298

73. Which of the following is defined as the resistance that a ventricle must overcome to eject

blood? a. Stroke work b. Stroke index c. Ventricular preload d. Ventricular afterload ANS: D

Afterload represents the resistance the ventricles must overcome to eject blood. Stroke work is defined as the force that a ventricle must produce to move a volume of blood. Stroke index refers to stroke work indexed to the BSA of the patient. Preload is defined as the filling pressure of the ventricles at the end of ventricular diastole. PTS: 1

REF: Page 304

74. Which of the following will cause an increase in systemic vascular resistance? a. Hydralazine b. Nitroglycerin c. Polycythemia d. Moderate hypoxemia ANS: C

Polycythemia increases the blood viscosity, which makes it more difficult for the heart to pump the blood, resulting in an increase in systemic vascular resistance. Moderate hypoxemia, hydralazine, and nitroglyceTrE inSaT ll B reAdN ucKeSsyEsL teL mEicRv.aC scOuM lar resistance. PTS: 1

REF: Page 306

75. Which of the following can increase pulmonary vascular resistance? a. Alveolar hypoxia b. Moderate hypoxemia c. Decreased parasympathetic tone d. Recruitment of pulmonary vessels ANS: A

The pulmonary vascular resistance can increase significantly during periods of alveolar hypoxia. PTS: 1

REF: Page 306

76. Which of the following events can lead to ventricular fibrillation? a. A ventricular rate of ninety beats a minute b. A premature ventricular beat that occurs during the T wave c. The presence of saw tooth waves instead of P waves on an electrocardiogram d. An increased width of the QRS complex ANS: B

A ventricular rate of ninety beats a minute is within normal limits. A premature ventricular beat during the T wave would be immediately after the relative refractory period and could lead to ventricular tachycardia or ventricular fibrillation. Saw toothed waves instead of P waves indicate that atrial flutter is present. An increased width of the QRS is associated with any ventricular arrhythmia. PTS: 1

REF: Page 289

77. Which of the following lumens found in a standard balloon floatation catheter would be used

to obtain a mixed venous blood sample? a. Balloon lumen b. Distal lumen c. Proximal lumen d. Thermodilution lumen ANS: B

The balloon lumen is used to inflate the balloon; this is done during insertion of the catheter and measurement of wedge pressure. The distal lumen is positioned in a branch of the pulmonary artery; it is used to measure pulmonary artery pressure, pulmonary artery occlusion pressure, and to obtain mixed venous blood sample. The proximal lumen is positioned in the right atrium and is used to measure central venous pressure. The thermodilution lumen is used to measure CO. PTS: 1

REF: Page 296

78. Which of the following is a normal range for left ventricular stroke work index (LSWI)? a. 0.5 to 0.6 kg-m/m2 b. 0.07 to 0.1 kg-m/m2 c. 0.1 to 0.12 kg-m/m2 d. 0.2 to 0.3 kg-m/m2 ANS: A

The LSWI normally ranges from 0.5 to 0.6 kg-m/m2, and the right ventricular stroke work index (RSWI) from 0.07 to 0.1 kg-m/m2. PTS: 1

REF: Page 306

79. Which of the following conditions will cause an increase in the amount of work the ventricle

must perform? 1. An increase in the stroke volume 2. An increase in the mean pressure 3. A decrease in the stroke volume 4. A decrease in the mean pressure a. 1 and 4 b. 2 and 3 c. 1 and 2 d. 2 only ANS: C

It should be apparent from these equations that conditions that increase the stroke volume or mean pressure generated by the ventricles increase the amount of work the ventricle must perform. PTS: 1

REF: Page 306

Chapter 10: Blood Gas Monitoring Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. Which of the following are the most common sites for the percutaneous sampling of arterial

blood for blood gas analysis? 1. Earlobe 2. Radial artery 3. Brachial artery 4. Side of the heel a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1 and 4 ANS: B

Specimens for arterial blood gas analysis can be drawn from a peripheral artery by means of a percutaneous needle puncture or from an indwelling intravascular cannula. Blood is most often drawn from the radial, brachial, or femoral arteries or the dorsalis pedis artery of the foot. PTS: 1

REF: Page 310

2. Which of the following statements is true concerning capillary blood gases? a. They can be drawn from TEthSeThBeeAl.NKSELLER.COM b. They correlate with arterial blood gases. c. They can be drawn from a peripheral artery. d. They require the performance of an Allen test. ANS: A

Capillary blood samples from an earlobe or the side of the heel can be substituted when arterial blood cannot be obtained, although the results may vary considerably from arterial blood gas values. PTS: 1

REF: Page 310

3. When a negative Allen, blood for blood gas analysis should be drawn from which of the

following sites? a. Earlobe b. Radial artery c. Brachial artery d. Side of the heel ANS: C

Another sampling site, such as the brachial artery, should be chosen if the result of a modified Allen test is negative. PTS: 1

REF: Page 310

4. The purpose of an Allen test is to check blood flow in the

artery.

1. ulnar 2. brachial 3. posterior tibial 4. lateral plantar a. 1 and 2 b. 2, 3, and 4 c. 1, 3, and 4 d. 3 and 4 ANS: C

An Allen test should always be done before a radial artery puncture is performed to ensure that there is collateral circulation in the ulnar artery. An Allen type of test should be performed to ensure collateral circulation in the posterior tibial and lateral plantar arteries when drawing arterial blood from the dorsal artery of the foot. PTS: 1

REF: Page 310

5. Which is the correct sequence of events when one is obtaining arterial blood from the radial

artery of a patient? 1. Perform the modified Allen test. 2. Remove any air bubbles from the sample. 3. Apply direct pressure to the puncture site. 4. Clean the puncture site with a suitable antiseptic solution. 5. Use a needle and a plastic syringe containing an anticoagulant. a. 1, 4, 3, 5, 2 b. 4, 1, 5, 2, 3 c. 1, 4, 5, 3, 2 d. 1, 5, 2, 4, 3 ANS: C

Collateral circulation must be ensured before the puncture by performing a modified Allen test. After the test shows sufficient collateral circulation, the site should be prepared for the puncture by cleaning with a suitable antiseptic solution. Blood samples should be obtained with a small-gauge needle (i.e., 23 to 25 gauge). After blood has been withdrawn and the needle removed, direct pressure should be applied to the puncture site to prevent the formation of a hematoma. Air bubbles should then be removed because their presence can produce erroneous measurements. PTS: 1

REF: Pages 310-311

6. Which size of needle should be used to draw arterial blood from an adult? a. 22 gauge b. 23 gauge c. 26 gauge d. 28 gauge ANS: B

Blood samples from adult patients should be obtained with 23- to 25-gauge needles. PTS: 1

REF: Page 312

7. Which is the correct order of steps to perform the modified Allen test?

1. Pressure is applied to both the radial and the ulnar arteries. 2. The fist is opened but not fully extended. 3. Pressure on the ulnar artery is removed. 4. The hand is clenched into a tight fist. 5. The palm and fingers are blanched. a. 4, 1, 2, 5, 3 b. 4, 5, 1, 3, 2 c. 1, 4, 3, 2, 5 d. 4, 2, 1, 3, 5 ANS: A

The order for the modified Allen test is as follows: (1) the hand is clenched into a tight fist; (2) pressure is applied to both the radial and the ulnar arteries; (3) the hand is opened but not fully extended; (4) the palm and fingers are blanched; and (5) pressure on the ulnar artery is removed—this should result in flushing of the entire hand. PTS: 1

REF: Page 313, Fig. 10.1

8. Capillary blood gas samples should be used to measure which of the following?

1. Partial pressure of arterial carbon dioxide (PaCO2) 2. Partial pressure of arterial oxygen (PaO2) 3. pH 4. Hemoximetry oxygen saturation (SaO2) a. 1 and 3 b. 2 and 3 c. 1 and 4 d. 1 and 2 ANS: A

The correlation between capillary and arterial pH and partial pressure of carbon dioxide (PCO2) measurements is better than the correlation between capillary and arterial partial pressure of oxygen (PO2) measurements. Consequently, capillary blood gases are more often used to discern acid-base balance rather than to assess a patient’s oxygenation status. PTS: 1

REF: Page 312

9. Which of the following factors will cause analysis of blood gas samples to be erroneous?

1. Warming the blood prior to analyzing a sample 2. The presence of air bubbles in the sample 3. Icing the sample between obtaining and analyzing 4. Prolonged time delay between obtaining and analyzing a sample a. 1 and 3 b. 2, 3, and 4 c. 1, 2, and 4 d. 1 and 4 ANS: B

A prolonged delay between obtaining and analyzing a specimen (i.e., longer than 5 minutes) can lead to erroneous results. This problem is particularly evident in patients with high leukocyte counts. Chilling the specimen to below 5C by placing the syringe in ice water can reduce the metabolic rate of the white blood cells, minimizing this problematic effect. PTS: 1

REF: Page 313

10. The maximum amount of blood that should be discarded from the indwelling arterial catheter

of an infant is a. 0.3 b. 0.5 c. 0.8 d. 1.0

mL.

ANS: B

The discarded volume for an infant is typically only approximately 0.2 to 0.5 mL. PTS: 1

REF: Page 312

11. Hydrogen ion activity can be expressed as which of the following? a. pH = log10[H−] b. [H+] = log  10 c. pH = −log10[H+] d. pH = 1  10−7 mol/L ANS: C

Sorenson introduced the term pH as a shorthand way to express the hydrogen ion activity of solutions. It is defined as thTeEnSegTaBtiA veNlK ogSaE riL thL mE(R ba.sC eO 10M) of the hydrogen ion concentration, + or pH = −log10[H ]. PTS: 1

REF: Page 313

12. Acid-base neutrality is expressed as which of the following?

1. pH 14 2. pH <7.0 3. pH 7.0 4. [H+] = [OH−] a. 1 b. 3 and 4 c. 2 and 3 d. 1 and 4 ANS: B

In general chemistry textbooks, a pH of 7 represents universal neutrality, where the concentration of hydrogen ions (1  10−7 mol/L) and hydroxyl ions (1  10−7 mol/L) is equal. This is the pH of pure water. PTS: 1

REF: Page 313

13. Which of the following are true concerning pH?

1. A blood pH 7.50 is alkaline.

2. A blood pH <7.40 is alkaline. 3. A blood pH >7.40 is acidotic. 4. A blood pH 7.30 is acidotic. a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1 and 4 ANS: D

A blood pH that is greater than 7.40 is alkalotic. Therefore, a pH of 7.50 is alkalotic. A blood pH that is less than 7.40 is acidotic. Therefore, a pH of 7.30 is acidotic. PTS: 1

REF: Page 313

14. A standard pH electrode includes which of the following? a. Nylon spacer b. Silver anode c. Mercury bead d. Silicon elastic membrane ANS: C

Refer to Fig. 10.4 on page 324, which shows a schematic of the pH electrode. PTS: 1

REF: Page 315, Fig. 10.4

15. The reference half-cell of a pH analyzer is composed of a. silver anode. b. platinum cathode. c. silver–silver chloride. d. mercury–mercurous chloride. ANS: D

A pH electrode’s second cell is the reference cell. This reference half-cell is composed of mercury–mercurous chloride (Hg/Hg2Cl2), which is immersed in a solution of saturated potassium chloride (KCl). Mercurous chloride is also known as calomel. PTS: 1

REF: Page 318

16. A blood sample is analyzed within a Sanz electrode. The voltage difference = 44.90 mV.

What is the resultant pH of this blood? a. 7.11 b. 7.34 c. 7.57 d. 8.18 ANS: C

A voltage of 61.5 mV is developed for every pH unit difference between the sample and the measuring electrode, which remains 6.84. Therefore, the voltage difference is 44.90 mV divided by 61.5 mV, or 0.73. The resultant pH can be calculated as 6.84 + 0.73 = 7.57. PTS: 1

REF: Page 315

17. A voltage difference of 18.7 mV is measured when a blood sample is being analyzed for pH.

What is the resultant pH of the blood? a. 7.54 b. 7.34 c. 7.14 d. 8.71 ANS: C

A voltage of 61.5 mV is developed for every pH unit difference between the sample and the measuring electrode, which remains 6.84. Therefore, the voltage difference is 18.7 mV divided by 61.5 mV, or 0.30. The resultant pH can be calculated as 6.84 + 0.30 = 7.14 PTS: 1

REF: Page 315

18. In a PCO2 electrode, carbon dioxide does which of the following?

1. It reacts with potassium chloride. 2. It reacts with water to form carbonic acid. 3. It diffuses through a polyethylene membrane. 4. It diffuses through a semipermeable Teflon membrane. a. 2 and 3 b. 1 and 3 c. 1 and 4 d. 2 and 4 ANS: D

A PCO2 electrode is basically a pH electrode covered with a carbon dioxide–permeable Teflon or silicone (Silastic) membrane. A bicarbonate-buffered solution is held between the ES Teflon membrane and the T pH glT asBsAelNecKtS roE deLbLyEaRn.yC loO n Mspacer. CO2 from the blood diffuses across the semipermeable Teflon membrane and reacts with the water to form carbonic acid, which dissociates into hydrogen ions and bicarbonate. PTS: 1

REF: Page 316

19. Which chemical reaction occurs within the Stow-Severinghaus electrode? a. CO2 + H2O → H2CO3 → H+ + HCO3− b. O2 + 2H2O + 4e− → 4OH− c. 4Ag → 4Ag+ + 4e− d. EH+ = 0.0615  pH ANS: A

The Stow-Severinghaus electrode is the standard PCO2 electrode. Within the electrode, CO2 from the blood diffuses across the Teflon membrane and reacts with water to form carbonic acid, which dissociates into hydrogen ions and bicarbonate. The reaction can be written as CO2 + H2O → H2CO3 → H+ + HCO3−. The hydrogen ions from the bicarbonate-buffered solution then diffuse across the glass electrode, and the pH of the solution is measured as it is in the pH electrode. PTS: 1

REF: Page 315 | Page 328

20. The Henderson-Hasselbalch equation is used in acid-base analysis to relate which of the

following?

a. b. c. d.

pH to PCO2 pH to bicarbonate (HCO3−) Carbonic acid (H2CO3) to HCO3− PO2 to oxygen saturation

ANS: B

A modified version of the Henderson-Hasselbalch equation is used in the PCO2 electrode to relate the pH measured to the PCO2 of the blood. Therefore, the PCO2 is determined as a function of the change in pH of the bicarbonate solution in the PCO2 electrode. PTS: 1

REF: Page 316

21. If the PCO2 of an arterial blood sample is 60 mm Hg, the expected pH is a. 7.20. b. 7.30. c. 7.50. d. 7.60. ANS: A

The pH changes by 0.1 unit for every 10-mm Hg increase in PCO2. Therefore, a PCO2 of 60 mm Hg is 20 mm Hg higher than normal, which equates to 2  0.1 = 0.2 decrease in pH from normal, or 7.40 − 0.2 = 7.20 PTS: 1

REF: Page 314, Table 10.3

22. Erroneous PCO2 measurements can be caused by which of the following?

1. A worn electrode 2. A cracked electrode 3. Increased temperature of the patient 4. Dehydration of bicarbonate solution a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1, 2, and 4 ANS: D

The most common problems encountered with a PCO2 electrode involve interference with the diffusion of CO2 across the Teflon membrane and the H+ ions across the glass membrane from either worn or cracked electrodes or protein deposits. If the bicarbonate solution dehydrates between the Teflon membrane and the pH glass electrode, erroneous data can result. PTS: 1

REF: Page 316

23. Which of the following electrodes measures the PO2 in the blood? a. Sanz b. Severinghaus c. Pauling d. Clark ANS: D

The PO2 in the blood is most commonly measured by using the Clark electrode. The Sanz electrode is used to measure pH. The Severinghaus electrode is used to measure PCO2. Pauling is a type of oxygen analyzer. PTS: 1

REF: Page 316

24. The PCO2 electrode uses which of the following? a. HCO3− solution b. Mercury bead c. KCl solution d. Silver anode ANS: A

Between the Teflon membrane and the pH glass electrode is a bicarbonate-buffered solution. A mercury bead is part of a pH electrode. A KCl solution is used in the pH electrode. A silver anode is used in the Clark electrode. PTS: 1

REF: Page 316

25. What is the pH of the phosphate buffer solution in a Sanz electrode? a. 6.84 b. 7.00 c. 7.32 d. 7.90 ANS: A

The phosphate buffer solution in the pH electrode has a pH of 6.84. PTS: 1

REF: Page 314

26. Which reaction occurs at the platinum cathode of the Clark electrode? a. CO2 + H2O → H2CO3 → H+ + HCO3− b. AgCl + KCl → Ag2 + Cl2 + K c. O2 + 2H2O + 4e− → 4OH− d. 4Ag → 4Ag+ + 4e− ANS: C

Oxygen from the blood sample diffuses across the semipermeable plastic membrane into the KCl solution and reacts with the platinum cathode, altering the conductivity of the electrolyte solution. The platinum cathode donates electrons, which reduce oxygen to produce hydroxyl ions. PTS: 1

REF: Page 316

27. Which of the following represents the technique used to measure current changes that occur

when oxygen is reduced? a. Blood gas factor b. Potentiometric c. Amperometric d. Tonometry ANS: C

The PO2 is determined by measuring current changes that occur as oxygen is reduced, hence the technique represents an amperometric measurement. The blood gas factor is a phenomenon due to the slow rate of oxygen diffusion in fluids (i.e., oxygen consumed by an electrode is not replaced by oxygen from the blood). Measurements based on voltage changes are called potentiometric measurements. Tonometry is a measure of pressure and a method of quality control for arterial blood gas machines. PTS: 1

REF: Page 316

28. The blood gas factor results from the a. slow rate of oxygen diffusion in fluids. b. slow rate of carbon dioxide diffusion in blood. c. amount of carbon dioxide necessary to change the pH by 0.01. d. quantity of electrons that need to be added to the silver anode to reduce oxygen. ANS: A

When blood samples are analyzed, the consumption of oxygen by the electrode leads to an underestimation of the PO2 in a blood sample by 2% to 6%. This phenomenon is due to the slow rate of oxygen diffusion in fluids (i.e., oxygen consumed by an electrode is not replaced by oxygen from the blood). The magnitude of the blood gas factor depends on the diameter of the cathode and the thickness of the membrane between the sample and the cathode. PTS: 1

REF: Page 317

29. Exposure of a Clark electrode to gaseous anesthetic agents such as nitrous oxide will cause

which of the following to occur? a. The pH will increase. b. The electrode will function normally. c. There will be an increase in the production of peroxide ions. d. The carbon dioxide in the blood will increase and cause an erroneous reading. ANS: C

Exposure of the PO2 electrode to nitrous oxide might alter its electronic output by increasing the production of peroxide ions. PTS: 1

REF: Page 316

30. Which of the following variables are measured directly by a blood gas machine?

1. pH 2. PaO2 3. HCO3− 4. SaO2 a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1 and 4 ANS: A

The pH is measured directly by using a Sanz electrode. The PaO2 is measured directly by using a Clark electrode. The HCO3− is derived from measurements of pH and PaCO2 is derived by using the Henderson-Hasselbalch equation. The saturation of hemoglobin can be calculated by using an equation empirically derived from the oxyhemoglobin saturation curve. PTS: 1

REF: Pages 317-318

31. Which of the following variables can be calculated from measured arterial blood gas values?

1. P50 2. PCO2 3. HCO3− 4. SaO2 a. 1, 2, and 3 b. 2 and 4 c. 1, 3, and 4 d. 2 and 3 ANS: C

The P50 can be derived by using the oxyhemoglobin dissociation curve to look for the PaO2 at 50% hemoglobin saturation. The HCO3− is derived from measurements of pH and PaCO2 by using the Henderson-Hasselbalch equation. The saturation of hemoglobin can be calculated by using an equation empirically derived from the oxyhemoglobin saturation curve. The pH is measured directly by using a Sanz electrode, and the PaO2 is measured directly by using a Clark electrode. PTS: 1

REF: Pages 317-318

32. A P50 measurement refers to which of the following? a. The amount of oxygen diffusion in fluids b. The PO2 when hemoglobin is 50% saturated with oxygen c. The partial pressure of fetal hemoglobin at 50% saturation d. The PO2 consumed by the oxygen electrode ANS: B

P50 is a way of describing hemoglobin affinity for oxygen because it identifies the PO2 in millimeters of mercury when hemoglobin is 50% saturated with oxygen. PTS: 1

REF: Pages 317-318

33. Which of the following will cause a left shift in the oxyhemoglobin dissociation curve? a. Methemoglobin b. Acute acidosis c. Increased temperature d. High 2,3-diphosphoglycerate (2,3-DPG) ANS: A

Methemoglobin will increase hemoglobin’s affinity, causing a left shift in the oxyhemoglobin dissociation curve. Acute acidosis, hyperthermia, and increased levels of 2,3-DPG will decrease hemoglobin affinity. PTS: 1

REF: Pages 317-318

34. Which of the following will decrease oxygen’s affinity for hemoglobin? a. Increased CO2 b. Acute alkalosis c. Methemoglobin d. Hypothermia ANS: A

Increased CO2 causes acidosis, which decreases hemoglobin’s affinity for oxygen. Acute alkalosis, methemoglobin, and hypothermia cause left shifts in the oxyhemoglobin dissociation curve. PTS: 1

REF: Page 317, Fig. 10.8

35. Which of the following would create the highest P50? a. pH 7.40 b. pH 7.50 c. PCO2 = 40 mm Hg d. PCO2 = 60 mm Hg ANS: D

A pH of 7.40 creates a normal oxyhemoglobin dissociation curve with a P50 of 27 mm Hg. A pH of 7.50 is indicative of alkalosis and will cause a left shift in the curve, lowering the P50 below 27 mm Hg. A PCO2 of 40 mm Hg is normal and will not cause a change in the P50 from the normal 27 mm Hg. However, a PCO2 of 60 mm Hg is acidotic and will shift the curve to the right, causing the P50 to be greater than normal. PTS: 1

REF: TPE agSesT3B1A 7-N 31K8SELLER.COM

36. Which of the following would create the lowest P50? a. pH 7.26 b. pH 7.35 c. PCO2 = 32 mm Hg d. Temperature = 39C ANS: C

A pH of 7.26 and 7.35 are acidotic and will cause a right shift in the oxyhemoglobin dissociation curve, increasing the P50 above 27 mm Hg (normal). A PCO2 of 32 mm Hg indicates alkalosis and will shift the oxyhemoglobin dissociation curve to the left, lowering the P50 below 27 mm Hg. A temperature of 39C is hyperthermia and will cause a right shift in the curve, increasing the P50 above 27 mm Hg. PTS: 1

REF: Pages 317-318

37. Standard bicarbonate is calculated by use of which of the following? a. Henderson-Hasselbalch equation b. Two-point calibration method c. Lambert-Beer law equation d. Levy-Jennings chart ANS: A

HCO3− is derived from measurements of pH and PaO2 by using the Henderson-Hasselbalch equation. A two-point calibration is a quality assurance test that is performed at least three times daily for the measuring electrodes. The Lambert-Beer law is applied in oximetry to determine the concentration of hemoglobin. A Levy-Jennings chart is used to record quality control data for a blood gas machine. PTS: 1

REF: Page 329

38. Normal plasma bicarbonate levels are a. 15 to 25 b. 22 to 26 c. 30 to 40 d. 44 to 48

mmol/L.

ANS: B

Plasma bicarbonate levels normally range from 22 to 26 mmol/L. PTS: 1

REF: Page 330

39. Which of the following are considered a buffer base? a. A metabolite solution b. An electrolyte-specific solution c. The solution used to perform a three-point calibration d. Hemoglobin, inorganic phosphate, and negatively charged proteins ANS: D

The buffer base represents the sum of all the anion buffers in the blood, including bicarbonate, hemoglobin, inorganic phoTspEhSatTeB , aAnN dK neSgE atL ivLelEyRc. haCrgOeM d proteins. PTS: 1

REF: Page 318

40. What type of electrode is used to measure calcium and sodium? a. Clark b. Ion-selective c. Polarographic d. Glucose-oxidase ANS: B

The sensors used for electrolyte measurements are ion-selective electrodes. A Clark electrode is used to measure the PO2 in the blood. A polarographic electrode is a Clark electrode. Glucose-oxidase is an enzyme that is used to coat the ion-selective electrode used to measure glucose. PTS: 1

REF: Page 318

41. The Siggaard-Andersen alignment nomogram is used for which of the following? a. Calculating pH b. Measuring PCO2 c. Calculating sodium (Na+), potassium (K+), chloride (Cl−), and calcium (Ca++) d. Calculating actual and standard bicarbonate ANS: D

The Siggaard-Andersen alignment nomogram is used to calculate the actual and standard bicarbonate, buffer base, and base excess concentrations. PTS: 1

REF: Page 318

42. Which of the following plasma electrolyte levels are outside the normal range?

1. Total calcium 7.4 mEq/L 2. Potassium 4.2 mEq/L 3. Chloride 115 mEq/L 4. Sodium 155 mEq/L a. 1, 3, and 4 b. 3 and 4 c. 1 and 2 d. 2 ANS: A

Normal values for the plasma electrolytes are as follows: Total calcium, 9.9 to 11 mEq/L; potassium, 3.5 to 5.0 mEq/L; chloride, 98 to 106 mEq/L; and sodium 136 to 145 mEq/L. Therefore, the total calcium is low, the chloride is high, and the sodium is high. PTS: 1

REF: Page 318, Table 10.4

43. What is responsible for the conversion of glucose to hydrogen peroxide and gluconic acid on

the surface of the glucose electrode? a. Hydrogen peroxide b. Phosphodiesterase c. Glucagon oxidase d. Glucose oxidase ANS: A

As a blood sample comes in contact with the measuring electrode of the glucose sensor, the glucose oxidase on the surface of the electrode converts the glucose in the sample to hydrogen peroxide and gluconic acid. PTS: 1

REF: Page 318

44. What type of calibration should be performed after an electrode is changed? a. Quality control b. Three-point c. Two-point d. One-point ANS: B

A three-point calibration should be performed every 6 months or whenever an electrode is replaced. A two-point calibration is usually performed at least three times daily, typically every 8 hours. In many cases, analyzers can be programmed to perform a two-point calibration at predetermined intervals. The one-point calibration involves adjusting the electronic output to a single, known standard and should be performed before an unknown sample is analyzed, unless the analyzer is programmed to perform a one-point calibration automatically at regular intervals, such as every 20 to 30 minutes. Quality control is the system that includes the analysis of control samples and assessment of the measurements against defined limits, identification of problems, and specification of corrective actions. PTS: 1

REF: Page 320

45. The two-point calibration for the pH electrode uses two buffers. Which of the following pH

values are correct for these two buffers? 1. 6.839 2. 6.840 3. 7.384 4. 7.495 a. 1 and 3 b. 1 and 4 c. 2 and 4 d. 2 and 3 ANS: D

The National Institute of Standards and Technology (NIST) and the International Federation of Clinical Chemistry (IFCC) have established standards for the calibration of blood gas electrodes. A one-point calTibEraStiToB nA usNeK s aSnEeL arLlyEnRo.rm CaOl MpH buffer with a pH of 7.384. A second, lower pH buffer, pH 6.840 is analyzed in the two-point calibration to ensure that the electronic output of the electrode is linear over a wide range of pH levels. PTS: 1

REF: Page 320

46. Quality control includes which of the following?

1. Analyzing unknown samples and submitting to the sponsoring organization 2. Assessing control sample measurements against defined limits 3. Addressing problems through corrective actions 4. Identifying problems a. 1 and 2 b. 3 and 4 c. 2, 3, and 4 d. 1, 2, 3, and 4 ANS: C

Quality control is the system that entails the analysis of control samples and assessment of the measurements against defined limits, identification of problems, and specification of corrective actions. The analysis of unknown samples and submitting the analysis results to a sponsoring organization is known as proficiency testing. PTS: 1

REF: Page 320

47. The gold standard for quality control for PCO2 and PO2 electrodes is

a. b. c. d.

capnography. polarography. tonometry. anometry.

ANS: C

Although tonometry remains the gold standard for quality control of PCO2 and PO2 electrodes, most laboratories use commercially prepared quality control systems for biosafety and convenience. PTS: 1

REF: Page 318 | Page 320

48. Which of the following statements is true concerning quality control of a blood gas analyzer? a. Commercially prepared controls ensure instrument accuracy. b. A Levy-Jennings chart is used to record quality control data. c. Protein buildup on electrodes will not cause errors in the instrument. d. Commercial controls are not susceptible to variations at room temperature. ANS: B

The most common method of recording quality control data involves the use of Levy-Jennings charts. These charts allow the operator to detect trends and shifts in electrode performance, which helps prevent problems associated with reporting of inaccurate data because of analyzer malfunction. Commercially prepared control systems provide information on the instrument’s precision—not the accuracy of the data—and are susceptible to variations in room storage temperature. PTS: 1

REF: Page 320

49. What organizations offer proficiency testing programs?

1. The American Association for Respiratory Care (AARC) 2. The American College of Chest Physicians (ACCP) 3. The College of American Pathologists (CAP) 4. The American Thoracic Society (ATS) a. 3 and 4 b. 1 and 2 c. 1 and 3 d. 2, 3, and 4 ANS: A

CAP and ATS currently offer two proficiency testing programs that provide a means of assessing blind samples (periodically) and the technical competence of laboratory personnel, as well as a means of reporting the variability of individual blood gas analyzers. PTS: 1

REF: Page 318 | Page 320

50. Which size of scalp vein needle should be used to draw arterial blood from an infant? a. 22 gauge b. 24 gauge c. 26 gauge d. 28 gauge ANS: C

For infants, a 25- to 26-gauge scalp vein needle can be used to collect arterial samples. PTS: 1

REF: Page 312

51. Absorbance or fluorescent sensors are used with which of the following? a. Capnography b. Photoplethysmography c. In vitro blood gas analysis d. In vivo blood gas analysis ANS: D

In vivo blood gas monitors use optical sensors that are generally categorized in terms of how they modify the initial optical signal; they are classified as either absorbance or fluorescent sensors. Absorbance sensors absorb a fraction of the incident light as it is transmitted down the fiber and through the microcuvette. The amount of light transmitted is proportional to the concentration of the analyte in question. Fluorescent sensors use dyes that fluoresce when they are struck by light in the UV or near-UV visible range. Light from the monitor is transmitted to the microcuvette containing the dye. The concentration of the analyte in question can be measured by determining the ratio of fluorescent light emitted to the original excitation light signal. PTS: 1

REF: Page 321

52. A fluorescent sensor can measure which range of pH values? a. 6.0 to 7.5 b. 6.5 to 7.5 c. 6.8 to 7.8 d. 7.0 to 8.0 ANS: C

Fluorescent sensors can measure pH values from 6.8 to 7.8. PTS: 1

REF: Page 322

53. Which of the following in vivo arterial blood gas values is comparable with in vitro

measurements? a. pH b. PCO2 c. PO2 d. Bicarbonate ANS: A

Compared with in vitro blood gas analysis, intraarterial blood gas monitoring systems are comparable for pH, but the correlation may not be as good for PCO2 and PO2 measurements. PTS: 1

REF: Pages 321-322

54. Which of the following statements are true concerning in vivo arterial blood gas analyzers? a. They incorporate a polarographic electrode. b. The operating principle is light transmission. c. Temperature correction is unnecessary. d. They are more accurate than in vitro blood gas analyzers.

ANS: B

In vivo arterial blood gas monitors use optical sensors and fiberoptic technology for light transmission through the sensors. Polarographic electrodes are not used in vivo. In many cases, temperature corrections might be required because the sensor may be in a peripheral artery, where the measured temperature might not equal the patient’s core temperature. Correlations may not be as good for PCO2 and PO2 as they are for pH and therefore may be less accurate than in vitro blood gas analyzers. PTS: 1

REF: Pages 321-322

55. What type of instrument could be used to analyze pH, PO2, PCO2, and various electrolytes at

the patient’s bedside? a. Point-of-care blood gas analyzer b. CO-oximeter c. Potentiometer d. Capnograph ANS: A

Point-of-care testing typically involves the use of portable devices that can be located at or near the point of patient care. These devices are not only portable but also lightweight, allowing in vitro arterial blood gas and pH measurements to be made in the emergency department, intensive care unit, physician’s office, or a transport vehicle. PTS: 1

REF: Page 322

56. Which of the following is true concerning the typical point-of-care blood gas analyzer? a. It is only able to measuTreEpSHT, B PA aCNOK2S , aEnL dLPE aO R2.. COM b. It measures actual hemoglobin oxygen saturation. c. It uses silicone chips with microelectrodes. d. It requires 1 to 2 mL of blood. ANS: C

Point-of-care blood gas analyzers use solid-state sensors, which rely on either fluorescence technology or thin-film electrodes that have been fabricated onto silicone chips. The microelectrodes are incorporated into a single-use disposable cartridge that also contains calibration reagents, a sampling stylus, and a waste container. PTS: 1

REF: Page 322

57. The relative transmission and/or absorption of portions of the light spectrum are the basis for

which of the following? a. Amperometry b. Plethysmography c. Spectrophotometry d. Potentiometry ANS: C

Oximeters operate on the principle of spectrophotometry, which is based on the relative transmission or absorption of portions of the light spectrum. Amperometry refers to measuring an electrical current at a single applied potential. A plethysmograph is a type of instrument that is used to measure changes in volume within an organ or the entire body. Potentiometry uses changes in voltage to measure pH and PCO2. PTS: 1

REF: Page 325

58. A CO-oximeter identifies the different types of hemoglobin through the use of a. fiberoptics. b. spectrophotometry. c. optical plethysmography. d. potentiometric measurements. ANS: B

Oximeters operate on the principle of spectrophotometry, which is based on the relative transmission or absorption of portions of the light spectrum. PTS: 1

REF: Page 325

59. CO-oximeters routinely measure which of the following?

1. Carboxyhemoglobin 2. Fetal hemoglobin 3. Oxyhemoglobin 4. Methemoglobin a. 1 and 2 b. 1, 3, and 4 c. 3 and 4 d. 2 and 3 ANS: B

Most commercially available CO-oximeters provide measurements of only four types of hemoglobin: O2Hb, deoxyhemoglobin, metHb, and HbCO. Sulfhemoglobin and fetal hemoglobin are not usually determined by means of CO-oximetry. PTS: 1

REF: Page 322

60. A patient with a bilirubin level of 28 mg/dL has arterial blood drawn for CO-oximetry. The

respiratory therapist should expect a(n) a. accurate O2Hb b. lower-than-actual O2Hb c. higher-than-actual O2Hb d. higher-than-actual HbCO

measurement.

ANS: B

The presence of bilirubin in quantities greater than 20 mg/dL of whole blood can alter measurements because it absorbs near-infrared (IR) and IR light. Absorbance of light by bilirubin lowers the actual O2Hb measured. PTS: 1

REF: Page 324

61. What are the two wavelengths of light used to determine hemoglobin saturation with a pulse

oximeter? a. 550 nm and 730 nm b. 660 nm and 940 nm c. 730 nm and 940 nm d. 550 nm and 840 nm ANS: B

O2Hb and deoxygenated hemoglobin (HHb) are differentiated by shining a light with 660-nm and 940-nm wavelengths through the sampling site. PTS: 1

REF: Page 325

62. Which device allows in vitro arterial blood gas and pH measurements in a transport vehicle? a. CO-oximeter b. Pulse oximeter c. Plethysmograph d. Point-of-care analyzer ANS: D

Point-of-care analyzers provide in vitro arterial blood gas and pH measurements, and they are lightweight, portable, and usually battery powered, which makes them perfect for transport use. PTS: 1

REF: Page 322

63. How is the oxygenation status of a burn victim best measured? a. CO-oximeter b. Pulse oximeter c. In vitro blood gas analyzer d. In vivo blood gas monitor ANS: D

Patients who have been in a fire have been exposed to carbon monoxide (CO) and are very likely to have elevated HbCO levels. In vitro and in vivo blood gas analyzers calculate O2Hb levels, so a CO-oximeter is appropriate because it measures the O2Hb directly and will also provide the HbCO level. High levels of HbCO can adversely affect a pulse oximeter because HbCO is relatively transparent to IR light and can lead to an overestimation of pulse oximetry oxygen saturation (SpO2). PTS: 1

REF: Page 321

64. Which of the following techniques allows a pulse oximeter to determine the amount of

hemoglobin in a blood sample? a. Tonometry b. Spectrophotometry c. Fluorescent technology d. Optical plethysmography ANS: B

Pulse oximeters use spectrophotometry to determine the amount of hemoglobin in a blood sample. They use optical plethysmography to estimate the heart rate by measuring cyclic changes in light transmission through the sample site during each cardiac cycle. PTS: 1

REF: Page 325

65. Which of the following could adversely affect the measurement of oxygen saturation?

1. Hypobilirubinemia 2. Peripheral vasodilation 3. Hypothermia 4. Methemoglobin a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1 and 4 ANS: C

Hypothermia causes a low perfusion state, which interferes with the accuracy of a pulse oximeter. Dapsone, an antibiotic used to treat malaria and Pneumocystis carinii, can cause increased levels of metHb, which interferes with the proper function of a pulse oximeter. Hypobilirubinemia is a low bilirubin blood level and will not interfere with a pulse oximeter. Peripheral vasodilation will cause more blood to circulate through the extremities, which is good for pulse oximetry. Peripheral vasoconstriction will affect pulse oximetry readings because low perfusion states are associated with a diminished pulsatile signal, resulting in an intermittent or absent SpO2 reading. PTS: 1

REF: Pages 325-326

TESTBANKSELLER.COM

66. Which of the following are important blood tests to perform on a victim of a fire?

1. Na+ 2. PaO2 3. O2Hb 4. HbCO a. 1 and 2 b. 2 and 3 c. 2, 3, and 4 d. 1, 3, and 4 ANS: C

Patients who have been exposed to fires have a high risk of developing CO poisoning. CO will compete with oxygen for hemoglobin. Therefore, measurements of HbCO, O2Hb, and PaO2 are important for these patients. PTS: 1

REF: Page 324

67. Which of the following statements is true concerning the CO-oximeter measurement of a

patient with a bilirubin level greater than 20 mg/dL in whole blood? a. The O2Hb value will be lower than the actual O2Hb. b. The O2Hb value will be higher than the actual O2Hb. c. The HbCO value will be higher than the actual HbCO level. d. The bilirubin level will not affect the results of the CO-oximeter.

ANS: A

Bilirubin levels of greater than 20 mg/dL of whole blood will alter measurements, because bilirubin absorbs near-IR and IR light. Absorbance of light by bilirubin lowers the actual O2Hb measured. PTS: 1

REF: Page 324

68. What are the two principles of operation for pulse oximetry?

1. Photoplethysmography 2. Tonometry 3. Spectrophotometry 4. Amperometry a. 1 and 3 b. 2 and 4 c. 1 and 4 d. 2 and 3 ANS: A

Pulse oximetry is based on the principles of spectrophotometry and photoplethysmography. PTS: 1

REF: Page 325

69. Shining a red light with a wavelength of 660 nm on a blood sample will cause which of the

following? a. HHb will absorb less light than O2Hb. b. O2Hb will absorb less light than HHb. c. MetHb will absorb lessTlE igS htTtB haAnNOK2S HE b.LLER.COM d. Sulfhemoglobin will absorb more light than HHb. ANS: B

When a light with a wavelength of 660 nm (red light) shines on a sample site, HHb absorbs more light than O2Hb. PTS: 1

REF: Page 325

70. Which site will provide the most accurate pulse oximetry reading in the event of low

peripheral perfusion? a. Toe b. Thumb c. Earlobe d. First digit ANS: C

The earlobe is more central and is not as susceptible to reductions in peripheral perfusion as are the fingers and toes. PTS: 1

REF: Pages 324-325

71. Fractional hemoglobin saturation is calculated from values measured by which of the

following? a. Pulse oximeter

b. CO-oximeter c. Clark electrode d. Severinghaus electrode ANS: B

The fractional hemoglobin saturation is calculated by dividing the amount of O2Hb by the sum of HHb + O2Hb + HbCO + metHb. All four hemoglobin can be measured by a CO-oximeter. A pulse oximeter noninvasively measures oxygen saturation and heart rate only. A Clark electrode measures only the PO2, and a Severinghaus electrode measures the PCO2. PTS: 1

REF: Page 322

72. A patient is being treated with dapsone, an antibiotic, for P. jiroveci infection. Which of the

following ways of measuring oxygen saturation would be most appropriate? a. In vivo blood gas monitoring b. In vitro blood gas monitoring c. Pulse oximetry d. CO-oximetry ANS: D

The use of dapsone causes an increase in metHb, which will interfere with the accuracy of a pulse oximeter. The presence of metHb will decrease the actual saturation of Hb. Therefore, direct measurement of O2Hb is most appropriate in this case. A CO-oximeter will not only measure the O2Hb, but it will also measure the metHb level. PTS: 1

REF: Pages 323-324

lsE eS oxTiB mA etN ryKm 73. Optical shunting during puT SaEyLbLe EcaRu.seCdObMy which of the following? a. Dark skin pigmentation b. Light skin pigmentation c. Hyperbilirubinemia d. Hyponatremia ANS: A

Optical shunting occurs when transmitted light never comes in contact with the vascular bed. This causes SpO2 values to be either erroneously high or low, depending on whether this light is pulsatile. Light skin pigmentation will not have any negative effects on pulse oximetry. Hyperbilirubinemia and hyponatremia do not affect pulse oximetry readings. PTS: 1

REF: Pages 325-326

74. A patient on continuous pulse oximetry is receiving supplemental oxygen. Her SpO2 has been

93%  2% for the past 12 hours. The pulse oximeter suddenly emits an alarm and reads 78%. A rapid assessment reveals central and peripheral cyanosis and shortness of breath. Which of the following is the appropriate immediate action? a. Take a stat arterial blood gas reading. b. Recalibrate the pulse oximeter. c. Change the pulse oximeter probe. d. Decrease the supplemental oxygen. ANS: A

Even if the pulse oximeter’s accuracy is in question at this time, the fact that the patient is exhibiting central and peripheral cyanosis and shortness of breath indicates that there is an oxygenation problem. The presence of peripheral cyanosis indicates that the patient’s extremities are in a low perfusion state. Taking a stat arterial blood gas is the only way to fully assess this patient’s current oxygenation status. PTS: 1

REF: Pages 325-326

75. Which of the following devices should be used for noninvasive monitoring of oxygen tension

of a premature newborn? a. In vivo PO2 b. Pulse oximetry c. Point-of-care PO2 d. Transcutaneous PO2 ANS: D

Newborns are usually monitored with transcutaneous PO2 monitors because they are noninvasive and the ratio of transcutaneous PO2 to PaO2 measured by hemoximetry has been shown to be good for neonatal use. In vivo PO2 and point-of-care PO2 are invasive. Pulse oximetry is affected by light sources such as heat lamps used with premature newborns and is therefore not used with these patients. PTS: 1

REF: Page 327

76. To produce capillary vasodilatation below the surface of a transcutaneous PO2 electrode,

which of the following should be done to the electrode? a. Icing to 0C b. Heating to 44C c. Cooling to 25C d. Warming to 35C ANS: B

The transcutaneous PO2 electrode is heated to 42C to 45C to produce capillary vasodilatation below the surface of the electrode. Heating improves gas diffusion across the skin, because it increases local blood flow at the site of the electrode and alters the structure of the stratum corneum, the fibrinous tissue within a lipid-and-protein matrix. Cooling or icing the skin will decrease blood flow to the area, making it difficult to obtain an accurate PO2. A temperature of 35C is not warm enough to arterialize the area under the skin. PTS: 1

REF: Page 327

77. Which of the following cause erroneous transcutaneous oxygen (PtcO2) readings?

1. Hypovolemia 2. Hypothermia 3. Septic shock 4. Asthma a. 1 and 3 b. 1 and 4 c. 1, 2, and 3 d. 2, 3, and 4

ANS: C

Hypovolemia, hypothermia, and septic shock will decrease peripheral perfusion caused by reductions in cardiac output. This can significantly affect the accuracy of PtcO2 measurements. Asthma does not necessarily cause a decrease in cardiac output. PTS: 1

REF: Page 328

78. The standard transcutaneous carbon dioxide electrode is which of the following? a. Clark b. Levy-Jennings c. Spectrophotometer d. Modified Stow-Severinghaus ANS: D

The standard transcutaneous carbon dioxide electrode is a modified Stow-Severinghaus blood gas electrode composed of pH-sensitive glass with a silver–silver chloride (Ag/AgCl) electrode. The Clark electrode measures oxygen. Levy-Jennings is a chart that allows the operator of blood gas analyzers to detect trends and shifts in electrode performance. A spectrophotometer is a device for measuring light that can measure intensity as a function of the wavelength of light. It is used in pulse oximeters. PTS: 1

REF: Page 328

79. Which of the following statements is true concerning the operation of a transcutaneous carbon

dioxide electrode? a. PtcCO2 readings are slightly lower than the PaCO2 value. b. Electrodes should be calibrated when they are repositioned. TESTBANKSELLER.COM c. Heating the transcutaneous PCO2 (PtcCO2) to 43C will adversely affect its operation. d. Before its use, the electrode should be calibrated to 20% and 40% CO2. ANS: B

Manufacturers typically suggest calibration of an electrode each time it is repositioned. PtcCO2 readings are slightly higher than the PaCO2 value because of the higher metabolic rate at the site of the electrode caused by heating the skin. The PtcCO2 electrode must be heated to 42C to 44C. The PtcCO2 electrodes are calibrated with a two-point calibration procedure by using 5% CO2 and 10% calibration gases. PTS: 1

REF: Page 328

80. During the calibration of a transcutaneous electrode, the signal is found to be drifting. Which

of the following is the most appropriate action to take? a. Move the electrode to another site. b. Increase the temperature of the electrode. c. Clean off the silver deposit on the cathode. d. Change the electrolyte and the sensor membrane. ANS: D

The electrolyte and the sensor’s membrane should be checked regularly and changed weekly or whenever a signal drift during calibration is noticed.

PTS: 1

REF: Page 328

81. A 38-year-old woman is currently in the emergency department and has a diagnosis of an

asthma attack. The most current arterial blood gas result reveals the following: pH of 7.24; PaCO2 of 55 mm Hg; and an HCO3− of 27 mEq/L. The acid-base status of this patient can be interpreted as a. uncompensated respiratory acidosis. b. partially compensated respiratory acidosis. c. partially compensated metabolic alkalosis. d. partially compensated metabolic acidosis. ANS: B

A pH of 7.24 indicates acidosis because it is below 7.35. The PaCO2 of 55 mm Hg is a respiratory acidosis because it is greater than 45 mm Hg. The arterial blood gas is partially compensated because the HCO3− of 27 mEq/L is greater than 26 mEq/L and the pH is less than 7.35. PTS: 1

REF: Pages 330-331, Tables 10.6, 10.7

82. Which of the following is the correct interpretation of the following arterial blood gas results

taken from a patient receiving no supplemental oxygen: pH 7.37; PaCO2 = 55 mm Hg; PaO2 = 53 mm Hg; SaO2 = 88%; and HCO3− = 31 mEq/L? a. Compensated metabolic alkalosis with mild hypoxemia b. Compensated respiratory acidosis with moderate hypoxemia c. Partially compensated respiratory acidosis with mild hypoxemia d. Partially compensated respiratory acidosis with severe hypoxemia ANS: B

The pH of 7.37 indicates acidosis, but it is compensated because it is greater than 7.35 and less than 7.40 and the HCO3− is greater than 26 mEq/L. The PaCO2 of 55 mm Hg is indicative of a respiratory acidosis. The PaO2 of 53 mm Hg shows that the patient has moderate hypoxemia. PTS: 1

REF: Pages 330-331, Tables 10.6, 10.7

83. A patient has the following acid-base status: pH 7.26; PaCO2 = 70 mm Hg; and HCO3− = 31

mEq/L. Which of the following could be the cause of his arterial blood gas status? a. Diabetes mellitus b. Salicylate intoxication c. Excess antacid ingestion d. Acute airway obstruction ANS: D

First, the acid-base balance must be analyzed. A pH of 7.26 indicates acidosis. A PaCO2 of 70 mm Hg indicates respiratory acidosis. The HCO3− of 31 mEq/L is indicative of a compensation for the respiratory acidosis. Therefore, this blood gas result is indicative of partially compensated respiratory acidosis. Respiratory acidosis can be caused by acute airway obstruction. Diabetes mellitus causes metabolic acidosis. Salicylate intoxication causes metabolic acidosis. Excess antacid ingestion will cause metabolic alkalosis. PTS: 1

REF: Pages 330-331, Table 10.6 and Box 10.2

84. Which of the following arterial blood gas results could be caused by severe diarrhea? a. pH 7.15; PaCO2 = 20 mm Hg; and HCO3− = 7.4 mEq/L b. pH 7.20; PaCO2 = 65 mm Hg; and HCO3− = 26 mEq/L c. pH 7.57; PaCO2 = 22 mm Hg; and HCO3− = 20 mEq/L d. pH 7.49; PaCO2 = 49 mm Hg; and HCO3− = 38 mEq/L ANS: A

Diarrhea can be caused by a metabolic acidosis. Arterial blood gas values in which the pH is 7.15 (acidosis), PaCO2 is 20 mm Hg, and the HCO3− is 7.4 mEq/L are indicative of a partially compensated metabolic acidosis. Answer B is an uncompensated respiratory acidosis. Answer C is a partially compensated respiratory alkalosis, and answer D is a partially compensated metabolic alkalosis. PTS: 1

REF: Pages 330-331, Table 10.6 and Box 10.2

85. What is the correct interpretation of the following arterial blood gas values: pH 7.36; PaCO2 =

65 mm Hg; and HCO3− = 35 mEq/L? a. Chronic respiratory acidosis b. Chronic metabolic alkalosis c. Acute respiratory acidosis d. Acute metabolic acidosis ANS: A

A pH of 7.36 is indicative of an acidosis; a PaCO2 of 65 mm Hg indicates a respiratory acidosis; a HCO3− of 35 mEq/L represents a metabolic alkalosis. Because the pH is greater than 7.35, it is compensated. Therefore, this arterial blood gas value is a compensated respiratory acidosis. This level of blood gas is consistent with chronic ventilatory failure or chronic respiratory acidosis. PTS: 1

REF: Page 330, Table 10.6

86. Which of the following can cause respiratory alkalosis?

1. Encephalitis 2. Diuretic therapy 3. Renal dysfunction 4. Excessive mechanical ventilatory support a. 2 and 3 b. 1 and 4 c. 1 and 3 d. 1, 2, and 4 ANS: B

Respiratory alkalosis can be caused by encephalitis and excessive mechanical ventilatory support. Diuretic therapy and nasogastric suctioning can cause metabolic alkalosis, and renal dysfunction can cause metabolic acidosis. PTS: 1

REF: Page 331, Box 10.2

87. Which of the following are true if a patient has a PaO2 of 155 mm Hg?

1. The patient has mild hypoxemia.

2. The patient has an overcorrected PaO2. 3. The patient is in need of supplemental oxygen. 4. The patient is receiving supplemental oxygen therapy. a. 1 and 3 b. 2 and 4 c. 1 and 4 d. 2 and 3 ANS: B

When the PaO2 is greater than 100 mm Hg, the oxygen status is considered excessively or overly corrected. A PaO2 of 155 mm Hg is not possible without supplemental oxygen. PTS: 1

REF: Page 331, Table 10.7

88. Excessive nasogastric suction will cause what type of acid-base disorder? a. Acute metabolic alkalosis b. Chronic respiratory acidosis c. Uncompensated metabolic acidosis d. Uncompensated respiratory alkalosis ANS: A

Nasogastric suctioning can cause an acute metabolic alkalosis. PTS: 1

REF: Page 331, Box 10.2

89. Renal failure will likely cause what acid-base disorder? a. Respiratory alkalosis b. Respiratory acidosis c. Metabolic alkalosis d. Metabolic acidosis ANS: D

Renal failure will cause a buildup of acids in the blood, which results in a metabolic acidosis. PTS: 1

REF: Page 331, Box 10.2

90. Which is the correct interpretation of the following arterial blood gas values: pH 7.26; PCO2 =

64 mm Hg; PO2 = 48 mm Hg; HCO3− = 26 mEq/L; and fractional inspired oxygen (FIO2) = 0.21? a. Acute respiratory acidosis with moderate hypoxemia b. Acute metabolic acidosis with severe hypoxemia c. Acute metabolic alkalosis with severe hypoxemia d. Compensated respiratory acidosis with moderate hypoxemia ANS: A

A pH of 7.26 indicates an acidosis; a PaCO2 of 64 mm Hg is indicative of a respiratory acidosis; a HCO3− of 26 mEq/L is within normal limits. Therefore, the acid-base balance of the blood gas represents an acute respiratory acidosis. A PO2 of 48 mm Hg represents moderate hypoxemia. PTS: 1

REF: Page 330 | Page 341, Tables 10.6 and 10.7

91. Which is the correct interpretation of the following values: pH 7.36; PaCO2 = 22 mm Hg; and

HCO3− = 12 mEq/L? a. Combined alkalosis b. Combined acidosis c. Compensated respiratory alkalosis d. Compensated metabolic acidosis ANS: D

The pH of 7.36 is a compensated acidosis; any value greater than 7.35 is indicative of acidosis. A PaCO2 of 22 mm Hg is indicative of a respiratory alkalosis and a HCO3− of 12 mEq/L represents a metabolic acidosis. Therefore, the interpretation is a compensated metabolic acidosis. PTS: 1

REF: Page 330, Table 10.6

92. Which of the following can cause respiratory alkalosis? a. Vomiting b. Salicylate overdose c. Hyperventilation d. Pneumothorax ANS: C

Hyperventilation will decrease the amount of carbon dioxide in the blood, causing a respiratory alkalosis. Vomiting can cause a metabolic alkalosis, salicylate overdose can cause a metabolic acidosis, and a pneumothorax can cause a respiratory acidosis. PTS: 1

REF: Page 331, Box 10.2

93. After arterial blood has been drawn from a patient, which of the following should be done to

the blood? a. Transported at 37C b. Processed after 5 minutes c. Transported in an ice bath d. Placed in the freezer until processed ANS: C

Chilling the blood specimen to below 5C by placing the syringe in ice water can reduce the metabolic rate of the white blood cells. Transporting without the ice bath may take longer than 5 minutes, prolonging the delay between obtaining and analyzing the specimen, which can lead to erroneous results. Placing the blood in a freezer will not cool all sides of the syringe as uniformly as an ice water bath. PTS: 1

REF: Pages 322-323

94. Placing blood gas samples in an ice bath serves to do which of the following? a. Keep the specimen cold. b. Slow down in vitro metabolism. c. Allow the red blood cells to remain intact. d. Prevent the white blood cells from destroying the red blood cells. ANS: B

Chilling the blood specimen to below 5C by placing the syringe in ice water can reduce the metabolic rate of the white blood cells. The ice bath does keep the specimen cold, but the purpose of keeping it cold is to reduce the in vitro metabolism rate. PTS: 1

REF: Page 312

95. Approximate the corresponding saturation for a PaO2 of 80 mm Hg under normal acid-base

conditions by using the oxyhemoglobin dissociation curve in the figure.

a. b. c. d.

80% 85% 90% 95%

ANS: D

Find 80 mm Hg on the x-axis of the oxyhemoglobin dissociation curve, and draw a straight vertical line up to the dissociation curve. Then from that point, draw a horizontal line across to the y-axis. That will give the saturation. PTS: 1

REF: Page 331, Fig. 10.17

96. Which of the following are electrolytes?

1. PO2 at 50% saturation (P50) TESTBANKSELLER.COM 2. Na+ 3. Ca++ 4. HCO3− a. 2 and 3 b. 1, 3, and 4 c. 2 and 4 d. 2, 3, and 4 ANS: A

Sodium and calcium are electrolytes. P50 is the PO2 at 50% saturation. HHb is deoxygenated hemoglobin, and HCO3− is bicarbonate. PTS: 1

REF: Page 313, Table 10.2

97. A 60-year-old male patient is admitted to the medical unit with a bowel obstruction causing

him to vomit frequently. What is the correct interpretation of the most recent arterial blood gas values for this patient: pH 7.51; PaCO2 = 43 mm Hg; and HCO3− = 34 mEq/L? a. Respiratory acidosis b. Metabolic acidosis c. Respiratory alkalosis d. Metabolic alkalosis ANS: D

The increased pH indicates alkalosis, and the HCO3− is increased, reflecting a primary metabolic problem most likely caused by the patient’s vomiting. PTS: 1

REF: Pages 330-331, Table 10.6 and Box 10.2

98. The respiratory system compensates for metabolic problems by changing which of the

following levels? a. H2O b. HCO3− c. CO2 d. HHb ANS: C

The respiratory system will either retain carbon dioxide when there is a metabolic alkalosis or excrete carbon dioxide when there is a metabolic acidosis. PTS: 1

REF: Page 330

99. What is the correct interpretation of the following arterial blood gas values: pH of 7.38,

PaCO2 of 38 mm Hg, and HCO3− of 23 mEq/L? a. Normal b. Respiratory alkalosis c. Respiratory acidosis d. Metabolic acidosis ANS: A

The values for all three results are within normal limits. PTS: 1

REF: Page 330

100. Which of the following can cause a respiratory acidosis?

1. Diabetes mellitus 2. Neuromuscular disorder 3. Overdose of opiates 4. Restrictive pulmonary disease a. 2, 3, and 4 b. 2 and 3 c. 1 and 4 d. 1, 2, and 4 ANS: A

Diabetes mellitus will primarily cause a metabolic acidosis that will lead to the body compensating by hyperventilating, resulting in a respiratory alkalosis. Neuromuscular disorders, overdosing with sedatives, and restrictive pulmonary diseases can cause respiratory acidosis. PTS: 1

REF: Page 331, Box 10.2

101. You are performing quality control on a machine for your hospital and the trend below is

produced. What is the likely cause?

a. b. c. d.

Protein buildup on an electrode A tear in the electrode An old electrode Loss of the electrolyte that bathes the electrode

ANS: A

The most common method of recording QC data involves the use of Levy-Jennings charts (figure below). These charts allow the operator to detect trends and shifts in electrode performance, which helps prevent problems associated with reporting of inaccurate data because of analyzer malfunction. For example, a trend (A) typically is associated with protein buildup on an electrode membrane or an electrode that is nearing the end of its life expectancy. A shift (B) can be caused by a tear in the electrode membrane or loss of the electrolyte that bathes the electrode.

PTS: 1

REF: Page 320

Chapter 11: Sleep Diagnostics Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. Which of the following brain waveforms are present during wakefulness?

1. Alpha waves 2. Beta waves 3. Relatively low-voltage, mixed-frequency waves 4. Delta waves a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1, 2, and 4 ANS: A

An electroencephalogram (EEG) shows that alpha waves and beta waves are present during wakefulness and diminish as the sleeper’s EEG converts to relatively low-voltage, mixed-frequency waves. Delta waves are present during slow-wave sleep or the deepest stages of non–rapid eye movement (NREM) sleep. PTS: 1

REF: Page 336

2. Stage N2 sleep is characterized by the presence of which of the following?

1. Relatively low-voltage, mixed-frequency waves 2. Sleep spindles 3. Delta waves 4. K-complexes a. 1 and 3 b. 2 and 4 c. 1 and 4 d. 2, 3, and 4 ANS: B

Stage N1 sleep lasts for only a brief time and is followed by a transition to Stage N2 sleep, which is identified by the appearance of sleep spindles and K-complexes on the sleeper’s EEG. Sleep spindles are waveforms with waxing and waning amplitude that occur at a frequency of 9 to 13 cycles per second. K-complexes are large, vertical, slow waves that have an amplitude of at least 75 V, with an initial negative deflection. PTS: 1

REF: Page 336

3. Which characteristics are associated with rapid eye movement (REM) sleep?

1. Lower level tonic activity 2. High-voltage, low-frequency waves on an EEG 3. Absence of tonic activity on an electromyogram 4. Often absent responsiveness to external stimuli a. 1 and 2 b. 3 and 4 c. 1, 2, and 4

d. 2, 3, and 4 ANS: B

Absence of tonic activity on an electromyogram and an often absent responsiveness to external stimuli are associated with REM sleep. Lower level tonic activity on an electromyogram and high-voltage, low-frequency waves on an EEG are indicative of NREM sleep. PTS: 1

REF: Page 336, Table 11.1

4. Sleep spindles occur at a frequency of a. 4 to 7 b. 9 to 13 c. 14 to 16 d. <3.5

cycles/s.

ANS: B

Sleep spindles are waveforms with waxing and waning amplitude that occur at a frequency of 9 to 13 cycles/s. PTS: 1

REF: Page 336

5. The age at which infants first exhibit the classic sleep stages seen in adults is a. 6 b. 9 c. 12 d. 18

months.

ANS: C

By 12 months of age, infants exhibit the classic sleep stages seen in adults. PTS: 1

REF: Page 338

6. During a typical night of sleep, a normal adult sleeper cycles between NREM sleep and REM

sleep at approximately every a. 30 to 60 b. 60 to 90 c. 90 to 120 d. 120 to 150

minutes.

ANS: C

During a typical night of sleep, a normal adult sleeper cycles between NREM sleep and REM sleep approximately every 90 to 120 minutes. PTS: 1

REF: Page 338

7. Normally, the number of cycles of sleep stages that occur per night is a. 4 to 6 b. 6 to 8 c. 8 to 10 d. 10 to 12 ANS: A

cycles.

Normally, 4 to 6 cycles of sleep stages occur per night. PTS: 1

REF: Page 338

8. Which stage(s) of sleep is (are) shown in the figure?

a. b. c. d.

Stage N1 sleep Stage N2 sleep Stage N3 sleep REM sleep

ANS: B

Stage N2 sleep is characterized by relatively low-voltage background EEG activity, sleep spindles and K-complexes, absence of eye movements, and tonic activity on an electromyogram. PTS: 1

agSe T 33B7A , FNigK. S 11E.1LBLER.COM REF: TPE

9. Which stage(s) of sleep is (are) shown in the figure?

a. b. c. d.

Stage N1 sleep Stage N2 sleep Stage N3 sleep REM sleep

ANS: D

REM sleep is characterized by relatively low-voltage, mixed-frequency background EEG activity, with a burst of notched theta waves; rapid, saccadic, conjugate eye movements; chin muscle tone significantly decreased from that found with waking; and NREM sleep levels. PTS: 1

REF: Page 337, Fig. 11.1D

10. Which sleep stage is characterized normally by irregular breathing patterns with short, central

periods of apnea and inhibited rib cage muscles and upper airway muscles? a. Stage N1 sleep b. Stage N2 sleep c. Stage N3 sleep d. REM sleep ANS: D

REM sleep is characterized by the following physiologic effects on respiration: irregular pattern of breathing; short, central apneas; variable and elevated partial pressure of arterial carbon dioxide (PaCO2) (2 to 8 mm Hg above wakefulness); inhibited rib cage muscles; inhibited upper airway muscles; decreased chemoresponsiveness; and high threshold of arousability to respiratory stimuli. PTS: 1

REF: Page 338, Table 11.2

11. Which statements are true concerning NREM sleep?

1. Early stages predispose a person to apneic periods. 2. partial pressure of arterial oxygen (PaO2) levels decrease by 5 to 10 mm Hg. 3. Minute ventilation increT asEesSbTyB1AtN oK 2 SLE /mLiL nE duRr. inC gO SM tages 3 and 4. 4. The amount of time spent in these stages is less than 50% of the total sleep time. a. 1 and 2 b. 3 and 4 c. 1 and 4 d. 2 and 4 ANS: A

The reduction in respiratory drive that occurs during the early stages of NREM sleep (Stages 1 and 2) predisposes the person to apneic periods during fluctuations between being awake and asleep. With the establishment of NREM slow-wave sleep (Stages 3 and 4), nonrespiratory inputs are minimized, and minute ventilation is regulated by metabolic control. Minute ventilation decreases by 1 to 2 L/min compared with wakefulness. As a consequence, PaCO2 increases by 2 to 8 mm Hg, and PaO2 decreases by 5 to 10 mm Hg. PTS: 1

REF: Pages 338-339

12. Which of the following constitute the effects of normal sleep on the cardiovascular system?

1. Tachycardia during slow-wave sleep 2. Vasoconstriction during slow-wave sleep 3. Hypotension with significant phasic elevations during REM sleep 4. Slightly decreased cardiac output during NREM and REM sleep a. 1 and 2 b. 2 and 3

c. 1 and 4 d. 3 and 4 ANS: D

During REM sleep, there is hypotension with significant phasic elevations in blood pressure. During NREM and REM sleep, cardiac output is slightly decreased. Bradycardia and vasodilation occur during slow-wave sleep. PTS: 1

REF: Page 338, Fig. 11.3

13. Standard polysomnography includes which of the following?

1. Esophageal pH 2. Submental electromyogram 3. Electrooculogram 4. Intrapleural pressure a. 1 and 2 b. 2 and 3 c. 2, 3, and 4 d. 1, 2, 3, and 4 ANS: B

Standard polysomnography includes EEG, electrooculogram, submental electromyogram, tibialis electromyogram, breathing pattern, oxygen saturation as measured using pulse oximetry (SpO2), partial pressure of carbon dioxide (PCO2), and electrocardiogram. Intrapleural pressure and esophageal pH are special procedures that may be required after polysomnography. PTS: 1

NaKblSe E11L.4LER.COM REF: TPE agSe T 34B1A ,T

14. Monitoring of respiratory effort during polysomnography may be accomplished by using

which of the following? 1. Impedance pneumography 2. Pneumotachograph at airway opening 3. Strain gauge belt around the abdomen 4. Respiratory inductance plethysmography a. 1 and 2 b. 3 and 4 c. 2, 3, and 4 d. 1, 2, 3, and 4 ANS: D

All of the above-listed equipment can be used to assess and measure respiratory effort during polysomnography. PTS: 1

REF: Page 342

15. The submental electromyogram electrodes are placed in which of the following positions?

1. One on the center of the chin 2. Two along the jawline, 3 cm apart 3. Two on the hyoid bone lateral to each other and 2 cm apart 4. One on either side of the chin, between the chin and the hyoid bone, 2 cm apart

a. b. c. d.

1 and 2 1 and 4 2 and 3 3 and 4

ANS: B

Three electrodes are typically affixed to the chin with tape. Two of these electrodes are placed between the tip of the chin and the hyoid bone, lateral to each other and 2 cm apart; a third electrode is placed in the center of the chin. PTS: 1

REF: Page 342

16. Which of the following measurements is used to identify REM sleep? a. Electrocardiogram b. Electroencephalogram c. Electromyogram d. Electrooculogram ANS: D

The electrooculogram records eye movements during sleep and allows the clinician to differentiate NREM sleep states from REM sleep states. An electromyogram records arousal responses and sleep movements. An EEG measures brain wave activity during sleep. An electrocardiogram measures cardiac activity. PTS: 1

REF: Page 342

17. The electrooculogram electrodes should be placed in which of the following positions? a. TESTBANKSELLER.COM

ANS: B

Electrodes are placed on the skin surface in the periorbital region, specifically approximately 1 cm lateral to the outer canthi of the eyes and offset from the horizontal plane (i.e., 1 cm above the horizontal plane on one side and 1 cm below the horizontal plane on the other side). PTS: 1

REF: Page 342

18. Electrooculogram electrodes are in place, and eye movement is to the left. The

electrooculogram recording is shown by which of the following? a.

TESTBANKSELLER.COM

ANS: B

REF: Page 343, Fig. 11.7

19. Electrooculogram electrodes are in place, and the eyes are looking up. The electrooculogram

recording is shown by which of the following? a.

ANS: D

TESTBANKSELLER.COM

The height or depth of the deflection depends on the movement of the eyes relative to the fixed electrodes. Eye movement away from the electrode shows an upward deflection on the electrooculogram, and eye movement toward the electrode shows a downward deflection. When looking up with the electrodes in place, the left eye has moved away from its electrode, and the right eye has moved toward its electrode. Because the movement is not directly toward either right or left, the deflections produced by either electrode are smaller than left or right movement. PTS: 1

REF: Page 343, Fig. 11.7

20. Which waveforms are present during wakefulness and during the onset of quiet sleep?

1. Alpha waves 2. Beta waves 3. Delta waves 4. Theta waves a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1 and 4 ANS: A

Alpha and beta waves are present during wakefulness and during the onset of quiet sleep. PTS: 1

REF: Page 336

21. Slow, rolling, pendulous movement of the eyes is present during which of the following sleep

stages? a. Stage N1 sleep b. Stage N2 sleep c. Stage N3 sleep d. REM sleep ANS: A

This type of eye movement is indicative of Stage 1 sleep. PTS: 1

REF: Page 336

22. What is the distinguishing feature of the EEG during sleep Stage N3? a. Small beta waves b. Large k-complexes c. Sleep spindles d. Large delta waves ANS: D

The deepest stages of NREM sleep (Stage N3) are referred to as slow-wave sleep because of the presence of large delta waves that appear when the sleeper enters these stages. PTS: 1

REF: Page 336

23. A sleeper is predisposed to periods of apnea during which of the following NREM sleep

stage(s)? a. N1 and N2

b. N2 and N3 c. N2 d. N3 ANS: A

The reduction in respiratory drive that occurs during the early stages of NREM sleep (Stages N1 and N2) predisposes the person to apneic periods (i.e., Cheyne-Stokes respiration) when fluctuating between being awake and asleep. PTS: 1

REF: Page 339, Table 11.3

24. What are the chief symptoms associated with obstructive sleep apnea (OSA)?

1. Nosebleeds 2. Insomnia 3. Morning headaches 4. Daytime sleepiness a. 1 and 4 b. 2 and 4 c. 2 and 3 d. 3 and 4 ANS: D

The symptoms most commonly associated with OSA in adult patients are chronic loud snoring, gasping, or choking episodes during sleep, excessive daytime sleepiness, morning headaches, and personality and cognitive deterioration related to fatigue from lack of sleep. PTS: 1

REF: Pages 343-344

25. The criteria for diagnosing OSA with polysomnography in an adult include which of the

following? a. More than 2 periods of obstructive apnea, of 15 seconds’ duration each, per hour b. More than 5 periods of obstructive apnea, of 10 seconds’ duration each, per hour c. At least 5 periods of obstructive apnea, of 30 seconds’ duration each, per hour d. At least 10 periods of obstructive apnea, of 20 seconds’ duration each, per hour ANS: B

Part of a diagnosis of OSA requires that the patient demonstrate more than 5 periods of obstructive apnea, each of 10 seconds’ duration, per hour of sleep. PTS: 1

REF: Page 344, Box 11.2

26. An adult patient diagnosed with OSA would have which of the following polysomnographic

testing results? a. 8 apnea periods, of 4 to 8 seconds’ duration, per hour of sleep and an SpO2 of 90% to 93% b. 20 apnea periods, of 5 to 9 seconds’ duration, per hour of sleep, with no arousals c. 15 apnea periods, of 15 to 20 seconds’ duration, per hour of sleep and bradycardia d. 5 apnea periods, of approximately 8 seconds’ duration each, per hour of sleep, with snoring ANS: C

This patient has more than 5 apnea periods per hour of sleep with each episode lasting more than 10 seconds, along with bradycardia. PTS: 1

REF: Page 344, Box 11.2

27. The criteria for diagnosing mild OSA with polysomnography in a child less than 12 years of

age include which of the following? a. apnea/hypopnea index (AHI) of 1 to <5 episodes per hour b. AHI 5 to <10 episodes occur per hour c. AHI of 10 to <20 episodes per hour d. AHI of >20 episodes per hour ANS: A

Classification of severity of OSA in children (<12 years) differs from the criteria used with adult patients. For example, mild OSA is characterized by AHI of 1 to <5 episodes per hour, moderate OSA is present if 5 to <10 episodes occur per hour, and severe OSA is associated with AHI of >10 episodes per hour. PTS: 1

REF: Pages 343-344

28. Patients who are at highest risk for developing OSA include patients with which of the

following? 1. Asthma 2. Nuchal obesity 3. Neuromuscular disorders 4. Nasopharyngeal narrowing a. 1 and 3 b. 2 and 3 c. 2 and 4 d. 1 and 4 ANS: C

Patients at the greatest risk of developing OSA are patients with obesity, especially nuchal obesity, and patients with nasopharyngeal narrowing. PTS: 1

REF: Pages 343-344

29. Which of the following factors increase a patient’s risk for OSA?

1. Systemic hypertension 2. Exercising late in the day 3. Excessive coffee drinking 4. Alcohol consumption close to bedtime a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1 and 4 ANS: D

Some factors that add to the risk of OSA include systemic hypertension, ingestion of central nervous system depressants, and alcohol consumption close to bedtime.

PTS: 1

REF: Pages 343-344

30. Which factors may augment the symptoms of patients with mild OSA?

1. Excessive day-shift work 2. Sleep deprivation 3. Respiratory allergies 4. Scuba diving a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1 and 4 ANS: B

Factors that may increase the symptoms of patients with mild OSA include partial sleep deprivation, as with shift work; respiratory allergies; exposure to smoke; and ascent to altitude. PTS: 1

REF: Pages 343-344

31. Which oxygen desaturation level is generally considered abnormal in children? a. <98% b. <95% c. <92% d. <90% ANS: C

Oxygen desaturation of less than 92% is generally considered abnormal in children, depending on their baselinT eE oxSyT geBnAsN atK urSaE tioLnL . ER.COM PTS: 1

REF: Page 345

32. Which criteria related to measurements of end-tidal PCO2 (PETCO2) are used to determine

sleep-disordered breathing in children? a. PETCO2 values of >8 mm Hg above baseline b. PETCO2 values of >12 mm Hg above baseline c. PETCO2 values of >40 mm Hg for at least 25% of total sleep time d. PETCO2 values of >45 mm Hg for at least 60% of total sleep time ANS: D

For children, it has been suggested that PETCO2 values of greater than 45 mm Hg for at least 60% of the total sleep time or PETCO2 values greater than 13 mm Hg above baseline values indicate sleep-disordered breathing. PTS: 1

REF: Page 345

33. Which of the following is a common problem among patients with central sleep apnea? a. Obesity b. Insomnia c. Depression d. Hypersomnolence ANS: C

Depression is a common finding in patients with central sleep apnea. Patients with central sleep apnea do not normally report insomnia and hypersomnolence and typically have a normal body habitus. PTS: 1

REF: Page 346

34. Which of the following represents the polysomnographic tracing of a patient with central

sleep apnea? a.

TESTBANKSELLER.COM

ANS: D

The polysomnographic tracing of a patient with central sleep apnea shows a complete cessation of nasal and oral airflow during the apneic episode. PTS: 1

REF: Page 348, Fig. 11.11

35. Which of the following represents the polysomnographic tracing of a patient with OSA? a.

TESTBANKSELLER.COM d.

ANS: C

The polysomnographic tracing of a patient exhibiting OSA shows paradoxical movement of the chest and abdomen and recurrent complete airway obstructions, leading to oxygen desaturation. PTS: 1

REF: Page 348, Fig. 11.12

36. The polysomnographic tracing of a patient with mixed apnea is shown by which of the

following?

ANS: A

With mixed apnea, there is cessation of airflow at the nose and mouth. Initially, there is an absence of respiratory effort, which is the central component, followed by at least two cycles of respiratory effort with continued absence of airflow, which is the obstructive component.

PTS: 1

REF: Page 348, Fig. 11.12

37. A K-complex is which of the following?

a. b. c. d.

A B C D

ANS: A

K-complexes are large, vertical, slow waves that have an amplitude of at least 75 V, with an initial negative deflection. PTS: 1

REF: Page 336

38. What is the key to recognizing OSA when the results of a sleep study are analyzed? a. No airflow and no respiratory effort b. No airflow with increasing respiratory effort c. Reduced airflow with minimal respiratory effort d. No airflow with no or m inS imTaB lA reN spKirS atEoL ryLeE ffR or.t COM TE ANS: B

The finding of no airflow with increasing respiratory effort is needed to diagnose OSA. PTS: 1

REF: Page 348, Fig. 11.12

39. The number of apneic periods observed is 15, and the number of hours slept is 5. The apnea

index is a. 3. b. 8. c. 20. d. 45. ANS: A

To determine the apnea index, divide the calculated periods by the number of episodes per hour. PTS: 1

REF: Page 343

40. Which of the following are potential applications of electromyography?

1. Monitoring activation of the muscles of the upper airway 2. Monitoring contractile strength of the heart 3. Monitoring activity of intercostal muscles 4. Monitoring peripheral perfusion

a. b. c. d.

2 and 4 1 and 2 1 and 3 2, 3, and 4

ANS: C

The electromyogram can be used to monitor activation of the muscles that expand the upper airway and to monitor the intercostal muscles as an alternative to assess respiratory activity. PTS: 1

REF: Page 342

41. When monitoring nasal airflow, what is the most common problem associated with the use of

the pneumotachograph? a. Change in temperature of expired gas b. Variability in expiratory flow rates c. Requirement to reposition the probe d. Recalibration of the sensor ANS: C

The most common problem with the pneumotachograph relates to probe position. PTS: 1

REF: Page 342

42. During polysomnography, the patient has 15 periods of apnea and 10 episodes of hypopnea

during 6 hours of sleep. What is their AHI? a. 2.5 b. 3.5 c. 4.2 d. 5.6 ANS: C

The AHI is calculated by taking the sum of the total number of apneas and the number of episodes of hypopnea. The total is then divided by the number of hours of sleep. PTS: 1

REF: Page 343

43. Which of the following are considered landmarks for the international 10/20 EEG system?

1. Nasion 2. Inion 3. Zero line 4. Two preauricular points a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1, 2, and 4 ANS: D

The landmarks that are used include the nasion (the indentation between the forehead and the nose), the inion (the ridge at the back of the skull), and two preauricular points (indentations in front of the tragus cartilage). Each electrode is designated relative to a particular area of the brain (e.g., F [frontal], T [temporal], O [occipital], C [central], A [auricular], M [mastoid], Z [midline or “zero line”]).

PTS: 1

REF: Page 341

Chapter 12: Introduction to Ventilators Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. Pneumatic ventilators may incorporate which of the following components for operation?

1. Pistons 2. Air entrainers 3. Flexible diaphragms 4. Internal direct current batteries a. 1 and 2 b. 2 and 3 c. 1 and 4 d. 3 and 4 ANS: B

Pneumatic ventilators may incorporate components such as air entrainers, needle valves, flexible diaphragms, and spring-loaded valves to perform certain functions. Electrically powered ventilators most often use electrical power to run internal motors for operating pistons and may have internal direct current batteries, which can provide electrical power during patient transport or in the event of a power failure. PTS: 1

REF: Page 355

2. An iron lung is which type of ventilator? a. Fluidic b. Positive pressure c. Negative pressure d. Positive/negative pressure ANS: C

An iron lung and a chest cuirass are both negative–pressure ventilators that are rarely used in the ventilation of patients these days. PTS: 1

REF: Page 356

3. Which type of ventilator creates a sinusoidal pressure waveform pattern of positive and

negative pressures? a. Fluidic b. Pneumatic c. Positive pressure d. Combined pressure ANS: D

A combined-pressure device, such as a high-frequency oscillator, produces oscillating gas pressure waveforms at the upper airway, producing a waveform that is sinusoidal, with positive-pressure and negative-pressure oscillations produced at the upper airway. PTS: 1

REF: Page 356

4. An open-loop ventilator system can be described as which of the following? a. Feedback b. Hierarchical c. Unintelligent d. Servo-controlled ANS: C

Unintelligent ventilators are called open-loop systems because they do not respond to changes in the delivery of gas to the patient when there are any problems. PTS: 1

REF: Pages 356-357

5. A closed-loop ventilator system can be described as which of the following?

1. Feedback 2. Hierarchical 3. Unintelligent 4. Servo-controlled a. 1 b. 2 and 3 c. 1 and 4 d. 2 and 4 ANS: C

A closed-loop ventilator system is an intelligent system that can respond to certain inputs based on programming. This type of system is similar to cruise control on a car. When a parameter is set on the ventilator, the ventilator compares the input with the output and makes certain adjustments. These systems are also called feedback or servo-controlled systems. PTS: 1

REF: Page 357

6. Which of the following is the flow waveform created by a linear-drive piston? a. Sinusoidal b. Rectangular c. Ascending ramp d. Descending ramp ANS: B

The rod of the piston moves the piston forward linearly inside a cylinder housing at a constant rate, producing a constant or rectangular waveform of gas flow to the patient. PTS: 1

REF: Page 357

7. The function of the exhalation valve in the external circuit is to do which of the following? a. Deflate during inspiration to allow the gas to go to the patient b. Inflate during inspiration to prevent leaks in the inspiratory circuit c. Inflate during inspiration to divert gas coming from the ventilator into the patient d. Inflate during expiration to allow the patient to exhale through the expiratory line ANS: C

With an external circuit, gas flows both through the main inspiratory line to the patient and through the expiratory valve line during inspiration. This line inflates a balloon or puts pressure on a diaphragm, closing a hole. The hole in the exhalation valve is where the patient’s exhaled gases normally vent into the room. During inspiration, the hole is covered by the balloon or diaphragm. During exhalation, no gas goes through the main inspiratory line or the expiratory valve line. The balloon deflates, and the patient’s exhaled volume passes through the open hole. PTS: 1

REF: Page 358

8. Which of the following flow-controlling valves operates by using the principles of

electromagnetism? a. Poppet b. Stepper motor c. Proportional solenoid d. Microprocessor operated ANS: C

Proportional solenoid valves operate on a basic principle of physics concerning electricity and magnetism. PTS: 1

REF: Page 360

9. Which two of the following basic physical principles are used in the power transmission

design of fluidic ventilators? 1. Venturi 2. Bernoulli 3. Beam deflection 4. Wall attachment a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1 and 4 ANS: C

Fluidic devices operate on two basic physical principles: wall attachment and beam deflection. PTS: 1

REF: Pages 361-362

10. A separation bubble in a fluidic device does which of the following? a. Causes a flip-flop to occur b. Causes a high-pressure vortex c. Bends the gas jet stream toward the wall d. Pushes the gas jet stream away from the wall ANS: C

A separation bubble is a low-pressure vortex that develops between a wall and a jet stream of gas. The bubble attracts or bends the jet stream toward the wall. The pocket of turbulence forms an air foil, similar to that seen with an airplane wing. When the gas entrained into the bubble from the jet stream equals the amount of air moving from the vortex flow of the bubble back to the jet stream, the attachment is stable.

PTS: 1

REF: Page 363

11. A patient receiving continuous positive airway pressure of 7.5 cm H2O via a mask and

freestanding system appears to be in distress. The patient is using accessory muscles and is diaphoretic. The manometer is fluctuating between –5 cm H2O on inspiration and 7.5 cm H2O on expiration. The most apparent cause of the patient’s distress is which of the following? a. Leak in the system b. Improper mask fitting c. Inadequate flow rate d. Obstruction of the threshold resistor ANS: C

The patient is pulling in more than the flow of the continuous positive airway pressure system was set to deliver. This is apparent because of the wide fluctuation in the pressures. If there was a leak or improperly fitting mask, the pressure on expiration would not be at the set pressure. If there was an obstruction of the threshold resistor, it would prevent the patient’s exhaled gas from exiting and cause the pressure-release valve to pop off. PTS: 1

REF: Page 366

12. Which of the following uses a spring to adjust pressure to establish positive airway pressure? a. Weighted ball b. Magnetic valve c. Spring-loaded valve d. Opposing gas flow ANS: C

Changing the spring tension adjusts the amount of pressure needed to move the valve off its seat and allows expiration to occur. When the circuit pressure equals the force applied on the valve by the spring, the valve closes. PTS: 1

REF: Page 364

13. A patient is receiving continuous positive airway pressure from a freestanding,

continuous-flow system. The respiratory therapist notices the pressure-release valve venting on each patient exhalation. What action should the respiratory therapist take? a. Replace the continuous positive airway pressure device. b. Decrease the flow rate. c. Increase the pressure level. d. Remove the pressure-release valve. ANS: A

When the pressure-release valve is activated, it indicates that the threshold resistor or spring-loaded valve is jammed, and the patient’s exhaled volume is not exiting through the continuous positive airway pressure valve. This is not proper function and indicates that the device needs to be replaced. PTS: 1

REF: Page 366

14. A patient is receiving a continuous positive airway pressure of 10 cm H2O via mask from a

Downs continuous positive airway pressure generator. During each inspiration, the pressure manometer decreases to 3 cm H2O. The patient is diaphoretic, tachypneic, and tachycardic. To correct this situation, the respiratory therapist should do which of the following? a. Increase the gas flow b. Increase the pressure c. Tighten the fit of the mask d. Replace the spring-loaded valve ANS: A

The patient is pulling in more than the flow of the continuous positive airway pressure system is able to provide. This is evident by the swing in pressures between 10 cm H2O and 3 cm H2O. Increasing the flow would decrease the patient’s work of breathing. Increasing pressure would make the patient work harder because of the inadequate flow rate. If there was a leak through an improperly fitting mask, very little pressure could be maintained. Replacement of the spring-loaded valve would not solve this problem. PTS: 1

REF: Page 366

15. The set tidal volume is 500 mL. During the first breath, the exhaled volume measures 390 mL,

with a peak pressure of 18 cm H2O. The second breath returns 460 mL, with 20 cm H2O. The third breath has a peak pressure of 22 cm H2O, with an exhaled volume of 500 mL. This can be described as what type of system? a. Open loop b. Closed loop c. Single circuit d. Double circuit ANS: B

This is a closed-loop system because the ventilator is making changes to the pressure based on the exhaled tidal volume. The pressure is being increased incrementally, which increases the exhaled volume to the set tidal volume. PTS: 1

REF: Page 357

16. The gas that enters the ventilator from high-pressure sources goes directly to the patient. This

is a description of a _ system. a. single-circuit b. double-circuit c. pneumatic circuit d. power transmission ANS: A

In a single-circuit ventilator, the gas enters the ventilator and goes directly to the patient. PTS: 1

REF: Page 358

17. Which of the following is a device that uses a flow resistor to create expiratory pressure? a. Positive expiratory pressure mask b. Spring-loaded valve c. Modern ventilator

d. Fluidic device ANS: A

Flow resistors are used in positive expiratory pressure masks to combat atelectasis and aid in the removal of secretions. They are used less commonly in ventilator circuits. The Downs continuous positive airway pressure generator uses a threshold resistor to generate positive pressure. Modern ventilators use threshold resistors to generate expiratory pressure. Fluidic devices do not use flow resistors. PTS: 1

REF: Page 363

18. The main parameter that the ventilator manipulates for any given breath is referred to as

which of the following? a. Control circuit b. Phase variable c. Control variable d. Cycle variable ANS: C

The main parameter or variable controlled by the ventilator for any given breath is referred to as the control variable. A control circuit is part of the internal circuit of a mechanical ventilator and consists of mechanical devices, such as spring-loaded valves, pneumatic systems, or fluidic components. Phase variables are the variables that control the four phases of a breath. A cycle variable is the variable that is being used by the ventilator to end inspiration. PTS: 1

REF: Page 367

19. What variable begins the inspiratory phase of a ventilator? a. Cycle b. Limit c. Control d. Trigger ANS: D

The trigger variable begins inspiration. The cycle variable ends the inspiratory phase and begins exhalation. The limit is the maximum value for a variable that cannot be exceeded during inspiration. The control variable is one of the four elements of breath delivery that the ventilator is manipulating. PTS: 1

REF: Page 369

20. Which of the following variables ends the inspiratory phase? a. Cycle b. Limit c. Trigger d. Sensitivity ANS: A

The cycle variable ends the inspiratory phase and begins exhalation. PTS: 1

REF: Page 369

21. Which of the following variables begins a mandatory breath? a. Flow b. Time c. Volume d. Pressure ANS: B

Time triggering the ventilator enables control of the beginning of inspiration based on the set mandatory rate. The breath is mandatory. PTS: 1

REF: Page 367

22. The pressure maintained at the airway during exhalation is known as which of the following? a. Baseline b. Proximal c. Sensitivity d. Mean airway ANS: A

Baseline pressure is the pressure maintained at the airway during exhalation and the pressure from which inspiration begins. Proximal pressure is the pressure measured near the Y-connector of the ventilator circuit. Sensitivity is the control set by the operator that determines the amount of work the patient must do to trigger a breath. The mean airway pressure is the average pressure occurring in the airway during a complete respiratory cycle. PTS: 1

REF: Page 369

23. Which two of the following patient triggers are most common?

1. Flow 2. Neural 3. Volume 4. Pressure a. 1 and 2 b. 1 and 4 c. 2 and 3 d. 3 and 4 ANS: B

Pressure and flow are the most common variables used for patient triggering. However, volume triggering and neural triggering also can be used. PTS: 1

REF: Page 370

24. On a mechanical ventilator, pressure triggering is usually set within which of the following

ranges? a. –0.5 to –1.5 cm H2O b. –2.0 to 0.5 cm H2O c. 0.5 to 2.0 cm H2O d. 1.0 to 3.0 cm H2O ANS: A

Pressure triggering usually is set at –0.5 to –1.5 cm H2O. This means that the trigger will occur at 0.5 to 1.5 cm H2O below the baseline pressure. PTS: 1

REF: Page 370

25. If the base flow is 8 L/min and the flow-trigger setting is 3 L/min, at what flow rate would the

ventilator be triggered? a. 3 L/min b. 5 L/min c. 8 L/min d. 11 L/min ANS: B

The ventilator will begin inspiration when the expiratory flow is measured at 5 L/min (8 L/min –3 L/min = 5 L/min). PTS: 1

REF: Page 370

26. If the base flow is 10 L/min and the flow-trigger setting is 4 L/min, the flow during the

expiratory phase is a. 4 b. 6 c. 10 d. 14

L/min.

ANS: C

The base flow is the bias or background flow that is present during the expiratory phase. That flow is the set base flow, oT rE 10SL mA inNiK nS thE isLcL asEeR . .COM T/B PTS: 1

REF: Page 370

27. With a baseline pressure setting of 6 cm H2O and a sensitivity setting of –1.5 cm H2O,

inspiration will begin at a. –1.5 b. –4.5 c. +1.5 d. +4.5

cm H2O.

ANS: D

The actual pressure at which the breath will be triggered is +4.5 cm H2O (6 cm H2O – 1.5 cm H2O = 4.5 cm H2O). PTS: 1

REF: Page 370

28. What is the flow rate if the set volume is 550 mL and the inspiratory time is 1.2 second? a. 27.5 L/min b. 45.8 L/min c. 55 L/min d. 66 L/min ANS: A

Volume = flow  time, so flow = volume ÷ time. 550 mL = 0.55 L. Flow = 0.55 L ÷ 1.2 s = 0.46 L/s  60 = 27.5 L/min. PTS: 1

REF: Page 372

29. Decreased lung compliance during pressure-limited ventilation would cause which of the

following? a. Increased flow rates b. Increased pressure delivery c. Decreased volume delivery d. Decreased inspiratory pressures ANS: C

During pressure-targeted ventilation, volume delivery varies with the set inspiratory time and the patient’s lung characteristics. When the patient’s lung compliance is decreased, the lungs are stiff, and less volume is delivered for the same amount of pressure. PTS: 1

REF: Page 377

30. Which of the following variables cannot be exceeded during inspiration? a. Limit b. Cycle c. Safety d. Trigger ANS: A

A limiting variable has a maximum value that cannot be exceeded during inspiration because Mit does not end inspiratory flow to the ventilator does not alloT wEitS; T hoBwAeN veKrS , rE eaLcL hiE ngR. thC eO lim the patient. PTS: 1

REF: Pages 374-375

31. The maximum safety pressure should be set at

cm H2O when the peak pressure reached

during volume-controlled ventilation is 25 cm H2O. a. 30 b. 35 c. 40 d. 45 ANS: B

The maximum safety pressure is usually set by the operator at 10 cm H2O above the peak pressure reached during inspiration. PTS: 1

REF: Page 375

32. When the maximum safety pressure setting on an adult ventilator is reached, which of the

following occurs? a. Inspiration is triggered. b. Flow begins to decrease. c. Inspiration ends prematurely. d. Pressure is held until the target volume is delivered.

ANS: C

When the maximum safety pressure is reached, the ventilator will sound an alarm, limit the pressure, and cycle out of inspiration, ending inspiration early. PTS: 1

REF: Page 375

33. When the maximum safety pressure on a volume ventilator is reached, which of the following

occurs? a. The flow rate begins to taper. b. Pressure is held until the time cycle is reached. c. Pressure is held until the ventilator volume cycles. d. Inspiration ends before the entire volume is delivered. ANS: D

When the maximum safety pressure is reached, the ventilator sounds an alarm, limits the pressure, and cycles out of inspiration, ending inspiration early. PTS: 1

REF: Page 375

34. Which of the following represents the amount of time for a pressure-targeted ventilator breath

to reach the set pressure? a. Rise time b. Inspiratory time c. Total cycle time d. Inspiratory hold ANS: B

Inspiratory time dictates thTe E am ouBnA t oNfKtiS mEeLthLaE t aRv.eC ntOilM ator spends in the inspiratory phase. ST PTS: 1

REF: Page 368, Fig. 12.21

35. The flow, volume, and pressure waveforms characteristic of a pressure-limited, time-cycled

breath are represented in which column of the figure?

a. A b. B

c. C d. D ANS: C

The pressure waveform shown in column C has the characteristic flat top of a pressure limit. Because the breath does not end when the pressure limit is met, the breath is time cycled. PTS: 1

REF: Page 375

36. The flow, volume, and pressure waveforms characteristic of volume breaths with a constant

flow are shown in which column of the figure?

a. b. c. d.

A B C D

ANS: D

A constant-flow breath creates a rectangular or square flow waveform, as seen in column D. PTS: 1

REF: Page 375

37. The flow, volume, and pressure waveforms characteristic of volume breaths with a

descending ramp flow pattern are shown in which column of the figure?

a. b. c. d.

A B C D

ANS: A

The volume breath shown in column A has a descending ramp flow waveform. PTS: 1

REF: Page 375

38. The flow, volume, and pressure waveforms characteristic of volume breaths with a sinelike

flow pattern are shown in which column of the figure?

a. b. c. d.

A B C D

ANS: B

The sinelike flow waveform begins at zero and reaches the maximum inspiratory flow in the middle of inspiration. It then tapers down to zero. PTS: 1

REF: Page 375

39. The figure shows the pressure–time scalar for a pressure-support breath. To alleviate the

problem depicted in this figure, the respiratory therapist should do which of the following?

a. b. c. d.

Decrease the pressure setting Increase the inspiratoryTtE im SeTBANKSELLER.COM Add inspiratory sloping Decrease the set volume

ANS: C

The scalar shows a pressure overshoot owing to the rapid flow rate at the very beginning of inspiration. Adjusting the slope of the pressure and flow curves can change the rate of gas delivery at the very beginning of inspiration. This tapers the curves slightly until they reach their maximum value. Decreasing the pressure setting may alleviate the overshooting problem, but it does not provide the same level of assistance to the patient. Inspiratory time and volume are controlled by the patient in pressure-support ventilation and cannot be adjusted. PTS: 1

REF: Page 372

40. Improving lung compliance during volume-controlled ventilation would cause a(n)

peak . a. decease; pressure b. increase; pressure c. decrease; flow rate d. increase; flow rate ANS: A

During volume-controlled ventilation, the peak inspiratory pressure generated by the delivery of the volume varies according to the characteristics of the lungs. Improving compliance makes it easier to deliver a volume, decreasing the pressure generated in the lungs. PTS: 1

REF: Page 374

41. Worsening lung compliance during volume-controlled ventilation would cause which of the

following? a. A decrease in peak pressure b. An increase in peak pressure c. A decrease in volume delivery d. An increase in peak flow rate ANS: B

During volume-controlled ventilation, the peak inspiratory pressure generated by the delivery of the volume varies according to the characteristics of the lungs. Worsening lung compliance is indicative of stiffening lungs. This would cause more pressure to be generated during the delivery of a set volume. PTS: 1

REF: Page 374

42. Improving lung compliance during pressure-controlled ventilation would cause which of the

following? a. A decrease in peak pressure b. An increase in peak pressure c. An increase in volume delivery d. A decrease in volume delivery ANS: C

During pressure-controlled ventilation, the delivery of the volume varies according to the characteristics of the lungs. Improving compliance makes it easier to deliver a volume with the same set pressure. PTS: 1

REF: Page 374

43. Worsening lung compliance during pressure-controlled ventilation would cause which of the

following? a. A decrease in peak pressure b. An increase in peak pressure c. A decrease in volume delivery d. An increase in peak flow rate ANS: C

During pressure-controlled ventilation, the delivery of the volume varies according to the characteristics of the lungs. Worsening lung compliance is indicative of stiffening lungs. This would cause less volume to be delivered with the same set pressure. PTS: 1

REF: Page 374

44. During pressure-targeted ventilation with a set pressure of 24 cm H2O, the patient coughs. The

ventilator responds by in which of the following ways? a. Inspiration ends immediately.

b. Inspiratory time increases. c. Inspiration continues with the set pressure. d. Inspiratory pressure ends at the maximum safety pressure. ANS: D

It is a common misconception that the pressure-target setting cannot be exceeded during pressure-targeted ventilation. A cough by the patient can cause the pressure to rise above the set value. This is why it is vital that a safe upper pressure limit, or maximum safety pressure, be set at approximately 10 cm H2O above the pressure-target setting during pressure ventilation. PTS: 1

REF: Page 377

45. What is the compressibility factor for the patient circuit when the ventilator volume is set at

200 mL, the recorded peak inspiratory pressure is 72 cm H2O, and the measured volume is 148 mL? a. 0.36 cm H2O/mL b. 0.49 cm H2O/mL c. 2.06 mL/cm H2O d. 2.78 mL/cm H2O ANS: C

The compressibility factor of a patient circuit is the circuit’s tubing compliance. Tubing compliance equals the measured volume divided by the measured peak inspiratory pressure (tubing compliance = volume/peak inspiratory pressure). Tubing compliance = 148 mL ÷ 72 cm H2O = 2.06 mL/cm H2O. PTS: 1

NoKxS1E REF: TPE agSe T 37B4A ,B 2.L 12LER.COM

46. What is the compressibility factor for the patient circuit when the ventilator volume is set at

100 mL, the recorded peak inspiratory pressure is 41 cm H2O, and the measured volume is 68 mL? a. 0.41 cm H2O/mL b. 0.60 cm H2O/mL c. 1.66 mL/cm H2O d. 2.44 mL/cm H2O ANS: C

REF: Page 374, Box 12.12

47. What is the volume that will reach the patient when the volume setting is 700 mL, the tubing

compliance is 2 mL/cm H2O, and the measured peak inspiratory pressure is 35 cm H2O? a. 770 mL b. 698 mL c. 665 mL d. 630 mL

ANS: D

Volume lost because of tubing compliance is equal to the set volume minus the tubing compliance multiplied by the measured peak inspiratory pressure. Volume lost = 700 mL – (2 mL/cm H2O  35 cm H2O) = 700 mL – 70 cmH2O = 630 mL. PTS: 1

REF: Page 377

48. How much volume is lost in the ventilator circuit when the volume is set at 500 mL, the peak

inspiratory pressure is 40 cm H2O, and the tubing compliance is 3 mL/cm H2O? a. 380 mL b. 280 mL c. 150 mL d. 120 mL ANS: D

Volume lost in the ventilator circuit equals tubing compliance multiplied by the measured peak inspiratory pressure. Volume lost = 3 mL/cm H2O  40 cm H2O = 120 mL. PTS: 1

REF: Page 377

49. Pressure-support ventilation is classified as

1. flow cycled. 2. time triggered. 3. pressure targeted. 4. patient triggered. a. 2 and 3 b. 1 and 4 c. 1, 3, and 4 d. 1 and 2 ANS: C

In pressure-support ventilation, when the patient begins inspiration, inspiration is limited by pressure and ends when the patient’s peak inspiratory flow decreases by a certain percentage (flow cycled). PTS: 1

REF: Page 382

50. Which of the following flow-termination settings for a pressure-supported breath that has a

peak inspiratory flow of 30 L/min would allow enough time for a visible plateau on the pressure–time curve? a. 5 L/min b. 20 L/min c. 20% of peak flow d. 30% of peak flow ANS: A

The longest inspiratory time provides a visible plateau on the pressure–time scalar. This is caused by a flow termination that takes the longest time to reach. The flow termination that is lowest provides the most visible plateau on a pressure–time scalar. Because 20% of the peak flow of 30 L/min is 6 L/min and 30% of 30 L/min is 9 L/min, the lowest flow in this case is 5 L/min.

PTS: 1

REF: Page 382

51. Plateau pressure may be obtained during volume ventilation by using which of the following? a. Expiratory pause b. Inspiratory pause c. End-expiratory pressure d. Increased inspiratory time ANS: B

During volume ventilation, plateau pressure is obtained by using the maneuver that extends or delays exhalation by keeping the expiratory valve momentarily closed. This prevents the gas from leaving the circuit. The maneuver is known as an inspiratory pause, inspiratory hold, or inspiratory plateau. PTS: 1

REF: Page 382

52. During volume ventilation, peak inspiratory pressure is the pressure needed to overcome

which two of the following factors? 1. Muscle pressure 2. Airflow resistance 3. Elastic recoil pressure 4. Transthoracic pressure a. 1 and 2 b. 1 and 3 c. 3 and 4 d. 2 and 3 ANS: D

During volume ventilation, pressure increases as the volume is being delivered. The pressure at the end of inspiration, or peak inspiratory pressure, represents the pressure needed to overcome both airflow resistance and the elastic recoil pressure of the lungs and thorax. This concept is demonstrated in the equation of motion: muscle pressure + ventilator pressure = elastic recoil pressure + flow resistance pressure. Muscle pressure is the pressure generated by a person’s muscles of ventilation to overcome elastic recoil pressure and airflow resistance. Transthoracic pressure is a pressure gradient between the pleural space and the body surface. During spontaneous breathing, it is the total pressure needed to expand or contract the lungs and chest wall together. PTS: 1

REF: Page 368

53. The transairway pressure represents the pressure associated with which of the following? a. Elastic recoil b. Airflow resistance c. Tubing compressibility d. End-expiratory pressure ANS: B

The transairway pressure is the pressure required to overcome airflow resistance and is calculated by subtracting the plateau pressure from the peak inspiratory pressure.

PTS: 1

REF: Page 368

54. Increased transairway pressure is associated with which two of the following changes?

1. Increased airway resistance 2. Decreased airway resistance 3. Increased static compliance 4. Decreased static compliance a. 3 and 4 b. 1 and 3 c. 2 and 4 d. 1 and 2 ANS: B

Transairway pressure is the pressure required to overcome airflow resistance and is calculated by subtracting the plateau pressure from the peak inspiratory pressure. An increase in the peak inspiratory pressure with a constant plateau pressure increases the transairway pressure. Another way to increase transairway pressure would be to decrease the plateau pressure (i.e., improved static compliance) and keep a constant peak inspiratory pressure. PTS: 1

REF: Page 368

55. Which of the following is the formula for transairway pressure? a. Peak inspiratory pressure – plateau pressure b. Plateau pressure – peak inspiratory pressure c. Positive end-expiratory pressure (PEEP) – plateau pressure d. Peak inspiratory pressure – PEEP ANS: A

The transairway pressure is the pressure required to overcome airflow resistance and is calculated by subtracting the plateau pressure from the peak inspiratory pressure. PTS: 1

REF: Page 368

56. What is the transairway pressure from the information found in the figure?

a. b. c. d.

10 cm H2O 15 cm H2O 25 cm H2O 35 cm H2O

ANS: B

Transairway pressure = peak inspiratory pressure – plateau pressure = 35 cm H2O – 20 cm H2O = 15 cm H2O. PTS: 1

REF: Page 379

57. What is the static lung compliance when the returned tidal volume is 500 mL, the baseline

pressure is zero, and the plateau pressure reading is 25 cm H2O? a. 0.02 L/cm H2O b. 20.0 L/cm H2O c. 0.2 L/cm H2O d. 2.0 L/cm H2O ANS: A

Static lung compliance = volume ÷ (plateau pressure – PEEP) = 0.5 L ÷ (25 cm H2O – 0 cm H2O) = 0.02 L/cm H2O. PTS: 1

REF: Page 379

58. What is the static lung compliance when the returned tidal volume is 700 mL, the PEEP is 10

cm H2O, the peak inspiratory pressure is 45 cm H2O, and the plateau pressure is 35 cm H2O? a. 0.160 L/cm H2O b. 0.020 L/cm H2O c. 0.028 L/cm H2O d. 0.735 L/cm H2O ANS: B

Static lung compliance = vT olEuS mT eB ÷A(pNlaKteSaE uL prLeE ssR ur.eC–OPM EEP) = 0.7 L ÷ (45 cm H2O – 10 cm H2O) = 0.7 L ÷ 35 cm H2O = 0.02 L/cm H2O. PTS: 1

REF: Page 379

59. What is the static lung compliance when the returned tidal volume is 460 mL, the PEEP is 8

cm H2O, the peak inspiratory pressure is 27 cm H2O, and the plateau pressure is 18 cm H2O? a. 20 mL/cm H2O b. 26 mL/cm H2O c. 46 mL/cm H2O d. 51 mL/cm H2O ANS: C

Static lung compliance = volume ÷ (plateau pressure – PEEP) = 460 mL ÷ (18 cm H2O – 8 cm H2O) = 460 mL ÷ 10 cm H2O = 46 mL/cm H2O. PTS: 1

REF: Page 379

60. Increasing the functional residual capacity (FRC) of a spontaneously breathing patient to

improve oxygenation can be accomplished by which of the following? a. Inspiratory plateau b. PEEP c. Negative end-expiratory pressure d. Continuous positive airway pressure

ANS: D

Continuous positive airway pressure is a technique in which a patient breathes spontaneously at an elevated baseline pressure. This increases the FRC and mean airway pressure and improves lung recruitment and oxygenation. PTS: 1

REF: Page 364

61. What procedure is used to estimate the amount of air trapped in the patient’s lungs and in the

patient circuit? a. Inspiratory pause b. End-expiratory pause c. Pressure-control ventilation d. Pressure-release ventilation ANS: B

End-expiratory pause, or expiratory hold, is a procedure performed to estimate the pressure in the patient’s lung and ventilator circuit caused by trapped air. PTS: 1

REF: Page 380

62. Auto-PEEP can be detected without the use of an expiratory pause on which of the following

curves? a. Pressure–time b. Flow–time c. Pressure–volume d. Volume–time ANS: B

When a patient has auto-PEEP, the expiratory flow does not return to zero. A new inspiration begins before the patient has had time to exhale completely. As a result, air remains trapped in the lungs. A pressure–time curve shows auto-PEEP only when an expiratory pause is used. PTS: 1

REF: Page 380

63. What does point A represent on the pressure–time scalar shown in the figure?

a. b. c. d.

Plateau pressure Maximum safety pressure PEEP Auto-PEEP

ANS: D

Auto-PEEP is made visible on a pressure–time scalar with the use of an end-expiratory pause. Point A is not PEEP because there are areas in the waveform that go down to zero. PTS: 1

REF: Page 381, Fig. 12.39

64. Which of the following is the technique that can actively remove gas from a ventilator circuit

at the beginning of expiration? a. Expiratory pause b. Inspiratory pause c. PEEP d. Negative end-expiratory pressure ANS: D

If negative pressure is applied on exhalation, the decrease in pressure draws air out of the ventilator circuit. An expiratory pause facilitates the measurement of auto-PEEP. An inspiratory pause facilitates the calculation of static pressure and transairway pressure. PEEP is positive pressure applied on exhalation and facilitates the improvement of oxygenation. PTS: 1

REF: Page 380

65. Which of the following statements is true concerning mechanical ventilation classification? a. The names for modes of ventilation are current and accurate. b. Mode classification should be individualized by manufacturers. c. Mode classification terminology needs to be clearly defined. d. All manufacturer mode terminology adheres to Chatburn’s system. ANS: C

After years of studying theTeE ngSiT neBeA rinNgK, S clE inL icL alEaR sp.eC ctO s,Mand resources needed to train clinicians about ventilation modes, Chatburn reached four main conclusions about ventilator modes: (1) the current names for modes of ventilation are outdated and confusing, (2) confusion about names can lead to confusion about clinical application, (3) a ventilator mode classification system should be applicable to the modes available on any ventilator, and (4) all terminology proposed for ventilator classification needs to be clearly defined. PTS: 1

REF: Page 367

66. Which of the following is a ventilator mode that allows the ventilator to switch from pressure

control to volume control or vice versa? a. Dual-control mode b. Flow-control mode c. Volume-control mode d. Pressure-control mode ANS: A

A dual-control, breath-variable mode allows the ventilator to switch from pressure control to volume control or vice versa within a breath. In this type of mode, the primary breath control is both volume and pressure. PTS: 1

REF: Page 368

67. A dual mode that features a pressure-controlled breath pattern with volume as a conditional

variable is which of the following?

a. b. c. d.

Tactical control ventilation Pressure-targeted ventilation Pressure-regulated volume control Volume-regulated pressure control

ANS: C

Pressure-regulated volume control is a breath pattern for which the pressure-limit value is set by the operator, along with the minimum volume that needs to be delivered. The conditional variable, volume, is measured by the ventilator, and the pressure setting may be increased or decreased depending on that measurement. PTS: 1

REF: Page 368

68. Which of the following ventilator control types consists of the output of the ventilator

automatically matching a constant operator-preset input value? a. Optimal b. Set-point c. Auto-set-point d. Knowledge-based ANS: B

A set-point control-type example mode is available in volume-controlled intermittent volume ventilation; in this mode, mandatory breaths are volume limited and volume cycled for the tidal volume setting. Optimal control has one ventilator set-point automatically adjusted to optimize another set-point according to some model of system behavior, and the output can be maximized or minimized dynamically. The auto-set-point control type enables the ventilator to select which operator-adjusted set-points are enforced at the moment. The knowledge-based control type has set points T thEatSaTreBaAuN toK mSatEicLaL llyEaRd. juCstOedM according to a rule-based expert system. PTS: 1

REF: Page 367, Table 12.1

69. Which of the following control modes of ventilation consists of pressure-limited mandatory

breaths that can be automatically adjusted between breaths to achieve a preset tidal volume? a. Servo b. Optimal c. Adaptive d. Auto-set-point ANS: C

An example of an adaptive control type is pressure-regulated volume control, in which the mandatory breaths are pressure limited and can be adjusted between breaths to achieve a preset tidal volume chosen by the operator. In the servo-controlled mode, the ventilator output automatically follows a varying input by the patient. In the optimal control type, one ventilator set-point is automatically adjusted to optimize another set-point according to some model of system behavior, and the output can be maximized or minimized dynamically. The auto-set-point control type allows the ventilator to select which operator-adjusted set-point to enforce at the moment. PTS: 1

REF: Page 367, Table 12.1

70. Which of the following control modes of ventilation consists of ventilator output

automatically following a varying input (e.g., volume or flow generated by the patient)? a. Servo b. Optimal c. Neural network d. Knowledge-based ANS: A

An example of a servo-controlled mode is the proportional assist mode, in which the instantaneous value of pressure is proportional to the instantaneous volume or flow generated by the patient. The optimal control type has one ventilator set-point automatically adjusted to optimize another set-point according to some model of system behavior, and the output can be maximized or minimized dynamically. The artificial neural network is based on acceptable arterial blood gases to maintain patient ventilation (experimental). The knowledge-based control type has set-points that are automatically adjusted according to a rule-based expert system such as end-tidal carbon dioxide. PTS: 1

REF: Page 367, Table 12.1

71. The mandatory breath begins as a pressure-controlled breath, but it switches to volume control

during inspiration because a preset volume is not achieved. This describes which of the following control types? a. Set-point b. Adaptive c. Auto-set-point d. Knowledge-based ANS: C

In this example, inspiration is starting out in pressure control and then switches to volume control by using operator-adjusted set-points. One type of mode that fits this category of control types is pressure augmentation (BEAR 1000). In the set-point control type, the output of the ventilator automatically matches a constant operator-preset input value. The adaptive control type changes set-point types based on the patient’s changing condition. The knowledge-based control type has the set-points automatically adjusted according to a rule-based expert system, such as breathing frequency, tidal volume, and end-tidal carbon dioxide levels. PTS: 1

REF: Page 367, Table 12.1

72. The ventilator automatically adjusts the targets of the ventilator pattern using artificial

intelligence programs, rule-based expert systems, and artificial neural networks description pertains to which of the following ventilator control types? a. Adaptive b. Set-point c. Intelligent targeting d. Neurally adjusted ventilatory assist ANS: C

Intelligent targeting is when the ventilator automatically adjusts the targets of the ventilator pattern using artificial intelligence programs, rule-based expert systems (such as the Otis formula), and artificial neural networks. The mode designation for adaptive-support ventilation (ASV) is PC-IMVoi,oi. The reason for having two sets of tags is that the tag for each type of breath (mandatory and spontaneous in intermittent mandatory ventilation (IMV)) must be specified. Another example of intelligent targeting is Smart Care, found on Dräger ventilators, which has the designation PC-CMVi. PTS: 1

REF: Page 367, Table 12.1

73. The description “a mode where each breath is pressure limited and the pressure-limit level is

adjusted automatically between breaths by using ventilatory mechanics to minimize the patient’s work of breathing” pertains to which ventilator control type? a. Servo b. Optimal c. Adaptive d. Auto-set-point ANS: B

The optimal control type has one ventilator set-point—in this case, pressure limit—that automatically adjusts to optimize another set-point, which in this case is the patient’s ventilatory mechanics, according to some model of system behavior, and the output can be maximized or minimized dynamically. With the servo-controlled type, the ventilator output automatically follows a varying input from the patient. The adaptive control type automatically adjusts one set-point to achieve another set-point as the patient’s condition changes, such as pressure-limit changing to achieve a preset tidal volume. The auto-set-point control type enables the seT leE ctS ioT nBoA fw chEoLpL erE atR o. r-aCdOjuMsted set-point to enforce at the NhKiS moment. PTS: 1

REF: Page 367, Table 12.1

74. The ventilator mode that is either patient triggered or time triggered and allows the patient to

breathe spontaneously between mandatory ventilator breaths is known as a. pressure-support ventilation. b. pressure-controlled ventilation. c. IMV. d. continuous mandatory ventilation (CMV). ANS: C

IMV is designed to deliver volume-targeted or pressure-targeted breaths at a set minimum frequency (i.e., it is time triggered). Between mandatory breaths, the patient can breathe spontaneously from the ventilator circuit without getting the set volume or pressure from the ventilator itself. PTS: 1

REF: Page 382

75. Mandatory breaths during pressure-controlled mechanical ventilation (pressure-controlled

continuous mandatory ventilation, PC-CMV) are cycled into expiration by which of the following? a. Time b. Flow

c. Volume d. Pressure ANS: A

All PC-CMV breaths are time cycled. PTS: 1

REF: Page 382

76. Which of the following ventilator modes decreases the effect of airway resistance on the

patient’s spontaneous breathing? a. Pressure-support ventilation b. PC-CMV c. Volume-controlled intermittent mandatory ventilation (VC-IMV) d. Volume-controlled continuous mandatory ventilation (VC-CMV) ANS: A

Pressure-support ventilation is a spontaneous breath type of ventilation that allows the operator to select a pressure to support the patient’s work of breathing and counteract airway resistance. PTS: 1

REF: Page 378

77. Which of the following represents the safe starting point for pressure support of a patient just

placed on VC-IMV with the following set and measured parameters: tidal volume, 475 mL; peak inspiratory pressure, 30 cm H2O; plateau pressure, 10 cm H2O; and flow rate, 45 L/min? a. 4 cm H2O b. 7 cm H2O c. 20 cm H2O d. 27 cm H2O ANS: C

The safe starting point for pressure support is the transairway pressure value (peak inspiratory pressure – plateau pressure). In this case, transairway pressure = 30 cm H2O – 10 cm H2O = 20 cm H2O. PTS: 1

REF: Page 378

78. Adult candidates for pressure-support ventilation include patients with which of the

following? 1. Nasotracheal tube 2. Minute ventilation <10 L 3. Spontaneous tidal volume <100 mL 4. Spontaneous respiratory rate >20 breaths/min a. 1 and 2 b. 1 and 4 c. 2, 3, and 4 d. 1, 3, and 4 ANS: D

Patients who have nasotracheal tubes usually have tubes that are smaller than they would be if they were intubated orally. This increases the resistance through the artificial airway, making pressure support necessary when the patient is breathing spontaneously. Patients with small spontaneous tidal volumes can be assisted with pressure support to increase their tidal volumes. The pressure-support ventilation level can be adjusted to attain the desired tidal volume based on the patient’s ideal body weight. Patients with high respiratory rates can also benefit from pressure-support ventilation. Titrating the pressure support level to the patient’s respiratory rate and tidal volume provides the appropriate assistance to overcome the airway and artificial tubing resistance and improve the patient’s work of breathing. PTS: 1

REF: Page 397, Box 12.13

79. Which of the following ventilator modes is recommended for patients who have intact

respiratory centers and who are breathing spontaneously? a. IMV b. Pressure-support ventilation c. Pressure-controlled ventilation d. CMV ANS: B

Pressure-support ventilation is a spontaneous mode of ventilation, and it does not provide ventilator breaths to the patient. The patient must have an intact respiratory center and must be able to breathe spontaneously. PTS: 1

REF: Page 397

80. Which of the following is a mode of ventilation that is time triggered or patient triggered as

well as pressure limited anT dE tiS mT eB cyAcN leK d?SELLER.COM a. Pressure-support ventilation b. Pressure-controlled intermittent mandatory ventilation (PC-IMV) c. PC-CMV d. Dual control CMV ANS: C

Time triggered means that there are ventilator-initiated breaths. Patient triggered means that the patient is allowed to do the work to trigger a ventilator breath. Each breath is ended by a set inspiratory time. This is the description of the PC-CMV mode. All pressure-support ventilation breaths are patient triggered and flow cycled. PC-IMV breaths allow spontaneous breaths between ventilator breaths, and those breaths are flow cycled. Dual control CMV is a dual control mode of ventilation in which the breath may start out as pressure-limited but switch to volume-limited if the volume setting is not reached. PTS: 1

REF: Page 397

81. What is the mode depicted in the pressure-versus-time waveform in the figure?

a. Airway pressure-release ventilation

b. Bilevel positive airway pressure c. PC-IMV plus pressure support d. VC-IMV plus pressure support ANS: C

The larger “flat-top” pressure curves represent patient-triggered, pressure-limited, time-cycled breaths from the ventilator. The smaller “flat-top” pressure curves represent patient-triggered, pressure-limited (pressure-supported) spontaneous patient breaths. Pressure-supported spontaneous breaths between patient-triggered ventilator breaths are depicted in the figure. This is IMV, and, more specifically, it is PC-IMV because the ventilator breaths are pressure limited. PTS: 1

REF: Page 397

82. A patient being ventilated in the VC-CMV mode had a measured tidal volume of 620 mL for

the breath shown in the pressure–time scalar in the figure. What is the static compliance?

a. b. c. d.

18 mL/cm H2O 21 mL/cm H2O 31 mL/cm H2O 62 mL/cm H2O

ANS: C

Static lung compliance = tidal volume ÷ (plateau pressure – PEEP) = 620 mL ÷ (30 cm H2O – 10 cm H2O) = 31 mL/cm H2O. PTS: 1

REF: Page 378

83. Obstructive sleep apnea is most commonly treated with which of the following? a. Pressure-support ventilation b. Pressure-controlled ventilation c. CMV d. Bilevel positive airway pressure ANS: D

Bilevel positive airway pressure is commonly used to treat obstructive sleep apnea. PTS: 1

REF: Page 390

84. Which of the following modes is used for noninvasive positive-pressure ventilation? a. Pressure-support ventilation

b. Proportional assist ventilation c. Continuous positive airway pressure d. Bilevel positive airway pressure ANS: D

Bilevel positive airway pressure is similar to continuous positive airway pressure in that both breath delivery techniques provide positive pressure during inspiration and expiration. With bilevel positive airway pressure, the inspiratory positive airway pressure is higher than the expiratory positive airway pressure. Because bilevel positive airway pressure can be either patient triggered or time triggered, it can be used in the hospital setting for noninvasive ventilation. PTS: 1

REF: Page 397, Box 12.13

85. What is the total cycle time for a frequency of 14 breaths/min and a ratio of inspiratory time to

expiratory time of 1:3? a. 1.07 second b. 2.33 seconds c. 3.21 seconds d. 4.29 seconds ANS: D

Total cycle time = 60 s ÷ frequency = 60 ÷ 14 breaths/min = 4.29 s. PTS: 1

REF: Pages 367-368

86. What is the inspiratory time for a frequency of 30 breaths/min and an inspiratory

time-to-expiratory time ratT ioEoSf T 1:B3A ? NKSELLER.COM a. 0.13 second b. 0.50 second c. 0.75 second d. 2.00 seconds ANS: B

Total cycle time = 60 s ÷ frequency = 60 ÷ 30 = 2 s. There are four equal parts to the total cycle time (add the “I” from the inspiratory time-to-expiratory time ratio to the “E” from the inspiratory time-to-expiratory time ratio, or 1 + 3 = 4). Inspiratory time = total cycle time ÷ (I + E) = 2 ÷ 4 = 0.5 s. PTS: 1

REF: Pages 367-368

87. What is the inspiratory time for a frequency of 20 breaths/min and an inspiratory

time-to-expiratory time ratio of 1:3? a. 0.25 second b. 0.75 second c. 1.00 second d. 1.33 second ANS: B

Total cycle time = 60 s ÷ frequency = 60 ÷ 20 = 3 s. There are four equal parts to the total cycle time (add the “I” from the inspiratory time-to-expiratory time ratio to the “E” from the inspiratory time-to-expiratory time ratio, or 1 + 3 = 4). Inspiratory time = total cycle time ÷ (I + E) = 3 ÷ 4 = 0.75 s. PTS: 1

REF: Pages 367-368

88. What is the inspiratory time-to-expiratory time ratio given the following data: frequency of 12

breaths/min; inspiratory time of 0.90 second? a. 1:0.22 b. 1:2 c. 1:4.6 d. 1:6.4 ANS: C

Inspiratory time-to-expiratory time ratio = inspiratory time/expiratory time and expiratory time = total cycle time – inspiratory time. Inspiratory time-to-expiratory time ratio = inspiratory time/total cycle time – inspiratory time. Total cycle time = 60 ÷ 12 = 5 s. Inspiratory time-to-expiratory time ratio = 0.9/5 – 0.9 = 0.9/4.1. Reduce the inspiratory time-to-expiratory time ratio to its simplest form; divide the numerator and the denominator by inspiratory time. 0.9 ÷ 0.9/4.1 ÷ 0.9 = 1:4.56, or 1:4.6. PTS: 1

REF: Pages 367-368

89. What is the inspiratory time for a tidal volume of 600 mL and a flow rate of 60 L/min? a. 0.1 second b. 0.6 second c. 1.0 second d. 6.0 seconds ANS: B

Inspiratory time = tidal volume (in liters) ÷ flow rate (in liters/second) = 0.6 L ÷ 1 L/s = 0.6 s. PTS: 1

REF: Pages 367-368

90. What is the expiratory time when the tidal volume is 700 mL, the flow rate is 50 L/min, and

the inspiratory time-to-expiratory time ratio is 1:3? a. 0.42 second b. 0.70 second c. 2.52 seconds d. 4.67 seconds ANS: C

Inspiratory time = tidal volume (in liters) ÷ flow rate (in liters/second) = 0.7 L ÷ 0.83 L/s = 0.84 s. Expiratory time = 3  inspiratory time = 3  0.84 = 2.52 s. PTS: 1

REF: Pages 367-368

91. What is the inspiratory time-to-expiratory time ratio for the following ventilator settings: a

minute volume of 8 L/min, a respiratory rate of 10 breaths/min, and a flow rate of 40 L/min? a. 1:2

b. 1:3 c. 1:4 d. 1:5 ANS: C

40 L/min = 40 ÷ 60 L/s = 0.67 L/s. Tidal volume = VE ÷ f = 8 L/min ÷ 10 = 0.8 L. Inspiratory time = tidal volume (in liters) ÷ flow rate (in liters/second) = 0.8 L ÷ 0.67 L/s = 1.19 s. Total cycle time = 60 ÷ 10 = 6 s. Expiratory time = total cycle time – inspiratory time = 6 s – 1.19 s = 4.81 s. Reduce the inspiratory time-to-expiratory time ratio to its simplest form; divide the numerator and the denominator by inspiratory time. Inspiratory time/expiratory time = 1.19 ÷ 1.19/4.81 ÷ 1.19 = 1:4. PTS: 1

REF: Pages 367-368

92. The pressure-versus-time curve in the figure represents which of the following ventilator

modes?

a. b. c. d.

Airway pressure-releasT e EvS enTtiB laA tioNnKSELLER.COM Pressure-support ventilation with continuous positive airway pressure PC-IMV plus pressure support VC-IMV plus pressure support

ANS: A

Airway pressure-release ventilation provides two levels of continuous positive airway pressure while allowing the patient to breathe spontaneously at both continuous positive airway pressure levels. The sine waveforms at both continuous positive airway pressure levels represent the spontaneous breathing of the patient. The higher continuous positive airway pressure level is usually held longer than the lower continuous positive airway pressure level—hence the term airway pressure release. PTS: 1

REF: Pages 391-392

93. In the figure, the pressure–time curve that represents PC-IMV plus pressure support is which

of the following?

a. b. c. d.

A B C D

ANS: C

Graph C shows two pressure-limited breaths at two different pressures. The higher pressure is the pressure-limited ventilator breath, and the lower pressure is the pressure-limited spontaneous breath (or pressure-supported breath). Graph A shows VC-CMV, graph B shows airway pressure-release ventilation, and graph D shows VC-IMV plus pressure support. PTS: 1

REF: Page 389

94. The statement “The baseline pressure is elevated but is periodically released to a lower level

for a very brief period, and the patient is allowed to breathe spontaneously at each level” describes which of the following ventilator modes? a. Bilevel positive airway pressure b. Pressure-controlled inverse-ratio ventilation c. Airway pressure-release ventilation d. Mandatory minute ventilation ANS: C

Airway pressure-release ventilation provides two levels of continuous positive airway pressure and allows for spontaneous breathing at both levels. The ventilator is time triggered, pressure limited, and time cycled. The low time is usually approximately 0.2 to 1 second.

PTS: 1

REF: Page 391

95. Which of the following ventilator modes allow patients to perform part of the work of

breathing? 1. Volume-support ventilation 2. Mandatory minute ventilation 3. CMV 4. Proportional assist ventilation a. 1 and 3 b. 2 and 4 c. 1, 2, and 3 d. 1, 2, and 4 ANS: D

Volume-support ventilation on the Maquet Servo 300 is purely assist mode and is basically a form of pressure-support ventilation except that the volume delivery is targeted over several breaths. Mandatory minute ventilation is a closed-loop form of volume-targeted or pressure-targeted ventilation used in patients who can perform part of the work of breathing and are progressing toward weaning from mechanical ventilation. Proportional assist ventilation is a method of assisting spontaneous ventilation in which the practitioner adjusts the amount of the work of breathing assumed by the ventilator. PTS: 1

REF: Page 385

96. During pressure-targeted ventilation with volume guaranteed for every breath, the set volume

is not met. Which of the following phase variables would cycle that breath? a. Time b. Flow c. Volume d. Pressure ANS: C

If the volume is not delivered by the time flow decreases to its set value during pressure-targeted ventilation with volume guaranteed for every breath, the flow continues at the amount set on the flow control until the set tidal volume is delivered. Inspiration becomes volume cycled. PTS: 1

REF: Page 385

97. Which of the following ventilator modes is based on the equation of motion and delivers

pressure, flow, and volume dependent on the patient’s inspiratory effort? a. Proportional assist ventilation b. Mandatory minute ventilation c. Airway pressure-release ventilation d. PC-CMV ANS: A

The operation of proportional assist ventilation is based on the equation of motion. The amount of pressure generated by the patient’s own respiratory muscles is used as an index of inspiration effort.

PTS: 1

REF: Page 397, Box 12.13

98. Which of the following ventilator modes is represented by the pressure–time scalar in the

figure?

a. b. c. d.

VC-IMV with PEEP PC-IMV with PEEP Pressure-augmented, volume-guaranteed breaths Proportional assist ventilation

ANS: B

The pressure–time waveform is raised from the zero line; this means that there is PEEP. The flat pressure wave is indicative of pressure-limited breaths. The higher level represents the ventilator pressure-limited breath, and the lower level waveform represents the pressure-supported breaths. PTS: 1

REF: Page 390

TESTBANKSELLER.COM

99. Which of the following modes of ventilation requires the use of a special nasogastric tube that

is fitted with an electrode array? a. High-frequency oscillatory ventilation b. Neurally adjusted ventilatory assist c. High-frequency jet ventilation d. ASV ANS: B

Neurally adjusted ventilatory assist is a mode of ventilation based on neural respiratory input. It relies on detection of the electrical activity of the diaphragm to control ventilator function through a special nasogastric tube that is fitted with an electrode array. PTS: 1

REF: Page 399

100. The added clinical benefit of secretion removal is facilitated with which high-frequency mode

of ventilation? a. Jet b. Flow c. Percussive d. Oscillatory ANS: C

The clinical benefits of high-frequency percussive ventilation may include facilitation of secretion removal. PTS: 1

REF: Page 400

101. Active expiration occurs in which ventilator mode? a. Proportional assist ventilation b. High-frequency jet ventilation c. Airway pressure-release ventilation d. High-frequency oscillatory ventilation ANS: D

With high-frequency oscillatory ventilation, pressure is positive in the airway during the inspiratory phase and negative during the expiratory phase. Both inspiration and expiration are active. PTS: 1

REF: Page 401

102. Which of the following types of high-frequency ventilation involves the delivery of pulsations

under pressure through a small lumen at rates of 1.7 to 10 Hz? a. Jet b. Oscillatory c. Positive pressure d. Flow interruption ANS: A

High-frequency jet ventilation operates by passing gas from a high-pressure source through a variable regulator that reduTcE esStT heBpAreNsK suSreEtL o LthEeRd. esCirO edMworking level. The gas passes through a device, usually a solenoid or a fluidic valve, which governs the amount and duration of flow. The gas jet is delivered through a specially made triple-lumen endotracheal tube, which is similar to conventional endotracheal tubes except that two additional small lines are added. One line is for delivering jet ventilation, and the other is for monitoring distal airway pressures. PTS: 1

REF: Page 401

103. The movement of gases from one area of the lungs to another because of differences in the

compliance and resistance of various lung regions is known as a. pendelluft. b. gas streaming. c. Taylor dispersion. d. molecular diffusion. ANS: A

Pendelluft is defined as the movement of gases from one area of the lungs to another as a result of differences in the compliance and resistance of various lung regions; this is also called out-of-phase ventilation. PTS: 1

REF: Page 401

104. The erratic pattern of eddies and streams caused by the turbulent flow of high-velocity gases

moving through small airways and their bifurcations is caused by which of the following?

a. b. c. d.

Pendelluft Gas streaming Taylor dispersion Molecular diffusion

ANS: C

Taylor dispersion is the enhanced mixing of gases associated with the turbulent flow of high-velocity gases moving through small airways and their bifurcations. Taylor dispersion occurs when two gas streams meet, creating an erratic pattern of eddies and streams. PTS: 1

REF: Page 401

105. The tidal volume of a breath from a high-frequency jet ventilator depends on which of the

following factors? a. Pulsation pressure b. Amount of bias flow c. Frequency of the driving pressure d. Jet orifice size ANS: D

The tidal volume of a breath during high-frequency jet ventilation depends on four basic factors: (1) the length of the pulsation, (2) the amplitude or driving pressure of the jet, (3) the jet orifice size, and (4) the patient’s lung characteristics. PTS: 1

REF: Page 401

106. Patient discomfort from rapid gas flow during pressure-targeted ventilation may be alleviated

by which of the following T adEjuSsT tmBeAnN tsKtoStE heLvLeE ntRil. atC orO?M a. Decreasing expiratory time b. Decreasing total cycle time c. Increasing inspiratory time d. Increasing inspiratory rise time ANS: D

Adding or increasing inspiratory rise time changes the rate of gas delivery at the very beginning of inspiration. This tapers the rise of pressure and flow delivery until they reach their maximum value. PTS: 1

REF: Page 380

107. The statement “The breaths are pressure-limited, but the pressure limit can be adjusted

between breaths to achieve a preset tidal volume” describes which of the following modes of ventilation? a. Dual mode b. Servo mode c. Adaptive mode d. Knowledge-based mode ANS: C

This statement describes an adaptive mode because the ventilator has one set-point and automatically adjusts the set-point to achieve another set-point as the patient’s condition changes.

PTS: 1

REF: Page 393

108. Which of the following are reasons to apply PEEP?

1. Decrease FRC 2. Increase mean airway pressure 3. Lung recruitment 4. Improve oxygenation a. 1 and 3 b. 2 and 4 c. 1, 2, and 3 d. 2, 3, and 4 ANS: D

Application of PEEP include increases FRC, increases mean airway pressure, improves lung recruitment, and improves oxygenation. PTS: 1

REF: Page 364

Chapter 13: Mechanical Ventilators: General Use Devices Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. Which of the following is (are) used in the measurement of tidal volume on a CareFusion

AVEA ventilator? 1. Variable-orifice pneumotachometer 2. Pressure differential pneumotachometer 3. Ultrasonic flow sensor 4. Hot wire flow sensing device a. 1 only b. 1 and 4 c. 2 and 3 d. 1, 3, and 4 ANS: B

Proximal airway flow sensing with either a variable-orifice pneumotachometer or hot wire flow sensing technology is available for measuring tidal volume at the patient Y connector. PTS: 1

REF: Pages 411-415

2. The CareFusion AVEA ventilator is being used during transport; the electrical power source

in the ambulance fails. How long will the internal power source allow the ventilator to function? a. About 10 minutes b. About 20 minutes c. About 30 minutes d. About 40 minutes ANS: C

The internal battery provides about 30 minutes of power when both the ventilator and the compressor are running. PTS: 1

REF: Pages 411-415

3. What mixture of helium:oxygen can be administered with the CareFusion AVEA? a. 60% helium:40% oxygen b. 70% helium:30% oxygen c. 80% helium:20% oxygen d. 90% helium:10% oxygen ANS: C

The ventilator may be powered with an 80/20 mixture of helium and oxygen. PTS: 1

REF: Pages 411-415

4. Which of the following pressures can be monitored with the CareFusion AVEA?

1. Esophageal pressure 2. Tracheal pressure

3. Proximal airway pressure 4. Alveolar pressure a. 3 and 4 b. 1 and 4 c. 2 and 3 d. 1, 2, and 3 ANS: D

Patient monitoring from the AVEA includes esophageal, tracheal, and proximal airway pressure. PTS: 1

REF: Pages 411-415

5. What modes of ventilation on the CareFusion AVEA provide apnea backup ventilation?

1. Volume assist/control 2. Volume synchronized intermittent mandatory ventilation 3. Airway pressure-release ventilation/biphasic 4. Continuous positive airway pressure/pressure-support ventilation a. 1 only b. 1 and 2 c. 2 and 3 d. 2, 3, and 4 ANS: D

Apnea backup ventilation is available in all modes in which spontaneous ventilation is available (synchronized intermittent mandatory ventilation, airway pressure-release ventilation/biphasic, and continuous positive airway pressure/pressure-support ventilation modes). PTS: 1

REF: Pages 411-415

6. How long does the internal battery of the CareFusion AVEA power the ventilator and

compressor? a. About 20 minutes b. About 30 minutes c. About 40 minutes d. About 50 minutes ANS: B

The internal battery provides about 30 minutes of power when both the ventilator and the compressor are running. PTS: 1

REF: Pages 411-415

7. Which of the following respiratory mechanics can be measured with the CareFusion AVEA?

1. Alveolar pressure measurement 2. Peak inspiratory pressure/P100 3. Inflection point 4. Auto-positive end-expiratory pressure (auto-PEEP) a. 1 only b. 1 and 3

c. 3 and 4 d. 2, 3, and 4 ANS: D

Respiratory mechanics that can be measured with the CareFusion AVEA include esophageal pressure measurement, peak inspiratory pressure/P100, inflection point, and auto-PEEP. PTS: 1

REF: Pages 411-415

8. Which of the following on a Dräger EvitaXL is considered to be a dual control mode? a. Continuous mandatory ventilation b. Autoflow c. Synchronized intermittent mandatory ventilation d. Mandatory minute ventilation ANS: B

Autoflow is a dual control mode of ventilation. PTS: 1

REF: Pages 415-419

9. Which of the following statements describes how a sigh breath is delivered on a Dräger

EvitaXL ventilator? a. Every 100 breaths the delivered tidal volume is doubled. b. The PEEP level is increased to the sigh pressure for 2 consecutive breaths. c. The tidal volume is increased to set sigh volume. d. The sigh results in doubling the inspiratory time every 100 breaths. ANS: B

Sigh breaths are accomplished on the Dräger EvitaXL ventilator by intermittently increasing the PEEP level to the set sigh pressure for two consecutive breaths in the continuous mandatory ventilation mode. PTS: 1

REF: Pages 415-419

10. What is the available range for tidal volume when the CareFusion AVEA is used in the adult

mode? a. 0 to 1500 mL b. 100 to 2000 mL c. 100 to 2500 mL d. 100 to 3000 mL ANS: C

The range for tidal volume in the adult mode is 100 to 2500 mL. PTS: 1

REF: Pages 411-415

11. The inspiratory rise time on the CareFusion AVEA is set on one. What is the significance of

this setting? a. This results in an inspiratory pause. b. There is a slow rise in inspiratory pressure. c. Inspiration is delayed by one-tenth of a second. d. There is a rapid rise in inspiratory pressure.

ANS: D

A setting of one is the most rapid rise in the pressure and a setting of nine is the slowest. PTS: 1

REF: Pages 411-415

12. Which of the following waveforms is (are) available on the CareFusion AVEA?

1. Sine wave 2. Square wave 3. Decelerating wave 4. Accelerating wave a. 2 and 4 b. 1 and 3 c. 2 and 3 d. 1 and 4 ANS: C

This allows the operator to select either a square wave (constant flow) or a decelerating (descending) ramp flow pattern during volume ventilation. The default is a descending ramp. PTS: 1

REF: Pages 411-415

13. What is the maximum pressure limit in the CareFusion AVEA? a. 80 cm H2O b. 90 cm H2O c. 100 cm H2O d. 120 cm H2O ANS: B

Airway pressure-release ventilation sets the maximum pressure target 0 to 90 cm H2O (limited to a total peak inspiratory pressure of 90 cm H2O). PTS: 1

REF: Pages 411-415

14. Which of the following Maquet Servo models can be used to ventilate a neonatal patient?

1. Maquet Servo-U 2. Maquet Servoi 3. Maquet Servos 4. Maquet ServoN a. 1 and 3 b. 2 and 3 c. 1, 3, and 4 d. 1, 2, and 4 ANS: D

The Servoi and Servos are identical in functional design and user operation. The modes of ventilation available on the Servos are the same as those available on the Servoi for both invasive and noninvasive ventilation. The primary differences are in the design of the carts, the location of the batteries, and the fact that the Servos cannot be used for neonatal ventilation. In addition, the Servos currently cannot be configured for use in a magnetic resonance imaging (MRI) suite. The Maquet Servo-U was released for sale in the United States. It shares many of the same control features, modes and breath types, and alarm functions as the Servoi and Servos. Additionally, the Servo-N was released which is configured for neonatal application. PTS: 1

REF: Pages 439-443

15. What does the Carescape R860 use to measure exhaled parameter? a. It uses the level of the patient’s work of breathing. b. It uses an expiratory flow transducer. c. It uses a respirometer. d. It uses a flow sensor proximal to the patient’s airway. ANS: B

The Carescape R860 uses an expiratory flow transducer to measure exhaled parameters, which are updated on a breath-by-breath basis. PTS: 1

REF: Pages 422-425

16. What is the range for the delivered tidal volume for an adult on the Dräger EvitaXL? a. 0 to 1.0 L b. 0 to 1.2 L c. 0 to 1.5 L d. 0 to 2.0 L ANS: B

The adult range for tidal volume is 0 to 1.2 liters. PTS: 1

REF: Pages 415-419

17. What is the range for trigger sensitivity on the Dräger EvitaXL? a. 0.3 to 15 L/min b. 1.0 to 18 L/min c. 1.5 to 25 L/min d. 2.0 to 30 L/min ANS: A

The trigger sensitivity for the Dräger EvitaXL is 0.3 to 15 L/min. PTS: 1

REF: Pages 415-419

18. At what point in the ventilatory cycle is auto-PEEP measured on a Dräger EvitaXL? a. Peak inspiration b. Inspiratory pause c. Mid-expiration d. Expiratory hold

ANS: D

The level of auto-PEEP is displayed during an expiratory hold. PTS: 1

REF: Pages 415-419

19. What is measured by the P0.01 on the Dräger EvitaXL? a. Respiratory muscle strength b. Neurogenic drive c. Inspiratory flow rate d. Intrinsic PEEP ANS: B

The neurogenic drive is measured with the P0.01. PTS: 1

REF: Pages 415-419

20. What is the range of respiratory rates that can be provided by the Dräger V500? a. 0 to 100 breaths/min b. 0 to 125 breaths/min c. 0 to 150 breaths/min d. 0 to 200 breaths/min ANS: C

The Dräger V500 can provide respiratory rates between 0 and 150 breaths/min. PTS: 1

REF: Pages 415-419

21. What PEEP levels are avaiT laE blSeToB nA thN eK DSräEgL erLVE5R0. 0?COM a. 0 to 30 cm H2O b. 0 to 40 cm H2O c. 0 to 50 cm H2O d. 0 to 60 cm H2O ANS: C

The Dräger V500 can provide PEEP levels of 0 to 50 cm H2O. PTS: 1

REF: Pages 415-419

22. What modes of ventilation on the Dräger V500 allow for the use of autoflow? a. It can be used only in spontaneous modes of ventilation such as pressure support

and continuous positive airway pressure. b. It can be used in pressure-targeted modes such as pressure assist control and

pressure synchronized intermittent mandatory ventilation. c. It can be used in any volume-targeted mode of ventilation, such as continuous

mandatory ventilation, synchronized intermittent mandatory ventilation, or mandatory minute ventilation. d. It can be used with any mode of ventilation. ANS: C

Autoflow is a dual control mode of ventilation. It can be activated when a volume-targeted mode of ventilation is selected, such as continuous mandatory ventilation, synchronized intermittent mandatory ventilation, or maximum voluntary ventilation.

PTS: 1

REF: Pages 415-419

23. What mode of ventilation is used on the Dräger V500 to provide a minimum expired volume? a. Minimum minute volume b. Augmented ventilation c. Mandatory minute volume ventilation d. Synchronized intermittent mandatory ventilation ANS: C

With mandatory minute volume ventilation, the ventilator provides mandatory breathing only if the patient’s spontaneous breathing is not adequate and drops below the preselected maximum voluntary ventilation setting. PTS: 1

REF: Pages 415-419

24. What is meant by the term “proportional pressure support” on a Dräger V500? a. The level of pressure support is applied in proportion to the patient’s breathing

effort. b. The level of pressure support is inversely proportional to the patient’s inspiratory

effort. c. The level of pressure support is applied in proportion to the inspired tidal volume. d. The level of pressure support is applied in proportion to the work of breathing. ANS: A

Proportional pressure support is a spontaneous breathing mode in which the pressure support is applied in proportion to the patient’s breathing effort. PTS: 1

REF: Pages 415-419

25. What respiratory rate is available on the GE Healthcare Carescape R860? a. 1 to 100 breaths/min b. 1 to 120 breaths/min c. 1 to 150 breaths/min d. 1 to 200 breaths/min ANS: B

The respiratory rate is adjustable from 1 to 120 breaths/min (depending on the mode and breath type). PTS: 1

REF: Pages 422-425

26. What tidal volume can be delivered by the GE Healthcare Carescape R860? a. 10 to 1200 mL b. 10 to 1500 mL c. 20 to 2000 mL d. 20 to 2500 mL ANS: C

The GE Healthcare Carescape R860 can deliver tidal volumes between 20 and 2000 mL. PTS: 1

REF: Pages 422-425

27. What level of pressure support is available on the GE Healthcare Carescape R860? a. 0 to 30 cm H2O b. 0 to 40 cm H2O c. 0 to 50 cm H2O d. 0 to 60 cm H2O ANS: D

The pressure support level on the GE Healthcare Carescape R860 is between 0 and 60 cm H2O. PTS: 1

REF: Pages 422-425

28. Which of the following are displayed on the user interface of a GE Healthcare Carescape

R860? 1. Inspired tidal volume 2. Peak inspiratory pressure 3. Rapid shallow breathing index 4. Expired minute volume a. 1 and 3 b. 2 and 3 c. 1, 2, and 4 d. 2, 3, and 4 ANS: D

The expired tidal volume, peak inspiratory pressure, rapid shallow breathing index, and expired minute volume all are included in the displayed parameters of a GE Healthcare Carescape R860. PTS: 1

REF: Pages 422-425

29. Which of the following can be calculated using the INview Vent Calculation feature found on

the GE Healthcare Carescape R860? 1. Partial pressure of oxygen in the alveoli 2. Alveolar gas and arterial blood oxygen pressure difference 3. Partial pressure of oxygen in the arteries/fractional inspired oxygen 4. Carbon dioxide a. 1 and 3 b. 1, 2, and 3 c. 1, 2, and 4 d. 2 and 4 ANS: B

The partial pressure of oxygen in the alveoli, alveolar gas and arterial blood oxygen pressure difference, partial pressure of oxygen in the arteries/fractional inspired oxygen, carbon monoxide, and dead space-to-tidal volume ratio all are calculated with the INview Vent Calculations. PTS: 1

REF: Pages 422-425

30. Which of the following lung mechanics can be measured by the GE Healthcare Carescape

R860? 1. P0.1 2. Minute volume 3. Negative inspiratory force 4. Vital capacity a. 2 and 3 b. 1 and 2 c. 1, 3, and 4 d. 2, 3, and 4 ANS: C

The lung mechanics measured by the GE Healthcare Carescape R860 include the P0.1, negative inspiratory force, and vital capacity. PTS: 1

REF: Pages 422-425

31. Which of the following are standard alarms on the GE Healthcare Carescape R860?

1. High and low minute volumes 2. High and low respiratory rates 3. High and low airway pressures 4. High and low esophageal pressures a. 1 and 4 b. 2 and 3 c. 1, 2, and 4 d. 1, 2, and 3 ANS: D

The standard alarms on the GE Healthcare Carescape R860 include high and low minute volumes, high and low respiratory rates, high and low airway pressures, and high and low end-tidal carbon dioxide. PTS: 1

REF: Pages 422-425

32. Which of the following can be measured with the GE Healthcare Carescape R860?

1. Oxygen consumption 2. Carbon dioxide production 3. Ejection fraction 4. Respiratory quotient a. 1 and 3 b. 1, 3, and 4 c. 1 and 2 d. 2 and 3 ANS: C

Measurements of oxygen consumption and carbon dioxide production are used to calculate respiratory quotient and energy expenditure. PTS: 1

REF: Pages 422-425

33. What is the range for expiratory trigger sensitivity on the Hamilton G5?

a. b. c. d.

5% to 70% of peak inspiratory flow 10% to 70% of peak inspiratory flow 10% to 80% of peak inspiratory flow 10% to 90% of peak inspiratory flow

ANS: A

The expiratory trigger sensitivity on the Hamilton G5 is adjustable from 5% to 70% of the peak inspiratory flow rate. PTS: 1

REF: Pages 426-430

34. Which of the following flow patterns are available on the Hamilton G5?

1. Decelerating 2. Accelerating 3. Square 4. Sine a. 1 and 4 b. 1 and 2 c. 1, 3, and 4 d. 1, 2, and 4 ANS: C

The Hamilton G5 offers three inspiratory flow patterns: sine, decelerating, and square waveforms. PTS: 1

REF: Pages 426-430

edBoAnNaKHSaE mLilL toEnRG.5C ,w 35. When an inspiratory pauseTisEuSsT OhMat is the percentage of the cycle time it can be set for? a. 0% to 50% b. 0% to 60% c. 0% to 70% d. 0% to 80% ANS: C

When an inspiratory pause is set on the Hamilton G5, it can be set at 0% to 70% of the cycle time. PTS: 1

REF: Pages 426-430

36. What is the range for setting the level of flow trigger on the Hamilton G5? a. 0.1 to 10 L/min b. 0.1 to 15 L/min c. 0.1 to 20 L/min d. 0.1 to 25 L/min ANS: B

The effort required on a Hamilton G5 to trigger an assisted breath is adjustable from 0.1 to 15 L/min. PTS: 1

REF: Pages 426-430

37. What level of pressure support is available on the Hamilton G5? a. 0 to 70 cm H2O b. 0 to 80 cm H2O c. 0 to 90 cm H2O d. 0 to 100 cm H2O ANS: D

The range for the level of pressure support on the Hamilton G5 is 0 to 100 cm H2O. PTS: 1

REF: Pages 426-430

38. Which of the following statements best describes the use of adaptive pressure ventilation on

the Hamilton G5? a. The level of pressure support is directly proportional to the peak inspiratory pressure. b. The rise time is adjusted automatically to optimize volume delivery. c. Volume targeting is provided with pressure-controlled ventilation. d. Pressure-targeted breaths are provided to minimize a risk of barotrauma. ANS: C

Adaptive pressure ventilation provides volume targeting during a pressure-controlled breath. The clinician sets a target tidal volume, and the ventilator adapts to changing lung mechanics by altering the delivery pressure. PTS: 1

REF: Pages 426-430

39. Which of following parameters are measured and displayed on the user interface of a

Hamilton G5? 1. Peak inspiratory pressure 2. Mean airway pressure 3. Expired minute volume 4. Dynamic compliance a. 2 and 3 b. 1, 3, and 4 c. 1 and 4 d. 1, 2, and 3 ANS: D

All of the parameters listed are measured and monitored with a Hamilton G5. PTS: 1

REF: Pages 426-430

40. Which of the following alarms is(are) available on the Hamilton G5?

1. High and low expired minute volume 2. High and low end-tidal carbon dioxide 3. High and low fractional inspired oxygen 4. High and low expired tidal volume a. 1 and 4 b. 2 and 3 c. 1, 2, and 4 d. 2, 3, and 4

ANS: C

The alarms on the Hamilton G5 include high and low expired minute volume, high and low end-tidal carbon dioxide, and high and low expired tidal volume. PTS: 1

REF: Pages 426-430

41. Which of the following are measured by the Hamilton G5?

1. Partial pressure of end-tidal carbon monoxide 2. Airway dead space 3. P0.1 4. Work of breathing caused by endotracheal tube and ventilator circuit a. 2 and 3 b. 1 and 3 c. 1, 2, and 4 d. 2, 3, and 4 ANS: D

All of the above-listed parameters are measured on the Hamilton G5. PTS: 1

REF: Pages 426-430

42. What is the range for adjustment of the expiratory sensitivity on the Covidien PB 840? a. 1% to 50% b. 1% to 60% c. 1% to 70% d. 1% to 80% ANS: D

The expiratory sensitivity on the Covidien PB 840 can be adjusted between 1% and 80%. PTS: 1

REF: Pages 434-438

43. What is the range for adjustment of the inspiratory pressure on the Covidien PB 840? a. 0 to 80 cm H2O b. 5 to 90 cm H2O c. 10 to 100 cm H2O d. 10 to 125 cm H2O ANS: B

The inspiratory pressure on the Covidien PB840 can be adjusted between 5 and 90 cm H2O. PTS: 1

REF: Pages 434-438

44. What range of pressure support is available on the Covidien PB 840? a. 0 to 60 cm H2O b. 0 to 70 cm H2O c. 0 to 80 cm H2O d. 0 to 90 cm H2O ANS: B

The range for adjustment of pressure support on the Covidien PB 840 is 0 to 70 cm H2O.

PTS: 1

REF: Pages 434-438

45. When proportional assist ventilation is used on the Covidien PB 980, what percentage of

support is available? a. 0% to 50% b. 5% to 60% c. 10% to 70% d. 10% to 80% ANS: D

When proportional assist ventilation is used on the Covidien PB 980, the percentage of support can be adjusted between 10% and 80%. PTS: 1

REF: Pages 434-438

46. What range of pressure can be displayed on the user interface on the Covidien PB 840? a. –20 to 100 cm H2O b. –20 to 130 cm H2O c. –20 to 150 cm H2O d. –20 to 180 cm H2O ANS: B

The available range for display of the peak inspiratory pressure, mean airway pressure, and plateau pressure is –20 to 130 cm H2O. PTS: 1

REF: Pages 434-438

47. Which of the following paT raE mS etT erBs AarNeKdS isE plL ayLeE dR on.C thO eM user interface of the Covidien PB

980? 1. Expired minute volume 2. Peak inspiratory pressure 3. Rapid shallow breathing index 4. Dynamic compliance a. 1 and 2 b. 1, 2, and 3 c. 3 and 4 d. 2, 3, and 4 ANS: D

The display on the user interface of the Covidien PB 980 includes the expired minute volume, peak inspiratory pressure, rapid shallow breathing index, static compliance, and intrinsic PEEP. PTS: 1

REF: Pages 434-438

48. Which of the following statements best describes the function of proportional assist

ventilation on the Covidien PB 840? a. The percentage of the work done by the patient is adjusted by the ventilator monitoring the work of breathing. b. The percentage of the work done by the ventilator is automatically reduced as the compliance and resistance is improving.

c. The operator sets a percentage of the work of breathing that is done by the

ventilator; the remainder of the work of breathing is done by the patient. d. The ventilator adjusts the amount of work done by the ventilator based on

continuous monitoring of the partial pressure of end-tidal carbon dioxide and the oxygen saturation measured by pulse oximeter. ANS: C

The proportional assist breath targets a pressure based on a selected percentage of support set by the operator and the flow and volume reading from the patient. PTS: 1

REF: Pages 434-438

49. Which of the following statements best describes the volume support mode on the Covidien

PB 840? a. The ventilator ensures that a minimum of 80% of the set tidal volume is delivered with each breath. b. The ventilator delivers volume-targeted breaths with each inspiratory effort. c. The ventilator delivers pressure-limited breaths; the pressure is adjusted to ensure that the set tidal volume is delivered. d. The ventilator delivers pressure-targeted breaths, and the respiratory rate is adjusted to ensure delivery of a preset minute volume. ANS: C

Volume support is pressure-support ventilation with a volume target. In volume support, breaths are patient triggered (pressure or flow), pressure limited, and flow cycled. The ventilator automatically adjusts the pressure limit to achieve the set tidal volume. PTS: 1

REF: TPE agSesT4B3A 4-N 43K8SELLER.COM

50. Which of the following can be monitored with the Covidien PB 980?

1. Leak flow and volume 2. Dynamic compliance and airway resistance 3. Work of breathing during proportional assist ventilation 4. Esophageal pressure a. 1 and 4 b. 2 and 3 c. 1, 3, and 4 d. 1, 2, and 3 ANS: D

Advanced monitoring capabilities of the Covidien PB 980 include the ability to monitor leak flow and volume, dynamic compliance and airway resistance, work of breathing during proportional assist ventilation, and peak spontaneous flow. PTS: 1

REF: Pages 434-438

51. Which of the following alarms are used with the Covidien PB 840 ventilator?

1. Apnea interval 2. High and low circuit pressure 3. High and low exhaled minute volume 4. High intrinsic PEEP

a. 1 and 3 b. 2, 3, and 4 c. 1, 2, and 3 d. 1, 2, 3, 4 ANS: C

The Covidien PB 840 includes an apnea interval alarm, high and low circuit pressure alarm, high and low exhaled minute volume, and high and low spontaneous tidal volume alarm. PTS: 1

REF: Pages 434-438

52. What is the available range for the respiratory rate when the Maquet Servoi is used in the

continuous mandatory ventilation mode? a. 1 to 60 breaths/min b. 1 to 80 breaths/min c. 4 to 100 breaths/min d. 4 to 125 breaths/min ANS: C

The respiratory rate is adjustable from 1 to 60 breaths/min when the synchronized intermittent mandatory ventilation mode is used and from 4 to 100 breaths/min when the continuous mandatory ventilation mode is used. PTS: 1

REF: Pages 439-443

53. Which of the following is the available range for pressure support on the Maquet Servoi? a. 0 to (120 cm H2O – PEEP) b. 0 to (100 cm H2O – PETEE PS ) TBANKSELLER.COM c. 0 to (80 cm H2O – PEEP) d. 0 to (60 cm H2O – PEEP) ANS: A

The range for pressure support on the Maquet Servoi is 0 to (120 cm H2O – PEEP). PTS: 1

REF: Pages 439-443

54. What is the range for the tidal volume on the Maquet Servoi? a. 0 to 1500 mL b. 100 to 1500 mL c. 100 to 2000 mL d. 100 to 2500 mL ANS: C

The range for tidal volume for the Maquet Servoi is 100 to 2000 mL. PTS: 1

REF: Pages 439-443

55. Which of the following parameters are displayed on the user interface of the Maquet Servoi?

1. Expired minute volume 2. Inspiratory tidal volume 3. Intrinsic PEEP 4. Shallow breathing index

a. b. c. d.

2 and 4 1 and 3 1, 2, and 4 1, 2, and 3

ANS: C

The display of the Maquet Servoi includes the expired minute volume, inspiratory tidal volume, and shallow breathing index. The total PEEP is displayed; this includes the intrinsic PEEP and the applied PEEP. PTS: 1

REF: Pages 439-443

56. Which of the following statements best describes automode on the Maquet Servoi? a. The ventilator adjusts the delivered tidal volume based on the partial pressure of

end-tidal carbon dioxide and the oxygen saturation measured by pulse oximeter. b. The ventilator selects the optimal tidal volume and rate based on the compliance

and resistance. c. The ventilator automatically shifts between controlled ventilation and supported or

spontaneous ventilation based on the needs of the patient. d. The ventilator adjusts the delivered tidal volume based on the measured work of

breathing. ANS: C

Automode allows the ventilator to shift automatically between controlled ventilation, supported ventilation, and spontaneous ventilation based on the effort sensed from the patient. PTS: 1

REF: Pages 439-443

57. Which of the following ventilators can be used during MRI? a. CareFusion AVEA b. Covidien PB 840 c. Maquet Servoi d. Hamilton G-5 ANS: C

The Maquet Servoi can be adapted for use in a MRI environment using up to a 3-Tesla magnet; this makes an intensive care ventilator available in the MRI suite. PTS: 1

REF: Pages 439-443

58. Which of the following is a difference between the Maquet Servoi and the Maquet Servos? a. The Servos is able to deliver larger tidal volumes. b. The Servos is able to deliver a mixture of helium and oxygen. c. The Servos cannot be used to manage neonatal patients, whereas the Maquet Servoi

can be used with neonatal patients. d. The Servos can be adapted to deliver oscillatory ventilation. ANS: C

The Maquet Servoi and the Maquet Servos are identical in functional design and user operation. The Maquet Servos can be used for pediatric and adult patients but not for neonatal patients.

PTS: 1

REF: Pages 439-443

59. Which of the following statements best describes the application of the Open Lung Tool on

the Maquet Servoi? a. It is used to measure the level of the patient’s work of breathing. b. It is used to prevent overdistention and collapse of the alveolus. c. It is used to measure the static compliance and the airway resistance. d. It can be used to select the optimal minute ventilation for the patient. ANS: B

The Open Lung Tool allows the operator to select any method of evaluating the pressure of overdistention and the pressure that occurs when the lung unit collapses. PTS: 1

REF: Pages 439-443

60. Which of the following can be monitored with the Maquet Servoi?

1. Esophageal resistance 2. Patient work of breathing 3. Work of breathing associated with the ventilator 4. Electrical activity of the diaphragm a. 1 and 3 b. 2 and 3 c. 1, 3, and 4 d. 2, 3, and 4 ANS: D

Advanced monitoring capabilities of the Maquet Servoi include measurement of the LoErkR. inspiratory and expiratory T reE siS stT anBcA e,NpK atS ieE ntLw ofCbO reMathing, the work of breathing associated with the ventilator, and electrical activity of the diaphragm. PTS: 1

REF: Pages 439-443

Chapter 14: Infant and Pediatric Devices Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. What is the respiratory rate available on the Infant Flow SiPAP System? a. 1 to 100 breaths/min b. 1 to 125 breaths/min c. 1 to 150 breaths/min d. 1 to 200 breaths/min ANS: C

The respiratory rate on the CareFusion SiPAP is adjustable from 0 to 150 breaths/min. PTS: 1

REF: Page 451, Table 14.1

2. When are internal electrical and pneumatic checks Infant Flow SiPAP System performed? a. When the calibration control is activated b. When the ventilator is powered on c. When there is a change in the delivered fractional inspired oxygen d. At start-up and every 12 hours ANS: B

When the Infant Flow SiPAP System is powered on, it automatically performs internal electrical and pneumatic checks. PTS: 1

agSesT4B5A 0-N 45K3SELLER.COM REF: TPE

3. What is the maximum amount of time an alarm condition must persist on the CareFusion

Infant Flow Nasal CPAP System for an alarm to be delayed when the ventilator is being set up? a. 30 seconds b. 60 seconds c. 90 seconds d. 120 seconds ANS: D

Alarms are delayed for 120 seconds after entering the main screen to allow time for ventilator set up. PTS: 1

REF: Pages 450-453

4. The Infant Flow SiPAP System is able to operate with its built-in battery for approximately

hour(s). a. b. c. d.

1 2 3 4

ANS: B

An internal battery can provide up to 2 hours of operating time if the AC power source is lost. The battery requires 16 hours to become fully charged from a discharged state. PTS: 1

REF: Pages 450-453

5. Which of the following statements concerning the CareFusion/Infant Flow SiPAP System are

true? 1. This unit uses an abdominal transducer to detect apnea. 2. This unit is able to provide time-triggered biphasic ventilation. 3. This unit is able to provide patient-triggered biphasic ventilation. 4. The battery can provide 16 hours of operation if alternating current power is lost. a. 2 and 3 b. 1 and 2 c. 2, 3, and 4 d. 1, 2, and 3 ANS: D

The Comprehensive model uses an abdominal transducer known as a Grasby capsule is part of the design. This capsule is necessary to the detection of apnea. The Infant Flow SiPAP system is available in two configurations: the Plus and the Comprehensive. The Plus configuration offers nasal CPAP (nCPAP) and time-triggered biphasic ventilation with breath-rate monitoring. The Comprehensive configuration offers these same features plus patient-triggered biphasic ventilation (called “BiPhasic tr”) with backup breath-rate monitoring in the case of apnea. PTS: 1

REF: Pages 450-453

TESTBANKSELLER.COM

6. Patient inspiration causes which of the following to occur on the CareFusion Infant Flow

SiPAP System? a. Gas flow is diverted towards the expiratory limb to mix with an existing inspiratory flow. b. The expiratory limb is closed. c. The inspiratory limb is closed. d. Gas flow is diverted away from the expiratory limb to mix with an existing inspiratory flow. ANS: D

When the patient takes a breath, the inspiratory effort diverts gas flow away from the expiratory limb to mix with an existing inspiratory flow (see Fig. 14.7). The inspiratory flow is produced by the “Pres High” flowmeter. The sum of the two flows, which is larger than the expiratory flow alone, creates the targeted inspiratory PAP (IPAP). PTS: 1

REF: Pages 450-453

7. The CareFusion Infant Flow SiPAP System is set to deliver an inspiratory positive airway

pressure of 6 cm H2O and an expiratory positive airway pressure of 3 cm H2O. The high airway pressure alarm would activate at which of the following pressures? a. 9 cm H2O b. 11 cm H2O c. 17 cm H2O d. 21 cm H2O

ANS: A

The high airway pressure alarm activates with a pressure increase 3 cm H2O above the set pressure. PTS: 1

REF: Pages 450-453

8. A low battery charge alarm condition on the CareFusion Infant Flow SiPAP System is caused

by which of the following? a. Battery charge is totally drained. b. Battery charge fell below 75%. c. Battery charge fell below 40%. d. Battery voltage fell below 10 V. ANS: C

The low battery charge alarm activates if battery charge falls below 40%. PTS: 1

REF: Pages 450-453

9. The range of continuous positive airway pressure that the Fisher & Paykel Healthcare Bubble

CPAP System can provide is a. 1 to 10 b. 2 to 8 c. 3 to 10 d. 5 to 15

cm H2O.

ANS: C

The Fisher & Paykel Healthcare Bubble CPAP System has a continuous positive airway pressure range of 3 to 10 cT mEHS2T OB . ANKSELLER.COM PTS: 1

REF: Pages 453-455

10. The Fisher & Paykel Healthcare Bubble CPAP System requires which of the following power

sources? 1. 110-V alternating current main power 2. 12-V direct current battery 3. Air/oxygen blender 4. Air and oxygen high-pressure gas sources a. 3 b. 1 and 4 c. 1 and 2 d. 2, 3, and 4 ANS: A

The Fisher & Paykel Healthcare Bubble CPAP System requires an air/oxygen blender to power the unit. Only the humidifier requires the electrical source. PTS: 1

REF: Pages 453-455

11. The recommended flow rate range for the Fisher & Paykel Healthcare Bubble CPAP System

L/min.

a. 2 to 4

b. 4 to 6 c. 6 to 8 d. 8 to 10 ANS: C

The manufacturer-recommended flow rate is 6 to 8 L/min. PTS: 1

REF: Pages 453-455

12. Which of the following statements concerning the use of the Fisher & Paykel Healthcare

Bubble CPAP System is true? a. The bubbling in the continuous positive airway pressure generator should be vigorous. b. Blanching around the nostril rim suggests that the prongs are too long. c. If the prongs are too small, there is a decrease in airway pressure. d. Place the prongs, with the curved side up, into the infant’s nares. ANS: B

Large prongs decrease blood flow to the area, causing blanching of the rim of the nostrils. The bubbling in the continuous positive airway pressure generator should be gentle and continuous. If the prongs are too small, there will be an increase in airway pressure, and gas will leak from the system. The prongs should be placed, with the curved side down, into the infant’s nostrils. PTS: 1

REF: Pages 453-455

13. What is the maximum available tidal volume for a time-triggered, pressure-limited,

time-cycled infant ventilatT orEwSitThBthAeNfK loS wErL atL eE seR t a.tC8OLM/min and the inspiratory time at 0.4 second? a. 19 mL b. 22 mL c. 53 mL d. 88 mL ANS: C

Tidal volume (liters) = [inspiratory time (seconds)  flow (L/min)] ÷ 60 = [0.4  8] ÷ 60 = 0.053 L, or 53 mL. PTS: 1

REF: Page 457, Box 14.4

14. What is the maximum tidal volume available for a time-triggered, pressure-limited,

time-cycled infant ventilator with the flow rate set at 6 L/min and the inspiratory time at 0.6 second? a. 13 mL b. 36 mL c. 53 mL d. 60 mL ANS: D

Tidal volume (liters) = [inspiratory time (seconds)  flow (L/min)] ÷ 60 = [0.6  6] ÷ 60 = 0.6 L, or 60 mL.

PTS: 1

REF: Page 457, Box 14.4

15. The volume delivered by a time-triggered, pressure-limited, time-cycled infant ventilator

depends directly on which of the following ventilator parameters? 1. Flow rate 2. Pressure limit 3. Respiratory rate 4. Inspiratory time a. 1 and 2 b. 2 and 3 c. 1, 2, and 4 d. 2, 3, and 4 ANS: C

The volume delivered by a pressure-limited, time-triggered, time-cycled ventilator depends on the pressure setting, the flow rate, and the inspiratory time. The respiratory rate is not directly related to volume. It determines the total cycle time and expiratory time because inspiratory time is set. In the case of a set ratio of inspiratory time to expiratory time, the respiratory rate determines the inspiratory time, which is directly related to the volume delivered. PTS: 1

REF: Page 457, Box 14.4

16. The volume delivered by a time-triggered, pressure-limited, time-cycled infant ventilator is

dependent on which of the following factors? 1. Positive end-expiratory pressure level 2. Airway resistance 3. Lung compliance 4. Chest wall compliance a. 1 and 3 b. 1, 2, and 4 c. 2, 3, and 4 d. 1, 3, and 4 ANS: C

Changes in the patient’s airway resistance, lung compliance, and chest wall compliance can alter the volume delivered to the patient. Lower volumes are delivered when airway resistance is high or lung and chest wall compliance are low. PTS: 1

REF: Page 461

17. What is the maximum tidal volume available for a time-triggered, pressure-limited,

time-cycled infant ventilator with a set inspiratory time of 0.5 second and a set flow rate of 12 L/min? a. 36 mL b. 100 mL c. 240 mL d. 250 mL ANS: B

Tidal volume = [inspiratory time (seconds)  flow (L/min)] ÷ 60 = [0.5  12 L/min] ÷ 60 = 0.1 L, or 100 mL.

PTS: 1

REF: Page 457, Box 14.4

18. Circuit positive end-expiratory pressure may be avoided by using a. demand flow. b. continuous flow. c. flow interrupter. d. overpressure-relief valve. ANS: A

Demand flow is believed by some clinicians to be advantageous to operator-selected, continuous-flow systems because continuous-flow systems tend to produce resistance to expiration at the airway, commonly known as circuit positive end-expiratory pressure. For patients whose ventilatory needs include high inspiratory flows but low end-expiratory pressure, the demand system eliminates the need to set a high continuous flow. PTS: 1

REF: Page 457

19. Which of the following mechanisms is incorporated into the CareFusion V.I.P. Bird

Infant-Pediatric Ventilator to prevent the risk of auto-PEEP during ventilation with the time-cycled modes? a. Jet Venturi in the exhalation manifold b. Accumulator before the pneumatic regulator c. Differential pressure transducer by the control diaphragm d. Pulsation dampener between the regulator and the flow control ANS: A

Because of the possibility T ofEinSaTdB veArtN enKtSpE osLitL ivE eR en.dC -eOxM piratory pressure developing from the continuous flow present in the expiratory limb of the patient circuit during time-cycled, pressure-limited ventilation, a jet Venturi is incorporated into the exhalation manifold. PTS: 1

REF: Page 459

20. What are the two trigger mechanisms for the assist/control volume-cycled mode on the

CareFusion V.I.P. Bird Infant-Pediatric Ventilator? 1. Flow 2. Time 3. Volume 4. Pressure a. 1 and 2 b. 1 and 3 c. 2 and 4 d. 3 and 4 ANS: C

In the assist/control volume-cycled mode, inspiration is time-triggered or pressure-triggered as well as volume-targeted, flow-limited, and volume-cycled. PTS: 1

REF: Page 459 | Page 461

21. With a CareFusion V.I.P. Bird Infant-Pediatric Ventilator, a flashing pressure-support display

during spontaneous breathing can be caused by which of the following?

a. b. c. d.

Pressure support level too high High-pressure alarm threshold met Leaks around the artificial airway Decreased volume delivery

ANS: C

Leaks in the system, including around the artificial airway, may result in excessive inspiratory time. This would cause the ventilator to time-cycle instead of flow-cycle the pressure-support breaths. PTS: 1

REF: Page 459 | Page 461

22. What is the breath termination for a CareFusion V.I.P. Bird Infant-Pediatric Ventilator set to

deliver pressure support at tidal volume = 250 mL and peak expiratory flow 15 L/min? a. Time cycle at 1 second b. Time cycle at 1.25 second c. Flow cycle at 1 L/min d. Flow cycle at 3.75 L/min ANS: D

Breaths in the volume-cycled mode on the CareFusion V.I.P. Bird Infant-Pediatric Ventilator are terminated using flow-cycling. For delivered tidal volume greater than 200 mL, the flow-cycle value is 25% of peak flow. PTS: 1

REF: Page 459 | Page 461

23. The termination sensitivity control on the CareFusion V.I.P. Bird Infant-Pediatric Ventilator

does which of the followinT g?ESTBANKSELLER.COM a. Makes it easier to trigger a breath b. Sets the time cycle in the time-cycled modes c. Sets the flow cycle in the time-cycled modes d. Adjusts breath termination in pressure support ANS: C

The termination sensitivity control adjusts the flow-termination point of the breath, preventing air-trapping and an inverse inspiratory-to-expiratory ratio, providing expiratory synchrony. It is used only in the assist/control time-cycled mode and has a range of 5% to 25%. PTS: 1

REF: Page 461

24. What is the amount of pressure drop required to initiate the leak-compensation feature on the

CareFusion V.I.P. Bird Infant-Pediatric Ventilator during the volume-cycled mode? a. 0.25 cm H2O b. 0.50 cm H2O c. 1.00 cm H2O d. 1.50 cm H2O ANS: A

When pressure decreases 0.25 cm H2O below baseline pressure, the leak-compensation feature introduces small amounts of flow into the circuit in an attempt to reestablish baseline pressure.

PTS: 1

REF: Page 462

25. If a pressure-support breath on a CareFusion V.I.P. Bird Infant-Pediatric Ventilator is 25 mL

and the peak inspiratory flow is 10 L/min, the breath will flow-cycle at a. 0.50 b. 1.00 c. 1.25 d. 2.00

L/min.

ANS: A

Between tidal volumes of 0 and 50 mL, the flow-cycle value is 5% of peak flow. Therefore, 5%  10 L/min = 0.5 L/min. PTS: 1

REF: Page 461, Box 14.6

26. A pressure-support breath on a CareFusion V.I.P. Bird delivers 230 mL, and the peak

inspiratory flow is 18 L/min. This breath will flow-cycle at a. 0.9 b. 1.8 c. 3.6 d. 4.5

L/min.

ANS: D

For delivered volumes greater than 200 mL, the flow cycle value is 25% of peak flow. Therefore, 25%  18 L/min = 4.5 L/min. PTS: 1

REF: Page 461, Box 14.6

27. The CareFusion Bird Partner IIi infant sensor should be cleaned every a. 24 b. 48 c. 72 d. 96

hours.

ANS: A

The infant flow sensor should be cleaned every 24 hours to maintain accurate tidal volume measurements and flow-triggering capabilities. PTS: 1

REF: Page 463, Box 14.8

28. Which of the following statements concerning the CareFusion Bird Partner IIi monitor is true?

1. This device uses a vortex ultrasonic device to measure flow. 2. To prevent obstructions, 12 mL/min of gas is passed through the pressure line. 3. This device can measure artificial airway leak only with the use of the infant sensor. 4. Placement of the pediatric and infant sensors is the same in the ventilator tubing. a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1 and 4 ANS: B

The gas inlet on the back of the ventilator connects to a 50-psig source and is used to inject 12 mL/min of gas through the pressure line to prevent obstructions within the line and to prevent water from entering the differential pressure transducer. By pressing and holding the “CONT V” button on the touch pad, the clinician enables real-time flow through the infant sensor to be displayed. The clinician can use the baseline leak or the flow displayed between breaths to determine the best trigger sensitivity setting and to prevent auto-triggering. This device uses a variable-orifice differential pressure transducer. PTS: 1

REF: Pages 462-463

29. When using the CareFusion V.I.P. Bird Gold Infant/Pediatric Ventilator with the infant flow

sensor, the flow display comp button is pressed. The ventilator’s monitor display window shows real-time inspiratory and expiratory flows of 9 L/min and 8.2 L/min. The most appropriate assist sensitivity control setting is L/min. a. 0.3 b. 0.5 c. 0.8 d. 1.0 ANS: D

The baseline leak is 9 – 8.2 = 0.8 L/min. The assist sensitivity control should be set at least 0.2 L/min above the detected leak, which is 0.8 L/min + 0.2 L/min = 1.0 L/min. PTS: 1

REF: Page 462

30. A pediatric patient is being ventilated with a CareFusion V.I.P. Bird Gold Infant/Pediatric

Ventilator in the assist/control volume mode with appropriately set trigger sensitivity. Physical assessment of theTpE atS ieT ntBrA evNeK alS sE thL eL usEeRo. fC acOceMssory muscles during patient triggering. What is the most appropriate action? a. Turn the sensitivity off. b. Switch to another ventilator. c. Turn the leak compensation off. d. Remove the source of the airway leak. ANS: C

Leak compensation is used when an artificial airway leak prevents the ventilator from otherwise maintaining the positive end-expiratory pressure level. Small increments of flow are introduced into the circuit to provide back-pressure compensation for the leak. When leak compensation is in use, the patient’s ability to trigger may be diminished. PTS: 1

REF: Page 462

31. The bias flow for the CareFusion V.I.P. Gold Ventilator when the Infant “Smart” Flow Sensor

is in use is a. 2 b. 3 c. 4 d. 5

L/min.

ANS: B

When the infant sensor is in use, the bias flow is automatically turned on at 3 L/min.

PTS: 1

REF: Page 464

32. The bias flow for the CareFusion V.I.P. Gold Ventilator when the Pediatric “Smart” Flow

Sensor is in use is a. 3 b. 4 c. 5 d. 6

L/min.

ANS: C

When the Pediatric “Smart” Flow Sensor is in use, bias flow operates at a fixed 5 L/min flow when it is turned on. PTS: 1

REF: Page 464

33. When volume-assured pressure support is selected in the synchronized intermittent mandatory

ventilation/continuous positive airway pressure/pressure support setting on the CareFusion V.I.P. Bird Gold Infant Ventilator, mandatory breaths are classified as which of the following? a. Pressure-controlled, time-cycled b. Volume-controlled, flow-cycled c. Pressure-controlled, volume-guaranteed d. Volume-controlled, pressure-guaranteed ANS: C

When volume-assured pressure support is selected from the synchronized intermittent mandatory ventilation/contTinEuS ouTsBpA osNitKivSeEaL irw suMre/pressure-support column, LaEyRp.reCsO mandatory pressure-controlled breaths are delivered at a guaranteed volume. PTS: 1

REF: Page 467

34. On the CareFusion V.I.P. Bird Gold Infant Ventilator, the control that ends a pressure-support

breath in case of a leak also does which of the following to the breath? a. Flow cycle b. Time cycle c. Volume cycle d. Pressure cycle ANS: B

The pressure support/volume-assured pressure-support time limit control will time cycle the normally flow-cycled pressure-support breath when there is a leak. PTS: 1

REF: Page 467

35. Which of the following CareFusion V.I.P. Bird Gold Infant Ventilator controls can adjust

pressure delivery at the beginning of inspiration in the pressure control, volume-assured pressure support, or pressure support-mode? a. Bias flow b. Assist sensitivity c. Rise time d. Flow display comp

ANS: C

The rise time control adjusts the inspiratory pressure rise time. A setting of 1 is the fastest rise time, and a setting of 7 is the slowest rise time. The bias flow control is always present when the Infant “Smart” Sensor is used and can be turned on or off when the Pediatric “Smart” Sensor is used. The assist sensitivity controls how sensitive the ventilator is to the patient’s efforts, and the flow display comp is used to display real-time inspiratory and expiratory flows. PTS: 1

REF: Pages 466-468

36. When the Dräger Babylog 8000+ is used in the pressure-support mode, the patient’s peak

inspiratory flow is 30 L/min. At what flow rate will the ventilator cycle to expiration? a. 3.0 L/min b. 4.5 L/min c. 6.0 L/min d. 7.0 L/min ANS: B

Pressure-support breaths are flow-cycled on the Dräger Babylog 8000+ at 15% of peak flow. PTS: 1

REF: Pages 466-468

37. On a Dräger Babylog 8000, which of the following variables can trigger mandatory breaths in

the synchronized intermittent mandatory ventilation mode? a. Volume and flow b. Pressure and flow c. Time and volume d. Pressure and time ANS: C

The mandatory breaths in the synchronized intermittent mandatory ventilation mode on the Dräger Babylog 8000 are either time-triggered or patient-triggered. Patient-triggering is accomplished by volume, when a patient’s spontaneous inspiratory volume is equal to or greater than the set trigger volume. PTS: 1

REF: Pages 469-473

38. The oxygen concentration alarm limits on the Dräger Babylog 8000 are set

the setting. a. by the operator;  5% b. by the operator;  4% c. automatically;  5% d. automatically;  4% ANS: D

The Dräger Babylog 8000 microprocessor automatically sets the oxygen concentration limits at  4%. PTS: 1

REF: Pages 469-473

39. On the Dräger Babylog 8000, which of the following is an operator-adjustable alarm?

a. b. c. d.

Apnea Oxygen concentration Loss of positive end-expiratory pressure/continuous positive airway pressure High-pressure limit

ANS: A

Adjustable alarm limits include apnea (5 to 20 seconds), high and low minute ventilation, and minute ventilation delay. PTS: 1

REF: Pages 469-473

40. Which operating mode on the Dräger Babylog 8000 allows the clinician to adjust the flow

during the expiratory phase to match the patient’s needs during mandatory and spontaneous breaths? a. Assist/control b. Intermittent mandatory ventilation c. Variable inspiratory, variable expiratory d. Continuous positive airway pressure ANS: C

The variable inspiratory, variable expiratory operating mode allows the clinician to adjust the flow during the expiratory phase to match the patient’s needs during mandatory and spontaneous breaths. PTS: 1

REF: Pages 469-473

41. Which of the following statements concerning the volume guarantee mode on the Dräger

Babylog 8000 ventilator isTtrEuS e?TBANKSELLER.COM a. The breaths are volume limited in this mode. b. This mode does not operate with assist/control. c. The Dräger Babylog 8000 and 8000+ both have this mode. d. Positional endotracheal tube leaks may be hazardous with this mode. ANS: D

When the volume guarantee mode is activated, the ventilator continuously measures and compares inspired and expired tidal volume. Each following breath uses the comparisons from the previous breath to make adjustments to the peak inspiratory pressure so that a volume as close as possible to the present value can be delivered. If there is a positional leak and it is active, the expired tidal volume will be lower than the inspired tidal volume, and the ventilator will increase the pressure to attempt to match the two monitored volumes. This increase in pressure continues if the leak continues. However, if the patient’s position changes and the leak is not occurring, the breath delivered will be significantly larger than intended. The limit to the amount of volume is 130% of the targeted volume. At this point, the exhalation valve will open, and no additional ventilator-driven gas will be delivered to the patient. Close monitoring of patient–ventilator interaction is needed during use of this mode. PTS: 1

REF: Pages 469-473

42. A trigger sensitivity setting of 1 on a Dräger Babylog 8000 Infant Ventilator indicates

trigger. a. 1 L/min flow

b. 1 mL volume c. 0.25 L/min flow d. 1.5 mL volume ANS: C

The trigger sensitivity range is 1 to 10, with 1 (minimum) representing increased trigger sensitivity and 10 (maximum) representing the least-sensitive trigger. A setting of 1 indicates that when the Dräger Babylog measures a flow change of 0.25 L/min (straight flow-trigger), the mandatory breath is synchronized with the patient’s effort. PTS: 1

REF: Pages 469-473

43. Mean airway pressure can be increased when ventilating with the Bunnell Life Pulse

High-Frequency Jet Ventilator by doing which of the following? a. Closing off the purge valve b. Decreasing the rate on the Bunnell c. Decreasing the positive end-expiratory pressure on the Bunnell d. Increasing rate and volume of sigh breaths on the conventional ventilator ANS: D

The function of the purge valve is to provide a moisture-free environment in the monitoring line of the hi-lo jet tube. Decreasing the rate decreases the mean airway pressure because less time is spent at the inspiratory pressure. Decreasing the positive end-expiratory pressure level decreases the mean airway pressure. Increasing the rate and volume of the sigh breaths increases the mean airway pressure. PTS: 1

REF: Pages 469-473

44. The “cannot meet PIP” alarm is active on a Bunnell Life Pulse High-Frequency Jet Ventilator.

The respiratory therapist should do which of the following? 1. Check the humidifier cartridge for a leak. 2. Check the jet tube connection to the circuit. 3. Look for kinks in the jet tube connections. 4. Check the dump valve for proper function. a. 2 and 3 b. 1 and 2 c. 1, 3, and 4 d. 1, 2, and 3 ANS: D

The “cannot meet PIP” alarm can be a result of a leak in the humidifier cartridge/patient circuit; an incomplete connection of the circuit to the jet tube; a defective or damaged jet tube (e.g., a kinked tube, improper positioning, occlusion, leak); the present settings being insufficient to ventilate larger patients; a patient fighting the Life Pulse; or an ineffective pinch valve opening action resulting in higher servo pressures being necessary to meet current settings. PTS: 1

REF: Pages 473-477

45. The Bunnell Life Pulse High Frequency Jet Ventilator creates high-frequency jet ventilation

by using which of the following mechanisms?

a. b. c. d.

Rotary piston Pinch valve Spinning ball Flow interrupter

ANS: B

An electromagnetic solenoid activates the pinch valve, which breaks the flow of pressurized gas into small bursts with the pinch-and-release action of the silicone tube of the patient breathing circuit. PTS: 1

REF: Pages 473-477

46. The Bunnell Life Pulse High-Frequency Jet Ventilator is being set up to ventilate an infant

who has a regular endotracheal tube with a 3.5-mm internal diameter Life Port adapter. Conventional peak inspiratory pressure is set at 30 cm H2O. The high-frequency jet ventilation peak inspiratory pressure should be set at a pressure of cm H2O. a. 25.5 b. 27.0 c. 28.5 d. 30.0 ANS: B

When a LifePort adapter larger than 2.5-mm internal diameter is used, the clinician should set up the initial high-frequency jet ventilation peak inspiratory pressure at 90% of the conventional peak inspiratory pressure. Therefore, 90% of 30 cm H2O is 27 cm H2O. PTS: 1

REF: Pages 473-477

47. The Bunnell Life Pulse High-Frequency Jet Ventilator is being set up to ventilate an infant

who has already been intubated with a regular endotracheal tube. A 2.5-mm internal diameter Life Port adapter is being used. The conventional peak inspiratory pressure is set at 26 cm H2O. The high-frequency jet ventilation peak inspiratory pressure should be set at a pressure of cm H2O. a. 23.4 b. 24.7 c. 26 d. 28 ANS: C

When using a Life Port adapter with a 2.5-mm internal diameter, the clinician should set up the initial high-frequency jet ventilation peak inspiratory pressure equal to the conventional peak inspiratory pressure. Therefore, 26 cm H2O should be the setting. PTS: 1

REF: Pages 473-477

48. What is the function of the structure labeled “A” in the following figure of a Bunnell Life

Pulse High-Frequency Jet Ventilator?

a. b. c. d.

It measures volume. It monitors pressure. It delivers the jet bursts. It allows conventional ventilation.

ANS: B

“A” is the monitoring lumen of the hi-lo tube and is used to monitor pressures at the distal end of the hi-lo jet tube. PTS: 1

REF: Pages 473-477

49. The respiratory therapist has determined that a 4.0-mm internal diameter standard

endotracheal tube is necessary for the patient. What is the equivalent hi-lo jet tube to be used with a Bunnell Life Pulse High-Frequency Jet Ventilator? a. 3.0-mm internal diameter hi-lo jet tube b. 3.5-mm internal diameter hi-lo jet tube c. 4.0-mm internal diameter hi-lo jet tube d. 4.5-mm internal diameter hi-lo jet tube ANS: B

The external diameter of a hi-lo jet tube is approximately equal to the external diameter of a standard endotracheal tube that is a half-size larger. Therefore, hi-lo tube size = standard endotracheal tube size –0.5 mm; 4.0 mm is standard endotracheal tube size, so 4.0 mm – 0.5 = 3.5-mm hi-lo tube size. PTS: 1

REF: Pages 473-477

50. At what point in the Bunnell Life Pulse High-Frequency Jet Ventilator, shown in the

following figure, should a bacterial filter be placed?

a. b. c. d.

A B C D

ANS: D

The bacterial filter should be placed downstream from the pinch valve to provide particle filtration. PTS: 1

REF: Pages 473-477

51. What is the function of the purge valve on the Bunnell Life Pulse High-Frequency Jet

Ventilator? a. It releases internal pressure. b. It allows water into the humidifier cartridge. c. It opens to dry out the monitoring line of the hi-lo jet tube. d. It breaks pressurized gas flow into small bursts of gas. ANS: C

The purge port supplies gas to the purge valve, which is located in the patient box. The gas is used to provide a moisture-free environment in the monitoring line of the hi-lo jet tube. PTS: 1

REF: Pages 473-477

52. The jet rate range for the Bunnell Life Pulse High-Frequency Jet Ventilator is

insufflations/min. a. 60 to 150 b. 150 to 240 c. 240 to 660 d. 660 to 900 ANS: C

The Life Pulse High-Frequency Jet Ventilator can provide 240 to 660 insufflations/min. The range 660 to 900 insufflations/min is considered high-frequency oscillation. The range 60 to 150 insufflations/min is considered high-frequency positive-pressure ventilation. PTS: 1

REF: Pages 473-477

53. The “jet valve fault” alarm is active on a Bunnell Life Pulse High-Frequency Jet Ventilator.

This problem can be corrected by doing which of the following? a. Changing out the pinch valve tubing b. Changing the tubing to the dump valve outlet c. Reconnecting the purge valve to the patient box d. Reconnecting the pressure-monitoring tube to the patient box ANS: A

The jet valve fault alarm alerts the clinician that the pinch valve in the patient box is not functioning appropriately. This could be because of a worn-out pinch valve tube. PTS: 1

REF: Pages 473-477

54. How many cycles per minute is 15 Hz? a. 300 b. 600 c. 900 d. 1200 ANS: C

A value of 1 Hz is 60 cycles/min. Therefore, 15 Hz  60 cycles/min = 900 cycles/min. PTS: 1

REF: Pages 473-477

55. Which of the following actions will maximize the life of the oscillator mechanism on a

CareFusion 3100A High-frequency Oscillatory Ventilator? a. Use low-bias flow settings. b. Minimize time and amplitude settings. c. Maintain the piston at the center of the bar graph. d. Keep the piston toward the maximum inspiratory limit. ANS: C

Keeping the piston in the center of the bar graph will prevent the piston from being driven against a mechanical stop for an extended period. Operating against a mechanical stop will wear out the oscillator mechanism quickly. PTS: 1

REF: Page 481

56. Increasing the bias flow on the CareFusion 3100A High-frequency Oscillatory Ventilator

would cause which of the following to occur? a. Decrease in amplitude b. Increase in percent inspiratory time c. Increase in mean airway pressure d. Automatic centering of piston ANS: C

Changes to the bias flow can increase mean airway pressure. A limit to how much mean airway pressure can develop in the system is controlled by the mean pressure limit control knob. This control is used to protect the patient from inadvertent increases in mean airway pressure caused by changes in bias flow, percent inspiratory time, or frequency. PTS: 1

REF: Pages 479-480

57. After an increase in the bias flow on a CareFusion 3100A, the airway pressure has increased.

What is the most appropriate action? a. Decrease the airway pressure. b. Decrease the power. c. Re-center the piston. d. Maintain the current airway pressure. ANS: A

If a change in the airway pressure occurs because another control has been adjusted, the mean pressure adjust control knob should be used to return the airway pressure to the desired level. PTS: 1

REF: Page 480

58. Which of the following statements concerning the CareFusion 3100A and 3100B is true? a. There is a mean pressure limit control on both models. b. Piston centering is automatically performed by electronic sensors. c. The high mean airway pressure alarm is the same on both models. d. The inspiratory time control limits have been expanded on the 3100B. ANS: B

The CareFusion 3100B hasTaEuS toTmBaA ticNpKisStoEnL-cLeE ntR er.inCgO , aMnd the center piston control has been eliminated from the 3100B. The 3100A has a mean pressure limit control; on the 3100B, this control has been eliminated. The high mean airway pressure alarm is 50 cm H2O on the 3100A and 60 cm H2O on the 3100B. The inspiratory time control limits are the same on both models. PTS: 1

REF: Page 480

59. Lowering the frequency on the CareFusion 3100A or 3100B would do which of the

following? 1. Decrease the volume delivered 2. Increase the inspiratory time 3. Increase the volume delivered 4. Increase the mean airway pressure a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1 and 4 ANS: C

When the frequency is lowered, the piston is allowed more travel time. This results in greater piston displacement, or more delivered volume, the amount of which is unknown. PTS: 1

REF: Pages 479-480

60. An increase in % inspiratory time on the CareFusion 3100A would cause which of the

following? 1. Alteration in the symmetry of the oscillator waveform 2. Decrease in the frequency 3. Increase in the airway pressure 4. Decrease in volume a. 1 and 2 b. 2 and 4 c. 1 and 3 d. 3 and 4 ANS: C

An increase in % inspiratory time would cause more time to be spent in the inspiratory phase, so the symmetry of the waveform would be altered. The change to % inspiratory time would also cause an increase in airway pressure. This change should be readjusted by using the power control. PTS: 1

REF: Pages 479-480

61. The purpose of the Venturi-type air amplifier on the CareFusion 3100A is to do which of the

following? a. Provide gas for bias flow b. Add gas to increase the volume delivered c. Cool the electrical coil that moves the piston d. Prevent the square wave driver from overheating ANS: C

The function of the VenturT i-E tyS peTaBirAaNmKpS liE fieLrLisEtR o. inCtrO odMuce cooling air around the electrical coil. PTS: 1

REF: Pages 479-480

62. A CareFusion SiPAP device is being used to support an infant; the pressure is set a high

pressure of 12 cm H2O and a low pressure of 4 cm H2O. The low airway pressure alarm will be activated if the pressure drops cm H2O below the set level. a. 2 b. 4 c. 6 d. 8 ANS: A

The low airway pressure alarm is activated if the pressure falls 2 cm H2O below the set pressure. PTS: 1

REF: Pages 479-480

63. What is the available range for peak inspiratory pressure for a Dräger Babylog 8000 infant

ventilator? a. 5 to 50 cm H2O b. 10 to 60 cm H2O c. 10 to 80 cm H2O

d. 10 to 100 cm H2O ANS: C

The available range for the peak inspiratory pressure for the Dräger Babylog 8000 Infant Ventilator is 10 to 80 cm H2O. PTS: 1

REF: Pages 450-453

64. Which of the following events occur when the mean airway pressure exceeds 50 cm H2O? a. The oscillator decreases by 50%. b. The pinch valve closes to decrease pressure. c. The dump valve opens, causing the oscillator to stop. d. The mean airway pressure is reduced by 25%. ANS: C

The mean airway pressure alarm greater than 50 cm H2O is activated if the mean airway pressure rises above 50 cm H2O for any reason. When this alarm is activated, the dump valve opens, causing the oscillator to stop. PTS: 1

REF: Pages 469-472

Chapter 15: Transport, Home Care, and Noninvasive Ventilatory Devices Cairo: Mosby’s Respiratory Care Equipment, 10th Edition MULTIPLE CHOICE 1. The pneumatic control logic of the Airon pNeuton Model A requires a flow of

L/min to

operate. a. 1 b. 2 c. 3 d. 4 ANS: D

The internal control logic requires a flow of 3 L/min. The additional 1 L/min on the Airon pNeuton model A is to power the patient-disconnect alarm. PTS: 1

REF: Pages 488-491

2. What alarms are on the Airon pNeuton ventilator?

1. Low positive end-expiratory pressure/continuous positive airway pressure (CPAP) 2. Patient disconnect 3. High patient pressure 4. Low oxygen inlet pressure a. 2 and 3 b. 1 and 4 c. 2 and 4 d. 1 and 3 ANS: C

The pNeuton has two functional alarms that are always active: a low oxygen inlet pressure alarm that activates at pressures less than 30 psi and a patient-disconnect alarm that sounds when a disconnect situation is sensed by the ventilator. PTS: 1

REF: Pages 488-491

3. Which of the following modes of operation are offered by the Airon pNeuton?

1. Volume-controlled intermittent mandatory ventilation 2. Pressure-controlled intermittent mandatory ventilation 3. CPAP 4. Pressure-regulated volume control a. 1, 2, and 3 b. 2 and 4 c. 1, 3, and 4 d. 2 and 3 ANS: A

The pNeuton offers nonsynchronized volume-controlled intermittent mandatory ventilation or pressure-controlled intermittent mandatory ventilation and positive end-expiratory pressure/CPAP.

PTS: 1

REF: Pages 488-491

4. The bias flow on the Airon pNeuton is a. 3 b. 5 c. 8 d. 10

L/min.

ANS: D

The pneumatic system of the pNeuton provides a continuous flow of gas through the circuit of approximately 10 L/min to meet the inspiratory demand during spontaneous breaths. PTS: 1

REF: Pages 488-491

5. The internal direct current battery of the Bio-Med Crossvent operates for approximately

hours. a. 2 b. 4 c. 6 d. 8 ANS: C

The internal direct current battery is operational for approximately 6 hours when fully charged. PTS: 1

REF: Pages 491-494

6. Which of the following staT teE mSeT ntB sA isNtrK ueScEoL ncLeE rnRin.gCtO heMBio-Med Crossvent? a. The battery duration is 4 hours when fully charged. b. None of the Crossvent models can ventilate infants. c. Noninvasive ventilation is one of the modes of ventilation. d. Volume- and pressure-controlled assist/control and synchronized intermittent

mandatory ventilation are available. ANS: D

Both volume-targeted and pressure-targeted assist/control and synchronized intermittent mandatory ventilation are available on this ventilator. The battery duration is 6 hours when fully charged. Infant ventilation is offered by several of the Crossvent models. Noninvasive ventilation is not offered by this ventilator. PTS: 1

REF: Pages 491-494

7. During transport, an infant who is using a Bio-Med MVP-10 unit in the intermittent

mandatory ventilation mode with 60% fractional inspired oxygen requires 3 L/min of oxygen and 2 L/min of air to maintain the fractional inspired oxygen and desired peak pressure. An E cylinder with 2200 pounds per square inch gauge of oxygen would last minutes. a. 88.8 b. 155.5 c. 207.3 d. 314.3 ANS: A

Pressure of gas supply = tank pressure  conversion factor = 2200 pounds per square inch gauge  0.28 = 622 L. 622 L ÷ (3 L/min for the oxygen + 4 L/min for the fluidic logic) = 622 ÷ 7 = 88.8 minutes. PTS: 1

REF: Page 493, Clinical Scenario 15.3

8. A respiratory rate of 40 breaths/min is required to ventilate an infant with an MVP-10. The

inspiratory and expiratory time settings that would provide 40 breaths/min are which of the following? Inspiratory Time a. 0.25 s b. 0.5 s c. 0.75 s d. 0.95 s

Expiratory Time 0.9 s 1s 2s 1.75 s

ANS: B

The total cycle time for 40 breaths/min is 60 ÷ 40 = 1.5 s. Inspiratory time plus expiratory time must equal 1.5 s. The only combination that adds up to 1.5 s is inspiratory time = 0.5 s and expiratory time = 1 s. PTS: 1

REF: Pages 494-496

9. What modes are available on the MVP-10?

1. Pressure-controlled assist/control 2. CPAP 3. Pressure-regulated volume control 4. Intermittent mandatory ventilation a. 1 and 3 b. 2 and 4 c. 1 and 4 d. 2 and 3 ANS: B

The MVP-10 has two modes of ventilation, intermittent mandatory ventilation and CPAP. PTS: 1

REF: Pages 494-496

10. The operation time for a Dräger Oxylog 3000 with a lithium ion battery is a. 3 b. 4 c. 5 d. 6

hours.

ANS: B

The Oxylog 3000 is functional for 4 hours with the lithium ion battery. PTS: 1

REF: Pages 496-500

11. How is the minute ventilation high alarm (MVhigh) set on the Dräger Oxylog 3000? a. Operator set at 2 L/min above the set minute ventilation

b. Operator set at 3 L/min above the measured minute ventilation c. Automatically set at 3 L/min above the set minute ventilation d. Automatically set at 2 L/min above the measured minute ventilation ANS: D

The Oxylog 3000 has multiple built-in alarms to help support quick start-up of the ventilator. The MVhigh alarm is set at the measured minute ventilation +2 L/min. PTS: 1

REF: Pages 496-500

12. The Dräger Oxylog 3000 can provide which of the following modes of operation?

1. Pressure-controlled ventilation/synchronized intermittent mandatory ventilation (SIMV+) 2. Continuous mandatory ventilation/vital capacity 3. Pressure-regulated volume control 4. Control a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1 and 4 ANS: A

Box 15.4 lists the modes of ventilation available on the Oxylog 3000 Plus. PTS: 1

REF: Pages 496-500

13. The Zoll 731 Series Electrical Mini Ventilator (EMV+) can be used on patients weighing

greater than a. 5 b. 10 c. 15 d. 20

kg.

ANS: A

The EMV+ (Fig. 15.6) is indicated for use in the management of infant through adult patients weighing 5 kg with acute or chronic respiratory failure. PTS: 1

REF: Pages 500-505

14. The estimated internal battery on the Zoll 731 Series EMV+ can provide

hours of

operation. a. 4 b. 6 c. 8 d. 10 ANS: D

The internal battery has an estimated life of 10 hours. PTS: 1

REF: Pages 500-505

15. Which of the following statements is true concerning the oxygen reservoir bag assembly on a

Zoll 731 Series EMV+?

a. Provides interface to the ventilator and the attachment of the high-flow O2 supply

hose. b. Provides an inlet for air in the event the VT is less than the supplied O2. c. It acts a reservoir collecting O2 during the expiratory phase of ventilation. d. Reservoir mode is indicated on the display with an asterisk (*) sign next to the

FIO2 value. ANS: C

O2 is entrained through the Fresh Gas/Emergency Air Intake when the EMV+’s internal compressor cycles to deliver a breath. In order to assure efficient O2 delivery, the manufacturer recommends that the operator use the Oxygen Reservoir Bag Assembly. This assembly performs a number of functions: (1) It acts a reservoir collecting O2 during the expiratory phase of ventilation; (2) Provides interface to the ventilator and the attachment of the low-flow O2 supply hose; (3) Provides an inlet for air in the event the low-flow O2 supply fails or the VT is greater than the supplied O2. O2 Reservoir mode is indicated on the display with a plus (+) sign next to the FIO2 value. PTS: 1

REF: Pages 500-505

16. The large external battery that is used with the CareFusion LTV 1000 ventilator lasts

approximately a. 4 b. 6 c. 8 d. 10

hours when fully charged.

ANS: C

The fully charged large exT teE rnS alTbBatAteNryKcSaE nL prLoE viR d. e uCpOtM o approximately 8 hours of power. PTS: 1

REF: Pages 505-514

17. The alarm sound on the CareFusion LTV 1000 ventilator is generated out of which of the

following structures in the figure?

a. b. c. d.

(1) (2) (3) (4)

ANS: A

The right side of the CareFusion LTV 1000 contains the following: (1) a small opening for the alarm sound that should never be covered, (2) a 22-mm connector for the main inspiratory flow line, (3) an external connection for the exhalation valve, and (4) two flow-transducer connectors that attach to the patient Y-adapter. PTS: 1

REF: Pages 505-514

18. Using the figure, what amount of oxygen is necessary to be bled into a CareFusion LTV 1000,

with a minute volume of 10 L/min, to achieve a fractional inspired oxygen level of 70%?

a. b. c. d.

5 L/min 8 L/min 10 L/min 15 L/min

ANS: C

Locate the minute volume of 10 L/min on the right side of the chart. Follow the 10 L/min line down until it intersects with the 0.70 vertical line. Follow the vertical line left to read the input oxygen flow (L/min). PTS: 1

REF: Pages 505-514

19. During volume-targeted assist/control with a CareFusion LTV 1000, the tidal volume is set at

800 mL, and inspiratory time is set at 1 s. Inspiration will end when which of the following is reached? a. Tidal volume of 800 mL b. Inspiratory time of 1 s c. Set pressure limit d. Flow rate of 24 L/min ANS: D

During volume-targeted breaths, the peak flow at the beginning of inspiration is calculated by the ventilator so that the tidal volume can be delivered during the set inspiratory time, and inspiration ends when flow decreases to 50% of the peak or 10 L/min, whichever is highest. The calculated flow rate is 0.8 L ÷ 1 s, or 0.8 L ÷ 1/60 of a second. Flow rate = 48 L/min; 50% of 48 L/min is 24 L/min.

PTS: 1

REF: Pages 505-514

20. Which of the following statements concerning the CareFusion LTV 1000 ventilator is true? a. An external positive end-expiratory pressure valve must be added. b. There is a backup pressure trigger of –3 cm H2O. c. The square-flow waveform is automatically set. d. Volume-targeted breaths are the only breath type available. ANS: B

In addition to flow triggering, there is a backup pressure-sensing trigger that pressure triggers a breath when the airway pressure drops below –3 cm H2O. PTS: 1

REF: Pages 505-514

21. The CareFusion ReVel is designed for what patient population? a. Critical care transport for pediatric patients (15 kg) to adult patients b. Home care noninvasive ventilation for pediatric patients (15 kg) to adult patients c. Critical care transport for pediatric patients (15 kg) to adult patients d. Home care noninvasive ventilation for pediatric patients (15 kg) to adult patients ANS: C

The CareFusion ReVel (CareFusion, Inc., Yorba Linda, California) is the Palm Top Ventilator (PTV) based on the LTV series ventilators. The Revel is electrically powered and incorporates an ActivCore blower technology to power the ventilator. It is designed for critical care transport for pediatric patients (15 kg) to adult patients. PTS: 1

agSesT5B1A 8-N 52K5SELLER.COM REF: TPE

22. What three parameters can be turned off on the CareFusion ReVel ventilator? a. Sensitivity, pressure support, and respiratory rate b. Sensitivity, FIO2, and respiratory rate c. Bias flow, pressure support, and CPAP d. Pressure support, respiratory rate, and CPAP ANS: A

Three parameters—sensitivity, pressure support, and respiratory rate—can be turned off. The respective display for any of those three parameters will be blank (“- -”) when it is turned off. PTS: 1

REF: Pages 518-525

23. On the Smiths Medical Pneupac ventiPAC ventilator, which of the following would provide a

15 breaths/min respiratory rate? a. Set inspiratory-to-expiratory ratio at 1:4 b. Set the rate control = 15 breaths/min c. Set inspiratory time at 1.5 s and expiratory time at 2.5 s d. Set flow rate control = 30 L/min, tidal volume = 500 mL, and expiratory time = 3 s ANS: C

Respiratory rate is set by manipulation of the inspiratory and expiratory time control knobs. Inspiratory time is adjustable from 0.5 to 2 seconds. Expiratory time is adjustable from 0.6 to 6 seconds.

PTS: 1

REF: Pages 525-527

24. What inspiratory flow and inspiratory time would produce a tidal volume of 750 mL on the

Smiths Medical Pneupac ventiPAC ventilator? Inspiratory flow Inspiratory time 1. 0.33 L/s 1s 2. 0.5 L/s 1.5 s 3. 0.75 L/s 1s 4. 0.45 L/s 2s a. b. c. d.

1 and 3 2 and 3 1 and 4 2 and 4

ANS: B

Tidal volume (L) = Inspiratory flow (L/s)  Inspiratory time (s). 0.5 L/s  1.5 s = 0.75 L, or 750 mL, and 0.75 L/s  1 s = 0.75 L, or 750 mL. PTS: 1

REF: Pages 525-527

25. Which of the following is a magnetic resonance imaging–compatible transport ventilator? a. Smiths Medical Pneupac ventiPAC b. Dräger Oxylog 3000 c. CareFusion ReVel d. Bio-Med Crossvent ANS: A

The Smiths Medical Pneupac ventiPAC has a magnetic resonance imaging–compatible version. PTS: 1

REF: Pages 525-527

26. The transport ventilator that can be used on newborns is the a. Airon pNeuton. b. Smiths Medical Pneupac ventiPAC. c. Bio-Med Crossvent 4. d. CareFusionLTV 1000. ANS: C

The Bio-Med Crossvent 4 and 2+ can be used for neonatal ventilation. PTS: 1

REF: Pages 491-494

27. Which of the following statements concerning the Newport HT50 ventilator is true? a. It requires both oxygen and air sources to operate properly. b. It can be used to ventilate patients who weigh more than 5 kg. c. The internal battery can sustain ventilator operation for 10 hours. d. The “battery empty” message is activated when there are less than 15 minutes left. ANS: C

The internal battery has 10 hours of battery life when fully charged. This ventilator does not require external gas sources to perform all of its operations properly. It can be used on patients who weigh 10 kg or more, and the “battery empty” message activates when there are 30 minutes of battery life left. PTS: 1

REF: Page 527

28. What is the tidal volume delivered when the Newport HT50 is set to deliver

volume-controlled ventilation with an inspiratory time of 0.75 second and a flow of 0.83 L/s? a. 375 mL b. 623 mL c. 904 mL d. 1107 mL ANS: B

Tidal volume = Inspiratory time (s)  Flow (L/s) = 0.75 s  0.83 L/min = 623 mL. PTS: 1

REF: Page 530

29. The apnea alarm on the Newport HT50 ventilator is triggered after how much time? a. Operator-selected value b. Ventilator set at 15 seconds c. Ventilator set at 20 seconds d. Ventilator set at 30 seconds ANS: D

When a patient breath goes undetected for 30 seconds, an apnea alarm occurs. PTS: 1

REF: Page 531

30. During the transport of a patient being ventilated with a Newport HT50 ventilator, the low

airway pressure/apnea indicator begins to blink red and the “check proximal line” alarm is triggered. What is the most appropriate action? a. Suction the patient’s airway. b. Increase the pressure limit. c. Check the circuit’s integrity. d. Switch the mode of ventilation. ANS: C

The “check proximal line” alarm occurs during inspiration when the proximal pressure measured is significantly different from the internal backup pressure sensor measurement taken inside the ventilator. In addition to the message, the low airway pressure/apnea indicator blinks red. Causes include disconnections, kinking of the circuit, and a water-filled proximal sensor line. PTS: 1

REF: Page 531

31. Which of the following situations is most likely to activate the occlusion alarm on the

Newport Medical Instruments HT50 ventilator? a. Increased airway resistance b. Secretions in the patient circuit

c. Water in the proximal sensor line d. Patient biting the endotracheal tube ANS: D

The occlusion alarm activates when the airway pressure remains +15 cm H2O above the positive end-expiratory pressure setting for 3 seconds after exhalation has begun or at the end of exhalation, whichever comes first. This could occur when a patient bites the endotracheal tube because biting the tube can keep the pressure elevated for long periods. PTS: 1

REF: Page 531

32. Which of the following is a transport ventilator that operates normally up to an altitude of

15,000 ft? a. Airon pNeuton b. Dräger Oxylog 2000 c. CareFusion ReVel d. CareFusionLTV 1000 ANS: A

The pNeuton operates normally up to an altitude of 15,000 ft. Altitude does not affect pressure settings. PTS: 1

REF: Pages 488-491

33. What is the trigger variable for the Respironics BiPAP Focus? a. Time b. Flow c. Volume d. Pressure ANS: C

One of the two methods for triggering to inspiratory positive airway pressure breathing is volume. When 6 mL of volume from patient effort is inhaled from the circuit, the ventilator will volume trigger to inspiratory positive airway pressure breathing. PTS: 1

REF: Page 546

34. The default value for “Ramp Start” on the Respironics BiPAP Focus is a. 2 b. 4 c. 6 d. 8

cm H2O.

ANS: B

The default level for the ramp pressure initiation level is 4 cm H2O. PTS: 1

REF: Pages 547-548

35. The Respironics BiPAP Synchrony is limited to a patient weighing a. 15 b. 20 c. 25

kg or more.

d. 30 ANS: D

The BiPAP Synchrony is designed to provide noninvasive ventilatory assistance to adult patients who weigh 30 kg or more. PTS: 1

REF: Page 552

36. The low-priority alarms on the BiPAP Synchrony include which of the following? a. Low battery b. Patient disconnect c. Battery voltage too high d. Momentary loss of power ANS: D

“Momentary loss of power” is a low or yellow/constant alarm on the BiPAP Synchrony. “Low battery” is a medium-priority alarm (yellow flashing). “Patient disconnect” is a high-priority, red, flashing alarm. “Battery voltage too high” is a medium-priority (yellow flashing) alarm. PTS: 1

REF: Page 553, Table 15.26

37. The Puritan Bennet 540 can be used on patients weighing at least a. 5 b. 11 c. 16 d. 21

kg.

ANS: A

The Covidien Puritan Bennett 540 (PB 540) Ventilator (Covidien) (Fig. 15.26) is indicated for the continuous or intermittent mechanical ventilatory support of patients weighing at least 11 lb (5 kg) who require mechanical ventilation. PTS: 1

REF: Page 539

38. The two mechanisms that are used to identify and adjust baseline values in response to leaks

in the Respironics V-60 are which of the following? 1. Tidal volume 2. Total flow rate 3. Inspiratory time 4. Expiratory flow rate a. 1 and 2 b. 3 and 4 c. 1 and 4 d. 2 and 3 ANS: C

The BiPAP Vision has a system called Auto-Trak sensitivity that uses a combination of two mechanisms to identify and modify baseline values in response to leaks. These are expiratory flow rate and tidal volume adjustments. PTS: 1

REF: Page 548

39. When using a Newport HT-50 ventilator, what is the maximum of the sum of the pressure

support and positive end-expiratory pressure level? a. 50 cm H2O b. 55 cm H2O c. 60 cm H2O d. 65 cm H2O ANS: C

The ventilator does not allow a combined positive end-expiratory pressure/CPAP value and pressure support level of greater than 60 cm H2O. PTS: 1

REF: Page 530

40. Which of the following alarms are included on a Respironics V-60?

1. High peak airway pressure alarm 2. Low inspiratory pressure alarm 3. Low end-expiratory positive airway pressure alarm 4. High tidal volume alarm a. 1 and 3 b. 1, 2, and 3 c. 1, 2, and 4 d. 2, 3, and 4 ANS: C

The Respironics V-60 includes a high peak airway pressure alarm, a low inspiratory pressure alarm, a high and low tidal volume alarm, a high rate alarm, a low minute ventilation alarm, and a low inspiratory pressure delay time. PTS: 1

REF: Page 548

41. Which of the following modes of ventilation on the Respironics V-60 delivers a pressure that

relates to the patient’s inspiratory effort? a. Proportional pressure ventilation b. Average volume-assured pressure support c. Pressure-controlled ventilation d. CPAP ANS: A

Proportional pressure ventilation increases the pressure as the patient’s inspiratory effort increases. PTS: 1

REF: Page 548

42. Which of the following interfaces are used in the application of noninvasive positive pressure

ventilation? 1. Nasal mask 2. Nasal pillow 3. Oronasal mask 4. Endotracheal tubes a. 1, 2, and 3 b. 2 and 3

c. 1, 2, and 4 d. 2, 3, and 4 ANS: A

The interfaces that are presently being used include the nasal mask, nasal pillow, oronasal mask, total face mask, and mouthpiece. PTS: 1

REF: Pages 543-545

43. The Respironics BiPAP Synchrony is limited to a patient weighing a. 15 b. 20 c. 25 d. 30

kg or more.

ANS: D

The BiPAP Synchrony is designed to provide noninvasive ventilatory assistance to adult patients who weigh 30 kg or more. PTS: 1

REF: Page 552

44. The low-priority alarms on the BiPAP Synchrony include which of the following? a. Low battery b. Patient disconnect c. Battery voltage too high d. Momentary loss of power ANS: D

REF: Page 552

45. Which of the following statements concerning the Puritan Bennett GoodKnight 425 is true? a. This unit has a leak alarm and a power disconnect alarm. b. This unit can be used for noninvasive and invasive ventilation. c. If apneic events are a significant issue, the patient should not use this unit. d. Oxygen is supplied by a high-pressure hose attached to the back of the unit. ANS: C

The bilevel mode supplied by this ventilator is not a timed mode. It is a spontaneous mode only. Because there are no alarms, use of this ventilator on a patient who has apnea episodes is contraindicated. PTS: 1

REF: Pages 554-555